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Apr13
Interventional Pain Management: Approach to Chronic Pain
Dr (Maj)Pankaj N Surange
MBBS,MD,FIP
Interventional Pain and spine specialist
Pain treatment begins with an assessment of the severity of the pain. Commonly, the first steps of treatment are rest, application of cold or heat and intake of OTC (over the counter) medication. The next step in the treatment of pain is a combination of physical therapy and prescribed pain medication. It is important to note that sometimes, interventional pain management needs to be started prior to Physical Therapy in order to stop acute pain (i.e. acute radiculopathy) and allow the patient to comply with necessary exercise. If prescribed pain medication and physical therapy don't work, the next step is usually interventional pain management, unless the patient has acute loss of function or acute neurological deficit (in which case surgery is needed. However, even after surgery interventional pain management has a very important role in the treatment of patients, especially when all other options are exhausted (eg. "failed back surgery" syndrome).
The Specialty of “Pain Management” has progressed significantly in the last 20 years through a better understanding of anatomy and physiology, and through advances in pharmacology and technology.
The goals of interventional pain management are to relieve, reduce, or manage pain and improve a patient's overall quality of life through minimally invasive techniques specifically designed to diagnose and treat painful conditions. Interventional pain management also strives to help patients return to their everyday activities quickly and without heavy reliance on medications. Often other treatments are include such as physical therapy, occupational therapy, and lifestyle modification (such as exercise, diet, and smoking cessation) to further enhance these procedures.
Before any treatments are started, we may perform diagnostic tests to rule out other conditions that may present similar symptoms. These tests may include x-rays, CT scan, MRI, and possibly blood tests.

Early Intervention:

Early interventional treatments in Pain Medicine have been found to return injured patients to work and regular activities more rapidly than past conservative therapies. Early treatment of inflamed injured tissues and articulations quickly resolves the insult, not allowing chronic inflammation with resultant joint and tissue destruction. Pain Medicine physicians are trained in diagnostic patient evaluations, including radiographic interpretations and diagnostic injections when indicated. Early intervention decreases unnecessary chronic pain, long-term treatments and disabilities.

Some facts about the Speciality

American society of Interventional pain physician
In USA, The Department of Health and Human Services Centers for Medicare and Medicaid Services issued a memo March 4, 2005, including Interventional Pain Management specialists on the list of clinical specialties to be included in carrier advisory committees.

Pain relief a human right – WHO (world health organization)
"Pain relief should be a human right, whether people are suffering from cancer, HIV/AIDS or any other painful condition,"

Study by International association for study of pain and European federation of IASP
One person in five suffers from moderate to serious chronic pain, and one in three are unable or only with difficulty able to lead an independent life .One in four sufferers say pain disrupts or destroys relations with family and friends.

American cancer society
30%-50% have pain at the time of diagnosis of cancer. 70% to 90% have severe pain when the disease is advanced. 40% die with severe pain. 60%-80% complains of inadequate pain relief by their physician.30% are not relieved by drug treatment alone, so require interventional pain management. ___________________________________
• More than 90% cancer pain can be adequately controlled


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