User Tools

Site Tools


Interventional pain management

see Pain treatment.

Interventional pain management or interventional pain medicine is a medical subspecialty which treats pain with invasive interventions such as trigger point injection, facet joint injections, epidural steroid injections, nerve blocks (interrupting the flow of pain signals along specific nervous system pathways), neuroaugmentation (including spinal cord stimulation and peripheral nerve stimulation), vertebroplasty, kyphoplasty, nucleoplasty, endoscopic discectomy and implantable drug delivery systems.

See Medically refractory trigeminal neuralgia treatment procedures particular to trigeminal neuralgia.

Techniques for other conditions include:

1. electrical stimulation

a) deep brain stimulation: targets include thalamus and periaqueductal or Periaqueductal gray.

b) spinal cord stimulation

2. direct drug administration into the CNS:

a) different routes: spinal, epidural or intrathecal, intraventricular

b) different agents: local anesthetics, narcotics (without motor, sensory, or sympathetic impairment seen with local anesthetics)

3. intracranial ablative procedures:

a) cingulotomy: theoretically reduces the unpleasant a ect of pain without eliminating the pain. Must be done bilaterally, recently with MRI. Intolerable pain usually recurs after ≈ 3 mos. 10– 30% develop flattened affect.

b) medial thalamotomy: no longer used (presented for historical reasons). Controversial. Was used for some for nociceptive cancer pain. Performed stereotactically

c) stereotactic mesencephalotomy: for unilateral head, neck, face and/or UE pain. Use MRI to create lesion 5 mm lateral to sylvian aqueduct at the level of the inferior colliculus. Unlike spinal cordotomy, the lesion is not near any motor tracts. Main complication is diplopia due to in terference with vertical eye movement, often transient

4. spinal ablative surgical procedures

a) cordotomy:

● open

● percutaneous

b) cordectomy

c) commissural myelotomy: for bilateral pain

d) punctate midline myelotomy: for relief of visceral cancer pain

e) dorsal root entry zone lesion

f) dorsal rhizotomy: not useful for large areas of involvement

g) dorsal root ganglionectomy (an extraspinal procedure)

h) sacral cordotomy:for patients with pelvic pain who have colostomy and ileostomy.A ligature is tied around the dural sac below S1 nerve roots

5. sympathectomy: possibly for causalgia major; see Sympathectomy and Complex regional pain syndrome (CRPS)

6. peripheral nerve procedures

a) nerve block:

● neurolytic: injection neurodestructive agents (e.g. phenol or absolute alcohol) on or near the target nerve

● nonneurolytic: using local anesthetics, sometimes in combination with corticosteroids

b) neurectomy: (e.g. intercostal neurectomy for pain due to infiltration of chest wall by malignancy). Performed open or percutaneously with radiofrequency lesion. May sacrifice motor function with mixed nerves

c) peripheral nerve stimulators: rarely discussed

interventional_pain_management.txt · Last modified: 2019/02/11 08:31 by administrador