1 Interventional Pain ManagementPain, Pain and Pain Scott A. Burlison, M.D. Interventional Pain Management Azalea Orthopedics

2 My Pathway Born in Shreveport, LouisianaElementary through medical school in Louisiana Residency – UTMB, Anesthesiology Private practice anesthesiology – Tyler Fellowship- UTMB, Anesthesiology, Pain Management Private Practice – Azalea Orthopedics

3 Pain An unpleasant sensory and emotional experience associated with actual or potential tissue damage, or described in terms of such damage No one likes it Can manifest in a lot of ways

4 Acute Pain vs Chronic PainAcute pain- normal sensation that alerts us to possible injury Chronic pain – any pain lasting more than 12 weeks (3 months)

5 Acute Pain Office setting Emergency setting Surgical settingPreoperative Intraoperative Postoperative

6 Chronic Pain Myriad of treatments Medical managementPsychological management Physical/Occupational therapy Massage Interventional management Advanced interventional management Surgical management

7 Implantable Pain TherapiesNeurostimulation Targeted Drug Delivery Delivery of low-voltage electrical stimulation to the spinal cord to inhibit or mask the sensation of pain Delivers precise doses of prescribed medication directly into the cerebrospinal fluid(CSF) to modulate the transmission of pain signals

8 Implantable Therapy Realistic expectations Sufficient pain reliefADL’s improve Increased ROM Overall improvement in quality of life

9 Neurostimulation IndicationsFailed Back Surgery Syndrome (FBSS) Radicular pain syndrome Post laminectomy pain Multiple back surgeries Degenerative Disk Disease/herniated disc refractory to conservative and surgical intervention CRPS Epidural Fibrosis/ Arachnoiditis Ischemic leg pain Angina

10 Neurostimulation Psychological evaluation Trial period 3-7 daysSuccessful trial defined as: >50 % relief in pain/symptoms ADL’s improved Able to take less medications? Life was better

12 Percutaneous vs Paddle

14 Neurostimulator Lead Placement

15 Lead Placement

16 Spinal Cord StimulatorsMedtronic Nevro

17 Spinal Cord Stimulators

18 Intrathecal Drug DeliveryPsychological evaluation Single shot vs catheter trial Duramorph Baclofen Ziconotide >50% pain/symptom relief

19 Targeted Drug Delivery IndicationsFailed Back Surgery Syndrome Degenerative Disc Disease Spinal Stenosis Radicular Leg pain CRPS Compression Fractures Cancer Pain Spasticity

20 Intrathecal Drug Therapy

21 Logistics Refill schedule -1 month, 3 month, 6 months Internal SupportProblem(s)

23 Usually lower quadrant placementOccasional back

24 Medtronic Synchromed IIVery common

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26 Coders Absolutely essential the entire way