Click to edit Master title style Ouch!!! That’s ... Conference Documents-Images/H… · Stellate Ganglion Block 31 •A type of sympathetic nerve block performed to determine if
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Ouch!!! That’s Better: Interventional Pain Options
K a thy A . B au le D N P, R N , A P N -A C N S-B C, C C R N , C N R N
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Conflict of Interest Disclosure
• Author’s conflicts of interest:• Dr. Baule has no conflict of interest
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Objective 1:
At the conclusion of the presentation, the learner will be able to provide examples of treatment interventions for cervical, thoracic, and lumbar pain.
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Objective 2:
After participating in the presentation, the participant will be able to provide examples of treatment options for cancer pain.
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Objective 3:
At the conclusion of the presentation, the learner will be able to identify two intraoperative procedures for pain control.
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Types of Spinal Pain
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•Cervical
•Thoracic
•Lumbar
Image from Disabled World; Retrieved from https://disabled-
world.com/disability/types/spinal/spine-picture.php
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Spinal Pain Interventions
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• Epidural injection
• Selective nerve root block
• Radiofrequency (RF) nerve ablation
• Sacroiliac joint (SI) joint injection
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Image from Spine Center of the Emerald Coast; Retrieved from
http://www.emeraldcoastspine.com/transforaminalinjection.html
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SI Injection
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Image from Los
Angeles Minimally
Invasive Spine
Institute; Retrieved
from
https://www.lamisinstit
ute.com/procedures/sp
inal-
injections/sacroiliac-
joint-injection-los-
angeles
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RACZ Caudal Neurolysis
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Image from Shepherd Pain Institute;
Retrieved from
http://www.shepherdpaininstitute.org/tre
atment/spine/RACZ
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Facet Injection
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Image from University of Rochester Medical
College; Retrieved from
https://www.urmc.rochester.edu/imaging/patie
nts/procedures/joint-injection.aspx
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RF Ablation
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Image from BoneandSpine.com; Retrieved from https://boneandspine.com/radiofrequency-neurotomy/
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The Spine & Pain Institute of New York; Retrieved from
https://www.youtube.com/watch?v=6m133lQsJBE
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Treating Cancer Pain
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Cancer Pain Treatments
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• Head, neck and cervical
spine
• Maxillary and mandibular
nerve blocks
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Cancer Treatment, Cont.
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• Abdominal cancer
• Celiac plexus
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More Cancer Options
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• Splanchnic nerve
• Associated pelvic and perineal
visceral pain
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Treatment of Metastatic Spine Disease
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• Stereotactic body radiation therapy
(SBRT)
• Percutaneous tumor ablation
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Nerve Blocks
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Three Step Process for Nerve Blocks
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•Diagnostic blocks
•Prognostic blocks
•Therapeutic blocks
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Types of Nerve Blocks
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• Trigeminal
• Sphenopalatine ganglion
• Glossopharyngeal
• Occipital
• Vagal
• Cervical plexus
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Trigeminal
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Neuroablation
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Image retrieved from
https://www.moddb.com/m
embers/snehadiva82/video
s/radiofrequency-
neuroablation
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Occipital Nerve Block
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Other Nerve Blocks
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Sympathetic Nerve Block
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A sympathetic nerve block is one
that is performed to determine if there is damage to the sympathetic
nerve chain.
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Stellate Ganglion Block
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• A type of sympathetic nerve block
performed to determine if there isdamage to the sympathetic nerve
chain supplying the head, neck,
chest, or arms and if it is the
source of pain in those areas.
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Stellate Ganglion Block
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Genicular Nerve Block
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Genicular RF
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Surgical Interventions
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Surgical Interventions
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• Intrathecal Pain Delivery System
• Spinal Cord Stimulator
• Kyphoplasty/ vertebroplasty / sacroplasty
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Reasons for Intrathecal Pumps
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Image retrieved from www.ncbi.nlm.nlb.ov./pmc
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Is The Pump For You?
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• Must go through complex trial to see if
treatment decreases pain/spasticity
• Single injection through lumbar puncture
• Multiple injections over the course ofdays
• Continuous trial-catheter placed incorrect area of the spine connected to
external pump
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Spinal Cord Stimulator
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But Wait
There’s More!!!
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Minimally Invasive Spine Procedures
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• MILD®
• Endoscopic foraminotomy
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MILD®
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Endoscopic Foraminotomy
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Images from Atlantic Spine Center Video, Retrieved from https://www.youtube.com/watch?v=v1RwKwRDNPM
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Kyphoplasty
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Image from DrOsborn.com; Retrieved from
https://www.drbrettosborn.com/neurological/kyphoplasty
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Trauma
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• Rib fixations
• Bupivacaine liposomal
injection suspension
(EXPAREL®) – slow release
local anesthetic
• OnQ® Pump
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OnQ® Pump
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Image from Halyard Health Products;
Retrieved from
https://products.halyardhealth.com/acute-
pain/ambulatory-pain-pumps/variable-rate-
pumps/on-q-pump-with-ondemand.html
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Transversus Abdominis Plane (TAP) Block
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• Places local anesthetic in the
lateral abdominal wall in a planebetween the internal oblique and
the transvers abdominis muscles
• Can block many of the abdominalnerves as they pass to the
abdominal structures
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TAP Block
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Wrap Up
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• Explained interventions for spinal pain
• Provided an overview of interventions for
cancer pain
• Provided several intraoperativeprocedures for pain control
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Thank You for Your Attention
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