Pain Management in Interventional Radiologyassets.cambridge.org/97805218/65920/frontmatter/9780521865920... · Pain Management in Interventional Radiology ... Interventional Radiologist

Pain Management in Interventional Radiology

rather than solely as proceduralists, understanding and treating pain is a vitalpart of daily practice. This book provides an overview of the multiple techni-ques used in the management of pain in interventional radiology suites. Topicsinclude techniques for the treatment and prevention of pain caused by inter-ventional procedures, as well as minimally invasive techniques used to treatpatients with chronic pain symptoms. Approximately half of the book is dedi-cated to the diagnosis and treatment of spinal pain; other chapters focus onintraprocedural and post-procedural pain management, embolization andablation techniques used to treat patients with uncontrollable pain, and alter-native treatments for pain relief. This book is a practical resource for anyonelooking to acquire skills in locoregional or systemic pain control and wishing toimprove the quality of life for patients undergoing procedures or suffering fromdisease-related pain.

Charles E. Ray, Jr., MD is Professor of Radiology, Co-Director of Research(Clinical), and Associate Residency Program Director at the University ofColorado Health Sciences Center, Aurora, Colorado.

As interventionalists become more involved with patients as care providers

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Cambridge University Press978-0-521-86592-0 - Pain Management in Interventional RadiologyCharles E. RayFrontmatterMore information

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To C. Eugene and Virginia L. Ray






Pain Management in

InterventionalRadiology

Charles E. Ray, Jr., MDProfessor of Radiology

Co-Director of Research (Clinical)University of Colorado Health Sciences Center

Aurora, Colorado






CAMBRIDGE UNIVERSITY PRESS

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� Cambridge University Press 2008

This publication is in copyright. Subject to statutory exceptionand to the provisions of relevant collective licensing agreements,no reproduction of any part may take place withoutthe written permission of Cambridge University Press.

First published 2008

Printed in the United States of America

A catalog record for this publication is available from the British Library.

Library of Congress Cataloging in Publication data

Pain management in interventional radiology / [edited by] Charles E. Ray Jr.p. ; cm.

Includes bibliographical references and index.ISBN 978-0-521-86592-0 (hardback)1. Interventional radiology. 2. Analgesia. I. Ray, Charles E.[DNLM: 1. Pain–therapy. 2. Pain–prevention & control. 3. Radiology, Interventional. 4. Spine–

physiopathology. WL 704 P146591 2008]RD33.55.P35 2008616#.0472–dc22 2007052022

ISBN 978-0-521-86592-0 hardback

Cambridge University Press has no responsibility for the persistenceor accuracy of URLs for external or third-party Internet Web sites referredto in this publication and does not guarantee that any content on such Web sitesis, or will remain, accurate or appropriate.






Contents

Contributors page viiPreface ixAcknowledgments xi

1 Pain Management in Interventional Radiology: An Introduction 1Jason R. Bauer and Charles E. Ray, Jr.

2 Clinical Evaluation of Low-Back Pain 8Anthony P. Dwyer, Curt Freudenberger, and Vikas V. Patel

P A R T I . L O C O R E G I O N A L P A I N C O N T R O L

3 Local Anesthetics 21Jan Namyslowski

4 Functional Lumbar Spine Anatomy: A Review 32Anthony P. Dwyer, Curt Freudenberger, Vikas V. Patel,Michael Fleisher, and Charles E. Ray, Jr.

5 Percutaneous Vertebroplasty 43Mitchell T. Smith and Charles E. Ray, Jr.

6 Kyphoplasty 58Frances D. Faro, Anthony P. Dwyer, and Vikas V. Patel

7 Epidural Steroid Injections 71Brian D. Petersen, Kirkland W. Davis, and James Choi

8 Selective Nerve Root Blocks 112Brian D. Petersen, Kirkland W. Davis, and James Choi

9 Discography 131Charles E. Ray, Jr., and Leo J. Rothbarth

10 Facet (Zygapophyseal) Joint Injections 151Nick Stence

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11 Articular Interventions in Pain Management: A General Approach 164Blaze Cook

