Interventional Procedures

“Interventional pain management techniques have grown rapidly since 1990 and have become a major tool in treating acute and chronic pain.”

The American Society of Interventional Pain Physicians has developed evidence- based guidelines for improving compliance and the quality of care. Numerous reports have been published to investigate the long-term efficacy of interventional pain management techniques and have provided critical evidence indicating that these techniques may be useful.

Traditionally, neurosurgeons have utilized surgical techniques to destroy part(s) of the peripheral and central nerve systems to interrupt conduction of painful information into the central nervous system. These techniques include resection of peripheral nerves, dorsal root ganglia, the dorsal root entry zone, the spinal thalamic tract, the entire spinal cord, nuclei of the thalamus and the sensory cortex, as well as the pituitary gland. These techniques may provide temporary pain relief. However, the pain may quickly become even worse than the pre-surgical level, because of subsequent different pain that is often more severe and more difficult to treat than the previous pain. As a result, surgical resection techniques are not commonly used any more.

Instead, modern interventional pain management techniques emphasize the importance of accurate delivery of medications such as corticosteroids or local anesthetics to suppress the inflammation and block the conduction of painful information, respectively. Selective destruction of nerve tissue with heat generated by radio frequency energy or freezing the nerve tissue with liquid nitrogen (cryotherapy) has largely replaced surgical resections. Nerve stimulation techniques have also evolved as a result of neuroscience developments in the understanding the mechanism of pain.