Interventional Pain Management: What Primary Care Should Know

Sanford M. Silverman, MD

I am very fortunate and honored to represent the American Society of Interventional Pain Physicians who have led the way in teaching and implementation of interventional pain medicine. IPM techniques are effectively applied to spinal pain, the most prevalent pain we have. They are also effective for facial pain, and pain from pancreatitis, from metastatic disease, from pelvic pain. A condition that primary care may not associate with IPM is shingles. Very common, seen in primary care every day.  The treatment protocol is to give an antiviral, and analgesics and wait. But if they refer to a doctor who performs interventional pain procedures, let’s say a sympathetic block, it can be very effective and it may even reduce the incidence of postherpetic neuralgia if it’s aggressively treated.  The frontline practitioner should really take note if they have a patient who is in extreme pain with shingles, really is not doing well. That’s the time to send them to a doctor who performs interventional pain procedures.

There are exciting new avenues in IPM, for example involving biologics, platelet rich plasma (or PRP) and stem cells.  We don’t have a lot of evidence and the FDA guidelines are really kind of nebulous but this is a very exciting area.  We’re also talking about some specific techniques like decompression, hydrodissection, as well as advances that have in existing techniques, such as spinal cord stimulation to include high frequency stimulation, peripheral nerve stimulation and occipital stimulation for migraines.

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