Chronic pain is defined as ‘an unpleasant sensory and emotional experience associated with actual or potential tissues damage’. It is associated with the worst quality of life compared with other chronic diseases such as chronic lung or heart disease. It also results in depressed mood, loss of sleep, strained personal relationships and a constrained professional life.

Fortunately, nowadays there are various treatments available that, along with physical therapy and alternative medicine, help reduce pain. These include medication and interventional pain management techniques. Some of these treatments are briefly discussed below.

1. Facet Injections and radiofrequency

The facet joints are small joints on the back of the spine and are found in all levels from the low-back to the neck. Facet joint pain is usually due to arthritis or degeneration of the joints and is described as an ache that stays along the spine and is worsened with prolonged sitting, standing or driving.

Denervation means an ‘interruption of the pain-carrying nerves’, in this case the ones supplying the facet joints in our back. It is done using radiofrequency (RF) lesioning. RF current is used to heat up a small volume of nerve tissue interrupting pain signals from that specific area. This is a safe, proven method providing lasting relief.

2. Epidural

An epidural is most commonly used as a type of pain relief from sciatica in legs and arm pain due to nerve impingement. In this procedure a local anaesthetic mixed with steroids is injected into the space around the spinal nerves in the lower back.

3. Nerve Root Block

A Selective Nerve Root Block (SNRB) is a common injection of local anesthetic and steroid injected under X-ray guidance where the nerve exits the spinal column.

It is primarily used to diagnose the specific source of nerve root pain and for therapeutic relief of arm and leg pain. This pain is caused when the nerve root that exits out of the spinal cord, becomes compressed and inflamed.

4. Occipital Nerve Block

The greater occipital nerve is one of the most important nerves in transmitting touch, pain, or temperature sensations in the scalp to the brain and is frequently linked to migraines or chronic headaches that arise from the base of the neck.

Occipital nerve block is a minimally invasive therapeutic procedure used to treat pain conditions like the occipital neuralgia, cluster headaches, migraines etc.

It is performed through injection of steroids and a local anesthetic into the base of the skull, where the occipital nerves are located. This stops the flow of information, especially pain signals, from these nerves, leading to a decrease in chronic headaches. Occipital nerve blocks can also be used to reduce swelling and inflammation in the back of the head.

5. Suprascapular Nerve Block

The suprascapular nerve is a mixed motor and sensory peripheral nerve that supplies motor innervation to shoulder muscles and sends sensory branches to multiple places in the shoulder region.

Shoulder pain is a frequent complaint among elderly patients, which leads to a great functional disability and decrease in their quality of life. Suprascapular nerve block (SSNB) is a safe and effective method to treat chronic pain and disability that affect the shoulder from rheumatoid and degenerative arthritis. It improves pain, disability, and range of movement at the shoulder.

6. Sphenopalatine Ganglion Block

The Sphenopalatine Ganglion (SPG) is a group of nerve cells that is linked to the trigeminal nerve, the main nerve involved in headache. The SPG, located behind the nose, carries information about sensation, including pain, and also plays a role in autonomic functions, such as tearing and nasal congestion.

The Sphenopalatine Ganglion Block is an injection of a numbing agent through the nostrils (one or both) or the cheek with either a needle or a simple applicator. The numbing agent works on the ganglion area to provide pain relief for multiple head and facial pain conditions like acute migraine headaches, cluster headache, trigeminal neuralgia, etc.

7. Stellate Ganglion Block

A Stellate Ganglion Block is an injection of local anesthetic in the nerve tissue of the neck. These nerves are a part of the sympathetic nervous system, located on either side of the voice box, in the neck.

It blocks the sympathetic nerves that go to the arms, and, to some degree, the ones that go to the face. This may in turn reduce pain and swelling in the upper extremity and improve mobility. It is done as a part of the treatment of Reflex Sympathetic Dystrophy (RSD), Sympathetic Maintained Pain, Complex Regional Pain Syndrome (CRPS) and Herpes Zoster (shingles) involving an arm or the head and face.

