Interventional Pain Medicine (IPM)
London Pain Consultants perform a wide range of Interventional Pain Medicine Procedures, performed on a day-care basis.
Skip list of procedures to the contents
- Botulinum Toxin A Injections for Pain
- Although generally associated with cosmetic surgery, there is increasing evidence of its therapeutic benefits in painful conditions. Botulinum Toxin A Injections. are used in difficult to treat spinal pain, fibromyalgia (myofacial pain syndrome) and hyperhydrosis.
- Read the case study on Sacroiliac Joint Pain Treated With Botulinum Toxin A.
- Coeliac Plexus Block
- Used in abdominal pain which is difficult to treat, for example chronic pancreatitis.
- The Coeliac Plexus is a collection of nerves lying around the origin of the Celiac Artery in the abdomen.
- For a Coeliac Plexus Block a fine needle is located near the Coeliac Plexus under X-ray or CT guidance and local anaesthetic or radiofrequency is carefully delivered.
- Epidural Injection
- The epidural space in the back is located using a specially designed needle, under local anaesthetic.
- A solution of local anaesthetic and anti-inflammatory are carefully delivered into the epidural space. This acts to dilute a number of chemical factors that may be causing pain and has an anti-inflammatory effect.
- The technique can be used anywhere in the spine, including cervical, thoracic or lumbar spine.
- Read the article explaining epidural injections
- Epidural Injection information.
- Epiduroscopy
- Epiduroscopy involves inserting a thin fibre optic scope through a small incision in the lower back. Epiduroscopy allows the epidural space to be visualised directly. Adhesions or scar tissue, that may be pulling on or irritating specific nerve roots can be identified and treated using the device.
- Epiduroscopy information.
- Facet Joint Block
- Facet Joints are small joints on the back of the spine that allow it to articulate.
- If they are overused or injured, this can lead to Facet Joint Syndrome, where pain is a prominent feature. Thin needles are inserted near the painful Facet Joints under X-ray guidance, under local anaesthetic. Local anaesthetic and anti-inflammatory are then carefully delivered around the Facet Joints to reduce pain.
- Read the article explaining Facet Joint Blocks.
- Facet Joint Block information.
- Ganglion of Impar Block
- Used in pelvic pain which is difficult to treat, for example chronic cystitis.
- The Ganglion of Impar is a collection of nerves lying in front of the junction of the sacrum and coccyx, in the pelvis.
- A fine needle is located near the coeliac plexus under X-ray or CT guidance and local anaesthetic or radiofrequency is delivered.
- Ganglion of Impar Block
- Guanethidine Block
- Guanethidine is a drug used to block sympathetic nerves.
- Over activity in the sympathetic nerves is associated with a number of painful conditions including Complex Regional Pain Syndrome (CRPS).
- A tourniquet is applied to the effected arm or leg and Guanethidine is delivered via a vein.
- Guanethidine Block
- Hypogastric Plexus Block
- Used in pelvic pain which is difficult to treat, for example Chronic Pancreatitis.
- The Hypogastric Plexus is a collection of nerves lying in front of the fifth lumbar vertebra.
- A fine needle is located near the Hypogastric Plexus under X-ray or CT guidance and local anaesthetic or radiofrequency is delivered.
- Hypogastric Plexus Block information
- Lumbar Sympathectomy
- Over activity of the Lumbar Sympathetic nerves is associated with a number of painful conditions in the legs including Peripheral Vascular Disease and Complex Regional Pain Syndrome (CRPS).
- Lumbar Sympathetic nerves run in the abdomen near the bodies of the vertebrae.
- Thin needles are inserted near the nerves under X-ray or CT guidance, under local anaesthesia.
- Local anaesthetic or radiofrequency is then delivered to reduce the pain.
- Lumbar Sympathectomy
- Nerve Root Injection
- Some patients with lower back pain have sciatica-like symptoms. Sciatica involves pain and/ or sensory dysfunction, such as pins and needles and numbness in the territory of a nerve root, caused by, for example scar tissue or inflammation.
- A fine needle is located near the nerve root under X-ray or CT guidance and local anaesthetic or radiofrequency is delivered. Local anaesthetic with anti-inflammatory and hyaluronidase is delivered to the affected nerve root.
