Interventional Approaches to Pediatric Chronic Pain Management

Interventional pain management (IPM) is frequently utilized to treat pain syndromes in the adult chronic pain population (Smith et al., Med Clin North Am 100(1):103-115, 2016). Such techniques can reduce sensitization, provide regional pain relief, and are often performed in an effort to decrease systemic analgesic requirements. The standard of care in pediatric pain medicine harbors a multidisciplinary approach to restoring physical and social function while minimizing disability. Appropriately performed procedures often serve as diagnostic tools and, in select cases, may facilitate successful participation in rehabilitative programs. Procedural approaches are particularly useful for malignancy-related pain conditions, neuropathic pain syndromes, and chronic pain that is refractory to conservative treatment (Shah et al., Pain Pract 16(3):359-369, 2016). IPM encompasses a wide variety of techniques, including neuraxial injections, peripheral nerve blocks, joint infiltrations, neuromodulation, botulinum toxin application, and radiofrequency denervation. Although pediatric efficacy data are limited, appropriately performed procedures can play an important role in a child’s treatment plan, particularly after conservative measures have failed (Vega et al., Paediatr Anaesth 28:999, 2018). This chapter will provide an overview of commonly utilized interventional approaches to treat pediatric chronic pain.