Interventional Pain Procedures

Quick Answer

Interventional pain procedures provide diagnostic information and therapeutic benefit for chronic pain conditions when conservative management fails. Epidural steroid injection (ESI): Indicated for radicular pain from disc herniation or spinal stenosis, using fluoroscopic guidance, interlaminar or transforaminal approach, triamcinolone 40-80 mg or methylprednisolone 80 mg with local anaesthetic; 50-70% response rate, duration 3-6 months, maximum 3-4 injections per year. Facet joint injection and medial branch block: For axial back pain with positive diagnostic block (>80% pain relief), using 1-2 mL local anaesthetic ± steroid; radiofrequency ablation (RFA) of medial branches provides 6-12 months pain relief for 60-70% patients. Sacroiliac joint injection: For SI joint pain (positive Fortin finger test, pain below L5), 1-2 mL steroid + local; RFA of lateral branches if diagnostic block positive. Peripheral nerve blocks: Diagnostic (prognostic for neurolysis/neurectomy) or therapeutic (repetitive blocks for CRPS); examples: occipital nerve block (headache), suprascapular nerve block (shoulder pain), genicular nerve block (knee OA). Spinal cord stimulation (SCS): Indicated for FBSS (failed back surgery syndrome), CRPS, refractory angina; trial period 3-7 days, permanent implant if >50% pain reduction; complications: lead migration (10%), infection (5%), hardware failure. Intrathecal drug delivery: For refractory cancer or non-cancer pain; morphine, ziconotide, baclofen; complications: infection, granuloma formation, catheter failure. Contraindications: Coagulopathy (INR >1.4, platelets <100), infection, patient refusal, allergic to contrast. Complications: Bleeding, infection (1-2%), nerve injury (<1%), intravascular injection (systemic toxicity), pneumothorax (thoracic procedures), spinal cord injury. Indigenous patients may have limited access to interventional pain services due to geography; telehealth screening and prioritized referral pathways important. [1-10]