FAQs on Interventional Pain Management in Philadelphia

Interventional pain management is related to the diagnosis and treatment of chronic pain. Minimally invasive procedures are used for low back pain, spinal stenosis, chronic neck pain, and numerous other painful conditions.

What is interventional pain management?

The American Society of Interventional Pain Physicians (ASIPP) reports that interventional pain management is a discipline devoted to the diagnosis and treatment of any pain-related condition. Doctors from a variety of specialties work together to relieve and control the painful disorder. This is done using minimally invasive procedures with the goal of improving the usual functional level of mobility.

What training do interventional pain specialists have?

All doctors graduate from a four-year medical school after they have completed four years of undergraduate study. Depending on the specialty, the doctor also attends a 3-5 year residency program. Emphasis of pain management is placed on use of appropriate medication and interventional procedures for the alleviation of pain in a safe, effective manner.

What are the benefits of interventional pain management?

Interventional pain management offers an effective alternative for patients who have failed on conventional treatment. These procedures allow patients to not only enjoy pain reduction, but to avoid use of excessive pain medication.

What procedures are used by pain management specialists?

Interventional pain management involves the use of medications along with a combination of therapies and procedures to reduce pain. Options include:

  • Facet joint injection (FJI) – The facet joints are tiny joints along the posterior aspect of the spine where two adjacent vertebrae align. When these joints deteriorate from age and damage, facet joint arthritis occurs. One way to manage this is with the injection of a corticosteroid and long-acting anesthetic into the joint.
  • Epidural steroid injection (ESI) – This involves injection the epidural space with a long-acting steroid to reduce inflammation of spinal nerves. The epidural space lies outside the spinal cord.
  • Radiofrequency ablation (RFA) – This is used to treat chronic back pain related to medial branch nerves.
  • Sacroiliac joint injection – The sacroiliac (SI) joint is the hip joint. The doctor can numb the nerves surrounding this joint with a local anesthetic, and use a corticosteroid to reduce inflammation.
  • Sympathetic nerve block – The sympathetic nerves control sweating, blood flow, and digestion. The sympathetic nerve block is used to treat conditions of these nerves, such as phantom limb pain and reflex sympathetic dystrophy. This involves injecting a long-acting anesthetic onto the nerves.
  • Spinal cord stimulation – This procedure involves implanting a spinal cord stimulator (SCS) into the lower abdomen or buttocks. Wires run from the small unit and connect to electrodes, which are attached along the spinal cord. Mild electrical current is used to block pain signal transmission.
  • Joint injections – For painful joints, the doctor can inject a corticosteroid into the joint space to alleviate inflammation. Hyaluronic acid is injected to replace lost fluid and lubricate the joint.

What diagnostic procedures do interventional pain management doctors perform?

There are many diagnostic procedures used by pain specialist to assess chronic pain. These include:

  • Discography – This procedure is used to diagnose the source of chronic neck or back pain, as well as to assess the extent of damage to the disc. The doctor injections a contrast dye and antibiotic into the disc, and uses special x-ray technology to assess for inner disc content leakage and disc tears.
  • Myleogram – The doctor uses this test to assess spinal abnormalities and problems associated with the vertebrae. Radio-opaque dye is injected into the spinal canal, and special x-rays are taken to detect structural problems.

Do interventional pain management techniques work?

The success rate of facet joint injections is 71%, and effectiveness tends to last for 3-12 months. Based on clinical studies, the ESI procedure has an 85-90% efficacy rate. In a recent research study using an anesthetic and corticosteroid for SI joint pain, patients enjoyed a 90% success rate.

Resources

Boswell MV, Trescot AM, Datta S, et al. (2007). Interventional techniques: evidence-based practice guidelines in the management of chronic spinal pain. Pain Physician, 10(1): 7-11.

Manchikant L, Helm LS, Singh V, & Hirsch JA (2013). Accountable interventional pain management: a collaboration among practitioners, patients, payers, and government. Pain Physician, 16(6): 635-670.

Manchikanti L, Singh V, Falco FJ, et al. (2010). Evaluation of lumbar facet joint nerve blocks in managing chronic low back pain: a randomized, double-blind, controlled trial with a 2-year follow-up. Int J Med Sci, 7(3):124-35. 32.

Sahin O, Harman A, Akgun RC & Tuncay IC (2012). An intraarticular sacroiliac steroid injection under the guidance of computed tomography for relieving sacroiliac joint pain: A clinical outcome study with two years of follow-up. Archives of Rheumatology, 27(3): 165-173. DOI: 10.5606/tjr.2012.028