12 Percutaneous Management of Visceral Pain 188Frank Morello

13 Embolization of Painful Neoplasms 199Jennifer R. Huddleston and Stephen P. Johnson

14 Image-Guided Ablation of Painful Osteolyses 217David T. Wang and Charles E. Ray, Jr.

15 Chronic Pelvic Pain in Women 232Derek L. West

P A R T I I . S Y S T E M I C P A I N C O N T R O L

16 Sedation and Analgesia Medications 241George Behrens, Hector Ferral, and Nilesh H. Patel

17 Guidelines for Sedation Administered by Nonanesthesiologists 260Iftikhar Ahmad

18 Pediatric Sedation for Radiological Imaging Studies andInterventions 268Keira P. Mason

19 Nontraditional Pain Management in Interventional Radiology 280Salomao Faintuch, Gloria Maria Martinez Salazar,Felipe Birchal Collares, and Elvira V. Lang

20 Postprocedural Pain Control 296Stan Zipser

Index 315

CONTENTS

vi






Contributors

Iftikhar Ahmad, MDAmerican Access CarePittsburgh, Pennsylvania

Jason R. Bauer, MD, RVTDirector, Interventional RadiologyClinic

ICON, Interventional ConsultantsLegacy Good Samaritan HospitalPortland, Oregon

George Behrens, MDDepartment of RadiologyRush University Medical CenterChicago, Illinois

James Choi, MDStaff RadiologistIowa RadiologyClive, Iowa

Felipe Birchal Collares, MDDepartment of RadiologyHarvard Medical SchoolBeth Israel Deaconess MedicalCenter

Boston, Massachusetts

Blaze Cook, MDDepartment of RadiologyUniversity of ColoradoHealth Sciences Center

Aurora, Colorado

Kirkland W. Davis, MDAssociate Professor of Radiology

University of Wisconsin School ofMedicine and Public Health

Madison, Wisconsin

Anthony P. Dwyer, MDDepartment of RadiologyDenver Health Medical CenterDenver, Colorado

Salomao Faintuch, MDInterventional RadiologistDepartment of RadiologyHarvard Medical SchoolBeth Israel Deaconess MedicalCenter

Boston, Massachusetts

Frances D. Faro, MDDepartment of OrthopaedicsDenver Health Medical CenterDenver, Colorado

Hector Ferral, MDProfessor of RadiologyRush University Medical CenterChicago, Illinois

Michael Fleisher, MDDepartment of RadiologyDenver Health Medical CenterDenver, Colorado

Curt Freudenberger, MDDepartment of Orthopedic SurgeryCedars-Sinai Medical CenterLos Angeles, California

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Jennifer R. Huddleston, MDDepartment of RadiologyUniversity of Wisconsin Medical CenterMadison, Wisconsin

Stephen P. Johnson, MDDepartment of RadiologyUniversity of Colorado HealthSciences Center

Aurora, Colorado

Elvira V. Lang, MDAssociate Professor of RadiologyHarvard Medical SchoolDirector NonpharmacologicAnalgesia Program

Beth Israel Deaconess Medical CenterBoston, Massachusetts

Keira P. Mason, MDAssociate Professor of Anesthesia(Radiology)

Harvard Medical SchoolDirector, Radiology Anesthesia andSedation

Children�s HospitalBoston, Massachusetts

Frank Morello, MDWest Houston Radiology AssociatesHouston, Texas

Jan Namyslowski, MDClinical Associate Professor ofRadiology

University of Illinois College ofMedicine at Peoria

Interventional RadiologistMethodist Medical Center of IllinoisPeoria, Illinois

Nilesh H. Patel, MD, FSIRMedical Director, Vascular andInterventional Program

Central DuPage HospitalWinfield, Illinois

Vikas V. Patel, MDAssistant Professor of OrthopaedicSurgery

University of Colorado HealthSciences Center

Chief Orthopaedic Spine SurgeryThe Spine Center

University of ColoradoAurora, Colorado

Brian D. Petersen, MDAssistant Professor ofRadiology and Orthopaedics

Director Musculoskeletal RadiologyUniversity of Colorado HealthSciences Center

Aurora, Colorado

Charles E. Ray, Jr., MDDepartment of RadiologyUniversity of Colorado HealthSciences Center

