Ultrasound Applications in Pain Management

Pain is never fun, but quite often a part of life. Thankfully, there are a variety of ways in which pain can be managed – be it through physical therapy, diet, exercise, natural approaches, medication, or an assortment of medical procedures. And while we are familiar with most of these approaches, ultrasound’s role in effectively diagnosing as well as treating pain, both chronic and ongoing, is relatively unknown.

Most of us are aware that ultrasound uses high-frequency sound waves that enable practitioners to view the insides of our bodies through real-time, dynamic imaging. However, it has considerable other applications. Moreover, with advances in ultrasound technology contributing towards cheaper, smaller, and more portable devices that provide high-quality imaging, the applications of ultrasound machines have become much more widespread and extended to many healthcare fields including pain management.

Ultrasound has now become invaluable as a diagnostic and therapeutic tool in the sphere of pain management for primary care physicians, orthopedists, rheumatologists, and sports medicine physicians, among others[1].

We’ve compiled some important points and findings related to ultrasound-guided pain management, especially hyaluronic and corticosteroid injections, along with the conditions and types of pain it can alleviate.

Ultrasound-Guided Pain Management

Osteoarthritis is a debilitating and inflammatory condition that develops gradually and causes increasing pain over time. According to Centers for Disease Control and Prevention (CDC), more than 30 million US adults are affected by Osteoarthritis[2].

Ultrasound-guided injections play a crucial role in managing osteoarthritis and other debilitating and less serious conditions. Many times, medications and ice packs don’t provide sufficient relief, and this is when ultrasound guided injections come to the rescue. In the case of osteoarthritis, patients who experience pain that limits their activities and who don’t find relief despite having oral medicines are given ultrasound-guided injections. These may be accompanied by physical therapy before, during, or after the administration of injections.

How Does Ultrasound Assist in Pain Management

Ultrasound technology can evaluate and treat a variety of pain issues including muscle, joint, ligament, and tendon pain. While injections for pain relief can even be administered without ultrasound imaging, these aren’t likely to be as effective and accurate as ultrasound-guided ones simply because they are likely to miss the intended target area without the assistance of an imaging tool. Aptly called ‘blind’ injections, these do not provide 100% accuracy and for some joints, the accuracy falls to as low as 30-40%. [3]

In contrast, ultrasound-guided injections have a much higher accuracy rate, as real time ultrasound imaging allows medical professionals to visually navigate the needle as it enters the body, enabling them to administer the injection into a specific area. Furthermore, real-time imaging allows practitioners to view fluids and the surrounding structures before, during, and after treatment. Moreover, it enables dynamic feedback between practitioner and patient, further increasing the accuracy and efficacy of the guided procedure. As a result, these provide a much higher accuracy rate than that of blind injections, ranging from 90 to 100%[4]. Another significant advantage of ultrasound-guided injections is that these are much less painful than blind injections.

The accuracy offered by ultrasound is crucial as accurate administration of medication translates into higher treatment efficacy. It is for this reason that injections administered into the shoulder, knee, and hip joints are more effective when performed with ultrasound guidance. Besides, accuracy is all the more relevant especially when there are other painful, sensitive, or dangerous areas near the injection site.

Ultrasound has become a reliable and accurate way to guide injections of hyaluronic acids and corticosteroids. Ultrasound also guides other therapies such as stem cells, platelet rich plasma, and prolotherapy[5].

What Pain Conditions Does Ultrasound Diagnose and Treat

Ultrasound-guided injections are used to treat inflammatory and degenerative conditions, such as rheumatoid arthritis, osteoarthritis, arthritis, and also ligament tears, muscle tears, labral tears, and chronic tendinopathy. They can also provide major relief by helping people manage pain caused by sciatica, bursitis, tendonitis, carpal tunnel syndrome, and myofascial, joint, muscle, neck, phantom limb, and back pain. It can also help treat scar tissue-related pain, sprains, and strains. Ultrasound’s ability to visualize soft tissues and vascular structures in anatomic regions makes it suitable for posterior neuraxial, peri axial, peripheral nerve and joint-related structures[6].

Furthermore, apart from diagnosing and treating shoulder, hip, and knee problems, ultrasound-guided injections can also help detect the pain-generating structures.

