Interventional pain management blocks
What Is Interventional Pain Management?
Interventional Pain Management is a medical subspecialty that uses minimally invasive procedures to diagnose and treat chronic or acute pain, targeting the source of pain directly. Unlike traditional pain management (e.g., oral medications or physical therapy), interventional techniques involve injections, nerve blocks, or implantable devices to interrupt pain signals, reduce inflammation, or stabilize structures causing pain. It is commonly used for conditions like spinal tuberculosis (TB), degenerative disc disease, arthritis, or neuropathic pain and is typically performed by specialists like anesthesiologists, neurologists, or spine surgeons, such as those at centers like Sushrut Spine Center.
In the context of spinal TB, interventional pain management can address pain from vertebral damage, nerve compression, or inflammation caused by Mycobacterium tuberculosis infection, complementing anti-TB therapy and surgical interventions.
Types of Interventional Pain Management
Interventional pain management includes a range of procedures, each targeting specific pain sources. Here are the main types, with relevance to spinal TB:
- Epidural Steroid Injections (ESIs):
- Description: Corticosteroids and local anesthetics are injected into the epidural space around the spinal cord to reduce inflammation and pain.
- Uses: Radiculopathy, spinal stenosis, or pain from spinal TB-related inflammation or abscesses.
- Types: Interlaminar (midline), transforaminal (nerve root), or caudal (lower spine).
- Spinal TB Relevance: Can relieve pain from nerve compression due to TB-related epidural abscesses.
- Nerve Blocks:
- Description: Anesthetics or steroids are injected near specific nerves to block pain signals.
- Types :-
- Facet Joint Blocks: Target spinal joints affected by TB-related arthritis or deformity.
- Sympathetic Nerve Blocks: For visceral or complex regional pain.
- Peripheral Nerve Blocks: For localized nerve pain.
- Spinal TB Relevance: Useful for neuropathic pain from nerve irritation caused by vertebral collapse.
- Radiofrequency Ablation (RFA):
- Description: Heat from radio waves disrupts nerve function, reducing pain signals.
- Uses: Chronic back pain, facet joint pain, or post-TB neuropathic pain.
- Duration: Relief lasts 6–12 months.
- Spinal Cord Stimulation (SCS):
- Description: An implanted device delivers electrical impulses to the spinal cord to mask pain signals.
- Uses: Severe neuropathic pain or failed back surgery syndrome.
- Spinal TB Relevance: Considered for persistent pain after TB treatment.
- Joint Injections:
- Description: Steroids or hyaluronic acid injected into joints (e.g., sacroiliac or facet joints).
- Uses: Pain from TB-related spinal deformities or secondary arthritis.
Benefits of Interventional Pain Management
Interventional pain management offers several advantages, particularly for spinal TB patients:
- Targeted Pain Relief:
- Directly addresses pain sources (e.g., inflamed nerves or damaged vertebrae), offering faster and more effective relief than systemic medications.
- Spinal TB Example: ESIs can reduce inflammation from TB-related abscesses pressing on nerves.
- Minimally Invasive:
- Procedures involve small incisions or needles, reducing recovery time and complications compared to surgery.
- Spinal TB Example: Kyphoplasty stabilizes fractured vertebrae without extensive surgery.
- Reduced Reliance on Medications:
- Decreases the need for long-term opioids, minimizing side effects like dependency or gastrointestinal issues.
- Diagnostic Utility:
- Procedures like nerve blocks can pinpoint pain sources, aiding in accurate diagnosis.
- Spinal TB Example: Facet joint blocks can confirm if pain stems from TB-related joint damage.
- Improved Function and Quality of Life:
- Pain relief enables better mobility and participation in physiotherapy, crucial for spinal TB recovery.
Procedure for Interventional Pain Management
The process for interventional pain management procedures generally follows these steps, with variations depending on the specific technique:
- Initial Evaluation:
- A pain specialist (e.g., Dr. Nevish Patel or Dr. Ankit Khodifad at Sushrut Spine Center) reviews the patient’s history, symptoms, and imaging (e.g., MRI/CT for spinal TB).
- Physical exams assess pain location, neurological deficits, or spinal deformities.
- Procedure Planning:
- The specialist selects the appropriate intervention based on the pain source (e.g., ESI for nerve compression, kyphoplasty for vertebral fracture).
- Risks, benefits, and alternatives are discussed with the patient.
- Preparation:
- Performed in an outpatient setting or specialized suite, often under local anesthesia or mild sedation.
- Imaging guidance (fluoroscopy or ultrasound) ensures precise needle or device placement.
- Spinal TB Example: CT guidance for kyphoplasty to target TB-damaged vertebrae.
- Procedure Execution:
- The specialist inserts a needle or device to deliver medication, ablate nerves, or stabilize structures.
- Examples:
- ESI: A needle delivers corticosteroids into the epidural space, taking 10–20 minutes.
- RFA: A probe applies heat to a nerve, lasting 30–60 minutes.
- Kyphoplasty: A balloon inflates the vertebra, followed by cement injection, taking 1–2 hours.
- Patients are monitored for immediate complications (e.g., bleeding or allergic reactions).
- Post-Procedure Care:
- Patients rest briefly and are discharged the same day for most procedures.
- Instructions include avoiding strenuous activity for 24–48 hours and monitoring for side effects (e.g., infection or nerve irritation).
- Pain relief may be immediate (e.g., nerve blocks) or take days to weeks (e.g., ESIs).
