Interventional procedures
Interventional procedures are a branch of pain management that uses invasive techniques (delivered under the skin) for treating pain.
Injections
Many types of pain medications are given through needles. Some of these can be repeated regularly if they work to reduce your pain.
Botulinum toxin
Botulinum toxin is a chemical produced by bacteria. When a small amount of this chemical is injected into the tissue, it blocks nerve signals that tell your muscles to contract.
Botulinum toxin has been shown to reduce the intensity of headaches and improve quality of life if you have 15 or more headache days a month. It does not appear to be useful if you have fewer than 15 headaches a month and evidence is limited for other types of chronic pain.
Trigger point injection
A trigger point injection contains a local anaesthetic to treat painful areas of muscle, known as trigger points. These trigger points, or knots, form when muscles do not relax and can often be felt through the skin.
When a needle releases the local anaesthetic into a trigger point, it releases the knot in the muscle. How this works is not well understood, and the evidence for effectiveness is limited.
Intra-articular injection
“Intra-articular” means the space between your joints. Some medications, such as nerve blockers or steroids, are injected directly into this space to reduce pain. Common joints for injections include the shoulder, hip, knee, facet joints in the spine and sacro-iliac (SI) joint in the lower back. There is limited evidence that these injections provide a short-term benefit.
Epidural steroid injection
The epidural space is between the bones of the spine and the layer outside the spinal cord. Pain physicians can inject this space (from your lower back) with steroid medication and a small amount of local anesthetic to treat some types of pain.
Research shows that these injections can help ease lower back pain that travels down the legs for a limited time in some people. However, there are potential risks to this treatment, which you should discuss with your doctor.
Caution about injections
On their own, injections are not a long-term solution for persistent pain. It’s important to use them along with physical and psychological strategies, as well as prescribed medications, to help with your sleep, mood and overall wellbeing. Remember the 3 Ps approach!
Nerve ablation
Some pain doctors offer a procedure called nerve ablation. This involves using a needle to heat or cool the nerve until it cannot transmit pain signals. If heat is used, the procedure is called radiofrequency ablation. If the nerve is being cooled, the procedure is called cryoablation.
There is limited evidence that these offer some people temporary relief of certain types of spinal or peripheral nerve pain. However, there are potential risks to this treatment, which you should discuss with your doctor.
Pain pump
A pain pump is a device that can be implanted into the nervous system through surgery. It is designed to deliver pain medicine (such as morphine) directly into the body.
While delivering pain medication in this way may be faster, possible complications of inserting the pump include infection. In addition, once the pump is implanted, other complications may follow, such as leakage, battery failure or moving of the pump within the body.