Pain Management

What is Interventional Pain Management?

Pain management is a specialty of many different kinds of physicians including surgeons, radiologists, orthopedists, psychiatrists, physiatrists, chiropractors, acupuncturists, neurologists, anesthesiologists, and general practitioners. Interventional pain physicians are experts at diagnosing and treating acute or chronic pain conditions with precision-guided injections or minimally invasive therapies.

Acute pain is usually severe and short-lived that is often a signal of body-related injury or trauma. Without careful management, acute causes of pain can develop into chronic pain conditions. Chronic pain can range from mild to severe and is often the result of a disease that may require ongoing treatment to manage your symptoms in combination with a healthy lifestyle and exercise regimen.  

Dr. Huang-Lionnet at Greenwich Health is a double board-certified, interventional pain management expert in the processes that cause pain and utilizes cutting-edge, evidence-based treatments for all kinds of pain etiologies. Her team at Greenwich Health prioritizes patient care above all else and incorporates a multi-disciplinary, non-opioid based approach to overcoming your symptoms.

There’s far more to managing pain than prescribing pain medication, which only blocks the pain signals rather than treating the underlying cause and can further complicate your overall health with the development of tolerance and dependency.

What Conditions can Interventional Medicine Treat?

At Greenwich Health, Dr. Huang-Lionnet and her team provide image-guided interventional therapies for acute, sub-acute, or chronic pain conditions related to degenerative spinal discs, joints, muscles, tendons, or ligaments.

Interventional pain management has applications in all areas of pain control, but one of the most common reasons for seeing an interventional pain specialist is for musculoskeletal disorders. Degenerative conditions such as rheumatoid arthritis, degenerative disc disease, and osteoarthritis are frequent causes of chronic pain.  

The interventional treatments offered at Greenwich Health have been shown to potentially benefit a broad range of conditions, including:

• Pain in your joints (e.g., shoulder, hips, knees, wrist, ankle, and elbows)
• Pain in your neck and back
• Osteoarthritis, rheumatoid arthritis, and bursitis
• Post-Laminectomy Syndrome or Failed Neck or Back Surgery syndrome, Post-Surgical Pain, Nerve Entrapment Pain
• Abdominal pain, pelvic pain, coccydynia
• Complex Regional Pain Syndrome (Type 1-Reflex Sympathetic Dystrophy and Type 2-Causalgia)
• Degenerative Disc Disease, bulging discs, or herniations
• Facet joint pain or spondylosis
• Fibromyalgia, whiplash, myofascial pain (muscular)
• Headaches – including general and migraines, occipital neuralgia (scalp/head pain)
• Neuralgia, including carpal tunnel syndrome, intercostal (rib pain), inguinal, occipital, trigeminal, pudendal, peripheral neuropathy (diabetic nerve pain), phantom limb pain, post-herpetic neuralgia, and post-surgical
• Neurogenic claudication, radiculopathy, sciatica (“pinched nerve”)
• Sacroiliac joint dysfunction and pain
• Spinal stenosis, vertebral compression fractures
• Cancer pain (pancreatic, colorectal, lung, breast, bone, pelvic/GU)
• Peripheral vascular disease, venous insufficiency

What Types of Interventional Medicine Treatments are Available?

Symptoms of acute or chronic pain can have a tremendous impact on quality of life. Treatment of pain can be complex and requires a detailed understanding of your history, complete musculoskeletal evaluation, and review of pertinent imaging.

The philosophy at Greenwich Health involves providing high-quality, tailored care while bringing evidence-based and cutting-edge treatments to patients and providing resources in a multi-disciplinary approach to improve overall physical, mental, and emotional wellness.

Interventional Pain Procedures and Treatments

Interventional treatments often include a diagnostic procedure to confirm the etiology or pathology of the pain, by utilizing a local anesthetic to reduce the pain or entirely numb the affected area. Treatments for therapeutic purposes may utilize steroids to reduce inflammation and provide longer-term effect and a form of nerve denervation as appropriate by radiofrequency (thermal heat), neurolysis (chemical), or cryotherapy (cold). Both treatments may be used in conjunction with each other.

