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Interventional pain management for spinal disorders: a review of injection techniques

Interventionelles Managment spinaler Schmerzen: Eine Übersicht der Infiltrationstechniken

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Summary

Chronic spinal pain has a high prevalence and a severe economic, societal and health impact. In the last decades the practice and research of interventional techniques for the diagnosis and treatment of spinal pain has increased sharply. The level of evidence of the most common techniques is well documented. With image-guided precise diagnostic blocks it is possible to identify the source of chronic spinal pain in well over 60% of the cases. Nonsurgical specialties such as PM&R increasingly resort to the possibilities of interventional pain management for musculoskeletal disorders. For many forms of spinal pain there is at least fair evidence for long-term pain relief after a guided therapeutic injection often reducing the intake of analgesic medication or the need for surgery. This review focuses on the evidence, the application spectrum and special considerations of injection techniques for the treatment of spinal disorders.

Zusammenfassung

Chronische Wirbelsäulenschmerzen haben eine hohe Prävalenz und daher weitreichende ökonomische, gesellschaftliche und gesundheitspolitische Auswirkungen. In den letzten zwanzig Jahren hat die Erforschung und Anwendung interventioneller Techniken zur Diagnose und Therapie von Wirbelsäulenschmerzen stark zugenommen. Der Evidenzlevel der gängisten Techniken ist mittlerweile gut dokumentiert. Mittels bildgestützter diagnostische Blockaden ist es in mehr als 60% der Fälle möglich, eine Schmerzursache zu identifizieren. Konservative Fachgebiete wie die Physikalische Medizin nutzen zunehmend die Möglichkeiten des interventionellen Schmerzmanagements für muskuloskeletale Beschwerden. Für viele Formen von Wirbelsäulenschmerzen gibt es zumindest moderate, wenn nicht sogargute Evidenz für eine lang anhaltende Schmerzreduktion durch bildgestützte Infiltrationen. Dadurch verringert sich meistens auch der Analgetikabedarf oder die Indikation zur chirurgischen Intervention. Diese Arbeit fasst die Evidenz, das Anwendungsspektrum und spezielle Gesichtspunkte von Infiltrationstechniken zur Behandlung von Wirbelsäulenschmerzen zusammen.

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  1. Department of Physical Medicine and Rehabilitation, Landesklinikum Mistelbach, Liechtensteinstraße 64, 2130, Mistelbach, Austria

    Mathias Wewalka MD, MSc

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Wewalka, M. Interventional pain management for spinal disorders: a review of injection techniques. Wien Med Wochenschr 166, 48–53 (2016). https://doi.org/10.1007/s10354-015-0416-z

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