Promising new research is examining the effectiveness of these and other techniques in patients with pain from more common conditions, such as chronic back pain or osteoarthritis (OA).
Interventional radiology experts say IR didn’t play a significant role in the initial opioid crisis because the nature of the specialty means IRs don’t tend to write prescriptions for chronic pain. However, IRs can now play a critical role in fighting both the opioid epidemic and the pain crisis. In 2017, the U.S. Department of Health and Human Services (HHS) launched a five-point opioid strategy that includes better addiction services and research, as well as better pain management. The federal government has several ongoing initiatives examining enhanced pain management. IR pain treatment procedures could be an important component of the HHS plan.
“The application of the interventional radiology skill sets to pain has created a new reservoir for alternatives to opioids,” says J. David Prologo, MD, associate professor at Emory University School of Medicine and an interventional radiologist at Emory University Hospital in Atlanta. “There are brand-new options that didn’t exist 10 years ago to treat patients with pain.”
Even when opioids work to relieve sufferers’ pain, tolerance can become a problem. “We hear a lot about the addiction, but we have to take a step back and talk about the tolerance,” says Theresa Caridi, MD, assistant professor in the division of vascular and interventional radiology at MedStar Georgetown University Hospital in Washington. “Sometimes patients have a disease or injury that needs chronic pain relief. The problem is they need more and more opioids to get the same relief they were getting initially.”
And opioids come with unwelcome side effects, including sedation and
constipation, which diminishes quality of life. “Constipation sounds minor, but you take away one pain and you give them another discomfort,” Dr. Caridi says.
Pain solutions Even when Johnson was taking painkillers, they didn’t eliminate his pain. He needed a walker or cane to get around. His wife did all the driving. He quit his church choir because he could not stand for long periods of time. At first, he continued to work. But after about three years, his wife convinced him to quit the job he loved as an assistant principal at Rome High School. Then, one day, at a routine cancer checkup, a physician’s assistant they hadn’t met before recommended they meet with Dr. Prologo after hearing about Johnson’s pain.
After evaluating Johnson’s case, Dr. Prologo determined he was a candidate for treatment. To reduce Johnson’s pain, Dr. Prologo maneuvered around the four rods in his patient’s back to stabilize the old fractures with a newer technique called a percutaneous vertebral radiofrequency ablation and stabilization. Then he performed an intercostal nerve cryoablation.
“Historically these patients didn’t have a lot of options,” Dr. Prologo says. “Most of them are not candidates for neurosurgery, so they come to the ER in intractable pain.” They might be given painkillers and/or radiation to try to stop the pain, but that doesn’t address the underlying fractures, and, in Johnson’s case, the additional nerve damage.
But an IR can ablate cancer cells and then use vertebroplasty and kyphoplasty techniques to cement the fractures together (see sidebar). “The patient can have pain relief the same day,” Dr. Prologo said.
These pain therapies started with ablation, as IRs used the technique to treat liver and kidney cancer. Physicians discovered that ablation procedures also reduced patients’ pain so IRs started using the technique specifically to treat pain and improve quality of life.
IRs now use a wide variety of techniques that can reduce or eliminate pain, such as nerve blocks, ablation and
Spread the word Interventional radiology is in a unique position to potentially help millions of people in the United States suffering from chronic pain. But most people don’t know what IR can offer. Here are a few ways you can help increase awareness:
1. Build relationships with referring doctors, especially oncologists and pain management specialists. This can include organic conversations, hosting educational seminars and partnering on research projects. Assure colleagues that you want to partner to help their patients, not take over their care entirely.
2. Meet with hospital administrators. IR procedures are generally safer than more invasive surgeries and have shorter recovery times that allow patients to return to their normal lives faster. Talk to hospital leaders about the cost savings your specialty brings, while minimizing risks to patients and shortening hospital stays.
3. Reach out to local media. Local television news shows often have health segments and/or invite special guests for Q&As. Create a bulleted list of easy-to-understand talking points about how people in your community can find potential solutions to their pain.
Look for resources to help you build alliances with referring physicians as SIR launches the Vision to Heal, Together national communications campaign.
embolization. Promising new research is examining the effectiveness of these and other techniques in patients with pain from more common conditions, such as chronic back pain or osteoarthritis (OA).
“One area of interest for a lot of people is the potential treatment of arthritic pain through the use of embolization and/or ablative therapy,” says Alexander Kim, MD, division chief of interventional radiology and an associate professor of radiology at MedStar Georgetown University Hospital. “There are more and more areas in terms of pain that are being looked at that could potentially be treated by interventional radiologists.”
In 2018, results from the first U.S. clinical trial on geniculate artery embolization (GAE) showed that GAE reduced knee pain caused by osteoarthritis. The prospective, multicenter clinical trial evaluated 13 patients with severe OA pain. One
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