Spinal cord stimulation involves managing pain with the help of stimulation of certain parts of the spinal cord with varying degrees of electrical energy without any drug being injected into the body. It is a mildly invasive procedure to place the pacemaker like hardware into the body with long lasting effects. Newer models of these instruments are coming up with longer battery lives and even ones with rechargeable batteries. Destructive procedures like cordotomy and DREZ lesioning of the past, though still practised are now increasingly being replaced with SCS.
Surgery involves cutting of tissue &/or bones to reach the targetted place whether through a big incision or an endoscope. On the contrary, in interventional pain management, the approach is not to cut but to use certain agents like radiofrequency, laser, cryo, ozone, electrical energy etc to relieve or modify (neuromodulation) pain. Besides interventions, a pain management consultant has a good knowledge of the pharmacology as well and is capable of managing pain and related disorders with drugs also.
Primarily, an Anesthesiologist is the best person to relieve pains, because of his understanding in pain pathways and his skill in performing various nerve and plexus blocks. Though all Anesthetists are capable of performing certain blocks, but for advanced interventional techniques, a further expertise in the subject is required that is achieved through further learning and education in this super specialty.
Pains due to any reason can be treated with interventions, starting from headache, neck and shoulder pain, sprains, back pain due to slipped disc, sciatica, joint pains, pains due to rheumatological disorders. Certain acute pain conditions e.g. due to fractures, injury, surgery, cellulitis etc are best manageable by correcting the underlying disorder. On the other hand certain pains of neuropathic nature like diabetic neuropathy, nerve injuries, nerve compression as in slipped disc or pains due to various cancers are difficult to manage with routine measures and need the services of an interventionalist.
What is different about pain management through interventions than with medicines? The various bodily pains vary in severity from mild to extremly excrutiating and increasingly unbearable. Majority of mild to moderate pains can be managed easily with drugs. For pains unresponsive to drugs, pain management interventions or surgery is required. Since interventions are minimally invasive procedures, they take a preference over surgery whenever possible. Secondly, these interventions involve the use of modern technology and do not involve any cutting or damage to the surrounding tissues.