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The need for Interventional Pain Management

Pain that persists despite routine medical management poses a difficult problem for patients and their treating physicians. When pain continues despite medical care, there is an increasing possibility of physicial disability, phychosocial dysfunction, drug dependency and development of cromic pain.These procedures are very safe and effective.

Fluoroscopy:

  • Specific spinal pain source can be precisely targeted for diagnosis and therapy
  • A variety of refined techniques can be employed including routine posterior interlaminar epidural injection, transforminal epidural injection, selective nerve root block, intervertebral disc injection and and facet joint block depending on pain source.
  • Radiologic documentation of medication delivery is routine
  • Patients with difficult anatomy can accurately injected with minimal risk
  • Fine needles can be used, imposing less risk and improving patient comfort

Radiofrequency Neuroablation

Radiofrequency lesioning has recently been used successfully as a treatment for chronic refractory neck pain from whiplash injury, a condition in which recent scientific research has identified spinal facet joints as commonly responsible for persistent pain. Facet jointsmay also be the source for pain in certain types of cervicogenic headache and in non radicular low back pain. Once facet joint pain is precisely localized, radiofrequency denervation of the denervation is gaining acceptance as an feeective treatment option when more conservation approaches fail to relive symptoms. It is also successfully used for neuroablalism of sympathetic ganglia in sympathetically maintained pain syndromes.

Implantable Devices for pain Controller

There are two types of implantable systems that may provide effective relief of chronic refractory pain:

Spinal Cord Stimulation

With this technique, an electrode is implanted percutaneously into the epidural space using fluoroscopic guidance. This electrode is then connected to an electrical generator which is also implanted under the skin. Current is transmitted through the electrode into the spinal cord at the same level as pain impulses are entering the cord from the same pain source. Electrical stimulation of the spinal cord causes the pain sensation to be blocked and replaced by a bening vibratory sensation. This system has proven very useful in the treatment of pain in an extremity from chronic radiculopathy and as the advantages of requiring no medication and being non destructive.

Intrathecal Opiate Infusion Pump

Opiates placed directly on to spinal cord receptors have provided powerful analgesia for a number of difficult chronic pain conditions. Technology has now progressed to the point whereby a pump and a intrathecal catheter system may be implanted entirely within the body and said to deliver a continuous flow of intrathecal opiate with or without added local anaesthetic. The intrathecal pump system is usually reserved for patients who have failed all other means of pain control and is specially effective for generalised pain in multiple areas of the body.

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