About 21% of Americans suffer from chronic pain. In addition to physical therapy, medications and injections, pain management specialists use a variety of advanced interventional techniques to treat back and major joint pain. These minimally invasive procedures are used when a patient isn’t a good candidate for surgery or doesn’t want to have surgery. Jerry Markar, MD, a UCLA Health pain medicine physician in North Hollywood, describes some of these techniques.
What’s a newer interventional procedure you’re excited about?
“Genicular nerve radiofrequency ablation (RFA) can help patients with chronic knee pain who aren’t candidates for surgery or don’t want to have surgery,” Dr. Markar says. “They may be experiencing pain despite knee surgery, or they might have chronic osteoarthritis or traumatic injuries to the knee. First, we block the genicular nerves using a local anesthetic, and if it provides significant pain relief, we know the pain stems from these genicular nerves. If that’s the case, we use radiofrequency energy to heat and destroy small areas of nerve tissue. This prevents the nerves from sending pain signals to the brain. The relief usually lasts anywhere from six-to-24 months, after which the procedure can be repeated, if necessary.”
What are some other interventional techniques?
One of the newest techniques, called basivertebral nerve ablation, helps patients with vertebrogenic back pain, which stems from damage to the endplates of the vertebrae (bones of the spine). Damage to vertebral endplates causes pain when you sit, bend or lift. “This technique, also called the Intracept procedure, uses radiofrequency energy to heat the basivertebral nerve,” Dr. Markar says. “It’s only applicable to patients with certain anatomical features that we can see on an MRI and doesn’t work for everyone. However, it’s safe, effective and long-lasting, so it may prevent the need for other more invasive surgeries.”
Pain medicine physicians can also treat back pain with spinal cord stimulation. This procedure involves implanting a pulse generator and small battery pack connected to electrodes near the spinal cord. The device produces mild electrical pulses, which disrupt the pain signals.
While not a procedure that Dr. Markar performs, another therapy now covered by Medicare treats pain caused by lumbar stenosis, a narrowing of the space through which the spinal cord runs. Lumbar stenosis often manifests as pain radiating down the legs while standing and walking. This narrowing caused by thickening of the ligaments in the spine can be treated with an outpatient procedure called MILD, or minimally invasive lumbar decompression, using a small instrument about the diameter of a pen to remove some of the ligaments and create more space. Patients interested in the MILD procedure can seek a referral from their primary care physician.
What else would you like readers to know?
“Patients with chronic pain should know that pain medicine physicians have an arsenal of tools to reduce their reliance on medications, especially opioid therapies given the potential risk factors related to opioids in chronic pain conditions, including dependence and tolerance,” Dr. Markar says. “Even if we can’t completely eliminate pain, our goal is to turn down the volume of pain. This can make a big difference to a patient’s quality of life.”
