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SpU: Would you please explain the term "interventional pain medicine"?
In what ways is this type of care different from the treatment that perhaps
a primary care physician or radiologist might offer a patient with low back
pain?
Dr. Bennett: Interventional pain medicine is a sub-specialty of medicine,
which uses injections and minimally invasive techniques to diagnose and treat
painful conditions. The role is not that of a mere technician (that is only
one part), but a member of a diagnostic team. The interventional pain medicine
physician conducts a full history and physical examination and correlates
all interventional diagnostics with that examination and history, assisting
the other members of your health care team in determining what is causing
a patient's pain. This is quite distinct from the old days when patients
were referred to the hospital, showed up for a procedure done by a physician
they never met before, and then returned to their family doctor's office having
had a procedure with no exam or follow-up.
Furthermore, if your diagnosis is one that does not require surgery, say,
a facet joint that is painful, then the interventional pain physician has
interventional treatments that can be quite effective (like rhizotomy). Interventional
pain medicine performs a whole range of diagnostic injections such as epidural
injections and facet joint blocks; minimally invasive treatments such as intradiscal
thermal therapy; as well as palliative treatments such as spinal cord stimulation,
nerve root stimulation, and intrathecal medication delivery.
When your primary care physician cannot pinpoint the source of your pain,
it may be best to seek the care of a pain specialist such as an interventional
pain medicine physician. This physician can then help you determine whether
you have a carpentry or electrical problem and assist you in
obtaining the proper treatment.
SpU: Are drug infusion pumps or spinal cord stimulators appropriate
treatment for chronic back pain?
Dr. Bennett: Neuromodulation is the term associated
with treatment using spinal cord (or nerve root) stimulation or intrathecal
(spinal) drug infusion pumps. In general, neuromodulation in the form of spinal
cord stimulation and/or nerve root stimulation can be used when there is neuropathic
pain of the neck, thorax, low back, or extremities. We previously believed
that spinal cord stimulation was ineffective for neuropathic low back pain.
However, recent data has shown that with the appropriate electrode arrays
(complex arrays usually requiring a 16-electrode configuration), low back
pain can be controlled with a success rate approaching 80%. There are some
pain management centers that are using spinal cord stimulation with good success
in multilevel discogenic pain, where surgical (fusion) options are not feasible.
Intrathecal (spinal) drug infusion pumps are another option in the treatment
of chronic back pain. This mode of treatment is more invasive - it utilizes
a catheter that is placed into the cerebral spinal fluid (in the compartment
with the spinal cord). The treatment is also medication dependent -- therefore,
side effects must be anticipated and considered when making this choice for
therapy. What is unknown is the exact incidence of catheter granulomas (benign
tumors which form at the tip of the catheter and can compress the spinal cord);
these are estimated to occur with a 2% incidence.
SpU: Thank you Dr. Bennett. We appreciate your time and especially your
expertise on this important topic.
Dr. Bennett: You are welcome.
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