Dr. Massimo Barbieri, a specialist in Anesthesiology and Interventional Pain Management at the Ars Medica Clinic, explains the importance of pain therapy as a branch of medicine dedicated to the prevention, evaluation, and treatment of pain in its chronic and acute forms.
After graduating in Medicine and Surgery from the University of Milan and subsequently specializing in Anesthesia and Resuscitation from the University of Pavia, Dr. Massimo Barbieri has been treating chronic pain for many years. He also holds an additional international certification (FIPP) in interventional pain management. Dr. Massimo Barbieri has recently been joined by two other colleagues: Dr. Lorenz Wagner and Dr. Eva Koetsier, MD, completing the team. The team supports patients throughout the entire process, from diagnosis to pharmacological support and non-surgical interventional procedures. In daily clinical practice, most patients experience pain related to spinal disorders.
At Ars Medica, you've established a specialized unit to address issues related to pain therapy. What does it involve? What is interventional pain therapy, and what advantages does it offer?
«Interventional pain management procedures represent an innovative approach to the treatment of spinal disorders. These techniques aim to reduce pain and improve patient function. They are valuable and important techniques in all situations where surgery is not necessary. It should be noted that patients with a true indication for surgery represent a very small percentage of the vast majority of individuals suffering from back pain. To better understand the extent of the problem in the general population, consider that literature data indicates that nearly 75% of the population will experience back pain at some point in their lives.
Specifically, what are the main procedures performed?
Before proceeding with any procedure, an accurate diagnosis is essential. Imaging techniques such as magnetic resonance imaging (MRI) or computed tomography (CT) are used to identify the specific problem with the spine. The use of advanced technologies, such as ultrasound or fluoroscopy, is essential for the correct and safe execution of all procedures. One of the most commonly used procedures is the epidural injection. This is a technique that belongs to the field of anesthesiology and has evolved to be used in interventional pain management. It allows for the very precise and safe injection of a small amount of local anesthetic and cortisone, precisely at the site of the spinal column where the pain originates. Epidural injections are a combination of different techniques and are used to relieve pain caused by inflammation or irritation of the nerve structures originating from the spine (for example, the sciatic nerve). At a slightly more advanced level, we have radiofrequency treatments. These use a special type of electromagnetic field, which interrupts the transmission of electrical signals within the nerves that conduct pain and is particularly useful in treating chronic pain. Before applying this treatment, the patient is examined to precisely identify the exact spot where the radiofrequency will be applied. This preliminary phase involves performing several test injections, always under x-ray control. This is particularly important because radiofrequency is a highly selective and specific treatment that would be ineffective if not applied to the exact spot.
Which procedures represent the new frontier in the treatment of spinal disorders?
Spinal cord neurostimulation is an increasingly used therapeutic technique to treat chronic pain, especially in patients with spinal disorders. It is one of the areas where technological advances are most evident. This approach involves the implantation of an electrical stimulation device that sends impulses to the spinal cord. These impulses interfere with the transmission of pain signals to the brain, thus reducing its perception. The device consists of a pulse generator, which is usually implanted under the skin, and electrodes placed inside the spinal column near the spinal cord. Neurostimulation is particularly effective in cases of neuropathic pain and can improve patients' quality of life, allowing them to resume their daily activities. It is crucial that patients are carefully selected and that the procedure is performed by experienced professionals.
There's a lot of talk about regenerative medicine. Does it also represent a possible solution in your field of intervention?
One of the most promising applications is the use of growth factors and stem cells derived from bone marrow or adipose tissue, which can differentiate into cells from other tissues, potentially contributing to pain reduction by inhibiting inflammatory and degenerative processes within diseased tissue. Regenerative medicine therefore offers new hope for patients with conditions such as disc, ligament, and other spinal disorders. However, it is still in the research phase, and further studies are needed to determine the efficacy and long-term safety of these therapies.
