1. Dr (Maj) Pankaj N Surange
MBBS, MD (Anesthesiology), FIPP (Hungary)
Interventional Pain and Spine Specialist
Secretary, World Institute of Pain, India Chapter
www.ipscindia.com

2. Interventional Pain management
Interventional Pain management
Interventions are Minimally Invasive, Non
Surgical and Target Specific procedures to
Diagnose and to treat Various painful conditions
It fills the gap between
pharmacologic management of
pain & more invasive
operative procedure

3. Important facts about pain management as the
Speciality
Recognised as a 34th speciality in USA: American
society of Interventional pain physician
In USA, The Department of Health and Human Services Centers for
Medicare and Medicaid Services issued a memo March 4, 2005, including
Interventional Pain Management specialists on the list of clinical
specialties to be included in carrier advisory committees.
Pain as fifth vital
sign
Pain relief a human right – WHO
(world health organization)
"Pain relief should be a human right, whether people are
suffering from cancer, HIV/AIDS or any other painful condition,“

4. Intenational Association for study of Pain-
1973
World Institute of Pain-1993
Fellowship -2001

5. Semmelweis University, Budapest(Hungary)
FIPP-2009

6. CASE 1
• 36 Years, Executive
• Back pain with radiation
to Left leg for 4 months.
• Lost his job.
• Progressively increasing and
association with paresthesia.

7. Case 1-Contained Disc Herniation

8. Management : Disc Herniation
Percutaneous Ozonucleolysis + Transforaminal L5 and S1
Needle is inserted into the centre
Under fluoroscopic Guidance of the Disc and ozone is Injected.
Correct level of the prolapsed . Pain relief starts usually within
disc is identified one week and ozone takes 3-4
weeks for its complete effect

9. Management : Disc Herniation
Percutaneous disc decompression
Minimally invasive procedure using small needle and probe to remove disc
material of prolapsed disc ,releasing pressure on nerves and relieving pain in
most of the patients of prolapsed/ bulging / slipped disc

10. Management :
Case 1 Percutaneous Disc Decompression
Rotating tip removes
small portion of disc
material.
Because only enough of
the disc is removed to
reduce pressure inside
the disc, the spine
remains stable.
Insertion site covered with bandage.
Recovery is fast as unlike surgical
decompression no bone or muscle is cut.
2-3 days of bed rest and may return to normal
activity within one week.

11. Management :
Case 1 Nucleotomy

12. Case 2
• 42 Yrs/ Male
• Back pain X 2 yrs
• No h/o radiation to legs
• Aggravating factors
• Sitting > 40 min
• Driving
• Forward bending

13. Case 2- Discogenic Pain

15. Discogenic Pain

16. Management ;Case 2
• Intradiscal Ozone
By inhibiting inflammatory nociceptors

17. Management :
Discogenic Pain
Intradiscal Electrotherapy (IDET)

18. Management :
Discogenic Pain
Biculoplasty-

20. Facet Arthropathy secondary
MRI
to Disc degeneration
• Disc bears 80% of weight
• Facet joints bears 20 % of weight
A change in the intervertebral disc produces
Change in the whole motion segment

21. Facet Arthropathy
• Low back pain- unilateral or bilateral
• Tenderness over facet joints
• Pain is deep, dull aching, difficult to
localize
• Referred to the buttocks, groin, hip, or
posterior and lateral thigh.
• Pain is more prominent in the morning
and with inactivity
• May aggravate on extension after forward
flexion

22. Management- Facet Arthropathy
Inflammatory Type Degenerative type

23. Intra-articular Steroid

24. RF Ablation Median Branch

25. Case 3
• 56 yrs /Female
• Severe radicular pain in Rt Leg
• H/o frequent back pains
• Sensory loss in L5 Distribution and
EHL- 4/5.
• Known case of Rheumatoid Arthritis,
Ucontrolled DM, CAD, Interstitial Lung
disease.

26. Intraspinal Synovial Cyst

27. Management :Case 3
• Percutaneous Transforaminal Cyst Aspiration

28. Case 4
• 70 Yrs male/ obese
• Back pain Rt > lt
• Radiation to rt thigh --- lat surf of rt
leg
• Tossing on chair
• 1st Investigation ordered –MRI LS
SPINE

29. MRI

30. Case 5
Physical Examination
Rt SI Joint Tenderness +++

31. Management- Case 4
S I Jnt Injection

32. Case 5
• 35 Yrs/Female
• Known case of CA Cervix
• Metastasis
• Sudden onset of severe pain
mid back
• No neurological deficit

33. Compression Fracture Vertebral body

34. Case 6
– 45 Yrs Male, only earning member
– Traumatic Fracture D12 Vertebra
– Totally bed ridden, Urinary catheter, Ryles
tube feed

35. Fracture D12 Vertebra

36. Vertebroplasty

37. Kyphoplasty

38. Case 6
• 55 yrs
• DM X 25 Yrs
• Progressively increasing stiffness
Lt Shoulder
• Movements Painful
• MRI –Joint capsule and Synovial
Thickening

39. PRF-Suprascapular Nerve

40. Case -7
• 38 yrs male
• Low back pain radiating to both legs more on
right side.
• He had history of disc prolapse of L4-5 & L5-S1
and has undergone surgery 2 times before
(laminectomy, discectomy & excision of scar).
• Pain is increasing day by day.
• Repeated investigations & visit to 16 consultants
for last 4 years has taken away all faith from any
form of medical treatment.
• MRI-Epidural Fibrosis

41. Failed Back Syndrome (FBSS)
• Epidural Adhenolysis

42. Resistant Case of FBSS

43. Post op Trigeminal Neuralgia
– Pt presented after 2 years
of Surgery
– No improvement after surgery
– It was idiopathic TGN
•

44. RF Ablation –Trigeminal Nerve

46. Interventional Pain Procedures
• Limitations
• Contraindications
• Complications
• Not Alternative to Surgery

47. Welcome to ICIPM 2012, AIIMS, New Delhi
www.icipm2012.com
Dr (Maj) Pankaj N Surange MD, FIPP
Organizing Secretary, ICIPM 2012
Secretary, World Institute of Pain, India Section

48. Thanks