Providing successful care for the spine takes a talented team of health providers working in concert with the patient. In cases that involve chronic pain, it may be beneficial to have an interventional pain specialist as part of the spine care team. Here are 3 reasons why.
1. Understand psychosocial factors and pharmacology in pain treatment
In addition to understanding the spine’s intricate structure, management of chronic spinal pain requires specialized knowledge of psychosocial factors and the increasingly complex workings of medications (pharmacology). To that end, interventional pain specialists approach patient care with a comprehensive set of techniques specifically designed to manage both short- and long-term chronic pain.
The expertise provided by interventional pain specialists is typically reserved for patients whose pain levels continue without improvement for 2 to 3 weeks, and can involve short-term management of acute flare-ups, or long-term treatment in patients who have had a failed surgery or not responded to other treatments yet.
As part of a multidisciplinary approach to pain management in spine care, an interventional pain specialist is likely to be involved in reviewing all of the patient’s relevant tests, such as imaging studies, neurologic examination, and electrodiagnostic studies. A thorough patient history is also critical in determining the nature of the pain, how it correlates with objective testing, and the presence of other psychosocial factors. For example, psychosocial factors, such as employment status or drug dependence, must be considered because they play an important role in pain treatment and recovery.
2. Explore all nonsurgical options first
With a few exceptions, spine surgeons should strive to exhaust nonsurgical treatments in all patients who present with spine-related pain symptoms before looking to surgical treatment. In many cases, physical therapy is the preferred starting point, but in some patients this is not practical due to the degree of pain a patient is experiencing, which makes it difficult to fully participate in therapy.
In cases where chronic spinal pain has not yet been successfully managed with physical therapy and other treatments, interventional pain specialists may be able to help. Some of the more common techniques employed by interventional pain specialists include:
- Epidural steroid injections
- Cervical and lumbar nerve block injections
- Joint injections
- Radiofrequency ablation (rhizotomy)
- Spinal cord stimulation (neuromodulation)
In rare cases when chronic back or neck pain cannot be managed with nonsurgical treatments, surgery may be considered.
3. Manage post-surgery residual pain
Interventional pain specialists can also be utilized to manage a patient’s residual pain during post-surgery recovery. This aspect is particularly relevant considering today’s opioid epidemic, where patients may already be taking a variety of pain medications when they are referred to a surgeon. In such cases, it is often impractical for a surgeon to wean a patient off these medications over a brief 8- to-12-week postoperative period while the patient is already struggling with postsurgical pain. In these situations, the pain specialist needs to analyze patient factors such as overall health, age, weight, health habits, and the level of pain associated with recovery while balancing the risks of various drug interactions.
Pain management sometimes requires constant adjustment of the treatment plans in consultation with the patient before a suitable solution is realized. So it is essential for both the patient and physician to maintain an open mind and open communication. Alternative treatments, such as acupuncture, chiropractic treatment, and massage are commonly used as well. Thankfully, there are now a broad range of treatments and recovery plans for chronic pain which do not depend on an overreliance to prescribing opioids.