Interventional techniques in the management of chronic pain: Part 2.0.

The practice guidelines for interventional techniques in the management of chronic pain are systematically developed statements to assist physician and patient decisions about appropriate health care related to chronic pain. These guidelines are professionally derived recommendations for practices in the diagnosis and treatment of chronic or persistent pain. They were developed utilizing a combination of evidence and consensus based techniques, to increase patient access to treatment, improve outcomes and appropriateness of care, and optimize cost-effectiveness. The guidelines include a discussion of their purpose, rationale, and importance, including the patient population served, the methodology and the pathophysiologic basis for intervention. Various interventional techniques will be discussed addressing the rationale for their use in chronic pain with analysis of the outcomes data and cost effectiveness. These guidelines do not constitute inflexible treatment recommendations. It is expected that a provider will establish a plan of care on a case-by-case basis, taking into account an individual patient's medical condition, personal needs, and preferences, and the physician's experience. Based on an individual patient's needs, treatment different from that outlined here could be warranted.

Headache management in an interventional pain practice.

More than 20 million people in the United States suffer from severe headaches. Most have been diagnosed as "migraines," which have been assumed to be an intracranial process. Recognition of the extracranial sources of headaches (such as supraorbital neuralgia, infraorbital neuralgia, auriculotemporal neuralgia, facial neuralgia, posterior auricular neuralgia, occipital neuralgia, cervical facet pathology, masseter spasm, sternocleidomastoid muscle spasm, trapezius spasm, and interspinous ligament pathology) has led to an expansion of the treatment options available for practitioners skilled in interventional pain procedures. However, unless the clinical presentation is recognized, treatment cannot be offered. Clinical presentation, diagnostic injections, differential diagnosis, and advanced neurolytic techniques are discussed in this article.