“I am frequently asked to explain the definition of interventional pain management. Truthfully, the more people you ask this question, the more answers you will get in return. For me, interventional pain management includes spinal diagnostic/therapeutic injections such as epidural steroid injections, facet blocks, and radiofrequency nerve ablations, all of which utilize fluoroscopic (x-ray) guidance. I would also include implantable technology such as spinal cord stimulators and intrathecal pump procedures. A lesser form of interventional therapies would include joint/tendon and trigger point injections, which utilize ultrasound guidance. There are less invasive forms of interventional procedures, such as MLS laser therapy and implanted pump refills. If you have had injections in your neck or back, you have undergone interventional pain management.” – Dr. Vladimir Fiks
Injections that DO NOT require X-Ray
Botox Injections
Description:
Intramuscular injection of Botulinum toxin
Indication:
Intractable pain associated with cervical dystonia, myofascial trigger points, and/or chronic headaches
Joint Injections
Description:
Injection of steroid and/or medication
Indication:
Chronic pain associated with arthritis, synovitis, tendinitis, or impingement syndrome
Peripheral Nerve Block
Description:
Block of the peripheral nerve with local anesthetic and/or steroid
Indication:
Diagnosis and/or therapy of peripheral mononeuropathy
Trigger Point Injection
Description:
Injection of painful muscle(s) with local anesthetic and/or steroid.
Indication:
Myofascial pain syndrome is associated with the appearance of painful points in the muscle(s).
Injections that REQUIRE X-Ray
Celiac plexus/Splanchnic Block
Description:
Block of the sympathetic chain at the level of the lower thoracic spine
Indication:
Visceral upper to mid abdomen pain (chronic pancreatitis, colitis, hepatitis, cholecystitis, etc.)
Celiac plexus/Splanchnic Neurotomy
Description:
Chemical/thermal destruction of the sympathetic chain at the level of the lower thoracic spine
Indication:
Malignant pain of the upper to mid abdomen (pancreatic cancer, etc.)
Cervical/Thoracic Discography
Description:
Diagnostic injection of contrast or saline into the cervical/thoracic intervertebral discs in an attempt to provoke concordant symptoms
Indication:
Precision diagnosis of the discogenic pain generator and confirmation of the level of proposed surgical fusion
Cervical/Thoracic Facet Medial Branch Block
Description:
Block of cervical/thoracic facet joint nerve
Indication:
Precision diagnosis of suspected facet syndrome
Cervical/Thoracic Medial Branch Neurotomy
Description:
Thermal destruction of cervical/thoracic facet joint nerve
Indication:
Facet syndrome
Cervical Sympathetic Block
Description:
Block of the sympathetic chain at the level of the cervical spine.
Indication:
Neuropathic upper extremity or cranial pain (reflex sympathetic dystrophy, herpes zoster, trigeminal neuralgia, etc.)
Epidural Neurolytic Block
Description:
Chemical/thermal destruction of the spinal nerve roots
Indication:
Malignant pain of trunk and limbs (most frequently offered to patients with life expectancy of less than six months)
Epidural Port-A-Cath Implantation
Description:
Fluoroscopically guided indwelling epidural catheter implantation with or without subcutaneous port.
Indication:
Intractable malignant pain in patients with a life expectancy of less than three months, acute or subacute pain related to herpes zoster, reflex sympathetic dystrophy or other significant injury.
Epidural Steroid Injection, Cervical/Thoracic Translaminar
Description:
Delivery of steroids into the cervical/thoracic epidural space.
Indication:
Acute and chronic cervical/thoracic radicular pain, lumbar discogenic pain, cervical/thoracic spinal stenosis.
Epidural Steroid Injection, Lumbar/Caudal Translaminar
Description:
Delivery of steroids into the lumbar/caudal epidural space.
Indication:
Acute and chronic lumbar radicular pain, lumbar discogenic pain, lumbar spinal stenosis.
Epidural Steroid Injection, Lumbar/Caudal Transforaminal (Selective nerve root block)
Description:
Delivery of steroids into the lumbar/caudal epidural space.
