| interventional pain management

Interventional Pain Management: Science, Techniques, and the Future

Chronic pain affects millions globally, and despite advances in pharmacology, physical therapy, and behavioral health, many patients still do not achieve adequate relief. Interventional pain management (IPM) offers targeted, minimally invasive procedures — injections, ablation, and neuromodulation — that address the anatomy and neurophysiology of pain more directly than systemic medications. 

Below, we review foundational guidelines, highlight major recent discoveries (2023–2025), and look toward the future of IPM. 

What Is Interventional Pain Management? 

IPM includes: 

  • Epidural steroid injections 

  • Facet/medial branch blocks 

  • Radiofrequency ablation (conventional, pulsed, cooled) 

  • Spinal cord stimulation (SCS) 

  • Dorsal root ganglion stimulation (DRGS) 

  • Intrathecal therapies 

  • Percutaneous adhesiolysis 

These are integrated into multimodal care alongside rehabilitation, behavioral treatment, and pharmacotherapy — consistent with modern understanding of chronic pain as a complex neurobehavioral condition requiring targeted intervention within a broader biopsychosocial plan,Shape 

Foundational Scientific Evidence 

ASIPP Guidelines 

The American Society of Interventional Pain Physicians (ASIPP) guidelines (2009; updated 2013) established evidence grading for many procedures: 

  • Caudal epidural steroid injections: Level I evidence for short-term radicular pain relief. 

  • Percutaneous adhesiolysis: Strong evidence for short-term relief; moderate long-term. 

  • Spinal cord stimulation: Strong short-term; moderate long-term benefit for FBSS and CRPS. 

  • Facet nerve blocks: Level I–II diagnostic evidence across regions. 

  • Radiofrequency neurotomy for SI joint pain: Inconsistent evidence. 

These serve as the bedrock for practice, though they predate advances in neuromodulation and newer Randomized Controlled Trials. 

Recent Clinical Advances in Interventional Pain (2023–2025) 

1. Long-Term Neurostimulation Outcomes 

  • A systematic review of 24 RCTs (≥1-year follow-up) confirmed durable effects of neurostimulation; closed-loop SCS outperformed open-loop models with better sustained pain reduction and function. 

2. Optimal Pulsed Radiofrequency Duration 

  • A 2025 double-blind RCT showed 6 minutes of Pulsed Radiofrequency to the DRG delivers the best balance of efficacy and durability for lumbar radiculopathy. 

3. Combined DRG + SCS Hybrid Neuromodulation 

  • A 2024 retrospective series: 94% of patients achieved durable improvement (avg ~79% pain reduction) using combined DRG + SCS from a single IPG — suggesting complementary mechanisms. 

4. Predictors of Successful SCS 

  • A meta-regression of 27 studies (2,220 patients) identified predictors of ≥50% pain relief at 12–24 months: 

  • implantation technique 

  • baseline disability (ODI) 

  • pain duration 

  • sex 
    These findings refine patient selection. 

5. High-Frequency SCS Safety & Efficacy 

  • A 2024 meta-analysis found high-frequency SCS yields long-term pain relief and functional improvement without increased adverse events. 

6. Dorsal Root Ganglion Stimulation (DRGS) 

  • A 2024 systematic review of recent DRGS studies demonstrated consistent improvements in pain, function, and quality of life, with acceptable complication rates. 

7. Postherpetic Neuralgia: SCS vs Bipolar PRF 

  • A 2025 prospective comparison found both short-term SCS and bipolar PRF produced meaningful 24-month pain reduction in postherpetic neuralgia. 

8. Single-Stage SCS Implantation 

  • A multicenter study (2023) showed single-stage SCS (implant without trial) provided effective, durable pain relief in selected patients — potentially lowering costs and patient burden. 

9. Reassessing CMM as a Comparator 

  • A 2024–2025 meta-analysis concluded that conventional medical management (CMM) alone rarely yields clinically meaningful improvement in SCS-eligible patients, prompting reconsideration of its use as a “gold-standard” comparator in neuromodulation trials. 

Challenges & Future Directions 

Evidence Gaps 

  • Need for more sham-controlled and long-term RCTs 

  • Limited functional outcome data 

  • Underrepresentation of diverse populations 

Technological Innovation 

  • Closed-loop and adaptive SCS 

  • Hybrid SCS + DRG paradigms 

  • AI-assisted patient selection and programming 

  • Exploration of biologics and regenerative therapies 

Policy & Cost 

  • Device longevity and revision rates influence cost-effectiveness 

  • Coverage policies are evolving with new evidence 

  • Ensuring equitable access remains critical 

Patient-Centered Care 

Given variability in response and procedural tradeoffs, shared decision-making is essential to set expectations and personalize care. 

Conclusion  

Interventional pain management is evolving quickly, supported by high-quality new evidence in neuromodulation durability, optimized procedural techniques, and improved patient selection. These insights matter greatly to PAINWeek’s multidisciplinary audience — including physicians, advanced practice providers, nurses, pharmacists, mental health professionals, rehabilitation specialists, and trainees — all of whom contribute to evaluating, performing, coordinating, or supporting pain care. 

Across these roles, the goal remains the same: to deliver safer, more effective, patient-centered management of chronic pain. By staying current with emerging science and integrating interventional techniques within a multimodal framework, the PAINWeek community is well positioned to improve outcomes for patients living with chronic pain. Shape 

References  

Foundational & Guideline Sources 

  1. Manchikanti L, Boswell MV, Singh V, et al. Comprehensive Evidence-Based Guidelines for Interventional Techniques in the Management of Chronic Spinal Pain. Pain Physician. 2009. 

  1. Boswell MV, Shah RV, Everett CR, et al. Interventional Techniques in the Management of Chronic Spinal Pain: Evidence-Based Practice Guidelines. Pain Physician. 2005. 

  1. Imani F, Rahimzadeh P. Interventional Pain Management According to Evidence-Based Medicine. Anesth Pain Med. 2012. 

Recent Research (2023–2025) 

  1. Systematic Review: Long-Term Randomized Controlled Trials of Neurostimulation for Chronic Pain. Neuromodulation. 2023. 

  1. Zeng H, et al. Optimal Duration of Pulsed Radiofrequency on the Dorsal Root Ganglion: Double-Blind RCT. Reg Anesth Pain Med. 2025. 

  1. Deer TR, et al. Combined DRG + SCS Hybrid Neuromodulation for Focal Neuropathic Pain: Long-Term Outcomes. Pain Medicine. 2024. 

  1. Thomson S, et al. Predictors of Clinically Significant Pain Relief After SCS: Systematic Review & Meta-Regression. Pain. 2023. 

  1. Meta-analysis of High-Frequency SCS for Chronic Pain: Long-Term Safety and Efficacy. Journal of Pain. 2024. 

  1. Systematic Review: Dorsal Root Ganglion Stimulation for Chronic Neuropathic Pain. Neuromodulation. 2024. 

  1. Zhang Y, et al. Long-Term Comparison of Short-Term SCS vs Bipolar PRF for Postherpetic Neuralgia. Eur J Med Res. 2025. 

  1. Multicenter Real-World Outcomes of Single-Stage SCS Implantation. Interventional Pain Medicine. 2023. 

  1. Meta-analysis: Outcomes of Conventional Medical Management (CMM) in SCS-Eligible Patients. Pain Medicine. 2025. 

  1. Simpson EL, et al. Critique of Methodologic Errors in SCS Meta-Analyses. Brain Sciences. 2023. 

  1. Washington State HTA: Spinal Cord Stimulation for Chronic Pain — Evidence Update. Health Care Authority. 2023. 

Alysha Mahagaonkar

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