By Dr. Ming Kao
Earlier we noted the large number of pharmaceuticals that can be used for chronic pain.
Over the years, I have also been cataloging all pain-relief procedures that we perform in Pain Medicine. This is an exhaustive list that literally covers the head to the toe. We perform Botox injections of the scalp for chronic migraines, toe injections for metatarsalgia, and everything in between.
In order to ensure accuracy, we use fluoroscopy (X-ray) for deeper parts of the body, and live-ultrasound for more shallow structures.
Accuracy is crucial. Even the most common trigger point injection (injection of numbing medications into the muscles) can lose effectiveness if injected into the wrong muscle layer.
As an aside, this is why I think sometimes trigger point injections get a bad reputation. When it is done without ultrasound guidance, the doctor is unable to go after deep muscles. I routinely go after the serratus anterior muscle, intercostal muscle. We go after esoteric ones too, such as serratus posterior superior, that are only possible because of ultrasound.
We have 250 (and growing) pain-relief procedures in pain medicine.
Consider the fact that the Pain Medicine fellowship is only 365 days long, and a typical full-time job consist of 250 working days. This means a Pain Medicine specialist needs to learn/perfect 1 procedure per day during the fellowship!
Originally published at drmingkao.com.