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Interventional Pain Medicine to the rescue

Persistent pain, which is pain that has lasted beyond three months, is fast assuming epidemic proportions in India, affecting 20% of the general population. In addition to the individual, it places a great deal of strain on the fragile healthcare services, and affects the economy in terms of lost man hours at work. Persistent pain comes in a variety of sizes and shapes – headaches, neck pain, low back pain and cancer-related pain are to name a few. Fortunately, some of these pains can be effectively managed with medications and physical therapies. Many, however, fail to respond to these measures. Interventional Pain Medicine could provide much-needed relief to the sufferers who find, what in medical parlance is known as, conventional treatments, ineffective. Interventions, in addition, could help in making a precision diagnosis of the cause of pain. On occasions, it may even help one postpone surgery or avoid it all together. Let us have a look at a few examples.

Interventional Pain Medicine for back pain

Most low back and neck aches settle down with a bit of rest and pain killers. But in unfortunate some, these pains worsen, take a life of its own, affect the daily routine and generally make life a misery. The pain could arise from the nerves exiting the spinal canal, from the discs that provide a cushioning effect between our back bones, from the joints as well as the muscles. One of the sources of pain in the back as well as the neck, is the small joints in the back of the spine. There is a pair of these joints between the back bones at each level along the entire spine. Pain from these joints can be relieved in the short term by injecting certain medications, under careful X-ray guidance, close to the small nerve that carries pain sensations from the joints. Long term relief can be obtained by stunning these nerves with radiofrequency needles. Disc problems in the back and neck can cause sharp pains going down our leg or the arm. They might not always warrant surgery. One of the simplest procedures done under X-ray guidance is called the epidural injection, where medications are injected into the space around the major nerves in the spinal canal under X-ray control. This provides the most benefit when done during the early stages of back or neck pain.

Interventional Pain Medicine in Knee pain & shoulder pain

Arthritis is a common cause of knee and shoulder pains. It does not require surgery during the early stages. In addition, one might not be in a fit state for surgery or may want to avoid surgery. Furthermore, repeated steroid injections into the joints may lead to harmful consequences. Ultrasound and X-ray guided nerve blocks have been used successfully to reduce these pains significantly. There are certain types of head and neck pains which require a more specialised approach.

Trigeminal ganglion ablation

Trigeminal neuralgia is one such. It is felt like a severe shock like pain on one side of the head and face. The severity of the pain could even lead one to contemplate suicide. X-ray guided placement of radiofrequency needles and heating up the nerve at the place where it exits the skull helps relieve the pain. This procedure does not involve any incision or surgery, and discharge from hospital takes place the same day. There are more than a dozen such inteventions that could be done to the nerves supplying the head and face to relieve pain.

Cancer pain interventions

Cancer, especially at the end stages, could cause excruciating pain. It robs the human being of his or her dignity at the end-of-life. Many X-ray or CT-scan guided interventions could be done to block the nerves which carry the pain sensation to help the sufferer during the last stages of life. Certain other pains such as pelvic pain in women, persistent pain following surgeries, and pain associated with shingles are also amenable to interventional pain management techniques. In pain which is refractory to treatments, a tiny electrode could be placed next to the spinal cord to send programmed currents to relive pain. In certain other pains, a tiny catheter could be placed in the fluid bathing the spinal cord to deliver pain killers from a pump which is implanted under the skin.

There are more than three hundred different types of pains, for which there are an equal number of interventions. These procedures are safe and effective in the hands of an experienced pain physician; and could help not only in reducing the reliance on painkillers but also in getting back to the daily routine. When offered as a multi-disciplinary treatment, along with physiotherapy, psychological counselling and occupational therapy, these interventions could significantly improve the quality of life.