General Categories Of Interventional Pain Therapies

Dimitris Papadopoulos MD Fellow Of Interventional Pain Practice (FIPP)

Updated 09 January, 2011

A). Selected drug injection (local anaesthetics, corticosteroids, alcohol, medical cement) into peripheral nerves, spinal nerve roots, vertebrae and sympathetic ganglia) for diagnostic and therapeutic reasons.

Such cases are the following:

1. Lumbar transforaminal epidural injection (lumbar pain and sciatica, herniated disc, spinal nerve root inflammation/ dysfunction, vertebral metastasis)

2. Cervical and thoracic epidural injection (herniated cervical disc, thoracic pain)

3. Sacrococcygeal epidural injection (lumbar pain and sciatica)

4. Neuroplasty – adhesiolysis with RACZ catheter (lumbar pain and sciatica following spine surgery, chronic radiculitis, spinal stenosis)

5. Nerve blocks with neurostimulator (diagnosis/ treatment of peripheral neuropathy)

6. Kyphoplasty – spondyloplasty (osteoporotic or metastatic vertebral fracture)

Β) 1. Application of Radiofrequency  (RF) with the use of a needle and electrode (developing temperature up to 800 C) aiming at:

a) denervation of degenerated painful joints and intervertebral discs of the spine (chronic low back pain)

b) denervation of painful visceral abdominal and pelvic organs, to treat cancer pain.

c) Ablation of the trigeminal ganglion to relieve from trigeminal neuralgia resistant to conservative treatment.

2. Application of Pulsed Radiofrequency (PRF) (developing temperature up to 420C) with the aim of modifying the transmission of painful signals to the spinal cord. The specific technique is applied in the following cases:

a) peripheral neuropathies (injuries, dysfunction of peripheral nerves)

b) nerve root inflammation (chronic lumbar pain, sciatica and cervicobrachialgia due to herniated intervertebral disc, chronic radiculitis of other aetiology)

c)  cases of atypical prosopalgia

δ) painful joints (osteoarthritis etc)

Γ) Neuromodulation therapies, including:

1. Spinal cord stimulation

2. Peripheral neurostimulation

3. Subarachnoid continuous injection of drastic drugs

These therapeutic techniques are applied in properly selected patients with chronic neuropathic or/and somatic pain, who do not receive sufficient relief either with pharmacotherapy or  other less invasive methods.

Examples of such painful conditions are the persistent pain syndrome following low back surgery , ischaemic limb pain in peripheral angiopathy, neuropathic limb pain after amputation or traumatic nerve plexus injury, headache, cancer pain post-herpetic neuralgia, diabetic peripheral neuropathy etc.