Interventional Pain Management: Procedures, Cost and Safety

Interventional pain management treats chronic pain by identifying the structure that generates it and treating that target directly, with image-guided nerve blocks, radiofrequency ablation, sympathectomy or implanted devices. Dr. Ashu Kumar Jain, Chief – Pain Medicine & Palliative Care, Artemis Hospitals, Gurugram, India, stresses that 80 to 85 per cent of chronic pain patients can be managed conservatively; procedures are for the rest.

That framing matters for every referring doctor. The procedures described below are powerful, and most are performed as day cases, but they are a second line. They follow a failed trial of conservative care and, above all, a precise diagnosis.

What is chronic pain?

Dr. Jain defines chronic pain as any pain that persists for more than three months and beyond the normal time of tissue healing. By that point pain is no longer a symptom of an injury that is resolving. It has become a condition in its own right, and it reaches into every part of a patient's life: sleep, work, mood, anxiety and depression.

The burden grows with age. In his experience chronic pain is more common in women than in men, and particularly so above the age of 70. For clinicians in referral networks this has a practical consequence: many of the patients who most need a pain procedure are older, carry other illnesses and take blood thinners, which is precisely the group in whom open surgery is least attractive.

Why conservative treatment comes first

Dr. Jain's opening message was that interventions are not the default. Conservative treatment comes first, and it succeeds for the large majority. Interventional treatment begins only when that conservative pathway has failed.

The distinction he draws is between treating pain and treating its source. Injecting a painful area without knowing what is producing the pain is not pain management. Modern practice is, in his words, evidence-based, diagnosis-based and targeted, and that is what produces good results in chronic pain.

How interventional pain management finds the pain generator

The clinical skill at the centre of the specialty is locating the pain generator: the specific joint, disc, nerve or ganglion from which the pain arises. Several features of the procedures he showed serve that purpose.

• Imaging guidance. Needles are placed under fluoroscopy in a catheterisation laboratory (cath lab), so the operator sees exactly where the needle tip lies and how contrast spreads.
• Sensory stimulation before treatment. Before ablating a nerve, the team stimulates it and asks the patient whether the sensation matches their usual pain. In the trigeminal and cervical facet procedures he showed, the patient confirms that the stimulated pain sits exactly where they normally feel it.
• Treating the right level. After spinal surgery, for example, pain may come from the level below the fixation, from a nerve trapped in scar tissue, from the joint above the fixation or from the sacroiliac joint. Each needs a different procedure.

One case made the point. A woman from southern Africa had lived for many years with unexplained pain and carried a diagnosis of fibromyalgia. Assessment traced her pain to her neck and lower back. After radiofrequency ablation at both levels, together with medication and exercise, she reported about 70 per cent less pain within a month. Dr. Jain's conclusion was direct: there are solutions to chronic pain when patients are diagnosed properly.

Types of interventional pain procedures

Interventional pain procedures fall into seven main types, applied at different points along the nervous system.

• Nerve blocks. An injection of local anaesthetic, often with a steroid, around a nerve, joint or the epidural space. Blocks are used to treat pain and to confirm the diagnosis.
• Neurolysis. Deliberate, longer-lasting destruction of a nerve, for example with alcohol. Dr. Jain uses alcohol neurolysis and sympathetic neurolysis for cancer pain.
• Radiofrequency ablation (RFA). A needle electrode placed on the nerve that carries pain from a joint or organ delivers radiofrequency current that heats and interrupts the nerve. Cooled radiofrequency uses a water-cooled probe to create a larger lesion, which Dr. Jain uses for the lumbar disc and the knee.
• Percutaneous sympathectomy. Radiofrequency interruption of the sympathetic chain through needles, used for vascular, ischaemic and complex regional pain in the arms and legs.
• Epidural and adhesiolysis procedures. Epidural injections for nerve root pain, and needle-based release of a nerve trapped in scar or adhesions.
• Regenerative therapy. Platelet-rich plasma (PRP) and stem cell therapy for early joint degeneration, tendinopathies and muscular pain, often guided by ultrasound.
• Neuromodulation and drug delivery. Spinal cord stimulators for neuropathic and ischaemic pain, and intrathecal pumps that deliver drugs directly into the fluid around the spinal cord.

A head-to-toe map of treatable pain

Dr. Jain organised the session anatomically, from the face to the feet. The map below summarises which procedure he uses for which problem; each region is covered in depth in its own article.

The face, neck, shoulder and chest wall are covered in cervicogenic headache, facial and neck pain without surgery. The lower back, sciatica, the operated spine and the knee are covered in failed back surgery syndrome, sciatica and disc pain. Sympathectomy, cancer and pelvic pain, and implanted devices are covered in percutaneous sympathectomy, visceral nerve blocks and pumps.

Across this whole map, Dr. Jain reported results above 90 per cent for most of his procedures, which are mostly day-care procedures.

How safe are interventional pain procedures?

Asked about complications during the question session, Dr. Jain put the rate of serious complications at less than one in 1,000, and said that in his clinical practice he has never seen a serious complication. The complications that can occur are those of any needle procedure:

• bleeding;
• infection;
• nerve injury;
• injury to a nearby organ, such as the lung or the liver, when the needle works close to it, for example during sympathectomy.

He stressed that these events are very rare. Part of the safety case is the setting. Working in a cath lab under fluoroscopy allows needle position and contrast spread to be confirmed before any drug is injected or any lesion is made.

How much interventional pain procedures cost

Most interventional pain procedures cost between US$800 and US$4,500, on the figures Dr. Jain gave in US dollars in answer to the second question from the audience; the two implanted devices cost considerably more. His breakdown:

• Nerve blocks and neurolysis procedures: around US$800 to US$900.
• Radiofrequency ablation procedures: US$2,200 to US$4,500, depending on the area and the procedure.
• Most procedures, excluding the two implanted devices: within US$2,200 to US$3,000.
• Intrathecal pump and spinal cord stimulator: considerably more expensive than the other procedures.

These are the figures Dr. Jain gave at the session in June 2025. A treating team can confirm a current estimate once the diagnosis and the planned procedure are known.

Recovery time and length of stay

Dr. Jain put recovery time after most interventional pain procedures at 24 to 48 hours, after which patients can fly home. Recovery is short because most of these procedures are day cases. For most international patients he plans a stay of three to five days.

The operational implication for a referring doctor is that the bulk of the work happens before travel: imaging, a clear history of where the pain starts and spreads, and a record of the conservative treatment already tried.

When to refer for interventional pain management

Three messages from the session translate directly into referral practice.

1. Chronic pain is a diagnosis to be made, not a symptom to be suppressed. Pain beyond three months deserves a search for its generator.
2. Many structural problems do not need surgery. Dr. Jain's examples ranged from neck pain, where he said 95 to 97 per cent of cases can be managed without surgery, to frozen shoulder and sciatica without neurological deficit.
3. Patients unfit for surgery still have options. Elderly patients, patients on blood thinners and patients with cancer can often be treated with a needle rather than an operation.

The questions doctors put to Dr. Jain at the end of the session are set out in the Live Discussion. His profile is on the Dr. Ashu Kumar Jain page, and related content sits in the pain medicine and palliative care specialty. His later masterclass in July 2026, covering drug choice in nerve blocks, the limits on NSAID use and the criteria for surgery, is set out in Advances in Chronic Pain Treatment: A Complete Guide.