Target populationAll populations.
Pain Management Medicine or Pain Management Clinic is a subspecialty of, anesthesiology that is responsible for the management of patients with painful conditions who require specialized care due to the refractory and chronic nature of their disease.
It is supported by anesthesiologists specializing in pain management who, through outpatient consultation, assess patients and define, depending on the type of pain, the most convenient management alternatives to stabilize and improve their pain.
Available therapeutic alternatives include interventionist management, which is the use of percutaneous procedures, injections and nerve blocks, used to solve a clinical presentation of pain in a more efficacious and effective way. There is a wide variety of indications in both oncological and non-oncological pain.
Interventional procedures are provided according to the following pain areas:
Head and neck
-Trigeminal ganglion nerve block.
-Maxillary and Mandibular nerves block.
-Sphenopalatine ganglion nerve block.
-Major and Minor Occipital nerves block.
-Pericranial nerves block
-Sympathetic nerve block.
All of these procedures are performed under fluoroscopic guidance; sometimes, trigeminal ganglion nerve block is performed under scanographic guidance, depending on the patient and the technical complexity.
-Thoracic Sympathetic nerve block.
-Splanchnic nerves Block.
-Thoracic Paravertebral block.
-Costal and intercostal nerve block.
Abdomen and pelvis
-Celiac plexus blocks.
-Superior hypogastric plexus block.
-Abdominal wall nerve block.
-Lumbar Sympathetic block.
-Pre-sacral Sympathetic block.
Upper and lower extremities
-Nerve blocks of elbow, shoulder, wrist, hip, knee and ankles joints.
-Genicular Nerve Block for knee pain.
-Peripheral nerves block for upper and lower extremity pain.
-Epidural steroid injection.
-Medial dorsal branch blocks in facet joints.
-Sacroiliac joint blocks.
Radiofrequency is a technique for the interventional management of pain, where cannulation needles that conduct the heat emitted by a receiver are used.
It is indicated when traditional procedures are effective just for a short-term; therefore, to grant an indefinite period of effectiveness, radiofrequency is indicated to produce thermocoagulation of the peripheral and central nerves.
There are two modalities, thermal radiofrequency, where temperatures of 70-80 degrees Celsius are employed, and pulsed radiofrequency, with temperatures of 40-45 degrees Celsius. The main difference between both modalities is that thermal radiofrequency allows for a definitive heat injury.
The most common indications are: trigeminal ganglion, peripheral nerves, spinal facet joints, sacroiliac joints, and the splanchnic, celiac and hypogastric nerve plexuses.
Through the insertion of electrodes in the spinal epidural space, this technique generates a current to cause effects on the pain-driving fibers, in order to modify the painful sensation into a numbness sensation in the painful area.
Posterior spinal cord stimulation procedures are indicated for untreatable neuropathic pain.
The most important indications include: complex regional pain syndrome, failed back surgery syndrome, refractory angina pectoris, critical lower limb ischemia, phantom limb syndrome pain, etc.
For this analgesic modality, a Neuromodulation Clinic is available, a multidisciplinary board where several specialists committed to the case meet under the coordination of the Algology area, to analyze relevant indications. This is a significant space for the generation of patient reference cases within the region.
In patients with some types of oncological and non-oncological untreatable pain, programmable pumps are implanted for the infusion of drugs into the intrathecal space, such as morphine, baclofen, local anesthetics, clonidine, etc.
This is an analgesic modality currently being used for cancer patients with difficulties managing pain, whose life expectancy is longer than three months and whose studies and casuistry support a substantial benefit with significant improvement in their quality of life.
The procedures for neurostimulator and intrathecal pump implantation are always performed in a hemodynamic room under fluoroscopic guidance and with the support of anesthesiology specialists for patients’ sedation.
The process includes performing a test to the hospitalized patient for 3 – 5 days and, if the results are positive in terms of pain reduction, a permanent implant placement is scheduled, also with a 2 – 3 days hospitalization period.
We work with Medtronic and Boston Scientific, which provide the most reliable equipment and the most trustworthy technical-scientific support.
The vast majority of these procedures are performed in a special operating room, some guided by fluoroscopy, and some by scanography. The operating room must have a Vital Signs Monitor and every equipment necessary to perform cardiopulmonary resuscitation, if required.
Simultaneously, all opioid and non-opioid analgesic drugs are available to be used for the management of patients who require them within a multimodal analgesic approach where a combination of different analgesic techniques should lead to a better clinical response in most patients.