- Nerve Root Injection.
- Obturator Nerve Block
- The Obturator Nerve supplies sensation to the hip joint. In painful conditions of the hip joint, for example Osteoarthritis, the Obturator Nerve maybe blocked.
- A fine needle is located near the Obturator Nerve under X-ray guidance and local anaesthetic or radiofrequency is delivered.
- Obturator Nerve Block.
- Prolotherapy
- Prolotherapy uses a dextrose (sugar water) solution, which is injected into a ligament or tendon where it attaches to bone. This causes localized inflammation which increases the local blood supply and flow of nutrients and stimulates the tissue to repair itself. The treatment is useful for many different types of musculoskeletal pain.
- Prolotherapy.
- Radiofrequency Techniques (RF/ Pulsed RF)
- These include Radiofrequency and Pulsed Radiofrequency. These are Minimally Invasive Procedures which can be used for a variety of different nerve blocks including in place of local anaesthetic and anti-inflammatory, for a longer lasting nerve block.
- Radio Frequency (RF) can be used to temporarily deactivate minor nerves around the spine and other areas of the body.
- The pain generating nerves in many patients are often small, unimportant fibres which can cause severe pain. These nerves can be temporarily shut down using radiofrequency energy to heat and deactivate the pain generating nerve fibres. This can also be achieved using Pulsed Radiofrequency which ‘resets’ the function of nerve membranes.
- The procedure is performed by locating the affected nerve under x-ray guidance. A special probe is advanced into position, allowing the delivery of radiofrequency energy to the targeted area.
- Radiofrequency and Pulsed Radiofrequency is usually offered after local anaesthetic and anti-inflammatory have been tried and found to be beneficial.
- Results can last from months to years.
- Radiofrequency techniques.
- Stellate Ganglion Block
- The Stellate Ganglion consists of a collection of nerve fibres in the neck. Over activity in these nerves is implicated in a variety of painful conditions, for example Complex Regional Pain Syndrome and Atypical Facial Pain.
- A fine needle is located near the Stellate Ganglion and local anaesthetic or radiofrequency is delivered.
- Stellate Ganglion Block.
- Suprascapular Nerve Block
- The Suprascapular Nerve supplies sensation to the shoulder joint.
- By interrupting the Suprascapular Nerve, a pain-free window can be created allowing rehabilitation of the affected shoulder joint.
- A fine needle is located near the Suprascapular Nerve and local anaesthetic or radiofrequency is delivered. The procedure is performed under local anaesthetic on a day-case basis.
- Suprascapular Nerve Block.
- Therapeutic Spine Injections
- These involve the delivery of local anaesthetic and anti-inflammatory medications directly into the area surrounding pain generating nerves. This may relieve pain symptoms and often times allow the nerve area to heal and repair itself.
- Therapeutic Spinal Injections can effectively break the cycle of pain, which can become chronic if left untreated.
- Injections can be targeted to cervical, thoracic, and lumbar areas across the entire spine from lower back to neck.
- Patients may experience pain relief that ranges from several months to several years depending on their condition.
- Procedures are quick and performed as a day-case. Therapeutic Spine Injections include: Epidural injection, Facet Joint Blocks, Nerve Root injections and Epiduroscopy.
- Trigger Point Injections
- A Trigger Point is a knot or tight, ropy band of muscle that forms when muscle fails to relax properly. The Trigger Point can trap or irritate surrounding nerves and cause pain.
- The Trigger Points are injected with local anaesthetic and anti-inflammatory.
- Trigger Point Injections.
- Viscosupplementation
- Joints contain Synovial Fluid, which is essential for normal functioning. It is analogous to the oil on a hinge joint.
- Viscosupplementation consists of a synthetic fluid with a structure similar to natural Synovial Fluid.
- In some painful conditions, for example Osteoarthritis of the knee, Viscosupplementation may be used to relieve pain.
- A fine needle is advanced into the affected joint under X-ray or ultrasound guidance and Viscosupplement is delivered.
- Studies have shown that for patients with Osteoarthritis of the knee and hips it maybe possible to increase the time before joint replacement becomes necessary.
- Viscosupplementation.
You can find useful links to further information on all aspects of pain treatment in links and resources and via the list of conditions we treat.
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