Interventional Pain Management

  • Michael A. Cosgrove
  • David K. Towns
  • Gilbert J. Fanciullo
  • Alan D. Kaye


Invasive procedures performed by the pain management specialist are a mainstay in the diagnosis and treatment of both acute and chronic pain. They range from unguided percutaneous injections with short-acting local anesthetics to neurosurgical operations under computed tomography that permanently alter the anatomy. This chapter provides a description of the most common procedures performed by the pain management specialist, with more detail on the most frequent. The descriptions are not in sufficient enough detail to perform the procedures, and reference should be made to an interventional pain atlas for specifics.


Recurrent Laryngeal Nerve Nerve Block Stellate Ganglion Epidural Steroid Injection Sensory Innervation 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.


  1. Anderson EF. Epidural and intrathecal narcotics for pain relief. S D J Med. 1984;37(1):7–12.PubMedGoogle Scholar
  2. Ansari,S, Chaudhri K, Moutaery K. Neurostimulation for refractory angina pectoris. Acta Neurochir Suppl. 2007;97(Pt 1):283–8.PubMedGoogle Scholar
  3. Bala MM, et al. Systematic review of the (cost-)effectiveness of spinal cord stimulation for people with failed back surgery syndrome. Clin J Pain 2008;24(9):741–56.PubMedCrossRefGoogle Scholar
  4. Bogduk N, Dreyfuss P, et al. International spine intervention society practice guidelines for spinal diagnostic and treatment procedures. San Francisco, CA: International Spine Intervention Society; 2004.Google Scholar
  5. Classen AM, Wimbish GH, Kupiec TC. Stability of admixture containing morphine sulfate, bupivacaine hydrochloride, and clonidine hydrochloride in an implantable infusion system. J Pain Symptom Manage 2004;28(6):603–11.PubMedCrossRefGoogle Scholar
  6. Cohen SP, Raja SN, Pathogenesis, diagnosis, and treatment of lumbar zygapophysial (facet) joint pain. Anesthesiology 2007;106(3):591–614.PubMedCrossRefGoogle Scholar
  7. Coombs DW, et al. Intrathecal morphine tolerance: use of intrathecal clonidine, DADLE, and intraventricular morphine. Anesthesiology 1985;62(3):358–63.PubMedCrossRefGoogle Scholar
  8. Coombs DW, et al. Epidural narcotic infusion reservoir: implantation technique and efficacy. Anesthesiology 1982;56(6):469–73.PubMedCrossRefGoogle Scholar
  9. Deer T, Hassenbusch SJ, et al. Polyanalgesic consensus conference 2007: recommendations for the management of pain by Intrathecal (Intraspinal) drug Delivery: Report of an Inderdisciplinary Expert Panel. Neuromodulation: Technology At The Neural Interface, 2007, p. 10.Google Scholar
  10. de Leon-Casasola OA, Critical evaluation of chemical neurolysis of the sympathetic axis for cancer pain. Cancer Control 2000;7(2):142–8.PubMedGoogle Scholar
  11. Dreyfuss P, et al. Radiofrequency facet joint denervation in the treatment of low back pain: a placebo-controlled clinical trial to assess efficacy. Spine 2002;27(5):556–7.PubMedCrossRefGoogle Scholar
  12. Dreyfuss P, et al. Efficacy and validity of radiofrequency neurotomy for chronic lumbar zygapophysial joint pain. Spine 2000;25(10):1270–7.PubMedCrossRefGoogle Scholar
  13. Fanciullo GJ, et al. The state of implantable pain therapies in the United States: a nationwide survey of academic teaching programs. Anesth Analg. 1999;88(6):1311–6.PubMedCrossRefGoogle Scholar
  14. Ferrante FM, et al. Radiofrequency sacroiliac joint denervation for sacroiliac syndrome. Reg Anesth Pain Med. 2001;26(2):137–42.PubMedGoogle Scholar
