What is Interventional pain management?

It is the subspecialty of medicine that deals with treating pain using precision-guided injection techniques to deliver pain-relieving medicine to specific areas of your body. The doctors who perform these procedures are trained for one or more years in pain medicine and are board certified. The injections are typically done with X-ray or CT scan control. It involves blocking nerves to diagnose the exact source of pain. This helps us plan further management. The injections are also done in the joints and the discs between your spine. The medicines used in the injections could be local anaesthetics, corticosteroids, alcohol or phenol. We also use radiofrequency ablation to stun or destroy the nerves carrying pain impulses. A young man with Buerger’s disease referred to us by the vascular surgeon had severe pain despite embolectomy. Lumbar sympathectomy was performed with radiofrequency, which reduced his pain significantly. He now awaits stem cell therapy.

What kinds of pain are treated? 

Many different types of pain problems are treated, but the most common are chronic lower back pain, sciatica, neck pain, joint pain and cancer pain. The cancer pain interventions involve permanently blocking the nerve to provide respite in the end stages of life. As mentioned in the above example, pain due to problem in the blood vessels, and head and neck pains could all be treated. That is not all; we treat more than 300 types of pain using interventions.

What types of procedures are done? 

The most common procedures are X-ray guided injections to relieve inflammation in spinal structures caused by herniated discs, spinal stenosis or arthritis. These procedures include epidural injections, facet joint injections and sacroiliac joint injections. Local anaesthetics to block the tiny nerves in your lower back or neck are typically used to plan further treatments like radio-frequency ablations. Testing the integrity of the disc and confirming it as the source of pain – termed Diskogram, and Selective Nerve Root Blocks are done by us, to help the spine surgeon choose which levels the operation needs to be done. On occasions, 100% alcohol or phenol is injected to permanently destroy the nerves which cause cancer pain. Certain advanced procedures such as inserting electrodes in the spinal cord (spinal cord stimulator) and pumps which deliver pain killers into the spinal fluid (intrathecal pumps/spinal pumps) are also used. We have the largest experience in India for such advanced procedures.

What are the common concerns of patients before injections, and how do you address them? 

Most people are concerned about the discomfort or pain involved during the procedures. However, when performed with precision by a skilled and experienced doctor, the procedures are safe and relatively painless. You will have the opportunity to speak to the doctors prior to your procedure. Many of the concerns are allayed by having any questions and concerns addressed by the pain medicine specialist. At Axon, a nurse assists the doctor in making sure that you are comfortable and reassured during the procedure. 

On some occasions the pain following procedure might last for a few days. These are typically short lived and commonly seen after radiofrequency lesioning and cancer pain injections. You should ask around to find the best doctor for the job, as poorly performed interventions by doctors with limited experience in dealing with such conditions might result in increased pain and misery.

Are these treatments successful? 

The treatments can be very effective when expertly performed using X-ray guidance. The results depend upon the presenting diagnosis and the doctor’s expertise. For instance, we spend a good few hours with our patients, with multi-disciplinary assessment and comprehensive physical examination prior to offering interventions. Following interventions, you would be put through a rehabilitation programme which involves relaxation techniques, coping strategies, home-based exercises, ergonomic advice, and on occasion home modifications. If you have a very clear and specific diagnosis that correlates with your symptoms, the long-term success rates are good.