Treating Chronic Pain: An Interventional Approach

By: Jeremy Walker, MD

Reading Time: 3 minutes

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Are you suffering from chronic pain?

We agree. Pain sucks. Here’s why it’s time to get interventional. 

People suffering from chronic pain seek help from a wide variety of sources. After trying over-the-counter medications, altering their physical activity, and relying on the support of friends and family, many turn to healthcare providers for any relief that may be available. Physicians, nurses, physical therapists, chiropractors, and several other classes of professionals offer therapies aimed at reducing pain and improving functionality and quality of life.

At some point along the course of their pain progression, many patients are evaluated and treated by an Interventional Pain physician. This specialist may offer treatment with targeted procedures that focus on pain generators and allow the patient some respite from his or her daily struggle.

Interventional Pain physicians are specially trained to diagnose chronic pain conditions and to perform procedures aimed at treating underlying causes of pain. Most of these physicians underwent a residency training program in anesthesiology, neurology, or physical medicine and rehabilitation after medical school. After residency, these doctors go through another year of additional training in an accredited fellowship program, which allows them to obtain board certification in Pain Medicine after passing a battery of tests. These physicians often manage many classes of medications, but they are also prepared to offer more definitive treatment.

Historically, the most common procedures performed by “pain doctors” were epidural steroid injections. These injections place medication in the space around the lining of the spinal fluid. In the appropriate setting, they can reduce inflammation from disc material, bony contact of nerve roots, or other inflammatory processes and can reduce pain while the body recovers from the underlying process.

Because these procedures were the best alternative to surgery, they became heavily utilized. The problem, though, is that epidural steroid injections don’t treat every cause of pain.

Interventional Pain physicians now have many more options for procedural pain relief, but many pain patients and healthcare providers are hesitant to seek the aid of an Interventional Pain physician if they don’t think epidural steroid injections will help.

Since Interventional Pain Management has become a formalized subspecialty, the techniques available for treating chronic pain have progressed rapidly. Epidural steroid injections remain a valuable tool, but many patients now benefit from nerve blocks, ablations of nerves that transmit pain, and more advanced therapies, such neuromodulation, a blanket term for using implanting minimally-invasive devices to manage pain. Two great examples of the latter two options are knee pain after a knee replacement and chronic low back and leg pain after spine surgeries.

While total knee replacement usually offers great relief to patients with knee pain, up to 10% of patients suffer from residual pain after surgery. Over the last few years, Interventional Pain physicians have developed techniques to ablate sensory nerves to the knee to offer prolonged pain relief with no loss of function.

For patients who suffer from continued pain after one or multiple spine surgeries, Interventional Pain physicians can now use minimally invasive devices to change the way the spinal cord transmits pain signals to provide substantial pain relief for years. While this technology has existed for decades in crude form, the last several years have seen rapid progress in the field of neuromodulation, which portends an exciting future for Interventional Pain Management and for patients seeking relief.

Chronic pain is too complex to rely on medications alone. Fortunately, our field continues to improve in assimilating different types of therapies to achieve the best overall outcome for each patient. In order to continue to improve pain care, physicians and other practitioners must continue to incorporate treatment from multiple disciplines. Along with physical therapy, medications, and psychological support and techniques, interventional pain procedures are integral to pain management and will continue to offer relief and functional improvement to a rapidly-growing group of people suffering with pain.

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Jeremy Walker  MD, is an AffirmHealth Medical Advisor and a board-certified Pain Management Specialist practicing with Comprehensive Pain Specialists in Nashville, Tennessee.

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