Interventional Approaches

Abstract

Minimally invasive techniques are used to block, ablate, or modulate pain pathways for diagnostic and therapeutic purposes. Appropriate patient selection based on accurate diagnosis and benefit/risk analysis is critically important to ensure safety, efficacy, and cost-effectiveness. Proper use of sedation, monitoring, imaging guidance, and technical skills are required to safely perform interventional procedures. Pain physicians must understand the relevant anatomy, pharmacology, and toxicity of local anesthetic and other agents and essential equipment used in the procedures. He/she must be cognizant of potential complications and be able to recognize and manage various complications associated with each specific procedure. Blocking specific cranial nerves and their branches, spinal nerves and their branches, or visceral nerves with a local anesthetic with or without steroid is an important technique. Extended pain relief may also be achieved by radiofrequency ablation, cryoneurolysis, or chemical neurolysis of specific peripheral nerves. Intramuscular injections may be used to treat myofascial pain. Joint and/or bursa injections may be indicated for joint pain due to arthritis, bursitis, and tendonitis. Vertebroplasty and kyphoplasty are procedures used to percutaneously inject bone cement into the vertebral body to treat compression fractures due to osteoporosis or metastatic cancer, usually in the acute phase after a trial of conservative treatment has failed.