Interventional Pain Management

Interventional Pain Management

When an individual is suffering from chronic pain, it typically takes several visits to different medical professionals before being directed to a pain management specialists. Interventional pain specialists will be able to determine the source of the pain and the best way to manage it.

The goal is to improve the quality and functionality of a patient’s life. Interventional pain therapy includes minimally invasive techniques to better mitigate pain and provide relief. Some slightly more invasive techniques like injection therapy may also provide relief to patients who have had their daily functionality effected. 

Interventional pain management is a successful method of treatment for patients who have found little relief from traditional methods. Utilizing a multidisciplinary approach, interventional pain care can provide a wide range of treatments for patients suffering from chronic pain. A team of interventional pain specialists can determine which approach would best benefit a patient. These methods can help patients find relief from their pain and return to their daily activities without relying on a medication regimen. 

Injection Therapy

One of the most accessible form of treatment from an interventional pain program, injection therapy can provide immediate relief from chronic pain. A back pain specialist will determine the cause of your pain and its symptoms to determine which type of injection would be appropriate. Types of injections are:

• Epidural Steroid Injections
• Nerve/Root Blocks
• Medial Branch Blocks
• Radiofrequency Ablation
• Trigger Point Injections
• Facet Joint Injections

The goal of these injections is to make an individual suffering from chronic pain less difficult. At Pain and Spine Specialists we provide comprehensive pain care to help improve  patient’s quality of life without the burden of intense pain. To better understand how these injection therapies can help patients, it is important to know how they operate in the body. 

Epidural Steroid Injections

Inflammation is the body’s natural response to the presence of bacteria. If the body remains in a state of extended inflammation it will then begin releasing pain signals. The body responds with naturally produced cortisone (steroid) hormones to relieve the pain.

An epidural steroid injection (ESI) is a concentrated injection of steroid to treat the pain and inflammation. Commonly used to treat back pain and leg pain, it is a nonsurgical treatment method that can reduce inflammation and improve mobility. With the use of local anesthetic (numbing agent) and a steroid medication, the patient is given an injection in the epidural space of the spine.

When pain is caused by inflamed spinal nerves, delivering the ESI directly to the epidural space that surrounds the spinal cord and the nerve roots can reduce pain and inflammation. The majority of patients find relief from this type of injection therapy. However, each patient may experience different lengths of relief (some a few months, others a few years). It is common to get a series of these injections to provide long term relief. 

Nerve/Root Blocks

Nerve and roots blocks can be administered to patients via injections with medications that have an anesthetic effect. This numbing effect can create a loss of feeling in the nerve bundles that cause pain. The “numbed” nerves stop sending pain impulses to the central nervous system, helping the patient control and prevent their pain symptoms.

Medial Branch Blocks / Radiofrequency Ablation

A medial branch block (MBB) is a primarily diagnostic nerve block directed at the medial nerves. These nerves are branched through the facet joins in the spine. An interventional pain physician will use guided fluoroscopy (a live x-ray) to administer the injection outside of the joint and near the medial nerves. MBB’s allow the interventional pain physician to determine if the source of pain is from the facet joints or a separate issue.

If a patient has an appropriate level of relief for a duration of time, their pain specialists may recommend them to move onto receiving a radiofrequency ablation (RFA). As the name implies, the injection uses radio-frequency to prevent pain signals traveling through the body. RFA’s target specific nerves with a controlled, mild electric current that “burns” the nerves. A lesion is created over these nerves that prevents the nerves from sending pain signals to the brain.

Trigger Point Injections

Trigger points can be found through out the body; hyper irritable spots located in the taut band of skeletal muscle. When compressed they can cause pain and produce referred (radiating) pain. Pain that feels like it is spreading or radiating is a symptom of trigger point pain.

When the muscle cannot relax, creating “knots” (and pain symptoms) that you can feel. Trigger point injections (TPI) directly treat this type of pain. TPI’s can soothe throbbing muscles and provide the patient with relief. An interventional pain physician may administer a TPI to several injection sites associated with the trigger point pain. 

Facet Joint Injections

Facet joints are the spinal joints that connect the spine and provide stability. Injury or degenerative diseases can put strains on these areas of the spine causing severe pain. Facet joint injections (FJI) are a nonsurgical treatment option for many patients.

The interventional pain specialist uses fluoroscopy to determine the specific location of the facet joint injection. The injection penetrates the facet joint itself, delivering anesthetic and anti-inflammatory medication to the patient. 

Many patients find sufficient relief from injection therapy that lasts them months or years. However, other patients may require more invasive measures to appropriately and safely treat their pain. An interventional pain specialist can determine if some patients would benefit more with surgical interventions.

Surgical Interventions

A team of interventional pain specialists can determine if surgery is an appropriate treatment for the patient. Each approach must be individual to the patient’s unique health history and concerns. The patient’s care team will be able to recommend a surgeon to complete the treatment. There are other surgical approaches that a patient may be an appropriate candidate for, such as spinal cord stimulator or an intrathecal pump.

Spinal Cord Stimulator

The spinal cord stimulator (SCS) is a small device surgically placed in a patient’s lower back. Before a patient undergoes the final placement surgery, they are able to have a “trial” experience. The trial is used to determine if a patient will experience a sufficient amount of relief before undergoing an invasive surgery.

The trial is performed by an interventional pain specialist in the office. The trial lasts about 3-5 days and if the patient experiences more than 50% relief, they are a good candidate to move onto the full procedure. The patient will then go to a skilled surgeon who will place the SCS for them. 

The spinal cord stimulator has small threads (leads) that are surgically placed in specific areas of the spine. Attached to the nerves to directly treat pain, the SCS provides relief by sending small electrical impulses. These mild impulses mask the pain signals before they can reach the brain. Instead of pain radiating through out your body, the sensation changes to something manageable.

The pain-relieving stimulation can be flexibly programmed for the therapy to provide a gentle tingling sensation (if the patient even ends up feeling anything). A mild tingle wins over a pain that radiates. The spinal cord stimulator is clinically proven to provide superior relief when compared to other conventional pain treatments. The SCS treats the chronic pain that can be found through out the body, such as intense neck pain or shoulders.

The SCS has become an ideal solution to incorporate into a chronic pain patient’s journey to relief. With a spinal cord stimulator patients are given the opportunity to manage their pain with fewer oral opioid medications or none at all. Having a spinal cord stimulator can prevent a cycle of pain-suffering-disability-pain in patients.

Intrathecal Pump

A small medical device, an intrathecal pump is surgically placed within the body to deliver pain medication directly to the spinal cord. Similar to a spinal cord stimulator, an initial trial is done for the patient to determine if sufficient relief is provided. If the patient’s pain decreases by at least 50%, the patient is a good candidate for the intrathecal pump. An interventional pain specialist will refer the patient to the appropriate pain surgeon to place the device inside the patient’s body. Surgically placed, a catheter will deliver pain medication directly to the spinal cord providing immediate relief from chronic pain. An intrathecal pump provides a targeted approach to treating pain safely. 

When your pain is severe enough to interfere with your daily activities and becomes debilitative to your life, it is important to find an interventional pain specialist who can determine the best treatment course. A skilled pain management professional can assist chronic pain patients return to living a full, quality life. 

We Can Help!

If you would like more information about our comprehensive pain management practice, or what to expect, please call Pain and Spine Specialists and speak to our dedicated team to improve the quality of your life. You can call (301) 703-8767 (Maryland Locations), (724) 603-3560 (Pennsylvania Locations), or (540) 433-1905 (Virginia Locations) and schedule an appointment or schedule a tele-health appointment with us today.