Longnecker's Anesthesiology > Part 8. Care of the Chronic Pain Patient >

Chapter 93. Interventional Management of Chronic Pain

Carlos A. Pino, MD, and James P. Rathmell, MD

Specific Techniques Used in Image-Guided Intervention for Chronic Pain

Topics Discussed:

anesthesia, interventional; catheters, spinal, intrathecal, lumbar; cauda equina syndrome; celiac plexus; celiac plexus block; celiac plexus block technique; cervical spine; cervical sympathetic trunk; chronic pain; coccyx; complex regional pain syndromes; degenerative disc disease; dural puncture; epidural catheter; epidural steroid injection; ethanol; facet joint pain; fluoroscopy; glucose intolerance; herniated disc; imaging guidance technique; inflammation mediators; infusion pumps, implantable; intervertebral disc; intra-articular injections; intradiskal electrothermal therapy; ligamentum flavum; local anesthetic facet joint nerve block; lumbar discography; lumbar spinous process; lumbar sympathetic block; lumbar sympathetic block technique; lumbar sympathetic trunk; lumbar vertebra; medial branch block; methylprednisolone; migration of medical device or device component; needle injury; neurolysis; phenol; postdural puncture headache; prophospholipase a2; radiofrequency ablation; sacrum; seizures; spinal artery; spinal cord; spinal cord injuries; spinal cord stimulation; spinal nerve; spinal nerve root; spinal nerve root injection; spine; splanchnic nerve block; splanchnic nerves; spondylarthritis; stellate ganglion block; stellate ganglion block technique; superior hypogastric plexus; sympathetic nerve block; sympathetic nervous system; sympathetic trunk; thoracic spine; thoracic spinous process; transcutaneous electric nerve stimulation; triamcinolone; wound dehiscence; zygapophyseal joint.

Sections:

Anatomy Relevant to Image-Guided Intervention for Chronic Pain, Anatomy of the Spine, Anatomy of the Sympathetic Nervous System, Interlaminar Epidural Injection Steroids and Transforaminal Injection of Steroids, Overview, Patient Selection, Drug Selection for Epidural Steroid Injection, Technique, Interlaminar Technique for Epidural Steroid Injection, Cervical Epidural Steroid Injection Technique, Midthoracic Epidural Steroid Injection, Lumbar Epidural Steroid Injection, Caudal Epidural Steroid Injection, Transforaminal Technique for Epidural Steroid Injection, Cervical Transforaminal Steroid Injection, Lumbar Transforaminal Steroid Injection, Sympathetic Blocks, Overview, Stellate Ganglion Block, Celiac Plexus Block, Transcrural Technique, Splanchnic Nerve Block or Retrocrural Technique, Celiac Plexus and Splanchnic Neurolysis, Lumbar Sympathetic Block, Lumbar Sympathetic Neurolysis, Chemical Neurolysis, Radiofrequency Neurolysis, Facet Joint Injections: Intraarticular Injections, Medial Branch Blocks, and Radiofrequency Treatment, Overview, Intraarticular Facet Joint Injections versus Radiofrequency Treatment, Intraarticular Facet Injection, Cervical Intraarticular Facet Injection, Thoracic Intraarticular Facet Injection, Lumbar Intraarticular Facet Injection, Facet Medial Branch Blocks and Radiofrequency Treatment, Cervical Facet Medial Branch Block and Radiofrequency Treatment, Posterior Approach, Lateral Approach, Diagnostic Medial Branch Blocks, Radiofrequency Treatment, Thoracic Facet Medial Branch Block and Radiofrequency Treatment, Diagnostic Medial Branch Blocks, Radiofrequency Treatment, Lumbar Facet Medial Branch Blocks and Radiofrequency Treatment, Diagnostic Medial Branch Blocks, Radiofrequency Treatment, Complications of Medial Branch Block and Radiofrequency Treatment, Lumbar Discography and Intradiscal Treatments, Overview, Diagnostic Lumbar Discography, Complications of Lumbar Discography, Intradiscal Electrothermal Therapy, Complications of IDET, Implantable Drug Delivery Systems and Spinal Cord Simulation, Implantable Drug Delivery Systems, Surgical Technique, Surgical Technique for Permanent Epidural Catheter Placement, Complications, Spinal Cord Stimulation, Surgical Technique, Complications

Excerpt:

"This chapter provides an overview of the most common techniques used in interventional pain medicine. The section begins with a discussion of the anatomy relevant to image-guided interventions for treating chronic pain. Thereafter, the clinical utility of each technique and the technical aspects of conducting each intervention are described. Illustrations for the most common techniques are provided, as detailed illustration of each technique is beyond the scope of this chapter. Many books with detailed technical descriptions of these techniques have been published, and we refer the interested reader to one of these texts.⁵The key to success in any interventional pain technique is a clear understanding of the normal anatomy. The procedures described in this chapter require understanding of the normal anatomy of the spine, including the epidural and subarachnoid spaces, the zygapophyseal joints, intervertebral disks, and, most importantly, the spinal cord with its somatic and sympathetic components. The basic anatomy relevant to common interventions used in the treatment of chronic pain is reviewed here.The spinal cord is protected within the vertebral canal and extends from the foramen magnum to the first or second lumbar vertebra in human adults. Its is covered by three meninges. The most internal pia mater lies in close apposition to the cord. It is separated from the thin arachnoid mater by the free-flowing cerebrospinal fluid (CSF). The dense dura mater lies most external, surrounding the arachnoid..."

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