Interventional pain medicine
The Centre for Pain Medicine offers all the latest and best-known interventional procedures. Targeted, selective blocks are necessary to confirm a tentative clinical diagnosis and to assess the validity of radiological findings regarding the cause of pain. By reducing the intensity of pain, the right pain therapy can lead to improved attention and concentration skills, and therefore improve the chances of successful cognitive behaviour therapy. Specific blocks can alleviate a patient’s fear of movement and thus allow for physiotherapy to be conducted in a more effective manner. These so-called “blocks” can be guided by x-ray or ultrasound, as well as other instruments.
Nerve root blocks
When nerves are irritated (e.g. by a slipped disk or wear and tear to the spine) radiating pain can emerge in the arms or legs (e.g. sciatica in the legs). Targeted injections (diagnostic blocks) around these nerves can temporarily alleviate the pain, and thus confirm the suspicion that a dysfunction is present in the particular area. Pain can be alleviated for longer periods of time via the use of
further cortisone blocks or special electrified needles.
Intervertebral joint injections (facet blocks)
Wear and tear on the small intervertebral joints of the spine is one of the most frequent causes of back pain. Facet blocks involve the use of x-ray-guided needles which selectively search for the small nerves attached to these joints. Once these nerves are found, the needles numb them with a local anaesthetic. Other therapeutic techniques for providing long-lasting pain relief include the use of electrotherapy or a cortisone injection into the joint.
Epidural anaesthesia is a regional anaesthesia administered near the spinal cord which can temporarily block (pain) sensation in the lower half of the body. This anaesthesia is used for pain therapy, e.g. during the constriction of the spinal canal or of the exit holes of nerve roots. During this anaesthesia, an injection combining cortisone and a local anaesthetic is used to gradually reduce the patient’s pain. A special kind of epidural anaesthesia involves infiltration via the sacral canal, during which the injection is made into the lowest opening of the sacral canal just above the tail bone.
More injection procedures
Among others: Joint injections (e.g. hip, sacroiliac joint, shoulder joint), muscle injections (e.g. piriformis blocks), sympathetic nerve blocks (sympathetic nervous system blocks, e.g. during the treatment of CRPS), trigeminal ganglion blocks for facial pain, ultrasound-guided interventions.
Along with the x-ray-guided technique, ultrasound-guided interventions can be beneficial for certain indications. Here, ultrasounds are used to visualise painful structures such as nerves, muscles or joints. These interventions are performed while the patient is under local anaesthetic. This allows for the needle or catheter to be placed correctly, and for the injection of the analgesic to be monitored at all times.
Compared to x-ray-guided interventions, ultrasound-guided techniques are mostly used for peripheral nerves that are not attached to the spine. Because of the lack of x-rays, the ultrasound-guided method is also safe for pregnant women.
An epiduroscopy is a modern, minimally invasive, diagnostic and therapeutic procedure which is particularly well suited to patients with adhesions in their epidural space, as these adhesions must often be monitored after back operations. In many cases, these adhesions can cause nerve root irritation, and with it, persistent pain. During an epiduroscopy, a special endoscope only a few millimetres in width and containing a built-in camera, and if necessary, some other medical tool (balloon or lavage catheter, instruments for undoing adhesions), is inserted into the epidural space via the so-called “sacral hiatus”, a bony opening near the base of the sacrum. This intervention is usually performed in an outpatient setting with a local anaesthetic and light sedation.
Neuromodulation is a procedure that can bring about changes in the nervous system without having to perform irreversible, structural interventions.
In general, neuromodulative procedures are divided into two groups:
- Neurostimulation, which uses electrical currents to alleviate pain in the nervous system
- Pump therapy, which introduces medication directly into the central nervous system
Neurostimulation has been used in pain medicine for many years to treat certain kinds of pain, especially so-called nerve pain. Neurostimulation is usually performed in the spinal canal near the spinal cord or on the nerve roots. In recent years, however, new procedures have been developed which allow for the technique to be applied to the nerve structures of the extremities (rare) or directly under the skin. The direct stimulation of the spinal cord is called SCS (spinal cord stimulation) therapy, while the stimulation of nerve roots is known as DRG (dorsal root ganglion) stimulation. When the small nerves directly under the skin are stimulated, this is referred to as subcutaneous field stimulation. The main function of neurostimulation is to interfere with the pain signals that are sent to the brain. Considering that neurostimulation can only be performed in the context of an operation (or two smaller operations), it is mainly used when other, less invasive procedures prove ineffective at alleviating a patient’s pain.
Implantable pump systems
Implantable pump systems are used to introduce medication (via a catheter) into the spinal fluid, and thus act directly upon the spinal cord. These systems can be used to treat chronic pain (less common), as well as spasticity (involuntary muscle twitching caused by various neurological disorders). As with neurostimulation, these pumps are only implanted after an initial test phase involving the use of an outward-facing catheter and an external pump to prove that this type of therapy can be effective. This test is usually conducted during inpatient hospitalisation. After being implanted, the pump requires regular refilling. This procedure is offered by various specialist centres throughout Switzerland.