Minimally Invasive Techniques in Pain Management

Epidurals were the first minimally invasive technique for the relief of lumbosacral pain. This spurred the development of the subspecialty of pain management in anesthesia, which has evolved and added many techniques to alleviate or reduce lumbosacral pain. Specialists including physiatrists, orthopedic surgeons, and neurosurgeons also perform these procedures. This chapter discusses the proven techniques used to relieve lumbosacral pain, and the clinical presentation of herniated discs, spinal stenosis, facet syndrome, and pain arising from the sacroiliac joint and coccyx. Pain may arise from one or all the structures in the lumbosacral spine, complicating treatment. The technique for injections or other proven pain-relieving methods are described. Newer techniques for the treatment of the painful disc are in the early stages of development and have not completely evolved. The therapeutic benefits have not been proven by randomized blinded studies. These techniques are discussed but not described in detail.