When to refer a patient to interventional pain care

Often overlooked

Worth referring, often not thought of

Traditional spine pain and radiculopathy (lumbar, thoracic, cervical) are the obvious, commonly referred conditions. Providers outside the specialty often don't think of these patients as appropriate for referral. They absolutely are:

• Facet arthropathy
• Vertebrogenic pain with Modic changes
• Neck pain
• Vertebrogenic headaches
• Spine pain after spine surgery
• Painful diabetic neuropathy
• Chronic migraines
• Non-operable joint pain (shoulder, knee, hip, ankle, etc.)
• Facial pain
• Pain after joint surgery or replacement

Exceptions

Acute referral exceptions

Most other acute conditions resolve on their own. Two do not wait:

• Acute disc herniation with radiculopathy
• Acute or subacute vertebral compression fracture

For an acute fracture, a kyphoplasty can be performed, which demonstrates significant morbidity and mortality benefits. These patients are often not referred, but should be.

A chronic compression fracture should still be referred, but it is no longer an urgent referral. There are interventions that can be performed to mitigate chronic pain from a compression fracture.

Before the referral

Advanced imaging

Please obtain advanced imaging before referral.

• Typically an MRI of the site of injury or pain
• X-ray or CT can be appropriate depending on the condition

First referral

Physical therapy first

Physical therapy is an appropriate first referral for most conditions.

• An injection, nerve ablation, or other minimally invasive procedure can make PT more tolerable and more effective