1. Interventional Pain Management
Pain, Pain and Pain
Scott A. Burlison, M.D.
Interventional Pain Management
Azalea Orthopedics

2. My Pathway Born in Shreveport, Louisiana
Elementary through medical school in Louisiana
Residency – UTMB, Anesthesiology
Private practice anesthesiology – Tyler
Fellowship- UTMB, Anesthesiology, Pain Management
Private Practice – Azalea Orthopedics

3. Pain
An unpleasant sensory and emotional experience associated with actual or potential tissue damage, or described in terms of such damage
No one likes it
Can manifest in a lot of ways

4. Acute Pain vs Chronic Pain
Acute pain- normal sensation that alerts us to possible injury
Chronic pain – any pain lasting more than 12 weeks (3 months)

5. Acute Pain Office setting Emergency setting Surgical setting
Preoperative
Intraoperative
Postoperative

6. Chronic Pain Myriad of treatments Medical management
Psychological management
Physical/Occupational therapy
Massage
Interventional management
Advanced interventional management
Surgical management

7. Implantable Pain Therapies
Neurostimulation
Targeted Drug Delivery
Delivery of low-voltage electrical stimulation to the spinal cord to inhibit or mask the sensation of pain
Delivers precise doses of prescribed medication directly into the cerebrospinal fluid(CSF) to modulate the transmission of pain signals

8. Implantable Therapy Realistic expectations Sufficient pain relief
ADL’s improve
Increased ROM
Overall improvement in quality of life

9. Neurostimulation Indications
Failed Back Surgery Syndrome (FBSS)
Radicular pain syndrome
Post laminectomy pain
Multiple back surgeries
Degenerative Disk Disease/herniated disc refractory to conservative and surgical intervention
CRPS
Epidural Fibrosis/ Arachnoiditis
Ischemic leg pain
Angina

10. Neurostimulation Psychological evaluation Trial period 3-7 days
Successful trial defined as:
>50 % relief in pain/symptoms
ADL’s improved
Able to take less medications?
Life was better

12. Percutaneous vs Paddle

14. Neurostimulator Lead Placement

15. Lead Placement

16. Spinal Cord Stimulators
Medtronic
Nevro

17. Spinal Cord Stimulators

18. Intrathecal Drug Delivery
Psychological evaluation
Single shot vs catheter trial
Duramorph
Baclofen
Ziconotide
>50% pain/symptom relief

19. Targeted Drug Delivery Indications
Failed Back Surgery Syndrome
Degenerative Disc Disease
Spinal Stenosis
Radicular Leg pain
CRPS
Compression Fractures
Cancer Pain
Spasticity

20. Intrathecal Drug Therapy

21. Logistics Refill schedule -1 month, 3 month, 6 months Internal Support
Problem(s)

22. Intrathecal Therapy
Refill
Programming

23. Usually lower quadrant placement
Occasional back

24. Medtronic Synchromed II
Very common

26. Coders
Absolutely essential the entire way