Advances in Chronic Pain Management

No. These interventions are regional and can be repeated without causing nerve damage or nerve injury. Complications are rare given how far the technology and generators have advanced, and in this practice no serious complication has ever occurred with these blocks or ablations. Blocks can be repeated every four to six weeks and radiofrequency ablation every three months.

Ropivacaine for nerve blocks. For spinal procedures, dexamethasone is the primary steroid. For joint injections, Kenacort (triamcinolone).

That sits outside pain medicine. It belongs to cardiology and gastroenterology. This practice does not treat visceral pain originating from the heart or lungs and stays restricted to musculoskeletal and neuropathic pain.

Under international Spine Society guidelines, when the primary problem is pain alone, the patient does not need surgery, regardless of the degree of compression shown on imaging, as long as it is below L2. Surgery is indicated for disability: foot drop, motor deficit, sensory deficit, or more than moderate to severe canal stenosis on MRI, where an intervention can only buy time rather than treat the underlying disease. At Artemis, pain medicine and spine surgery work as a team. If a patient referred for pain turns out to have a neurological deficit, they go straight to the spine surgeon; if pain is the only presenting symptom, pain medicine treats it. The line between the two is clear.

If the femoral head itself is involved, radiofrequency ablation of the hip joint, targeting the genicular nerves supplying the joint, is a very rewarding procedure. But if the pain originates from the bone itself or has a visceral component, high-dose NSAIDs risk the kidneys and the better approach is opioid-based: morphine or tramadol with paracetamol and a neuropathic agent, alongside any specific interventional target that exists.

Roughly 12 to 15% of outpatient cases in this practice need an interventional procedure. Medical management and rehabilitation alone resolve the remaining 85 to 87% of patients.

Trigeminal and glossopharyngeal neuralgia, cervicogenic headache, cervical radiculopathy, thoracic and T2-T3 sympathetic pain, shoulder conditions, failed back surgery and sciatica, discogenic back pain, cancer and pelvic pain, coccydynia, knee pain, spinal cord stimulation, intrathecal pumps, and opioid use in sickle cell disease and cancer pain.

Because live imaging in a cathlab can catch a complication, such as contrast dye tracking into an unexpected web of epidural veins, that would go unnoticed under simple fluoroscopy and could otherwise prove fatal.