When should you see an interventional pain physician?

by | Apr 11, 2011

Cervical and lumbar spine injuries are the second most common reasons why patients will see a physician.  Common diagnoses include disc herniation’s, pinched nerves, arthritis, sciatica, and degenerative disc disease. These can arise from repetitive injury, incorrect posture, stress is on the spine such as with heavy bending and lifting, sports injuries, and injuries from work and automobile accidents.

A patient may go to ten different treatment centers for the same condition and each will prescribe something different.  Many different types of treatments exist including chiropractic manipulation, physical therapy and exercise, medications, acupuncture, epidural injections, and surgery.  While there was no exact science to the treatment of back pain, the most important rule of thumb is to start with conservative treatment, but if symptoms persist, a more aggressive approach may be warranted.

When are epidural steroid injections appropriate?

An adequate course of physical therapy should usually undertaken for about 6 to 8 weeks. Thereafter, the decision to seek care with an interventional spine physician is based upon several factors.  Symptoms that persist despite an adequate course of therapy, and if the nature and severity of the pain is significant, additional testing and treatment my be warranted.  At this point, an MRI Study will be necessary to help determine the ideology of the condition.  EMG testing is also another study administered by a neurologist to determine if there is a pinched nerve in the neck and back which is causing the arm or leg pain.  This is known as a cervical and lumbar radiculopathy.  However, these tests are imperfect and at times can either not show of the cause of the condition, or show a number of abnormalities but which have nothing to do with what is causing the pain. As an example, studies have shown that if you were to perform an MRI study on 100 people 70 years of age without back pain, 100% of them would have various abnormalities on the MRI. This could include degenerate disk disease, arthritis, and spinal stenosis.  In contrast, a young patient with severe back pain could have an MRI study that shows minimal findings such as a disc bulge.  In such circumstances, a well trained and experienced pain physician will devise a comprehensive work up to determine what is causing the condition.  Indications for a consultation with a pain management specialist include patients experiencing pain who have not improved with conservative treatment, who have MRI findings that do not explain their pain, or who either wish to avoid surgery or have contraindications to surgery.

Why undergo spine injections?

If you have tried different therapies and are still experiencing neck pain, or back pain, or arm or leg pain, then interventional therapy may be indicated. Many people are hesitant about having an injection in their neck or back, and may have heard negative things.  However, these treatments are extremely simple, safe, take minutes to perform, are relatively painless with the use of light anesthesia sedation, and are performed in a outpatient surgery center.  Please watch this video of me performing in the epidural steroid injection. You see how quick and simple it really is.

A good pain management specialist must be a good diagnostician as well as a good injectionist (meaning is skillful in performing injections quickly and without undue discomfort to the patient).  After a comprehensive work up, the pain physician must determine the correct procedure to perform.  Epidural steroid injections are the most common treatment which interventional pain specialist perform, and are probably over utilized.  More selective and specific nerve blocks are usually indicated to help determine what is the cause of the pain.  In other words, nerve blocks are an additional diagnostic tool to aid in the overall work up of the patient.

Once the cause of the pain is determined, more sophisticated interventions exist which can treat the disc herniation or other condition without surgery.  These include percutaneous and laser disc decompression, radiofrequency ablation, endoscopic rhizotomy, and minimally invasive decompression. Specific information can be found on other blogs on my website:  https://www.gspmweb.com/blog/.                                                                        The goal is to perform the lease to number and least invasive treatment to achieve permanent benefit.

In conclusion, any patient having persistent neck or low back pain after an adequate course of physical therapy or other treatments can benefit from interventional pain management therapies. Even if you have already trialed epidural steroid injections, many other treatments exist which could be beneficial.  I utilize specific nerve blocks as a diagnostic tool to determine the cause of the pain, then more sophisticated interventions to achieve long-term benefit.  There was very little down side to undergoing interventional pain management therapy.  These minimally invasive modalities are extremely simple, safe, done as outpatient procedures, and can be highly beneficial.  I have in my over 20 years of practice improved the pain, functioning, and quality of life of thousands of patients.

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