Introduction

Invasive procedures performed by the pain management specialist are a mainstay in the diagnosis and treatment of both acute and chronic pain. They range from unguided percutaneous injections with short-acting local anesthetics to neurosurgical operations under computed tomography that permanently alter the anatomy. This chapter provides a description of the most common procedures performed by the pain management specialist, with more detail on the most frequent. The descriptions are not in sufficient enough detail to perform the procedures, and reference should be made to an interventional pain atlas for specifics.

Procedures are usually performed in a dedicated room with nursing staff and monitoring equipment. Imaging equipment, most often fluoroscopy, is used to guide the interventions and add a high level of accuracy. Ultrasound is being utilized more frequently, probably due to its portability and popularity in regional anesthesia. Some patients require sedation, but most procedures can be performed with minimal parenteral medications. Patient participation during some procedures is advantageous. Some of the more invasive require a general operating room and anesthesia, such as intrathecal pumps, spinal cord stimulators, and most of the neurosurgical interventions.

There are many procedures or "blocks" for pre- and postoperative pain that fall into the realm of regional anesthesia that are also utilized in acute and chronic pain management, but the scope of this chapter prevents a detailed description of these blocks. An invaluable resource for these procedures is the New York Society of Regional Anesthesia web site (www. nysora.com). There are also many texts available.

Many of the procedures suffer from a lack of research-based validity due to the difficulty in performing prospective randomized controlled studies. Approval for studies using placebo or sham treatments is difficult to acquire from institutional investigational review boards.

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Natural Pain Management

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