It has been estimated that 5000 new opioid addictions begin with prescription medication per year. The need for alternatives to manage pain has never been greater. Interventional Radiologists (doctors who perform procedures using imaging guidance) are doing just that – managing pain without opioids.
Specifically, the application of a medical subspecialty (called interventional radiology) to conditions with painful symptoms, has resulted in the emergence of brand new therapies. Doctors are able to target nerves and pain centers deep in the body and provide multiple options for therapy that were not available until very recently.
Here are 3 of the newest, most effective therapies being offered.
1. Ablation of nerves for knee pain.
Knee arthritis is an increasingly common condition, causing disability for many aging folks. The options for management have historically been surgery or pain medication. Using X-ray guidance, interventional radiologists can insert small needles to the nerves around the knee carrying pain signals and block them. The block is a small (5mm) zone of heat that disrupts nerve signaling and decreases pain. The procedure itself takes about one hour and is performed as an outpatient.
The nerves in question are called genicular nerves, and they can be blocked because their primary job is to transmit pain (vs. motor function like moving the leg). The relief typically lasts for 8-12 months and the procedure can be repeated as needed.
The procedure can serve as a long-term solution for many patients who do not desire surgery. Alternatively, it can serve as an adjunct for people who are trying to lose weight in order to qualify for surgery, but are having difficulty because of the pain in their knee(s).
2. Ablation of cancer to treat pain. Unfortunately, more than half of patients diagnosed with cancer will develop a painful site of spread. During recent years, procedures have been developed to allow doctors to insert probes into painful cancer sites and freeze the tumor. The procedure works by disrupting and killing the cancer cells locally, which very often results in significant pain relief. The procedure is done in cat scan, usually with the patient asleep – and most go home the same day.
This procedure is the most well studied of the pain management procedures in interventional radiology and can be divided broadly in to two categories: cancer locations involving the spine, and cancer locations involving the rest of the body. Spine lesions are managed by destroying the tumor cells as well as providing a cement for stabilization in the vertebral bodies using X-ray guidance. Locations in the rest of the body are most often treated by only tumor freezing, using CT guidance.
As research continues, it is also being suggested that the freezing of these cancer locations for the purposes of relieving pain may also provide an overall response to the tumor itself from the body. Though unproven as of the time of this article, release of parts of the cancer (called intact antigens) during the ablation process may induce the body’s immune response to target that same cancer in other sites. Research is actively ongoing around this effect, called cryoimmunotherapy.
3. Injections to central nerve centers. Often the very presence of pain can cause the entire nervous system to “ramp up” in response. Using advanced imaging guidance, interventional radiologists can access deep central “dispatch” centers called nerve plexi. Injecting medications to these plexi can often have an overall calming effect for patients with severe abdominal or pelvic pain.
The needles used for the injections are quite small, and the procedure is performed using CT guidance. The desired effect is a calming of what is called the autonomic nervous system. Often patients with complex or long-standing pain develop a cycle of inflammation, nervous hyperactivity, altered biomechanics (favoring the area with pain), and central sensitization. In these situations, it is often beneficial to offer injections to the various plexi located throughout the body.
Overall, the application of advanced imaging guidance to pain syndromes has resulted in brand new options for patients with pain. Given the emerging dangers of many pain medications, these procedures often serve as much needed alternatives for pain management.
The ability of interventional radiologists to reach locations deep in the body with exquisite precision is providing new options for patients with long-standing pain, including the above examples – but also in the setting of pudendal neuralgia, occipital neuralgia, phantom limb pain, back pain, abdominal pain, and more. Patients with widely spread, painful cancer lesions are particularly good candidates for image guided, percutaneous (through the skin) therapy.
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