8. Botox

Botox injection around the head has now been approved by NICE for Chronic Migraine.

9. Splanchnic Nerve Block

The splanchnic nerves are located on both sides of our spine. They carry pain information to the brain from organs in the abdomen. Blocking these nerves can help one stop feeling chronic abdominal pain.

A Splanchnic Nerve Block is a minimally invasive treatment approach for individuals suffering from persistent abdominal pain that does not require surgery. This procedure effectively relieves or reduces pain caused by inflamed nerves in patients who have pancreatitis, pancreatic cancer, and additional conditions that affect the gall bladder, stomach, kidneys, liver, pancreas, and the small intestines.

10. Lumbar Sympathetic Block

A Lumbar Sympathetic Block is an injection of local anesthetic into or around the sympathetic nerves, located on the either side of spine, in the lower back.
It is performed to block the sympathetic nerves that go to the leg on the same side as the injection. It helps relieve pain from CRPS affecting the legs.

Lumbar Sympathetic block is done as a part of the treatment of Reflex Sympathetic Dystrophy (RSD), Sympathetic Maintained Pain, Complex Regional Pain Syndrome and Herpes Zoster (shingles) involving the legs. Certain patients with neuropathy or peripheral vascular disease may also benefit from lumbar sympathetic blocks.

11. Lumbar Plexus Block

Lumbar plexus is an advanced nerve block technique. It is also known as Psoas Compartment Block. Lumbar Plexus consists of a group of six nerves that supply the lower abdomen and the upper leg.

It is used for post-operative analgesia for major orthopedic surgeries of the hip, femur and the knee. It is extremely useful in hip pain in difficult cases otherwise not fit for surgery.

12. Ilioinguinal Block

Ilioinguinal nerve provides sensory innervation to the skin of the lower abdominal wall in addition to the upper hip and upper thigh. The ilioinguinal nerve travels down from the lumbar spine, around the pelvis, and into the groin and pubic areas. This nerve can be damaged by surgery or scar tissue following hernia repair causing persistent pain.

Ilioinguinal Nerve Block is used as a diagnostic, prognostic, and therapeutic maneuver in the evaluation and treatment of groin and genital pain. It also provides intraoperative and postoperative analgesia for inguinal hernia repair, Orchidopexy, Hydrocoele repair, Varicocoele surgery.

13. Genitofemoral Nerve Block

The Genitofemoral nerves reach the areas of the lower abdomen, groin, scrotum, labia and the inner thighs. They may be injured by trauma, or become trapped between muscle and scar tissue, resulting in chronic (long lasting) groin pain.

The Genitofemoral Nerve Block is used to evaluate and manage groin pain by blocking their pain signals.

14. Ganglion Impar Block

The ganglion impar is a bunch of nerves located in front of the coccyx (tail bone). A Ganglion Impar Block is a procedure used to evaluate and treat anorectal pain (anus and rectum), perineal pain (space around the genitals) and the genital pain by blocking nerve impulses. The pain is often experienced as a vague or widely-distributed burning or discomfort in the above areas, which is controlled by the ganglion impar.

15. Sacroiliac Joint Injection and Radiofrequency

The sacroiliac joint (SIJ) is formed where the pelvic bones join to the base of spine, or sacrum. This joint can be a source of pain like any other joint, and it may cause hip, low-back or buttock pain. Sacroiliac joint dysfunction may also be associated with radiation of pain into the groin and/or back of the thigh.

A sacroiliac joint injection involves the injection of local anaesthetic and steroid into the sacroiliac joint for pain resolution. Radiofrequency can be used in cases where nerve blocks are successful, but the duration of pain relief is too short. Radiofrequency can provide pain relief for longer periods.

16. Hip and Knee Radiofrequency

Hip and knee pain are common problems. While there are various causes of knee and hip pain, the most common is simply degeneration as we grow older.

Radiofrequency ablation is a tool used to address that pain for patients, outside of steroid-based injections or surgical interventions. X-rays are used to locate the affected nerves which are then numbed and deactivated by heating them. The process prevents pain signals from being sent to the brain, thus reducing discomfort.