Interventions

In pain intervention procedures, which are always performed under imaging guidance using ultrasound and/or an image intensifier (fluoroscopy/X-ray guidance), very small structures are selectively infiltrated. These are often nerves which, among other functions, transmit pain signals from the tissue to our central nervous system.

In diagnostic infiltrations, a local anesthetic can be used to interrupt the transmission of pain signals, allowing conclusions to be drawn about the source and cause of the pain. The effect is limited to the duration of action of the local anesthetic.

In therapeutic infiltrations using a steroid (cortisone preparation) and a local anesthetic, the aim is to achieve local decongestant and anti-inflammatory effects, which may lead to longer-term pain reduction. Neuromodulatory and neuroablative procedures are also therapeutic. However, in these procedures, the pain-causing or pain-conducting structure is treated with heat and ultimately rendered non-functional. These are nerve-ablating procedures. For this reason, they must be applied very precisely and only after thorough diagnostic assessment. If a diagnostic block is unsuccessful, meaning there is no relevant pain reduction after a test infiltration, it does not make sense to perform a nerve-ablating treatment. Neuroablative procedures also cannot be applied to all nerves, as this could otherwise impair other important functions.

The following pain medicine interventions are offered by us:

Diagnostic and therapeutic X-ray- or ultrasound-guided interventions on the spine:

• Local anesthetic infiltration in the area of the facet joints and the associated facet joint nerves
• Heat treatment using radiofrequency in the area of the facet joint nerves
• Steroid infiltrations in the area of the facet joints
• Local anesthetic and/or steroid infiltrations in the area of nerve roots, for example in conservatively treated disc herniations with neurological symptoms
• Diagnostic and therapeutic ultrasound- or X-ray-guided interventions in the area of peripheral nerves

  • Diagnostic nerve ultrasound examination of all peripheral nerves

  • Interventions, examples:

    • Knee pain: saphenous nerve, infrapatellar nerve, genicular nerves

    • Groin pain: ilioinguinal nerve, iliohypogastric nerve, genitofemoral nerve

    • Thigh pain: lateral femoral cutaneous nerve

    • Foot pain: sural nerve, peroneal nerve, tibial nerve

    • Headaches: greater and lesser occipital nerves, temporal nerve, frontal nerves

    • Shoulder pain: suprascapular nerve, axillary nerve

    • Pelvic pain: pudendal nerve

    • Chest pain: intercostal nerves
      Diagnostische und therapeutische, ultraschall- und/oder röntgenassistiert Interventionen im Bereich des autonomen Nervensystems

  • Ganglion impar 
  • Grenzstrang 
  • Ganglion stellatum 

• Neuromodulatory procedures

  • Evaluation in a multidisciplinary board, trial phase, and definitive implantation of electrical nerve stimulators in the area of the spine, such as spinal cord stimulation and dorsal root ganglion stimulation
  • Evaluation and definitive implantation of electrical nerve stimulators in the area of peripheral nerves
  • Evaluation in a multidisciplinary board, trial phase, and definitive implantation of intrathecal medication pumps
    
    
• Diagnostic and therapeutic intravenous medication infusions
• Functional assessment of sensory nerves using quantitative sensory testing (QST), in cooperation with our partner institute IISZ
• Training, trial phase, and evaluation of transcutaneous electrical nerve stimulation (TENS)
• Application of the high-concentration capsaicin patch (Qutenza)
• Pain medicine support for palliative pain patients
• Consultative advice regarding hospitalized patients with acute or chronic pain conditions
• Interdisciplinary board meetings with the respective treating specialist team

• • Pain and Spine Board, already existing under the leadership of Dr. Ludwigs at Spital Lachen

  • Peripheral Nerve Board, planned with cooperation partners

  • Pelvic Pain Board, planned with cooperation partners

  • Neuromodulation Board, already existing in cooperation with the Department of Neurosurgery at USZ and IISZ