Aurora, Colorado

Leo J. Rothbarth, MDRadiology Specialists of Denver, PCDenver, Colorado

Gloria Maria Martinez Salazar, MDDepartment of RadiologyHarvard Medical SchoolBeth Israel Deaconess Medical CenterBoston, Massachusetts

Mitchell T. Smith, MDDepartment of RadiologyUniversity of Colorado HealthSciences Center

Aurora, Colorado

Nick Stence, MDDepartment of RadiologyUniversity of Colorado HealthSciences Center

Aurora, Colorado

David T. Wang, DODepartment of RadiologyUniversity of Colorado HealthSciences Center

Aurora, Colorado

Derek L. West, MDDepartment of RadiologyUniversity of Illinois at ChicagoMedical Center

Chicago, Illinois

Stan Zipser, MD, JDAttending RadiologistSanta Clara Valley Medical CenterSan Jose, California

viii

CONTRIBUTORS






Preface

Everyone feels pain. Everyone feels physical pain, to one degree or another.Pain, or simply the thought of being in pain, often changes our actions as noother physical sensation can. While often a necessary physical response to keepus out of harm’s way (touching the hot handle of a pot, for example), painbecomes its own entity when it is associated with an underlying disease process.

Why is pain associated with disease? From an evolutionary perspective, waspain necessary for some reason to let the individual know that something wasamiss (even though nothing could be done about it)? Was disease-associatedpain used for some other, perhaps subconscious, purpose? Perhaps understand-ing the ‘‘why’’ is not all that important in today’s world; after all, the bottomline is that pain simply hurts! And disease-associated pain can hurt most of all.We as health care providers should be able to do something about it –shouldn’t we?

From one perspective, medicine (traditional or ‘‘Western’’ medicine in par-ticular) has done relatively little to abate pain. Most of the major advances in paincontrol over the past 150 years have been in the field of pharmacology; generalanesthesia is the prime example of pain control. With the exception of medica-tions, however, little progress has been made inmanaging disease-associated painover the past few decades. More work – much more work – remains. Shouldn’tminimaliy invasive techniques spearhead this effort?

The goal of this book is simple. It is to provide the appropriate tools to theinterventional radiologist, anesthesiologist, surgeon, or whoever else is inter-ested in minimally invasive techniques to control pain before, during, or afterprocedures. Its intent is to provide an overview of multiple techniques used inpain management, to review the currently available literature regarding thesetechniques, and hopefully to act as a springboard to motivate practitioners andresearchers alike to develop the next better mousetrap to care for our patients inpain. It is my sincere hope that someone, somewhere, will have an improvedquality of life stemming from the reading of this book by their health careprovider.

Charles E. Ray, Jr., MDDenver, CO

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Acknowledgments

Many individuals are secondarily involved in the publication of a book.Unfortunately, those who are most affected are often those with the least inter-est in the project. It is only through the support of those that surround us thatan undertaking such as this is finished – or, for that matter, even begun. Mysincerest thanks (a small token if ever there was one) to Bob Allen, MD, and mycolleagues at Radiologic Specialists of Denver, Denver Health Medical Center,and the University of Colorado for providing whatever time and support theycould during the generation of this text. Thanks are also extended to Beth Barryat Cambridge University Press, who has guided me through this book as well asanother. I would also like to thank artist Stacy Erickson for her illustrationsaccompanying this book. The staff at the Society of Interventional Radiology,most notably Joy Gornal and Beverlee Galstan, were remarkably tolerant astheir tasks were put on hold in order to meet another deadline related to thisbook.

Finally and foremost, my thanks and love are extended to my wife, Kris, forher endless support and unequaled patience during this project.

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Pain Management in Interventional Radiologyassets.cambridge.org/97805218/65920/frontmatter/9780521865920... · Pain Management in Interventional Radiology ... Interventional Radiologist