Advanced Interventional Techniques

Multiple intervention modalities can be used to control pain, when pharmacological pain control is suboptimal. Some of these include transcutaneous electrical nerve stimulation (TENS) unit patch, trigger point injections, epidural pumps, acupuncture, intrathecal pump placement for morphine, clonidine and other medications, intradiscal electrothermal therapy (IDET), nerve ablation therapy, facet joint injections, cryoablation, radiofrequency nerve ablation, peripheral nerve blocking catheters, fluoroscopic guided nerve blocks for cancer pain, and ganglion blocks for chronic regional pain syndrome (CRPS). Use of a particular technique in a patient, is guided by etiology of pain, concomitant co-morbidities, and the patient's current clinical status, than by age. Cancer is most prevalent in the elderly and is the third leading cause of death in the geriatric population. Celiac plexus block, hypo-gastric block, individual sympathetic nerve, and ganglion blocks are examples of blocks used to relieve chronic pain. Interventional radiologists, pain specialists, and neurosurgical specialists use such techniques in cancer-related or sympathetically mediated or debilitating chronic pain conditions. As with any invasive technique, it is important to exclude contraindications to the technique. Cardio-respiratory illnesses, cognitive dysfunction, and coagulopathy (secondary to anti-platelet or anti-coagulant therapies) may preclude certain interventions in the elderly (Boswell et al. 2007).

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