What is Interventional Pain Management?
For a long time, Interventional Pain Management had two options– ice it, or let’s bring you in for surgery. Seems like a pretty big gap, right?
Up until the 1980s, pain management seemed to only go down these two roads. For some patients, it meant going in for surgery that they didn’t necessarily need, and for others, it meant dealing with the pain as going into surgery would be too risky for them.
Interventional Pain Management is the gap that fills the spectrum of pain-management approaches. It’s helped doctors use diagnoses to apply pain management methods that are more effective than, say, liberal icing or stretching, while being less invasive and risky than surgery. Let’s talk more about how Interventional Pain Management helps our patients.
What is Interventional Pain Management?
Interventional Pain Management is taking a patient’s pain and trying to get at it at the source. It’s treating the problem where the actual pain generator is, rather than trying to cover it up with medication.
When thinking of regular pain management, we’re thinking of doctors using physical therapy or regular pharmaceutical approaches.
When thinking of interventional pain management, we’re thinking of doctors approaching the patient’s actual anatomy, finding areas that are causing the pain, figuring out which nerves are transmitting where the pain is, and figuring out how we might be able to interact with what’s going on to manage the pain closer to the source.
How long have practitioners been using Interventional Pain Management?
Interventional Pain Management has been around for just a little bit over three decades. The pioneers of pain management founded the methods in the 1980s, where it took a lot of growth throughout the 1990s and the early 2000s, and since then it’s continued to expand and emerge.
All it took was a couple of collaborative minds that started looking at several problems in their day-to-day practices. Most of these minds were anesthesiologists that practiced regional anesthesia, who were thinking: how can I apply techniques I use in anesthesia to treat patients that suffer from chronic pain, but not necessarily from post-surgical or acute pain?
What patients benefit most from Interventional Pain Management?
There are a vast number of patients that benefit from Interventional Pain Management. To determine which patients actually need it, doctors will look at those that have isolated problems; say, a migraine headache that’s triggered from the neck. There are nerves that can be interacted with in the neck to help with their headaches.
Then again, some patients have various types of chronic sciatica, in which doctors could interact directly with those nerves.
Beyond that, many doctors have patients that have disease processes like Rheumatoid Arthritis who have one joint in particular that’s giving them problems, say a knee. In Interventional Pain Management, there are procedures they can do to reduce the pain in the knee short of having an orthopedist do a full-blown knee-replacement. It’s a wide, wide range of patients that would benefit from Interventional Pain Management, preventing unnecessary overreaching for the medicine cabinet.
How do you assess what patient would be a good fit for Interventional Pain Management?
Interventional Pain Management is a lot about diagnosing patients appropriately, based on several different factors, such as their history with the pain and their exam results (MRI, nerve conduction).
Once they’ve received a proper diagnosis, their doctors will have a better idea about what parts of the anatomy they can interact with to help reduce that patient’s pain. Here’s a quick example:
Some doctors at APC see a lot of chronic pelvic pain in mid-to-younger-age females. It can come from a whole plethora of different places. A patient is oftentimes found to have some level of abdominal surgery done and feeling pain still. Between her surgeries, history, and how she’s describing her pain (whether it’s coming from her internal organs or abdominal wall), a doctor can utilize selective nerve blocks to further help isolate the pain.
For some of these female patients, spinal cord stimulators are used as well as other methods of Interventional Pain Management that bring them almost pain-free and back to life.
It’s all about taking the full picture of the patient, being able to diagnose what’s really going on, and drilling down where the pain’s coming from. Once a doctor does this, it gives them a better idea of what they can do to interact with that pain generator to make it “better.”
In the example of the female patient, a doctor may be able to tell that her pain was coming from the nerves by her abdominal wall that probably got injured during one of her surgeries. From there, her doctor may follow up with some diagnostic blocks where the nerves are blocked, making her pain get better and better (with the help of a local anesthetic.) That then might lead the doctor into the next best treatment for her.
Here’s another example:
A doctor might have a patient with an original ankle fracture. Sometimes after you have a peripheral injury, the nerves go haywire, creating a specific nerve type pain in that extremity that also starts changing the blood flow, making it swell or turn colors. Using blocks for specific nerves that would take care of the foot and ankle, their doctor is able to confirm that diagnosis, and from there, can use a specific type of spinal cord stimulator to bring that patient’s sensation in their foot and ankle back to normal.
What did we do before Interventional Pain Management Treatments were used?
Before doctors had access to Interventional Pain Management, the treatment algorithm for somebody that developed pain would start with something conservative, like suggesting rest, applying ice, going to physical therapy– that sort of thing. When that didn’t work, a patient would immediately go into some sort of surgical procedure to fix the problem.
Unfortunately, particularly depending on what type of surgery and what type of disease process the doctors were looking at, sometimes it had very mixed benefits from the patient.
Now that doctors have Interventional Pain Management, they can almost sneak into the middle of that algorithm. Now, you have a patient that has an injury. At APC, the first suggestion is typically conservative like suggesting rest, ice, or physical therapy, but now, instead of having to go straight to an invasive surgery if those methods don’t work, doctors can use Interventional Pain Management methods to step in and see where we can help out in place of that procedure.
In a lot of cases, it’s avoiding surgery that a patient doesn’t necessarily need. In other cases, they have patients that have pain even though the surgeon did a truly excellent job.
Nerves are like an iPhone cable: if you shut it in the car door, you can do a beautiful job of getting it back together, but there may be wires inside that don’t work right afterward.
What are some additional resources if we want to learn more about Interventional Pain Management?
A lot of the various clinic websites have a lot of information on them about the services they offer. There’s some additional information here at Advanced Pain Care if you want to browse through our blog. Various medical societies also deal with chronic pain, such as:
- The American Society for Interventional Pain Physicians (ASIPP)
- The American Society of Regional Anesthesia
If you as a patient have been suffering from a painful condition, whether three weeks, three years, or longer, it’s worth at least sitting down with a skilled Interventional Pain Practitioner to see if there’s something that they can help you with. There’s no need to go through life suffering without seeking some sort of answer. Like we say at APC: “pain is inevitable, but suffering is optional.”
It’s impossible to live on this earth and not have pain at some point in your life, but whether or not you decide to succumb and suffer is up to you. If you’re dealing with pain, but haven’t gotten the changes that you’ve wanted, click here to learn about our locations. As always, the pain stops here.