Neurology and Neurosurgery

Understanding interventional pain management: a guide for people with chronic pain

Young woman wearing yellow jumpsuit looking downward and smiling.


No one should live in pain. Thankfully, there are many ways to ease it, whether you have arthritis discomfort, back and spine conditions or headaches and migraines.


By Raj Murthy, MD, Pain Medicine, Nuvance Health


Living with chronic pain is a reality for more than 20% of adults in the United States, and 70% of us will suffer from chronic pain at some point in our lives. It is a struggle that can affect every aspect of your life, casting a shadow over your physical, mental and emotional well-being. No one should live in pain! Today, there are many ways to ease your unique pain, whether you have discomfort from the spine, bones, joints, tendons, ligaments, muscles or headaches and migraines.


This guide aims to explain interventional pain management and offer hope and solutions for those enduring regular pain. Remember, you are not alone and there are pain relief options to help you live the best life possible.


What is interventional pain management?


Interventional pain management is a specialized area of medicine focused on identifying and treating pain with various procedures, including epidurals, nerve blocks, peripheral nerve stimulators, spinal cord stimulators, physical therapy and minimally invasive surgeries. Interventional pain management goes beyond medication, offering long-term solutions for chronic pain sufferers.


Types of interventional pain management


Pain management can be multifaceted, involving medications, interventional procedures, surgery, physical therapy and mind-body techniques. Each method plays a crucial role in a holistic approach to pain relief, addressing its physical aspect and the emotional impact of enduring it.


Continue reading to find details about the different types of interventions for pain that affect your bones, joints and muscles.


Epidural steroid injections for pain relief


Epidural steroid injections (ESI) are a common treatment for spine and radicular pain caused by:


  • Degenerative joint disease, including osteoarthritis and spondylolisthesis

  • Pinched nerve in the cervical (neck) or lumbar (lower) spine

  • Sciatica nerve pain caused by a herniated disc or spinal stenosis (narrowing of the spinal column)



By injecting steroids directly into the epidural space in the spine, ESIs can significantly reduce inflammation and pain.



Kyphoplasty for pain relief


Kyphoplasty is a minimally invasive procedure typically used for treating compression fractures in the spine, called vertebral fractures. The most common cause of vertebral fractures is osteoporosis, a type of bone loss. Trauma to the spine from an accident or a spinal tumor can also cause vertebral fractures.


During a kyphoplasty, an interventional pain management physician inserts a balloon into the vertebra and then fills it with surgical cement to strengthen the bone.



Major joint injections for pain relief


Injections into major joints like the knee, shoulder or hip can provide relief from arthritis or other degenerative joint diseases. These injections usually contain a corticosteroid and an anesthetic to reduce inflammation and pain. Depending on the individual, corticosteroid injections can alleviate joint pain for several months.



Medial branch blocks for pain relief


Medial branch blocks are diagnostic procedures that help identify the source of spine pain. An interventional pain management doctor will use an anesthetic to numb the medial nerves connected to a specific facet joint. Your doctor can then determine which joint is the source of pain and develop a plan for effectively treating it.



Minimally invasive spine procedures for pain relief


An endoscopic discectomy is a minimally invasive spine procedure. The procedure aims to relieve spine pain with minimal tissue damage and faster recovery times compared to traditional open surgery.


During an endoscopic discectomy, an interventional pain management physician can remove parts of a damaged disc that is causing nerve pain, tingling or numbness in the arms or legs. This is minimally invasive and performed using endoscopy, a thin tube with a camera at the end of it to see inside the body.



Muscle and joint injections for pain relief


Muscle and joint injections, often containing corticosteroids, can alleviate pain and inflammation in specific areas. Corticosteroid medications include cortisone, hydrocortisone and prednisone. 


Corticosteroid injections can help conditions caused by inflammation in the joints, such as osteoarthritis, bursitis and tendonitis. The effects of the injection can last three to six months but can be shorter or longer depending on the individual.


Nerve blocks for pain relief


Nerve blocks involve injecting medication directly around a nerve or into the spine to block pain signals. Nerve blocks can help complex regional pain syndrome (CRPS), which affects the arms and legs. Nerve blocks can also help peripheral neuropathy; damage to peripheral nerves can cause numbness, weakness and pain in the hands and feet.


