Understanding the complementary role of interventional approaches in the treatment of chronic neuropathic pain is essential to optimizing analgesic benefit. Only a minority of patients experience both a significant reduction in pain intensity with tolerable side effects from drug therapy and behavioral approaches alone. Targeting the localized site of altered nociceptive processing along the neuraxis is a longstanding strategy adapted from the acute pain context. The myriad techniques range from reversible ion channel blockade of a peripheral nerve with a local anesthetic to continuous modulation of spinal cord signaling with electrical stimulation. The three principal domains of interventional techniques are: (1) ablation, (2) augmentation, and (3) anatomic modification. The risks and benefits must be assessed in both a condition-specific and technology-specific fashion. This chapter will also consider the improvement in therapeutic index potentially offered by neuraxial delivery of drugs through the intrathecal, epidural, and perineural routes of administration.
Relationship Disclosure: Dr Markman has received personal compensation for serving on the advisory board of Johnson & Johnson. Dr Markman has received research support from Endo Pharmaceuticals and Pfizer Inc.
Mr Hanson has nothing to disclose.
Unlabeled Use of Products/Investigational Use Disclosure: Dr Markman and Mr Hanson discuss the unlabeled use of many procedures in his chapter.