  15. Geurts JW, Kallewaard JW, Richardson J, Groen GJ. Targeted methylprednisolone acetate/hyaluronidase/clonidine injection after diagnostic epiduroscopy for chronic sciatica: a prospective, 1-year follow-up study. Reg Anesth Pain Med. 2002;27(4):343–52.PubMedGoogle Scholar
  16. Hassenbusch SJ, et al. Constant infusion of morphine for intractable cancer pain using an implanted pump. J Neurosurg. 1990;73(3):405–9.PubMedCrossRefGoogle Scholar
  17. Hassenbusch SJ, Portenoy RK, Current practices in intraspinal therapy – a survey of clinical trends and decision making. J Pain Symptom Manage 2000;20(2):S4–11.PubMedCrossRefGoogle Scholar
  18. Hildebrand KR, Elsberry DE, Anderson VC, Stability and compatibility of hydromorphone hydrochloride in an implantable infusion system. J Pain Symptom Manage. 2001;22(6): 1042–7.PubMedCrossRefGoogle Scholar
  19. Hildebrand KR, Elsberry DD, Hassenbusch SJ. Stability and compatibility of morphine-clonidine admixtures in an implantable infusion system. J Pain Symptom Manage. 2003;25(5):464–71.PubMedCrossRefGoogle Scholar
  20. Jasper JF, Hayek SM. Implanted occipital nerve stimulators. Pain Physician 2008;11(2): 187–200.PubMedGoogle Scholar
  21. Krames ES, et al. Continuous infusion of spinally administered narcotics for the relief of pain due to malignant disorders. Cancer 1985;56(3):696–702.PubMedCrossRefGoogle Scholar
  22. Kumar K, Nath RK, Toth C. Spinal cord stimulation is effective in the management of reflex sympathetic dystrophy. Neurosurgery 1997;40(3):503–8; discussion 508–9.PubMedCrossRefGoogle Scholar
  23. Lavelle ED, Lavelle W, Smith HS. Myofascial trigger points. Med Clin North Am. 2007;91(2):229–39.PubMedCrossRefGoogle Scholar
  24. Leclaire R, et al. Radiofrequency facet joint denervation in the treatment of low back pain: a placebo-controlled clinical trial to assess efficacy. Spine 2001;26(13):1411–6; discussion 1417.PubMedCrossRefGoogle Scholar
  25. Loyd R, Fanciullo G. Surgical procedures for intractable cancer pain. Palliat Pain Med Improving Care Patients Serious Illn. 2005;9(3):167–76.Google Scholar
  26. Lord SM, et al. Percutaneous radio-frequency neurotomy for chronic cervical zygapophyseal-joint pain. N Engl J Med. 1996;335(23):1721–6.PubMedCrossRefGoogle Scholar
  27. Magora F, et al. Observations on extradural morphine analgesia in various pain conditions. Br J Anaesth. 1980;52(3):247–52.PubMedCrossRefGoogle Scholar
  28. Maugars Y, et al. Assessment of the efficacy of sacroiliac corticosteroid injections in spondyloarthropathies: a double-blind study. Br J Rheumatol. 1996;35(8):767–70.PubMedCrossRefGoogle Scholar
  29. Medtronic. Available from: Accessed December 2008.
  30. Medtronic, Urgent Medical Device Correction: Updated information-Inflammatory Mass (granuloma) At or Near the Distal Tip of Intrathecal Catheters. 2008, January.Google Scholar
  31. Moore DC. Regional block; a handbook for use in the clinical practice of medicine and surgery. 4th ed. Springfield, IL: C. C. Thomas; 1965. p. xvii, 514p.Google Scholar
  32. Oakley J, Staats PS. The use of implanted drug delivery systems. In: Raj PP, editor. The practical management of pain. St. Louis, MO: Mosby; 2000. pp. 768–78.Google Scholar
  33. Ogoke BA, The management of the Atlanto-occipital and Atlanto-axial joint pain. Pain Physician 2000;3(3):289–93.PubMedGoogle Scholar
  34. Prager J, Jacobs M. Evaluation of patients for implantable pain modalities: medical and behavioral assessment. Clin J Pain. 2001;17(3):206–14.PubMedCrossRefGoogle Scholar
