Subscribe to RSS
DOI: 10.1055/s-0038-1673362
Global Approach to the Patient with Pain in Interventional Radiology
Publication History
Publication Date:
05 November 2018 (online)
![](https://www.thieme-connect.de/media/sir/201804/lookinside/thumbnails/10-1055-s-0038-1673362_001088-1.jpg)
The number of palliative procedures available to the interventional radiologist has rapidly expanded during recent years, and the need for continued implementation and innovation in this space is at an all-time high. The overuse of opioid analgesics has created a serious public health crisis, and the United States Centers for Disease Control and Prevention has called upon physicians to develop nonpharmacologic therapies for pain, stating clearly that procedures with adequate evidence of safety and efficacy are preferable to opioids for the management of chronic pain.[1] As interventional radiologists, we are uniquely equipped to deliver existing solutions and develop new alternatives through the application of advanced imaging guidance. Moreover, multiple percutaneous techniques have independently evolved in recent years for the management of cancer-related pain.[2] [3] [4]
The approach to a patient with pain who presents to interventional radiology can be simplified through the following algorithm ([Fig. 1]). Four categories of advanced interventional pain management techniques can be defined such that the options for therapy can be grouped to spine pain related to cancer, nonspine pain related to cancer, spine pain that is unrelated to cancer, and nonspine pain that is unrelated to cancer.
![](https://www.thieme-connect.de/media/sir/201804/thumbnails/10-1055-s-0038-1673362-i001088-1.jpg)
![Zoom Image](/products/assets/desktop/css/img/icon-figure-zoom.png)
-
References
- 1 Dowell D, Haegerich TM, Chou R. CDC guideline for prescribing opioids for chronic pain--United States, 2016. JAMA 2016; 315 (15) 1624-1645
- 2 Kurup AN, Morris JM, Callstrom MR. Ablation of musculoskeletal metastases. AJR Am J Roentgenol 2017; 209 (04) 713-721
- 3 Patel IJ, Pirasteh A, Passalacqua MA. , et al. Palliative procedures for the interventional oncologist. AJR Am J Roentgenol 2013; 201 (04) 726-735
- 4 Wallace AN, McWilliams SR, Connolly SE. , et al. Percutaneous image-guided cryoablation of musculoskeletal metastases: pain palliation and local tumor control. J Vasc Interv Radiol 2016; 27 (12) 1788-1796
- 5 Greenwood TJ, Wallace A, Friedman MV, Hillen TJ, Robinson CG, Jennings JW. Combined ablation and radiation therapy of spinal metastases: a novel multimodality treatment approach. Pain Physician 2015; 18 (06) 573-581
- 6 Anchala PR, Irving WD, Hillen TJ. , et al. Treatment of metastatic spinal lesions with a navigational bipolar radiofrequency ablation device: a multicenter retrospective study. Pain Physician 2014; 17 (04) 317-327
- 7 Wallace AN, Robinson CG, Meyer J. , et al. The metastatic spine disease multidisciplinary working group algorithms. Oncologist 2015; 20 (10) 1205-1215
- 8 Lea W, Tutton S. Decision making: osteoplasty, ablation, or combined therapy for spinal metastases. Semin Intervent Radiol 2017; 34 (02) 121-131
- 9 Kam NM, Maingard J, Kok HK. , et al. Combined vertebral augmentation and radiofrequency ablation in the management of spinal metastases: an update. Curr Treat Options Oncol 2017; 18 (12) 74
- 10 Prologo JD, Patel I, Buethe J, Bohnert N. Ablation zones and weight-bearing bones: points of caution for the palliative interventionalist. J Vasc Interv Radiol 2014; 25 (05) 769-775.e2
- 11 Ginat DT, Saad WE. Bowel displacement and protection techniques during percutaneous renal tumor thermal ablation. Tech Vasc Interv Radiol 2010; 13 (02) 66-74
- 12 Callstrom MR, Dupuy DE, Solomon SB. , et al. Percutaneous image-guided cryoablation of painful metastases involving bone: multicenter trial. Cancer 2013; 119 (05) 1033-1041
- 13 Prologo JD, Passalacqua M, Patel I, Bohnert N, Corn DJ. Image-guided cryoablation for the treatment of painful musculoskeletal metastatic disease: a single-center experience. Skeletal Radiol 2014; 43 (11) 1551-1559
- 14 Thacker PG, Callstrom MR, Curry TB. , et al. Palliation of painful metastatic disease involving bone with imaging-guided treatment: comparison of patients' immediate response to radiofrequency ablation and cryoablation. AJR Am J Roentgenol 2011; 197 (02) 510-515
- 15 Foster RC, Stavas JM. Bone and soft tissue ablation. Semin Intervent Radiol 2014; 31 (02) 167-179
- 16 Rathmell JP, Benzon HT, Dreyfuss P. , et al. Safeguards to prevent neurologic complications after epidural steroid injections: consensus opinions from a multidisciplinary working group and national organizations. Anesthesiology 2015; 122 (05) 974-984
- 17 Wald JT, Maus TP, Diehn FE. , et al. CT-guided cervical transforaminal epidural steroid injections: technical insights. J Neuroradiol 2014; 41 (03) 211-215
- 18 Arias Garau J. Radiofrequency denervation of the cervical and lumbar spine. Phys Med Rehabil Clin N Am 2018; 29 (01) 139-154
- 19 Stout A, Dreyfuss P, Swain N, Roberts S, Loh E, Agur A. Proposed optimal fluoroscopic targets for cooled radiofrequency neurotomy of the sacral lateral branches to improve clinical outcomes: an anatomical study. Pain Med 2017; DOI: 10.1093/pm/pnx287.
