Interventional Pain Management
Scope
Interventional pain management includes trigger point and joint injections, epidural steroid injections, nerve blocks, radiofrequency ablation, spinal cord stimulation, and intrathecal drug delivery. Success depends on patient selection, accurate diagnosis, informed consent, sterile technique, and a plan to measure functional response. A block can be diagnostic, prognostic, or therapeutic; define the question before the procedure.
Safety
Review anticoagulants and antiplatelets, allergies, infection, renal function, and pregnancy. Use image guidance and contrast when appropriate, and follow radiation safety. For neuraxial procedures, follow anticoagulation interruption intervals and document them. Consent should cover alternatives, expected benefits, and specific risks such as bleeding, infection, nerve injury, headache, and steroid effects. Sedation should not replace communication.
Traps
A frequent trap is interpreting pain relief after a block as proof of a specific diagnosis without a sham or repeat response. Another is assuming steroids are harmless; they can raise glucose and blood pressure and suppress the hypothalamic-pituitary-adrenal axis. Do not perform procedures on a patient with active systemic infection or over a suspected infection site. Also avoid treating psychosocial distress with repeated procedures.
Worked example
A patient on warfarin for a mechanical mitral valve requests an epidural steroid injection. The valve status makes stopping anticoagulation high risk. Rule of thumb: coordinate with the prescriber and follow guideline intervals; if anticoagulation cannot be safely interrupted, choose a non-neuraxial approach or defer. Document the shared decision.