The Role of Interventional Pain Medicine
Interventional Pain Medicine or Interventional Pain Management (IPM) is the field of medicine dedicated to the evaluation and treatment of those who suffer from any pain disease state. The scope of IPM is broad. The pain may be acute pain, chronic pain, post-operative pain, or cancer related pain. The pain may involve any organ system including neurological, musculoskeletal, cardiovascular, gastrointestinal, etc. Ultimately, the goals of IPM are to achieve pain relief or reduction, restore physical function, and subsequently improve quality of life.
In order to treat the myriad of pain conditions effectively, IPM employs an interdisciplinary approach that aims to address all aspects of the pain in the most comprehensive way possible. Pain assessment involves patient history, physical examination, imaging studies, and electrodiagnostic studies. Pain treatment includes physical therapy, modalities (heat/ice, TENS), manual therapy or massage, activity modification, bracing or orthotic prescription, pharmacotherapy, interventional procedures, and psychological therapy. This requires a concerted effort from a team of specialists coordinated by the IPM physician.
As the field of IPM continues to grow, its role in the healthcare algorithm has continued to be redefined. IPM should not reserved as a last resort considered years after initial injury or after multiple surgeries. IPM should in fact be introduced earlier in the patient plan of care; not only in order to achieve pain symptom relief sooner, but also to reduce the negative effects of delayed or inadequate treatment such as time missed from work, poor quality of life, mood and sleep disorders, physical deconditioning, and central pain sensitization.
Using back pain as an example, most mild to moderate cases in the acute phase may improve in few days to weeks with rest, ice, activity modification, and anti-inflammatory medications. However, if the pain is severe and unrelenting, or if it is accompanied by numbness, tingling, or weakness in the legs, evaluation by an IPM physician is required. In addition, any pain that persists beyond several weeks is deemed chronic and is likely more than a simple strain/sprain, which also requires the evaluation of an IPM physician. In this manner, the appropriate diagnostic studies and therapeutic interventions can be recommended as early as possible.
The reality is that the majority of chronic back pain is not a simple black or white issue, like chiropractic care versus surgical intervention for example. In fact, it usually falls somewhere in between, and this is the gray area where IPM serves best with flying colors.
Jimmy M Henry MD