Expert Insights: Pain Management in IR

Take a deep dive into advanced interventional pain management.

Course begins: August 19, 2024

Registration deadline: July 29, 2024

Course length: Self-paced, 7 weeks

Course Coordinators: J. David Prologo, M.D., FSIR, Shantanu Warhadpande, M.D. and John Smirniotopoulos, M.D. 

This course is designed to provide interventional radiologists with knowledge and skills in a group of procedures to treat patients with pain. In concert with growing demand, the availability and evolution of these procedures have rapidly expanded in the last decade.

This comprehensive 7-week course includes a blend of lectures, case-based learning modules, technique descriptions, and practice-building tips.

Course objectives

  • Logically organize and describe the rapidly expanding number of available procedures to treat patients with pain in interventional radiology.

  • Provide context and practice-building guidance for interventional radiologists interested in meeting the growing demand for advanced interventional pain procedures, including associated clinical care.

  • Provide selection criteria, efficacy evidence, and technique descriptions of procedures performed in interventional radiology for the management of patients with pain.

Curriculum


Week 1: Spine Injections and Augmentations -

Epidurals (transforaminal, midline, cervical, lumbar, CT, fluoro) Plexus injections, synovial cysts, intercostal nerves, facet injections, vertebroplasty, kyphoplasty, implantable augmentation devices.

Faculty: John Smirniotopoulos, M.D. ; Charles Gilliland, MD, FSIR 

Learning objectives:

  • Understand the importance and utility of a dermatomal map and be able to isolate the patient’s affected culprit dermatome(s) using physical exam and a thorough pain history such that interlaminar ESI, transforaminal ESI, facet injections, synovial cyst interventions, and more may be used to specifically manage pain generators.  

  • Discuss the indications, technique, evidence, evolution, and application of spinal augmentation techniques.

  • Understand the relevant anatomy, technique, and tools required to perform the variety of blocks in and around the spine.

Week 2: Spine ablations

BVNA, Medial Branch, Pulsed RF

Faculty: Junjian Huang, M.D.

Learning objectives:

  • Understand indication and technique for medial branch block and ablation.

  • Understand indication and technique for basivertebral nerve ablation.

  • Discuss differences between standard, cooled, and pulsed RF.

Week 3: Tumor ablations - spine, non-spine

Faculty: Alan Alper Sag, M.D. 

Learning objectives:

  • Discuss indications, tools, and procedure for vertebral body malignancy.

  • Discuss indications, tools, and procedure for extra-spinous malignancy.

  • Briefly discuss practice building with oncology, orthopedics, and palliative care to grow this field.

Week 4: Nerve interventions

Neoplastic, Non-neoplastic (knees, hips, shoulders, cryo, alcohol via cross sectional guidance)

Faculty: Felix Gonzalez, M.D.; J. David Prologo, MD, FSIR

Learning objectives:

  • Discuss indications and procedure steps for genicular nerve block/ablation, hip nerve block/ablation, sacroiliac joint nerve block/ablation, shoulder nerve block/ablation.

  • Discuss nerve ablations and neurolysis for pudendal, intercostal, mixed nerves as well as celiac/splanchnic plexus, superior hypogastric plexus, ganglion impar in the setting of cancer.

  • Explore the mechanisms of effect of neurolytic options (cryo, alcohol, heat), their pros and cons, applications, and outcomes – including potential neuroregeneration

Week 5: Spine implantables - stimulators and pumps

Faculty: J. Dana Dunleavy, M.D.; George Zlotchenko, M.D. 

Learning objectives:

  • List the options for spinal implantables (stimulators and intrathecal pumps). Understand the indications and work-up of patients who may benefit from them.

  • Understand technique for placement of a spinal cord stimulator and the relevant follow-up.

  • Understand technique for placement of a intrathecal pump and the relevant follow-up.

Week 6: Biologics and embotherapy

Faculty: Osman Ahmed, M.D.

Learning objectives:

  • List the different injectable biologic agents (platelet-rich plasma, bone marrow aspirate concentrate, stem cells, amniotic membrane-based products, etc), and their applicable targets/disease states.

  • Explore beyond our borders how biologics are being used and marketed through famous athletes and/or celebrities and potential evidence-based applications for the interventional radiologist.

  • Identify the disease states (and the relevant clinical work-up), embolization targets, and procedural techniques for MSK embolotherapy.

Week 7: Practice building

Faculty: Shantanu Warhadpande, M.D.

Learning objectives:

  • Describe the opportunities for interventional radiologists to enter the pain management space.

  • Delineate techniques for building referral patterns to interventional radiology for the management of pain.

  • Provide mitigation strategies to manage competition, address demand, and establish kinetic longitudinal care models for an advanced interventional pain practice.