  35. Racz GB, Heavner JE, Trescot A. Percutaneous lysis of epidural adhesions – evidence for safety and efficacy. Pain Pract. 2008;8(4):277–86.PubMedCrossRefGoogle Scholar
  36. Raj PP, Benzon AB, et al. Facet syndromes and blocks. In: Ross A. editor. Practical management of pain. 3rd ed. St. Louis, MO: Mosby; 2002. p. 746.Google Scholar
  37. Rosenberg M, Phero JC. Regional anesthesia and invasive techniques to manage head and neck pain. Otolaryngol Clin North Am. 2003;36(6):1201–19.PubMedCrossRefGoogle Scholar
  38. Rubin DI. Epidemiology and risk factors for spine pain. Neurol Clin. 2007;25(2):353–71.PubMedCrossRefGoogle Scholar
  39. Schmidek HH, Roberts DW. Schmidek & Sweet operative neurosurgical techniques: indications, methods, and results. 5th ed. Philadelphia, PA: Saunders Elsevier; 2006. 2 v. p. xxxix, p. 2337, 67p.Google Scholar
  40. Schwarzer AC, et al. The false-positive rate of uncontrolled diagnostic blocks of the lumbar zygapophysial joints. Pain 1994;58(2):195–200.PubMedCrossRefGoogle Scholar
  41. Shanahan EM, et al. Suprascapular nerve block (using bupivacaine and methylprednisolone acetate) in chronic shoulder pain. Ann Rheum Dis. 2003;62(5):400–6.PubMedCrossRefGoogle Scholar
  42. Shetter AG, Hadley MN, Wilkinson E. Administration of intraspinal morphine sulfate for the treatment of intractable cancer pain. Neurosurgery 1986;18(6):740–7.PubMedCrossRefGoogle Scholar
  43. Simpson BA. Spinal cord stimulation. Br J Neurosurg 1997;11(1):5–11.PubMedCrossRefGoogle Scholar
  44. Tekin I, et al. A comparison of conventional and pulsed radiofrequency denervation in the treatment of chronic facet joint pain. Clin J Pain. 2007;23(6):524–9.PubMedCrossRefGoogle Scholar
  45. Vallejo R, et al. Pulsed radiofrequency denervation for the treatment of sacroiliac joint syndrome. Pain Med. 2006;7(5):429–34.PubMedCrossRefGoogle Scholar
  46. van Kleef M, et al. Randomized trial of radiofrequency lumbar facet denervation for chronic low back pain. Spine 1999;24(18):1937–42.PubMedCrossRefGoogle Scholar
  47. van Wijk RM, et al. Radiofrequency denervation of lumbar facet joints in the treatment of chronic low back pain: a randomized, double-blind, sham lesion-controlled trial. Clin J Pain. 2005;21(4):335–44.PubMedCrossRefGoogle Scholar
  48. Waldman HJ. Neurophysiologic testing in the evaluation of the patient in pain. In: Waldman SD, Winnie AP, editors. Interventional pain management. Philadelphia, PA: WB Saunders; 1996;407–411.Google Scholar
  49. Winkelmuller M, Winkelmuller W. Long-term effects of continuous intrathecal opioid treatment in chronic pain of nonmalignant etiology. J Neurosurg. 1996;85(3):458–67.PubMedCrossRefGoogle Scholar

Copyright information

© Springer Science+Business Media, LLC 2011

Authors and Affiliations

  • Michael A. Cosgrove
    • 1
  • David K. Towns
    • 1
  • Gilbert J. Fanciullo
    • 1
  • Alan D. Kaye
    • 2
    • 3
    • 4
    • 5
    • 6
  1. 1.Department of AnesthesiologyDartmouth Medical School, Dartmouth Hitchcock Medical CenterLebanonUSA
  2. 2.Department of AnesthesiologyLouisiana State University School of MedicineNew OrleansUSA
  3. 3.Louisiana State University School of MedicineNew OrleansUSA
  4. 4.Interventional Pain ServicesLouisiana State University School of MedicineNew OrleansUSA
  5. 5.Department of AnesthesiologyTulane University School of MedicineNew OrleansUSA
  6. 6.Department of PharmacologyTulane University School of MedicineNew OrleansUSA

Personalised recommendations