Advanced Interventional Pain Management

“Can you help this patient with pain?” Of course we can…

The topic of this issue of Seminars in Interventional Radiology—deliberately called Advanced Interventional Pain Management—addresses the foundational and leading-edge components of an evolving subspecialty within interventional radiology. The procedural management of straightforward and/or complex pain conditions in interventional radiology has slowly grown over the past 10 years, fueled by innovation, technology, and demand.

Regarding the latter, legislation and societal guidelines have in part driven patients into our arms because of the opioid crisis—explicitly calling for interventional alternatives to narcotics. But it is much more than that. Our position as hospital-based physicians gives us a unique opportunity to help patients admitted for pain control, often related to cancer, sometimes not. Either way, our ability to shorten length of stay through pain management procedures has clearly put us on the radar in this space. Our abilities often run far ahead of our colleagues understanding of what we are doing, such that the question for us becomes, “Can you help?” versus any specific request for procedure or intervention—a welcome arrangement as our clinical positions develop. The pandemic put a spotlight on this scenario as hospitals scrambled to discharge patients to expand capacity for COVID casualties.

Technology has always been our friend, and these applications are no different. The radiofrequency ablation and cementoplasty devices for patients with vertebral body metastatic deposits and fractures have solidified our positions described earlier—serving as front-line therapies for patients admitted with cancer-related pain. Perhaps even more impactful is the integration of advanced imaging guidance to reach novel targets for ablation, injection, or embolization.

At the center of it all, though, is innovation. Interventional radiologists, “doing what we do,” solve difficult problems by integrating the interventional radiology skill set. Millions of patients with degenerative disc disease will benefit from the evolution of basivertebral nerve ablation. Likewise, the numbers of patients with osteoarthritis of the knee are staggering—a condition for which nerve ablations and/or embolization are showing early promise. Nerve ablations elsewhere in the body are being applied to block cancer pain, provide regional perioperative anesthesia, and even induce percutaneous neuroregeneration and repair.

The potential applications for pain management (and beyond, as these innovations often open the door to other ideas) by interventional radiology are stratospheric. As it is, though, this niche is only slowly growing and expanding – for several reasons. First, we are busy with other things. As exciting as this editorial is, we are doing the same thing for millions of patients with prostate hypertrophy or those in need of percutaneous dialysis access creation. Plus we have our day jobs. Finally, there are “real-world” issues to contend with, like FDA regulations and reimbursement.

The Society of Interventional Radiology (SIR) has recently restructured its governance matrix, creating several clinical specialty councils—of which pain management is one. The charge for these subspecialty councils is to support and accelerate the dissemination of care to patients through interventional radiology. This translates to research, guidelines, education, regulatory assistance, reimbursement support, and communication in each of the subspecialty realms. Each council is composed of representatives from other SIR specialty committees allowing for seamless liaisons and efficient work efforts. What's more, each clinical specialty council chair is now part of the SIR Steering Committee; and as such, each has a clear line of communication to leadership, and hence the full resources of the society.

As a result, the future is bright for advanced interventional pain management. The “nuts and bolts” necessary for the organized expansion and growth of innovative procedures and new technologies are being addressed. Interventional radiologists around the world have mobilized to meet the existing demand. The combined rising tide will likely result in the accelerated progression of an effective and exciting subspecialty within interventional radiology. The enclosed articles are written to reflect the current state of our leading-edge technologies as well as to revisit our foundational procedures in this space. I am sincerely grateful for the opportunity to contribute to this special issue.

Publication History

Article published online:
30 June 2022