What is Interventional Pain Management?

Most people know what a cardiologist is and have at least heard of heart catheterization and stents. Comparatively few understand what an interventional pain management (IPM) doctor is or does. If a patient has complex or mysterious chest pain that is not responding to conventional treatment their primary care doctor may send them to a subspecialist known as an interventional cardiologist. — A doctor with additional training in heart and blood vessel detective work, as well as learning minimally invasive options for surgery. For example, guiding catheters into the heart to determine where the blood vessel blockages are, and inserting stents or conduits across the blocked arteries to restore blood flow. Similarly, an interventional pain management doctor guides needles, catheters, and probes into the spine and other areas of the body to identify and treat the causes of complex pain disorders.

An IPM specialist is a physician with proper training and a large tool kit for the evaluation, diagnosis, and treatment of different types of pain (including chronic pain, acute pain, and cancer pain). In contrast to other pain management practices, IPM is different because it emphasizes the importance of a precise diagnosis, so treatment is predicated on the cause.

Basing treatment on the cause helps to ensure against treatment failure

An IPM doctor first conducts detective work to determine the source of pain (or “smoking gun”) and then develops a systematic treatment plan to relieve, reduce, or manage pain. They help patients return to function in everyday activities (including work and sports) without surgery or heavy reliance on medication. Physiatrists are medical physicians who specialize in physical medicine and rehabilitation (i. e. their focus is on restoring function). Some physiatrists have advanced fellowship training in interventional pain management and are ideally suited to ensure against long term dependence on unnecessary medications or surgeries. Perhaps most notably because complex pain treatment often requires a multidisciplinary approach, and their training is steeped in taking a “team approach” to physical disability. Consequently, they play an important role in coordinating additional care such as physical therapy, psychological therapy, and rehabilitation programs; thereby offering patients a comprehensive treatment plan.

So please check to ensure that the doctor is board certified in pain management and has had fellowship training specifically in pain management. A fellowship is additional specialized training after residency and medical school. Board certification is evidence that the doctor has been tested to demonstrate their competence, in standards commensurate with the fellowship training.

Detective or diagnostic work for discovering pain generators in cases involving complex or mysterious pain, often involves drawing on multiple tools. Searching for disrupted anatomy on MRI, CT or ultrasound, or looking for a source of nerve damage on electrodiagnostic studies (which examine nerve function) are some examples. Navigation controlled injections may be deployed in an attempt to uncover the pain source, by numbing or provoking a potential pain generator. Numbing or pain blocking procedures are used to diagnose pain emanating from a joint,

bursae, tendon or nerve. If the pain quickly dissipates after numbing up a specific structure, odds are that structure is causing pain – even if the relief only last while the numbing medication is working. Pain blocking techniques are applied to structures in the spine, as well as the arms and legs. An example of a provocative procedure is discography, where the disc is pressurized with fluid, in an attempt to provoke a pain response. A pain response consistent with the patient’s usual symptoms or pain pattern suggest that the disc is (in fact) a pain source.

Interventional treatment options are numerous and depend on the targeted structure and underlying pathology. These range from simple anti-inflammatory or steroid injections to deploying radiofrequency energy delivered by special probes to abolish the nerve supply to painful spinal structures. Other common procedures include: 1) using sophisticated, implantable generators and catheters (similar to pacemaker technology) to pulse electrical energy to nerves in various parts of the body, thereby scrambling and dampening pain signals, 2) guiding a special catheter into the spinal canal to deliver various scar busting medications which untethers nerves trapped after surgical procedures or from severe narrowing of the spinal canals (owing to degeneration or trauma), and 3) exploiting the natural healing capabilities of immune tissue (stem cells, growth factors and bio-scaffolding) to help injured body parts heal.

Author
Dr. Joseph Fortin, DO Dr. Joseph Fortin is the Medical Director at Spine Technology and Rehabilitation and a Clinical Professor at Indiana University School of Medicine.

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