Interventional Pain Procedures: A Narrative Review Focusing On Safety and Complications. PART 2 Interventional Procedures For Back Pain

Abstract

In patients where conservative approaches have failed to relieve from chronic pain, interventional procedures may be an option in well selected patients. In recent years there has been an increase in the use and development of invasive procedures. Concomitantly, there has also been an increase in the complications associated with these procedures. Taken this into consideration, it is important for healthcare providers to take a cautious and vigilant approach, with a focus on patient safety, in order to minimize the risk of adverse events and ensure the best possible outcome for the patient. This may include careful selection of patients for procedures, use of proper techniques and equipment, and close monitoring and follow-up after the procedure. The aim of this narrative review is to summarize the primary complications associated with commonly performed image-guided (fluoroscopy or ultrasoundguided) interventional procedures and provide strategies to reduce the risk of these complications. We conclude that although complications from interventional pain procedures can be mitigated to a certain degree, they cannot be eliminated altogether. In order to avoid adverse events, patient safety should be given considerable attention and physicians should be constantly aware of the possibility of developing complications.

Radiofrequency Ablation for Chronic Lumbar Zygapophyseal Joint Pain Using a V-Shaped Active Tip Needle: An Observational Retrospective Study

“…The RFA procedures were performed in operating rooms under continuous monitoring of patients’ vital parameters. 26 …”

“…The RFA procedures were performed in operating rooms under continuous monitoring of patients' vital parameters. 26 All patients were administered procedural sedation with short-acting intravenous agents (benzodiazepines, eg, midazolam), supplementing local anesthesia of the skin and underlying tissues. An 18-gauge 100 mm needle with a V-shaped active tip (Venom cannula, Stryker ® ) was introduced at each entry point, with RFA electrodes placed according to SIS guidelines for lumbar medial branch, L5 dorsal ramus, S1, S2, S3 lateral branches thermal radiofrequency neurotomy.…”

Interventional Pain Procedures: A Narrative Review Focusing on Safety and Complications. Part 1 Injections for Spinal Pain

“…Moreover, regular education, training, and international certification for healthcare providers, as well as collaboration with interdisciplinary teams, can also help to minimize the risk of adverse events. 6 Similar to all interventional pain therapy procedures, the number of infiltrative techniques has increased significantly in recent years. 4 , 5 Furthermore, the development of techniques using ultrasound-guidance has allowed their execution (at least to a degree) even in less controlled outpatient settings.…”

“…[1][2][3] However, an increase in the number of complications related to these procedures has also been observed, varying from minor to severe and debilitating. [4][5][6] The exact incidence of severe adverse events is considered low (under 1%) but it is probably underestimated since they are usually reported as case reports, deaths after epidural injections have been reported as well but the exact mortality rate is unknown (and probably less than 1 every million procedures). 7 It is estimated that over 9 million epidural injections are performed each year in the United States.…”

A comprehensive overview and scope of interventional pain management

“…From pharmaceuticals to interventional procedures, each modality offers a unique avenue towards relief, yet none are immune to limitations. Interventional procedures, such as nerve blocks, epidural injections, epiduroscopy, radiofrequency ablation, spinal cord stimulation, and more, offer a targeted approach to interrupt pain signaling pathways for chronic pain conditions [ 1 ]. Understanding the scopes and constraints of these intervention strategies is crucial for optimizing patient care and advancing the field of pain management.…”