CHALLENGES IN INTERVENTIONAL

PAIN MANAGEMENT DURING COVID-

19 PANDEMIC
Dedi Susila
 Acute
Pain

IPM
Chronic Immune Susceptible
Pain System Grup
EFFECTS OF CHRONIC PAIN ON IMMUNE SYSTEM
EFFECTS OF STEROID ON IMMUNE SYSTEM
Systemic effects of epidural steroid injections
for spinal stenosis
RISK MANAGEMENT
 Factors that should be taken into
consideration:
• Acuity
• Co-morbid psychiatric
• Pain level and accompanying functional
impairment
• Likelihood of the visit/procedure providing
meaningful benefit
• Need for physical examination
• Risk association with in-person visit or procedure
• Work status
Switch in care paradigm “from doing
what is the best for individual patient
to doing what is the the best for the
largest number of people”
 General Recommendations
1. Any elective, in-person patient visits or
meetings have to be suspended
2. No elective pain procedures, except specific
emergent/urgent procedures should be
performed
 Elective procedures
• Decreasing the exposure
• Conserving resources
• Telemedicine should be considered
• Practitionares must ensure that the interface
used satisfies the rules and regulations of
their place of practice
 Elective procedures
• Epidural steroid injection for chronic pain
• Selective nerve root blocks
• Dx MMB, most intraarticular facet, and repeat
preemptive RF denervation for chronic pain
• Triger point injection
• Dx discography
• Peripheral intra-articular joint injection
• Neuromodulation
• Ketamine and other intravenous infusions
 Urgent procedures
• Withholding procedure could lead to inability
to work, anxienty, depression and reliance on
opioid therapy
• Consider and discuss risks and benefits with
patient and facility
• May proceed after screening if resources
support
 Urgent procedures
• Neurolytic procedures for refractory cancer
associated pain
• Epidural steroid injection for acute disc
herniation or acute pain exacerbation
• Vertebroplasty of kyphoplasty for refractory
pain from acute vertebral compression
fracture
• Sympathetic blocks for early CRPS after
conservative treatment failure
• Treatment for acute or acute exacerbations of
refractory spinal pain where there is a high
likelihood of physical or psychological
disability (RF ablation, SIJ injection for acute)
• Debilitating nerve entrapment syndrome with
neurological deficits
• Acute headaches likely to respond to blocks
 Emergent Procedure
• Not performing or postponing a procedure
may lead to significant morbidity and other
adverse sequelae
• Proceed, do not postpone
 Emergent Procedure
• Complication in any currenly implanted patient
(infection or wound dehiscence)
• Stage 2 of DRG or SCS implant with external leads
• Epidural blood patch for PDBH or intracranial
hypotention
• Migration of SCS, DRG leads, leading to
neurological deficits or severe pain
• Intrathecal pump refill or malfunction
• Epidural or paravetebral catheter for rib fracture
 CONCLUSIONS
The risk-benefit calculation of performing in-
person visits and procedures must taken into
account not only individual factors, and
probability of benefit, but also contex, logistical
concerns, relevant regulations and condition in
the area, and the availability of resourses, all of
which are constantly evolving
Thank you