Epidural Interventions in the Management of Chronic Spinal Pain

Patient Guideline Summary

Publication Date: January 24, 2021

Objective

Objective

This patient summary means to discuss key recommendations from the American Society of Interventional Pain Physicians for epidural interventions in the management of chronic spinal pain.

Overview

Overview

  • Chronic pain in the neck and back has generated multiple minimally invasive procedures to relieve the pain.
    • Pain can be sharp and shooting or deep and aching.
  • Some of the most common causes of back pain are herniated or damaged discs, spinal stenosis, spinal joint disease, and trauma.
  • This patient summary focuses on pain-relieving techniques not requiring major surgery.

Diagnosis

Diagnosis

  • The source of pain must be exactly located before a treatment can be chosen.
  • X-rays, computed tomography (CT), or magnetic resonance imaging (MRI) may be used to find the site of the pain.
  • Injections of local anesthetic can pinpoint a target for treatment.

Treatment

Treatment

  • All these treatments are directed at the epidural area (the space around the spine that does not include the spinal cord or its dura [a thick membrane surrounding the spinal cord]).
  • Many of these treatments use x-ray–guided needles, probes, or catheters that deliver medicines, heat, cold, ultrasound, or laser light.
  • The goals of treatment can be:
    • Deactivate pain nerves
    • Reduce inflammation
    • Remove scar tissue
  • Injected medicines include isotonic saline, hypertonic saline, local anesthetics, cortisone, and hyaluronidase.
  • Each option has a certain level of risk. Some risks are small; some significant. Your doctors will weigh each in light of numerous published studies to determine if the benefit justifies the risk involved.
  • Repeat or additional treatments may be required before a satisfactory level of pain relief is obtained.

Abbreviations

  • CT: Computed Tomography
  • MRI: Magnetic Resonance Imaging

Source Citation

Manchikanti L, Knezevic NN, Navani A, Christo PJ, Limerick G, Calodney AK, Grider J, Harned ME, Cintron L, Gharibo CG, Shah S, Nampiaparampil DE, Candido KD, Soin A, Kaye AD, Kosanovic R, Magee TR, Beall DP, Atluri S, Gupta M, Helm Ii S, Wargo BW, Diwan S, Aydin SM, Boswell MV, Haney BW, Albers SL, Latchaw R, Abd-Elsayed A, Conn A, Hansen H, Simopoulos TT, Swicegood JR, Bryce DA, Singh V, Abdi S, Bakshi S, Buenaventura RM, Cabaret JA, Jameson J, Jha S, Kaye AM, Pasupuleti R, Rajput K, Sanapati MR, Sehgal N, Trescot AM, Racz GB, Gupta S, Sharma ML, Grami V, Parr AT, Knezevic E, Datta S, Patel KG, Tracy DH, Cordner HJ, Snook LT, Benyamin RM, Hirsch JA. Epidural Interventions in the Management of Chronic Spinal Pain: American Society of Interventional Pain Physicians (ASIPP) Comprehensive Evidence-Based Guidelines. Pain Physician. 2021 Jan;24(S1):S27-S208. PMID: 33492918.

Disclaimer

The information in this patient summary should not be used as a substitute for professional medical care or advice. Contact a health care provider if you have questions about your health.