Interventional Pain Management - What is it?

Sanjiv Parikh, M.D.

President, Algology Associates PC, New Jersey, USA

In the last decade of the 19^th century an evolution in the specialty of Pain Management has conceived Interventional Pain Management- a product line of services to bridge the gap between the advances in the basic science of pain management and the clinical management of the patient in pain.

What is Interventional Pain Management (IPM)? Over the last few years, the appropriateness of dominance of the Biopsychosocial model in pain management has been challenged (1). Pain Management, as a specialty, has been dominated by physicians and other practitioners managing chronic pain  predominantly by way of biopsychosocial approaches. This conventional approach is not only valid but essential in some cases. However, Interventional techniques are many times the only way to obtain accurate diagnosis and prepare a customized individual pain management plan.

The list at the end includes various interventional techniques utilized in the diagnosis and management of chronic pain and any one interested can find details on the web including their purpose, rationale, importance, outcomes, pathophysiologic basis and cost effectiveness. These are professionally derived recommendations developed utilizing a combination of evidence and consensus amongst the interventional pain management physicians.

Chronic pain has been estimated to cost the American society about $120 billion a year in treatment, lost revenues, and wages. Some frightening estimates show that annual costs for back pain itself, including disability and litigation, are more than $100 billion(2). Approximately 28% to 30% of the United States population suffer with some kind of chronic painful condition(s)(3). Pain of spinal origin effects 80% of the population at some point during their life span.  As many as 35% to 79% of the patients may suffer back pain and disability for over one year after its initial onset, contrary to the traditional belief that most back pain is cured in 60 days (4)(5).

The tragedy of needless pain and suffering can be avoided to a great extent by appropriate utilization of interventional techniques in managing chronic pain of spinal origin or non-spinal origin.

Diagnostic and Therapeutic Interventional Techniques for evaluation and management of chronic pain of spinal origin includes,

-Epidural Injections via Interlaminar or Caudal or Transforaminal approach

-Facet Joint / Facet Nerve Blocks

-Percutaneous Epidural Adhesiolysis via Epiduroscope or nonendoscopic technique (Racz)

-Diagnostic Disc Injection / Discography

-Percutaneous discectomy

-Radiofrequency Denervation of medial branch nerves of facet joints

-Neurolytic blocks

-Annuloplasty / IDET(IntraDiscal ElectroThermal Therapy)

-Implantable devices (Spinal Cord Stimulator/Intrathecal Drug Infusion Delivery Systems.

Some skeptics of pain management say that ‘does it work?’ My answer to them is that a difference is not a difference unless it makes a difference, therefore ask those who have benefited from interventional pain management.

References:

1. Manchikanti L. Interventional techniques in the management of chronic pain: part1.0.Pain Physician Vol.3,No.1,2000 P 7-42.
2. Leigh JP, Markowitz S, Fahs M et al. Occupational injury and illness in the United States. Estimates of costs, mobidity, and mortality. Arch Intern Med 1997; 157:1557-1568.
3. Gureje O, Persistent pain and well being: A WHO Study in Primary Care. JAMA 1998; 280: 147-151.
4. Thomas E, Predicting who develops chronic low back pain in primary care A prospective study. Brit Med J 1999;318:1662-1667.
5. Van den Hoogen HJM, The prognosis of low back pain in general practice. Spine 1997; 22:1515-1521.