What interventional modalities are available for pain control in the older patient?
In cases where pharmacologic and nonpharmacologic interventions may be limited in achieving adequate analgesia, interventional modalities that target the pain pathways may be beneficial. There are limited studies on the effectiveness of interventional procedures specifically in the elderly population; however, it is believed that a combination of medications and interventional procedures helps to overall reduce medication intake and decrease the risk for side effects.
Various interventions exist that use either chemical or electrical means to either destroy or alter the pain signals. These include nerve blocks, chemical neurolysis, cryoneurolysis, radiofrequency ablation, and neuraxial interventions, such as epidurals and intrathecal drug delivery, and spinal cord stimulation.
Epidural steroid injections have been useful for the treatment of spinal stenosis, degenerative disease, and sciatica. Studies are again limited, but in general a combination of epidural steroid injections, medication, and physical therapy affords the patient a good chance to reduce pain and increase function.
Spinal cord stimulation (SCS) and intrathecal drug delivery (IDD) are other options. Although no specific studies have been performed in the elderly specifically, studies that have included patients over the age of 65 have supported the use of IDD and SCS for patients with chronic pain uncontrolled by medication.