Interventional Pain Management

Minimally invasive procedures that target the source of chronic pain, offering relief when conservative treatments have not been enough.

What Is Interventional Pain Management?

Interventional pain management is a medical subspecialty focused on diagnosing and treating pain conditions using minimally invasive, image-guided procedures. These techniques target the specific anatomical source of pain rather than relying solely on systemic medications.

Interventional pain specialists are typically physicians who have completed fellowship training in pain medicine after residency in anesthesiology, physical medicine and rehabilitation, or neurology. They use advanced imaging such as fluoroscopy (real-time X-ray) and ultrasound to precisely guide needles and devices to the pain source.

This approach is particularly valuable for patients who have not found adequate relief from medications, physical therapy, or other conservative treatments, and who want to avoid or delay surgery.

Common Interventional Procedures

Epidural Steroid Injections

Epidural steroid injections deliver anti-inflammatory medication directly into the epidural space surrounding the spinal cord and nerve roots. They are one of the most commonly performed interventional pain procedures.

During the procedure, your specialist uses fluoroscopy to guide a needle into the epidural space. A combination of corticosteroid and local anesthetic is injected to reduce inflammation and pain. The entire procedure typically takes 15 to 30 minutes.

Epidural injections are commonly used for:

• Herniated or bulging discs pressing on spinal nerves
• Spinal stenosis (narrowing of the spinal canal)
• Sciatica and radiculopathy (radiating leg or arm pain)
• Degenerative disc disease

Nerve Blocks

Nerve blocks involve injecting medication around specific nerves to interrupt pain signals. They serve both diagnostic and therapeutic purposes — helping your specialist identify the exact source of pain while providing relief.

Common types of nerve blocks include:

• Facet joint nerve blocks: Target the small nerves supplying the facet joints of the spine, commonly used for arthritis-related back and neck pain
• Sympathetic nerve blocks: Address pain conditions involving the sympathetic nervous system, such as complex regional pain syndrome (CRPS)
• Peripheral nerve blocks: Target specific nerves outside the spine for conditions like occipital neuralgia or intercostal neuralgia
• Sacroiliac joint blocks: Diagnose and treat pain from the joint connecting the spine to the pelvis

Radiofrequency Ablation (RFA)

Radiofrequency ablation uses controlled heat generated by radio waves to temporarily disable nerves that are transmitting pain signals. This procedure is typically performed after a successful diagnostic nerve block confirms the pain source.

RFA can provide pain relief lasting 6 to 18 months, and in some cases longer. When pain returns as nerves regenerate, the procedure can be repeated. It is most commonly used for facet joint pain in the neck and lower back, sacroiliac joint pain, and certain types of knee pain.

Spinal Cord Stimulation

Spinal cord stimulation (SCS) involves implanting a small device that delivers mild electrical impulses to the spinal cord. These impulses modify pain signals before they reach the brain, providing ongoing pain relief.

The process begins with a trial period where temporary leads are placed to test effectiveness. If the trial provides significant relief (typically 50% or greater pain reduction), a permanent system is implanted. Modern SCS systems offer various stimulation patterns and can be adjusted over time.

Spinal cord stimulation is commonly considered for:

• Failed back surgery syndrome
• Complex regional pain syndrome (CRPS)
• Chronic radiculopathy
• Peripheral neuropathy
• Chronic pain that has not responded to other treatments

Intrathecal Drug Delivery (Pain Pumps)

An intrathecal pump is an implanted device that delivers medication directly into the spinal fluid. Because the medication reaches pain receptors more directly, much smaller doses are needed compared to oral medications, which may reduce side effects.

Like spinal cord stimulation, a trial period is performed before permanent implantation. The pump reservoir is refilled periodically by your pain specialist during an office visit.

Trigger Point Injections

Trigger point injections treat painful knots (trigger points) that form in muscles when they do not relax. These knots can cause pain at the site and in seemingly unrelated areas of the body (referred pain). A small needle is used to inject local anesthetic, and sometimes a corticosteroid, directly into the trigger point.

Who Is a Candidate for Interventional Pain Management?

Interventional procedures may be appropriate if you:

• Have chronic pain that has not responded adequately to medications and physical therapy
• Experience pain from a specific, identifiable source (such as a herniated disc or arthritic joint)
• Want to reduce reliance on pain medications
• Are looking for alternatives to major surgery
• Have pain that limits your ability to participate in physical therapy or daily activities
• Have been diagnosed with a condition known to respond to interventional treatment

What to Expect at Your First Visit

During your initial consultation with an interventional pain specialist, expect:

1. Medical history review: Your specialist will review your pain history, prior treatments, imaging studies, and medications
2. Physical examination: A focused examination to identify the source and nature of your pain
3. Diagnostic plan: Additional imaging or diagnostic procedures may be recommended to pinpoint the pain source
4. Treatment discussion: Your specialist will explain recommended procedures, expected outcomes, risks, and alternatives
5. Coordinated care: Many interventional pain programs include physical therapy, medication management, and psychological support alongside procedures

Questions to Ask Your Specialist

1. What is causing my pain and which procedure do you recommend?
2. How many times have you performed this procedure?
3. What are the success rates for my specific condition?
4. What are the risks and potential complications?
5. How long can I expect the pain relief to last?
6. Will I need to stop any medications before the procedure?
7. How soon can I return to normal activities afterward?
8. Is this procedure covered by my insurance?

Related Treatment Guides

• Pain Management Injections — A detailed guide to injection types, what each treats, and what to expect
• Chronic Pain Management — Understanding the multidisciplinary approach to long-term pain care
• Regenerative Orthopedic Medicine — PRP therapy, stem cell treatments, and prolotherapy
• Pain Management Guide — Comprehensive overview of pain types and treatment approaches

Find an Interventional Pain Specialist

Ready to explore interventional pain management? Use our clinic directory to find board-certified pain management specialists near you who offer interventional procedures. You can also browse all treatment options to compare approaches.