Occipital nerve blocks for pain relief


Occipital nerve blocks can reduce the frequency and intensity of headaches and migraines. An interventional pain management doctor will inject the medicine near the occipital nerve at the base of your neck. Relief may last for several months, depending on the individual.



Platelet-rich plasma (PRP) for pain relief


Platelet-rich plasma (PRP) involves injecting your platelets to promote healing of injured tendons, ligaments, muscles and joints. PRP is a natural pain remedy because it uses your own platelets. 


An interventional pain management physician will take a blood sample and then use a machine to separate parts of the blood, including the platelets. Then, they will inject the platelets into the damaged area of your body. The effects of PRP may last several months, depending on the individual. 


Radiofrequency nerve ablation for pain relief


Radiofrequency nerve ablation (RFA) uses radio waves to produce heat and disrupt nerve function. Your doctor may recommend radiofrequency if you have chronic lower back pain or neck pain. RFA may last six to 12 months, depending on the individual.


During the procedure, an interventional pain management physician will insert a needle into the nerve that is causing pain. They will place an electrode on the needle, which will send radio waves through the needle to the nerve and ablate it.


Spinal cord stimulator for pain relief


A spinal cord stimulator (SCS) is a device implanted under the skin in the back that sends low levels of electricity directly into the spinal cord to relieve pain. An SCS modifies pain signals before they reach the brain and trigger a response. The lifespan of an SRS depends on the type and if it is rechargeable or not; it could last a couple to more than 10 years.


Stem cell regeneration for pain relief


Stem cell therapy uses the body’s cells to repair and regenerate damaged tissues. Stem cell therapy may be an option to relieve pain from arthritis and spinal cord injuries.


Your doctor will take a sample of your stem cells and then use image guidance like ultrasound to inject them into the area of your body causing the pain. Stem cells can promote regeneration of damaged areas and healing.


Physical therapy for pain relief


Interventional pain management physicians also train in physical medicine and rehabilitation. At Nuvance Health, interventional pain management physicians, physiatrists and physical therapists work closely together. Oftentimes, someone with chronic pain may benefit from a combination of therapies to feel better, from interventions and medications to physical therapy.


Physical therapy involves exercises and manual therapy, such as massage, to improve strength, flexibility and mobility, and in turn, reduce your pain.



How often you will need physical therapy depends on the extent of your injury or source of pain and other factors such as your age and other medical conditions. 



How to deal with physical pain?


Chronic pain can take a significant toll on your mental health. Dealing with physical pain can be exhausting and frustrating. Chronic pain can make it difficult to feel comfortable and get quality sleep and prevent you from doing things you enjoy and staying active. All these things can lead to feeling anxious, depressed and disconnected from family and friends. 


Thankfully, there are many ways to manage chronic pain. Equally important is managing your mental health. Please share how you are feeling with your doctor — your interventional pain management doctor can connect you with resources, including a mental health provider and support groups. Yoga, meditation and biofeedback may also help you manage chronic pain and both your physical and mental health. Biofeedback involves learning how to manage bodily functions such as breathing and heart rate. 


When to see a doctor for pain


Acute pain happens immediately from an illness or injury. Body aches from the flu and bruises, cuts and broken bones cause acute pain. Headaches that happen occasionally are also a type of acute pain. You may be able to treat some acute pain with rest and over-the-counter medications. You may need to see an emergency medicine physician, urgent care doctor or primary care provider for acute pain that results from an illness requiring a prescription medication or injury like a broken bone.



An interventional pain management physician can help you with chronic pain. Chronic pain lasts for more than three months. Many times, primary care providers or specialists from neurology, neurosurgery and rheumatology connect their patients with chronic pain to an interventional pain management physician. 



The bottom line: Pain is a complex, deeply personal experience, but it does not have to define your life. With the right knowledge and support, you may find relief and reclaim the joy in your daily activities. Remember, you are not alone and do not need to live with pain. An interventional pain management physician can help develop a personalized plan for you, from injections and minimally invasive procedures to physical therapy and mind-body practices.