Interventional approaches to pain management.
This article reviews the evidence for several common interventional techniques for the treatment of chronic pain, including: intraspinal delivery of analgesics, reversible blockade with local anesthetics, augmentation with spinal cord stimulation, and ablation with radiofrequency energy or neurolytic agents. The role of these techniques is defined within the framework of a multidisciplinary approach to the neurobehavioral syndrome of chronic pain. Challenges to the study of the analgesic efficacy of procedural interventions are explored, as are the practical issues raised by their clinical implementation, with the aim of helping nonspecialist physicians identify the patients most likely to benefit from these approaches.
Neuromedicine Pain Management Center, Department of Neurosurgery and Neurology, University of Rochester School of Medicine and Dentistry, 601 Elmwood Avenue, Box 670 Rochester, New York 14642, USA. john_markman@urmc.rochester.edu
John D
JD
Markman
Annie
A
Philip
D000698:Analgesia / Q000009:adverse effects / Q000379:methods*; D000700:Analgesics / Q000008:administration & dosage / Q000009:adverse effects; D000701:Analgesics, Opioid / Q000008:administration & dosage / Q000009:adverse effects / Q000627:therapeutic use; D000779:Anesthetics, Local / Q000008:administration & dosage / Q000009:adverse effects; D017115:Catheter Ablation / Q000009:adverse effects; D002908:Chronic Disease; D006801:Humans; D007278:Injections, Spinal / Q000009:adverse effects; D009407:Nerve Block / Q000009:adverse effects / Q000379:methods; D010146:Pain / Q000188:drug therapy / Q000503:physiopathology; D059408:Pain Management; D010148:Intractable Pain / Q000628:therapy; D013116:Spinal Cord / Q000187:drug effects / Q000503:physiopathology; D004561:Transcutaneous Electric Nerve Stimulation / Q000009:adverse effects; D021801:Zygapophyseal Joint / Q000503:physiopathology
D000700:Analgesics; D000701:Analgesics, Opioid; D000779:Anesthetics, Local