Interventional treatments are helpful when conservative treatments are not sufficient in allowing proper physical therapy and exercise. There are a variety of different interventional pain procedures and treatment options offered, including:

• Epidural steroid injections - Cervical, Thoracic, Lumbar
• Radiofrequency neurotomy - Cervical, Thoracic, Lumbar
• Selective nerve root block - Thoracic, Lumbar
• Facet joint injections - Cervical, Thoracic, Lumbar
• Diagnostic medial branch block injections - Cervical, Thoracic, Lumbar
• Joint injections for knee, hip, sacroiliac joint, and shoulder
• Caudal or Interlaminar epidural steroid injections - Cervical, Thoracic, Lumbar
• Transforaminal epidural steroid injections - Thoracic, Lumbar
• Sympathetic Blocks (Stellate Ganglion, Celiac, Superior Hypogastric Plexus, Ganglion Impar) for Chronic Regional Pain Syndrome (CRPS)
• Musculoskeletal, joint and soft tissue injections using ultrasound guidance
• Peripheral nerve blocks (e.g. Genicular, Occipital, Ilioinguinal, Iliohypogastric, Genitofemoral, Pudendal, among others)
• Intravenous infusion therapy

Regenerative Medicine

Regenerative medicine is an exciting development in medicine that is showing effectiveness for certain degenerative or soft tissue injury conditions and great promise for potential expanded treatment indications.  When your body incurs damage as a result of injury or disease, your immune system acts to heal the damage and prevent infection. Growth factors and other cells in your blood flood into the damaged tissues and start the repair process in what’s usually an effective and efficient process.  The theory behind regenerative medicine is that by stimulating the body’s natural healing abilities, it’s possible to repair damaged tissue and generate healthy new tissue in patients with soft tissue injuries and certain degenerative conditions.

There are several types of regenerative medicine treatments available, including platelet-rich plasma (PRP) therapy, and Dr. Huang-Lionnet at Greenwich Health has tested several of the technologies currently available on the market to ensure the highest quality and standards are achieved.  Our team at Greenwich Health also utilizes the latest ultrasound-based imaging guidance to target the delivery of such treatments to optimize your likelihood of a positive response to these advanced therapies.

Neuromodulation and Minimally Invasive Implantable Technologies

Neuromodulation therapies improve lives and provide an alternative to long-term medication therapy for symptomatic relief of chronic conditions.  Spinal cord stimulation (SCS), a form of neuromodulation, is a proven, minimally invasive, effective treatment option for a variety of chronic pain indications that may obviate the need for medications or invasive surgery.  SCS therapy involves the application of micro-currents of electricity to specific target regions of the spinal cord, altering the perception of pain. Peripheral nerve stimulation (PNS) has been used for the treatment of a variety of neuropathic pain conditions, including occipital nerve stimulation, vagus nerve stimulation, sacral nerve stimulation, peripheral field stimulation, among others.  

Neuromodulation technologies also include intrathecal drug delivery systems that continuously deliver pharmaceutical agents directly to the source of the condition, with desired targets in the spinal cord or brain.  This method of medication delivery directly into the central nervous system lowers the effective dosage and decreases or avoids most side effects associated with more systemic medical management approaches that can lead to long-term tolerance development, addiction, and toxicity.

Several studies showing the early use of neuromodulation technologies is also more cost-effective at controlling certain conditions, including, cancer-related pain, neuropathic pain, chronic pain, and spasticity.  Before considering surgery, Dr. Huang-Lionnet of Greenwich Health uses the most appropriate, conservative forms of interventional pain and neuromodulation-based treatments where they may be effective. Such therapies include:   

• Spinal cord stimulation (SCS)
• High Frequency (HF10) SCS
• Burst SCS
• High Density (HD) SCS
• ECAP - Closed Loop SCS
• Dorsal root ganglion (DRG) stimulation
• Peripheral nerve stimulation (PNS)
• Intrathecal drug delivery system (IDDS)

The team at Greenwich Health also work with our referral network of leading, highly trained neurosurgeons and orthopedic surgeons, when potential surgery may be indicated.  To find out more about these and other treatments available, call Greenwich Health today, or book an appointment online.