Pain Treatment – Interventional Pain Therapy

Interventional Pain Therapy – Pain Treatment

Steroid (cortisone) injections combined with a local anesthetic, as well as nerve destruction using radiofrequency waves, are non-invasive methods for pain management. Injection therapy can help control pain caused by degenerative disc disease, osteoarthritis of the spine, and spinal injuries.
Cortisone injections play a significant role in managing both acute and chronic spinal pain.

Nerve Block

Nerve blocking (nerve block) involves injecting cortisone and a local anesthetic around a nerve. This is done in the following cases:

Facet Joint Block

Osteoarthritis of the small facet joints of the spine is one of the most common causes of lower back pain. In a facet joint block, a local anesthetic combined with cortisone is injected into these small joints of the spine. This results in immediate pain relief due to the anesthetic and long-term pain reduction from the cortisone.

Peripheral Nerve Block

Peripheral nerves can cause tingling, numbness, and a sensation of needles, collectively known as paresthesia. These symptoms result from peripheral nerve disorders. Injecting cortisone and a local anesthetic around a peripheral nerve helps control these sensations.

Selective Nerve Root Block

When pain originates from a compressed nerve root (the nerve emerging from the spine) and radiates to the arm or leg, depending on whether the issue is in the neck or lower back, a selective nerve root block can be performed. This is done by injecting a local anesthetic and cortisone around the specific nerve root.

Epidural Cortisone Injection

The epidural space is the area between the spine and the protective membrane (meninges) surrounding the nerves and spinal cord.
During an epidural injection, a local anesthetic combined with cortisone is administered into the epidural space. This reduces irritation and pain caused by pressure on the nerve roots. This method is more generalized than a selective nerve root injection but has some advantages (such as not requiring fluoroscopic guidance).

Sacroiliac Joint Injection

The sacroiliac joint is a large joint that connects the pelvis to the spine. It is involved in approximately 10–20% of lower back pain cases. Injecting a local anesthetic and cortisone can help alleviate pain in these cases.

Peripheral Nerve Ablation

Peripheral nerve ablation is usually performed on small nerves that supply the facet joints of the spine, which are a primary source of pain in spinal arthritis. This procedure uses radiofrequency (RF) energy to generate heat and destroy the targeted nerve, providing pain relief. The process is similar to a nerve block with local anesthetic and cortisone but is performed using fluoroscopy (real-time X-ray guidance) to ensure accurate needle placement. The entire procedure takes only a few minutes, with the most time-consuming part being the precise positioning of the needles.

Patient Eligibility for Local Pain Therapy

For safety reasons, certain groups of patients should not undergo local pain therapy. These include:

A) Patients allergic to the medications used.
B) Patients with the following conditions:

Anemia
Asthma
Bleeding disorders
Kidney disease
Pregnancy
Severe spinal conditions

Patient Preparation

Patients should follow these simple guidelines before undergoing local pain therapy:

Stop taking blood-thinning medications, such as anticoagulants, aspirin, and anti-inflammatory drugs.
Avoid eating or drinking for at least six hours before the procedure.
Arrive at the hospital with a companion who can assist them after the procedure.

Hospital Preparation

At the hospital, the patient changes into surgical attire. A heart and blood pressure monitor is always placed to ensure safe monitoring during the procedure. In some cases, medications are given to help the patient relax, as these procedures are performed while the patient is awake, without general anesthesia.

What to Expect During the Injection?

All procedures are performed under sterile conditions. The skin is cleaned, disinfected, and covered with sterile surgical drapes.
Before the injection, the fluoroscopic machine (X-ray guidance) is positioned around the patient to precisely guide the needle. Once the needle is in the correct position, the combination of local anesthetic and cortisone is injected.

After the Injection

After the injection, the patient remains under observation for about an hour. Sometimes, the injected area, and in rare cases the patient’s leg, may feel numb. Once the numbness subsides, the patient can go home.
Cortisone may cause mild side effects, such as increased blood sugar levels, blurred vision, and frequent urination. Occasionally, fever or pain at the injection site may occur.

In general, injections are safe procedures. However, in rare cases, complications such as headaches (due to meningeal puncture) or nerve pain (due to nerve injury) may occur.

If any complications arise, the patient should contact their doctor.

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Χειρουργός Σπονδυλικής Στήλης

Ο Χειρουργός Σπονδυλικής Στήλης/ Σκολίωσης Δρ. Ηλίας Χαρ. Παπαδόπουλος γεννήθηκε και μεγάλωσε στην Αθήνα. Αποφοίτησε με Άριστα από την Ιατρική Σχολή Αθηνών το 1994 και στη συνέχεια ειδικεύτηκε στην ορθοπαιδική, στην Α’ Ορθοπαιδική Κλινική του Πανεπιστημίου Αθηνών.