Interventional modalities for refractory neuropathic pain
| Interventional modality | Description | Clinical efficacy | Complications | Limitations |
|---|---|---|---|---|
| Epidural injections [11–16] | Injection of corticosteroids directly into the epidural space | Differing recommendations and moderate quality evidence | Complications rare, severe complications observed only with particulate formulations | Effectiveness for treating painful radiculopathy is a topic of debate with varying recommendations; relief provided by epidural corticosteroid injections is often short-term |
| RFA [3, 5, 17, 18] | Use of radiofrequency current passed through an electrode targeted to a specific pain pathway to cause tissue destruction resulting in the modulation of pain sensation | Mixed evidence on generalizable effectiveness when compared to other modalities | Complications rare, potential nerve damage | Mixed evidence on the generalizable effectiveness of RFA for all patients |
| Sympathetic blocks [19–21] | Administration of medication through ultrasound or fluoroscopic guidance directly to a bundle of sympathetic nerves to disrupt the sympathetic nerve supply to specific target areas | Efficacy demonstrated, useful option for interventional treatment | Common injection complications, more significant complications dependent on location of targeted injection | Potential complications include bleeding, bruising, swelling, weakness, visceral injury, or infection; more severe complications vary depending on the location of the targeted injection |
| Neurostimulation techniques [22–24] | Categorized into peripheral and CNS modulation, as well as invasive and non-invasive types. Devices with electrodes are applied to the brain, spinal cord, or peripheral nerves | Effective in managing chronic neuropathic pain, particularly in cases of paraplegia and above-knee amputation | Complications rare, potential for infection or device malfunction | Mixed evidence for effectiveness for all patients |
| SCS [3, 7–9] | Stimulation applied to the dorsal columns within the epidural space to decrease pain transmission from the small nociceptive pain fibers in the dorsal horn | Exceptionally useful for patients with failed back surgery syndrome, also used for truncal PHN, drug-refractory painful diabetic neuropathy, and complex regional pain syndrome | Complications rare, potential for infection or device malfunction | Primarily used for specific conditions such as failed back surgery syndrome and certain neuropathic conditions; effectiveness varies among all patients |
| Targeted drug therapy [1, 9, 10] | Intrathecal delivery of pharmacologic agents directly to the site of action at the dorsal horn of the spinal cord | Effective for neuropathic pain, only morphine and ziconotide are applicable in intrathecal pain therapy | Complications rare, potential for infection or catheter migration | Limited options for intrathecal drug therapy; not all patients may be suitable candidates for intrathecal drug delivery; typically considered after other treatments have failed |
