Evolution of interventional pain management

Chronic pain is a complex and multidimensional problem. It has been provided with multiple definitions as pain persisting for 6 months after an injury and beyond the usual course of an acute disease or a reasonable time for a comparable injury to heal that is associated with chronic pathologic processes that cause continuous or intermittent pain for months or years, chronic pain may continue in the presence or absence of demonstrable pathologies, which may not be amenable to routine pain control methods, and with healing sometimes never occurring. Interventional pain management started with the origins of neural blockade and regional anesthesia in 1884. Since then, regional anesthesia and interventional techniques have evolved by leaps and bounds. Specifically, epidural injections were started in 1901 with caudal epidurals, and subsequently, other modalities were developed. One of the major developments in interventional techniques was the development of diagnostic blockade, followed by ablation techniques. Subsequently, numerous neuromodulation techniques have been developed. Interventional pain management has been defined as the discipline of medicine devoted to the diagnosis and treatment of pain-related disorders, principally with the application of interventional techniques in managing subacute, chronic, persistent, and intractable pain, independently or in conjunction with other modalities of treatment by the National Uniform Claim Committee (NUCC). Similarly, the Medicare Payment Advisory Commission (MedPAC) has defined interventional techniques as minimally invasive procedures including percutaneous precision needle placement, with placement of drugs in targeted areas or ablation of targeted nerves, and some surgical techniques such as laser or endoscopic discectomy, intrathecal infusion pumps, and spinal cord stimulators, for the diagnosis and management of chronic, persistent, or intractable pain. This chapter describes the evolution of interventional pain management, the present status of utilization of interventional techniques, and its evolving role into the future.