Interventional pain management is the use of minimally invasive procedures to target specific areas of the body. The body part treated could be any part of the body: neck, back, shoulders, major joints, or specific nerves.
Pain physicians don’t only treat chronic pain patients, or patients with pain for more than three months. They can also treat patients with acute pain, or pain that’s less than 3 months.
For a majority of interventional pain physicians, our major scope of treatment is the spine, predominately the cervical spine (neck) or the lumbar spine (low back). The pain could be due to arthritis, disc herniations, the muscles themselves, the joints, or nerve-related pain.
The most common cause of pain that we treat in the neck is arthritis in the facet joints of the upper spine. This type of arthritis is caused by the normal aging process, including wear and tear and trauma. Arthritis pain tends to be localized to the neck and doesn’t tend to be a shooting type of pain that you may experience with nerve pain. It may be treated with NSAIDs, or non-steroidal anti-inflammatory drugs like ibuprofen, Aleve, or prescription NSAIDs; physical therapy; and injections.
Injections may be injected into trigger points, which is when the medication is injected into the muscle itself to help with muscle stiffness. Medial branch blocks are injections into a specific nerve that we target to help treat pain due to arthritis of the spine. If a medial branch block is successful, sometimes we apply heat to that nerve with a radiofrequency ablation to reduce pain.
Arthritis isn’t the only cause of pain; nerve impingement in the neck can cause pain to travel into the shoulders, arm, hands and fingers. Sometimes this pain is due to disc herniation. A disc is a gelatinous structure that sits in between the bones of our spine, and it can herniate, or go backwards, pinching the nerves. Other times the pain is due to spinal stenosis, which is narrowing of the canal the nerves are in due to age, trauma, or arthritis. Medications, physical therapy, and epidural steroid injections are all treatments for nerve impingement.
The epidural is a very thin layer within our spinal cord. We target the epidural and inject medication, usually steroid and saline, to help cut the inflammation down in the canal itself with the hope of relieving pressure on those nerves and that disc and relieving pain.
The lumbar or low back has many similarities to the cervical spine or neck. Arthritis can also be a cause of the pain due to wear and tear or trauma. Arthritis pain in the low back tends to be localized to the low back and buttock region. It can sometimes go sideways into the legs, but it is not often a shooting style pain. Treatment options include some medications, physical therapy and injections.
Injections for arthritis in the lumbar spine are similar to treating arthritis in the neck because the condition is similar: trigger point injections into the muscle directly; medial branch blocks into the specific nerves along the spine; and radiofrequency ablation to add heat to specific nerves.
Nerve impingement may also cause pain in the low back, but the symptoms may be different from nerve impingement in the neck. Pain may go to the hips, buttock, thighs, and lower down herniations may cause the pain to go below the knees to the calf and the foot. Treatment options include medications, physical therapy and epidural steroid injections.
Other causes of low back pain include sacroiliitis, where the bottom of the spine meets the pelvis; fractures; and hip pain.
Another potential treatment is a kyphoplasty, a procedure done for fractures of the spine. When a bone in the spine is squished into a wedge, if a kyphoplasty is the right treatment for it, a hollow tube is put into the bone, a balloon is inflated to make the bone open up again, and then the cavity is filled with cement to help stabilize the fracture. The decision of whether a kyphoplasty is right for you is a larger discussion with your doctor.
Joint pain treated by interventional pain management physicians is usually due to arthritis. Injections may be a treatment before surgery or if surgery isn’t an option, and the combination therapy of medications, physical therapy and injections is the best non-surgical treatment. The injections are usually steroids with a numbing agent and saline.
Although it is less common, the joint pain may be nerve related, which can be teased out using techniques like nerve conduction studies. Nerve blocks, physical therapy, and medications can help treat the pain.
What role do interventional pain management physicians play?
Interventional pain management physicians are another member of the care team. We work with the primary care physician, surgeon, physical therapy, chiropractors, or any other specialists a patient is seeing. A closed loop of communication is very important because one type of treatment isn’t the answer for every problem for every patient.
Overview of Procedures
The majority of the procedures are done with image guidance to allow us to be more specific and target the area that needs care in a precise way that also enhances the safety of the procedure itself. We may use x-ray guidance or ultrasound guidance.
Procedures we commonly do include:
- Trigger point injections (medicine into the muscle)
- Joint injections (often includes steroid component)
- Nerve blocks
- Epidural steroid injections (for nerve related pain)
- Medial branch block and radiofrequency ablation (RFA) (for pain due to arthritis)
- Kyphoplasty (for fractures of the vertebra)
- Spinal cord stimulation (an advanced form of therapy when injections/medications/surgery have not provided relief0
Frequently Asked Questions
How long does pain relief from an injection last?
Unfortunately, this is a difficult question to answer because each patient is different. I tell patients to focus less on numerical scores and more on the quality of life and functional status. For example, did the patient have difficulty walking before the injection and now they can walk without much pain? I consider that a win. For some people, pain relief lasts weeks-to-months, while for others it lasts months-to-years.
Are there any age restrictions for any of these procedures?
There are no precise age limits and treatments are patient-dependent. I tend not to see many pediatric patients, since wear and tear causes many of the issues being treated. Some of the injections may not be appropriate for a young person or a frail elderly person, but it depends on the individual patient. A 91-year-old patient who is still playing pickleball and is very active may be interested in any treatment that allows them to enjoy life as long as they can.
Are these treatments covered by most insurance?
Most commercial insurance and Medicare cover these treatments. However, insurances like to change what is covered regularly, especially at the start of a plan year. We recommend checking with your insurance company directly if you’re not sure.
Do interventional pain management specialists treat complex regional pain syndrome?
Complex regional pain syndrome, or CRPS, is a condition where the body has decided it’s going to heal in an unusual way. Patients may have intractable pain in the arms, legs, hands or feet. While it is not an easy condition to treat, we do treat it and can usually help reverse some of the symptoms if caught and treated early.