There was a time many years back when any intervention by a medical doctor on any patient meant surgery. Epidural injections (caudal, interlaminar or transforaminal) were one of the first spine interventions ever undertaken. With the advancement in technology and especially the use of C Arm fluoroscopes for image guided blocks and ultrasound, interventional pain procedures could be done in much more reliable and predictable manner.
Pain physician of today is competent to treat the entire range of pain encountered in the delivery of quality healthcare, whether it is due to a discrete cause like cancer pain and postoperative pain to primary pain problems like musculoskeletal pain, neuropathic pain, urogenital pain, headaches etc. Pain medicine, which incorporates interventional pain management, has been acknowledged as a discrete discipline by the American Medical Association.
The advent of Radiofrequency (RF) ablation both thermal and pulse radiofrequency have quiet changed the outlook of interventional pain procedures in terms of providing longer lasting solutions for pain problems of the patients. Whether it is medial branch RF for facet syndrome, gasserian ganglion RF for trigeminal neuralgia, genicular branch RF for knee osteoarthritis or Pulse RF of dorsal root ganglion for lumbar radicular syndrome, the scope RF in interventional pain practice has undergone marked change and occupies vital position for providing long term pain relief to the patients.
The spectrum of interventional pain management has broadened with neuromodulation. Be it spinal cord stimulators, intrathecal pumps or peripheral nerve stimulators, these devices have moved in the analgesic ladder and are now indicated earlier rather than late for managing neuropathic or cancer pains.
Therefore the present day pain physician has various weapons in their armoury and apart from medical management, interventional pain management procedures can be resorted to not only to help in the diagnosis but also to provide long-term pain relief for the patient. This can help in providing functional recovery and thereby improve the quality of life of our patients.
Author’s Note: Pain Medicine is one of the newer disciplines in medicine in India (though recognised as a speciality and practised in USA since 1970s) and awareness is low not only among patients but also among the medical fraternity. The Medical Council of India (MCI) now recognizes one year PDCC (Pain & Palliative care) as a requisite training after post graduation in Anaesthesiology.
Source: India Medical Times