Using Fluoroscopy in Pain Management Injections

It is truly remarkable what fluoroscopy has done for the field of interventional pain management. Fluoroscopy is a fancy term for the x-ray machine that allows real-time images during treatment.

Fluoroscopy has allowed more accurate needle placement as well as allowing the field of pain management to venture into new treatment avenues. During pain management procedures, doctors can now inject contrast material and see exactly where their needle is on a real-time basis, as opposed to the traditional way of getting just a regular x-ray.

Studies have shown in the past that epidural injections performed without fluoroscopy have upwards of a 30 to 40% miss rate which in effect is a huge disservice to patients. Therefore, a lot of pain doctors consider a fluoroscopy machine to be the standard of care during epidural injections. If you are a patient receiving an injection, don't you want the optimal chance of successful placement?

New procedures that have come about over the last decade or so that have benefited from fluoroscopy include spinal cord stimulators, vertebroplasty, and minimally invasive lumbar discectomy. When a pain doctor is in a tricky area for an injection, injection of dye may reveal whether or not needle placement is correct. It also saves time as you can see right away in real time whether or not you can go ahead and inject the final medication. You can also see with fluoroscopy fairly well whether or not the needle is located inside of a vascular structure.

Fluoroscopy machines can be moved in multiple different directions which can be extremely helpful if the patient has scoliosis or other aberrant anatomy. It also can be varied with its intensity which can be extremely helpful if the patient has a lot of excessive tissue to go through. As patient size increases the image quality goes down and the newest fluoroscopy machines are extremely good at optimizing the quality of the images generated.

Studies have shown that if an individual stands over 6 feet away from a fluoroscopy machine, well over 90% of the radiation dissipates by the time it reaches that distance from the machine. This is not to say the fluoroscopy is not amidst potentially harmful radiation, and anyone is going to be in the room where procedures are being done should wear lead both on their torso and thyroid.

There are practitioners who tend to over utilize fluoroscopy during procedures. Radiation training for staff is extremely important. With the new procedures made possible fluoroscopy and the increased accuracy allowed with the technique, usage of fluoroscopy is now similar to a cell phone, what would we do without it?