Pain Management

Arthritis (Shoulder/Geniculate Artery) embolization

Joints can degenerate over time, in a process known as osteoarthritis. How and why this degeneration occurs is unclear. However, it is often accompanied by chronic inflammation, which causes the joint lining (the synovium) to grow new, abnormal blood vessels. These abnormal blood vessels can accelerate the degeneration and cause pain. Similarly, frozen shoulder (aka adhesive capsulitis) is a chronic condition where the shoulder joint capsule and lining (the synovium) become thickened. This condition often resolves on its own after some time. In some cases, however, it persists and may benefit from treatment.

Both of these conditions may potentially be alleviated by arteriography and embolization. First, using ultrasound and x-ray guidance, a small needle is used to enter the artery of the leg or wrist. Then, small catheters and wires are used to find the arteries that supply the affected joint. Finally, plastic beads are slowly injected to block blood flow and alleviate symptoms.

The procedure is typically performed on outpatients. It has a low risk of bleeding, infection, and damage to nearby organs. Patients typically return home the same day.

Neurolysis (Celiac/Hypograstric/Other/Pudendal)

Many conditions can cause chronic pain. Ideally, we would treat the conditions and relieve the pain directly. In some cases, however, that is not possible. In these situations, we can stop the pain by numbing the nerve that carries the pain signals (from where they occur) to the brain (where they are felt). Common locations of chronic pain include the upper abdomen, the deep pelvis, and the groin. The nerves in these locations can be temporarily or permanently blocked.

Under CT guidance, one or more small needles can be advanced to the nerve’s location. Then, a mixture of medications can be injected to block the nerve, either temporarily or permanently.

Patients should refrain from eating and drinking for at least 6 hours prior to the procedure so that we may give them medications to help them relax (moderate sedation). We can perform for the procedure for both inpatients and outpatients, who usually return to their room or home the same day.

Joint/Intramuscular/Space injection

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Painful metastasis ablation/embolization/cementoplasty

Cancer can move from where it started to another place in the body, which is known as metastasizing. One of the places it can move is muscles or bones. When this happens, it can cause pain. It is possible to treat the pain by treating the cancer with medicines (such as chemotherapy or immunotherapy), surgery, radiation. In addition to these options, the Interventional Radiologists at HRA may be able to help by blocking the blood flow to the tumor (a process known as embolization) or by freezing/cooking the tumor (a process known as ablation). Additionally, if the cancer has eaten away some of the bone, a patient may then need to go to surgery to prevent a fracture, or, in some cases, the IRs at HRA can help by filling in the missing part of bone with cement and/or screws (a process known as cementoplasty/cement augmentation). Procedural technique, preparation, and expected recovery vary based on the location and amount of involved muscle and bone.