- 20 Engel AJ, Bogduk N. Mathematical validation and credibility of diagnostic blocks for spinal pain. Pain Med 2016; 17 (10) 1821-1828
- 21 Pomerantz SR, Hirsch JA. Intradiscal therapies for discogenic pain. Semin Musculoskelet Radiol 2006; 10 (02) 125-135
- 22 Knezevic NN, Mandalia S, Raasch J, Knezevic I, Candido KD. Treatment of chronic low back pain - new approaches on the horizon. J Pain Res 2017; 10: 1111-1123
- 23 Pettine KA, Suzuki RK, Sand TT, Murphy MB. Autologous bone marrow concentrate intradiscal injection for the treatment of degenerative disc disease with three-year follow-up. Int Orthop 2017; 41 (10) 2097-2103
- 24 Centeno C, Markle J, Dodson E. , et al. Treatment of lumbar degenerative disc disease-associated radicular pain with culture-expanded autologous mesenchymal stem cells: a pilot study on safety and efficacy. J Transl Med 2017; 15 (01) 197
- 25 Marhofer P, Harrop-Griffiths W, Willschke H, Kirchmair L. Fifteen years of ultrasound guidance in regional anaesthesia: Part 2-Recent developments in block techniques. Br J Anaesth 2010; 104 (06) 673-683
- 26 Hackworth RJ, Nagel EJ, Slotto JG. Computed tomographic-guided genitofemoral nerve block: a simple anterior approach. J Comput Assist Tomogr 2015; 39 (02) 295-297
- 27 Heywang-Köbrunner SH, Amaya B, Okoniewski M, Pickuth D, Spielmann RP. CT-guided obturator nerve block for diagnosis and treatment of painful conditions of the hip. Eur Radiol 2001; 11 (06) 1047-1053
- 28 Kastler A, Aubry S, Sailley N. , et al. CT-guided stellate ganglion blockade vs. radiofrequency neurolysis in the management of refractory type I complex regional pain syndrome of the upper limb. Eur Radiol 2013; 23 (05) 1316-1322
- 29 Conway JA, Adhikary SD, Giampetro D, Stolzenberg D. A survey of ultrasound training in U.S. and Canadian Chronic Pain Fellowship Programs. Pain Med 2015; 16 (10) 1923-1929
- 30 Wadhwa V, Scott KM, Rozen S, Starr AJ, Chhabra A. CT-guided perineural injections for chronic pelvic pain. Radiographics 2016; 36 (05) 1408-1425
- 31 Kastler A, Onana Y, Comte A, Attyé A, Lajoie JL, Kastler B. A simplified CT-guided approach for greater occipital nerve infiltration in the management of occipital neuralgia. Eur Radiol 2015; 25 (08) 2512-2518
- 32 Pieri S, Agresti P, Ialongo P, Fedeli S, Di Cesare F, Ricci G. Lumbar sympathectomy under CT guidance: therapeutic option in critical limb ischaemia. Radiol Med (Torino) 2005; 109 (04) 430-437
- 33 Masala S, Calabria E, Cuzzolino A, Raguso M, Morini M, Simonetti G. CT-guided percutaneous pulse-dose radiofrequency for pudendal neuralgia. Cardiovasc Intervent Radiol 2014; 37 (02) 476-481
- 34 Joshi DH, Thawait GK, Del Grande F, Fritz J. MRI-guided cryoablation of the posterior femoral cutaneous nerve for the treatment of neuropathy-mediated sitting pain. Skeletal Radiol 2017; 46 (07) 983-987
- 35 Bittman RW, Peters GL, Newsome JM. , et al. Percutaneous image-guided cryoneurolysis. AJR Am J Roentgenol 2018; 210 (02) 454-465
- 36 Ilfeld BM, Preciado J, Trescot AM. Novel cryoneurolysis device for the treatment of sensory and motor peripheral nerves. Expert Rev Med Devices 2016; 13 (08) 713-725