Interventional Pain Medicine: Options, Outcomes, Risks, and Complications

Author: Hans C. Hansen

Hans Hansen, MD, DABPP, FIPP

The procedures that we do in interventional pain medicine to alleviate pain, improve function and enhance quality of life are sometimes misunderstood and not clearly elaborated to the medical community. There are a range of pain conditions that interventional pain medicine can favorably impact.  We are very familiar with low back pain, pain after surgery, post laminectomy syndrome, but also some of the other not so well-understood pain complaints, such as vulvodynia or painful pelvic pain, pains that are somewhat vague and misunderstood, like chronic regional pain syndrome to an extremity after an injury. Headaches also respond very well to interventional therapy. And in addition to achieving better outcomes, we can help minimize escalation in, or reliance on controlled substances. Are there complications with these procedures? Of course, but the relative risk is very low. Some of the problems we see are as minor as some post injection discomfort, but sometimes there can be other issues. Bleeding, infection, nerve damage, that sort of thing have been described, but with proper patient selection, evaluation and diagnosis, these events are extraordinarily uncommon.

There are new techniques and procedures emerging that will expand our options in minimally invasive pain treatment, and drive the effort to cost containment in care provision. We’re looking forward, for example, to intradiscal procedures that remove the disc by hydro distention or taking parts of a bulging disc out with fluid percutaneously.  A very straightforward procedure that could be done in the office. Intravenous medications are very promising.  We’re looking at Ketamine.  We’re looking at some other promising interventions that aren’t just spinally oriented, that don’t just use a needle but use common sense and common applications of some very good medications.

In summary we’d like primary care practitioners to know that the application of diagnostic and therapeutic techniques of interventional pain medicine can be of great benefit in today’s cost constrained practice environment, and can help them improve patient outcomes and quality of life while minimizing risk and complication from controlled substance prescribing. That’s our goal.  That’s what we do every day when we get up, and we feel that interventional pain medicine is the future.

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