Indication:
Acute and chronic lumbar/caudal radicular pain, lumbar discogenic pain, lumbar/caudal spinal stenosis, and precision diagnosis of discogenic pain generator
Epidural Steroid Injection, Cervical/Thoracic Transforaminal (Selective nerve root block)
Description:
Delivery of steroids into the cervical/thoracic epidural space.
Indication:
Acute and chronic cervical/thoracic radicular pain, cervical/thoracic discogenic pain, cervical/thoracic spinal stenosis, and precision diagnosis of discogenic pain generator.
Intercostal Injection
Description:
Block of the intercostal nerve.
Indication:
Suspected intercostal neuralgia/neuritis, chronic pleuritic pain.
Intercostal Neurotomy
Description:
Chemical or thermal destruction of the intercostal nerve.
Indication:
Malignant or non-malignant chest wall pain unresponsive to conservative therapy (intercostal neuritis/neuralgia, chronic pleuritic pain, chest wall metastasis, etc.)
Kyphoplasty/Vertebroplasty
Description:
Delivery of cement into the fractured vertebral body.
Indication:
Painful vertebral compression fracture(s), metastatic vertebral body lesion, vertebral body hemangioma.
Lumbar Discography
Description:
Diagnostic injection of contrast or saline into the lumbar intervertebral discs in an attempt to provoke concordant symptoms.
Indication:
Precision diagnosis of the discogenic pain generator and confirmation of the level of proposed surgical fusion.
Lumbar Facet Medial Branch Block
Description:
Block of the lumbar facet joint nerve.
Indication:
Precision diagnosis of suspected facet syndrome.
Lumbar Medial Branch Neurotomy
Description:
Thermal destruction of the lumbar facet joint nerve.
Indication:
Facet syndrome.
Lumbar Sympathetic Block
Description:
Block of the sympathetic chain at the level of the upper lumbar spine.
Indication:
Neuropathic pain of the lower extremities (reflex sympathetic dystrophy, ischemic pain, herpes zoster, etc.)
Peripheral Nerve Stimulator Trial
Description:
Placement of external neurostimulator electrode(s) for trial of peripheral nerve stimulation.
Indication:
Chronic pain associated with mononeuropathy.
Peripheral Nerve Stimulator Implantation
Description:
Implantation of peripheral nerve stimulator electrode(s) and generator or receiver.
Indication:
Successful trial of peripheral nerve stimulation.
Peripheral Nerve Stimulator Trial
Description:
Placement of external neurostimulator electrode(s) for trial of peripheral nerve stimulation.
Indication:
Chronic pain associated with mononeuropathy.
Spinal Cord Stimulator Trial
Description:
Placement of external neurostimulator electrode(s) for trial of spinal cord stimulation.
Indication:
Chronic radiculopathy, neuropathy, neuralgia/neuritis of the trunk and limbs, chronic intractable stable angina, chronic intractable ischemic extremity pain, chronic pain associated with interstitial cystitis, and chronic pain associated with occipital neuralgia.
Spinal Cord Stimulator Implantation
Description:
Implantation of spinal cord stimulator electrode(s) and receiver or generator.
Indication:
Successful trial of spinal cord stimulation.
Spinal Infusion Trial, Lumbar or Cervical/Thoracic
Description:
Placement of a temporary external epidural catheter for trial of spinal infusion therapy.
Indication:
Failure of oral opioid therapy to control intractable pain or intractable side effects of systemic opioid therapy.
Spinal Infusion Drug Delivery Device Implantation
Description:
Spinal catheter and infusion device implantation.
Indication:
Successful trial of spinal infusion therapy.
Subarachnoid Neurolytic Block
Description:
Chemical destruction of the spinal nerve roots.
Indication:
Malignant pain of trunk and limbs (most frequently offered to patients with life expectancy of less than six months).
Superior Hypogastric Plexus Block
Description:
Block of the sympathetic chain at the level of the lower lumbar spine/sacrum.
Indication:
Visceral pain in the lower abdomen (endometriosis, prostatitis, colitis, etc.)
Advanced Pain Management Center: Interventional Pain Management Physician Located In Portland, Serving The Surrounding Areas Of Aloha, Hillsboro, Beaverton, Tigard & Lake Oswego.
