Interventions

During pain interventional procedures, which are always performed under imaging control using ultrasound and/or fluoroscopy (X-ray control), the smallest structures are targeted. Often, these are nerves that, among other functions, transmit pain impulses from the tissue to our central nervous system.

With a local anesthetic, diagnostic infiltrations can interrupt the pain impulse, allowing conclusions to be drawn about the pain trigger and cause. The effect is limited to the duration of the anesthetic’s action.

In therapeutic infiltrations with a steroid (cortisone preparation) and local anesthetic, the aim is to achieve local anti-inflammatory and decongestant effects that lead to long-term pain reduction. Neuromodulatory and neuroablative (nerve-destroying) procedures are also therapeutic, but in these, the pain-causing or pain-conducting structure is destroyed by heat, making it non-functional. These nerve-destroying procedures must, therefore, be used very specifically and only after precise diagnosis. If a diagnostic blockade is unsuccessful (no significant pain reduction during the test infiltration), there is no point in performing a nerve-destroying treatment. Neuroablative procedures cannot be used on all nerves because other important functions could be impaired.

 We offer the following Pain Management Interventions: The Following Pain Management Interventions Are Offered by Us

• Diagnostic and therapeutic, X-ray- or ultrasound-assisted interventions on the spine
• Local anesthetic infiltration in the area of the facet joints and the associated facet joint nerves
• Heat (radiofrequency) treatment 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 (e.g., for conservatively treated disc herniations with neurological symptoms)
• Diagnostic and therapeutic, ultrasound- or X-ray-assisted interventions on peripheral nerves
• Diagnostic nerve ultrasound examination of all peripheral nerves

Interventions (Examples)

• Knee pain: N. saphenus, N. infrapatellaris, Nn. geniculares
• Groin pain: N. ilioinguinalis, N. iliohypogastricus, N. genitofemoralis
• Thigh pain: N. cutaneus femoris lateralis
• Foot pain: N. suralis, N. peroneus, N. tibialis
• Headaches: Nn. occipitalis major et minor, N. temporalis, Nn. frontalis
• Shoulder pain: N. suprascapularis, N. axillaris
• Pelvic pain: N. pudendus
• Chest pain: Nn. intercostales

Diagnostic and Therapeutic Ultrasound- and/or X-ray-Assisted Interventions on the Autonomic Nervous System

• Stellate ganglion
• Ganglion impar
• Sympathetic trunk

Neuromodulatory Procedures

• Evaluation in a multidisciplinary board, test phase, and definitive implantation of electrical nerve stimulators in the spine area (spinal cord stimulation, dorsal root ganglion stimulation)
• Evaluation and definitive implantation of electrical nerve stimulators in peripheral nerves
• Evaluation in a multidisciplinary board, test phase, and definitive implantation of intrathecal medication pumps
• Diagnostic and therapeutic intravenous medication infusions
• Functional assessment of sensory nerves through quantitative sensory testing (QST) (in cooperation with our partner institute IISZ)
• Training, test phase, and evaluation of transcutaneous electrical nerve stimulation (TENS)
• Application of high-dose capsaicin patch (Qutenza)
• Pain management support for palliative care patients
• Consultative advice for inpatients with acute or chronic pain conditions
• Interdisciplinary board meetings with the respective treatment team
• Pain and spine board (already existing and  under the direction of Dr. Ludwigs at Spital Lachen)
• Peripheral nerve board (in planning with cooperation partners)
• Pelvic pain board (in planning with cooperation partners)
• Neuromodulation board (already existing in cooperation with Neurochirurgie USZ and IISZ)