Advantages of Ultrasound for Guiding Injections and Other Procedures

Ultrasound is the preferred imaging tool for guiding injections and other procedures due to a variety of reasons:

1. Easy & Improved Visualization of Joints and Surrounding Soft-Tissue and other Structures – While other imaging types like real-time X-ray allow easy visualization of joints for guiding injections, they don’t enable visualization of surrounding soft tissue structures such as nerves, blood vessels, and tendons that may be in the path of the needle. This could lead to unnecessary pain (that is avoidable with ultrasound) and worse, complications. Ultrasound tackles this challenge by allowing practitioners easy visualization of the joint, surrounding structures and whatever may be in the path of the needle, avoiding unwanted complications and unnecessary pain.

 

2. Radiation-Free, Cost-Efficient, and Easy-to-Use – Ultrasound is free of radiation and risks associated with contrast agents, unlike traditional radiologic imaging modalities. Moreover, CT-guided or CAT scan injections are not only harmful but also time-consuming and expensive.

 

3. Can be Used Even When Other Imaging Tools are Contraindicated – Patients, who cannot undergo an MRI due to a pacemaker or other imaging modalities due to harmful radiation, can easily undergo ultrasound diagnoses for conditions such as, for example, a rotator cuff tear[7].

 

4. Visualization of Fluid – In comparison to radiographs, ultrasound also enables practitioners to better identify and view fluid accumulated in and around structures such as, muscles, tendons, joints, nerves, and other soft-tissue structures.

 

5. Very Few Complications – Ultrasound-guided injections have very few complications that are in fact, common to any type of injection. It may give rise to complications such as bleeding, incomplete reduction of pain, infection, and damage to surrounding structures. In fact, ultrasound-guided injections have an overall low risk and help reduce further procedural complications and risks.

Cortisone for Chronic & Other Types of Pain Relief

Cortisone injections are widely used to treat pain due to their ability to provide pain relief by reducing inflammation and swelling in or around joints or other structures. Both cortisone and hyaluronic acid medication, or viscosupplementation have anti-inflammatory mechanisms and at a molecular level, they help protect the joints by building a barrier in the joint[8].

Ultrasound for Other Pain Diagnoses and Treatment

A majority of medical professionals have found ultrasound to be the perfect solution to helping their patients feel better sooner. Here are some specific applications of ultrasound in the field of pain management:

• Ultrasound helps in the diagnosis of rotator cuff injury and accurate administration of injections in structures such as the subacromial bursa, biceps tendon, glenohumeral joint, and the acromioclavicular joint[9].

• Ultrasound use in procedures such as stellate ganglion blocks, cervical nerve root blocks, and joint injections provides improved visibility, allowing physicians to inject in specific spots while bypassing others for a less invasive approach.
• Ultrasound facilitates diagnoses of meniscus injuries and determination of whether there is fluid in the knee joint. It also helps examine quadriceps and patellar tendons, the extra-articular (outside the joint) ligaments, and other structures to evaluate problems in these[10].
• Ultrasound makes it easier for doctors to locate nerves that are difficult to find. For example, the lateral cutaneous nerve of the thigh, which causes severe neuropathic pain, cannot be found without an ultrasound.

• Ultrasound is used in to view the hip joint, bursa, and muscles and tendons around the hip. It’s indispensable in administering hip injections as it gives an accuracy of 96 % compared to an accuracy of only 50-80% for blind injections. This is especially important given that the hip joint is not easily visible as it is located deep and typically has a close proximity to blood vessels and nerves. Hip joint injections are helpful in treating osteoarthritis of the hip and in diagnosing and treating labral tears[11].

• Ultrasound provides relief for inguinal and testicular pain by enhancing accuracy and efficacy in ilioinguinal, iliohypogastric and genitofemoral blocks[12].

 

These are but a few reasons why many practices are using ultrasound-guided pain management. Additionally, its cost efficiency is especially relevant, given that some procedures might not be covered by a patient’s insurance. Consequently, the use of ultrasound is a win for everybody because as a doctor, you will be able to recoup your investment in the ultrasound equipment, and for patients, it is less money out of their pockets.

National Ultrasound Machines for Pain Management

With positive outcomes of ultrasound-guided pain management – some of which have been explained above – ultrasound use in diagnosis and treatment of pain is expected to substantially increase. Additionally, advances in ultrasound technology and ultrasound machine trends favoring smaller, cheaper, and more accurate hand-held and portable ultrasounds may also increase the likelihood of usage of ultrasound-guided pain management.

If your office is looking for a new – or perhaps alternative – approach to pain management, then give one of our ultrasound professionals a call today. At National Ultrasound, we have so many options in ultrasounds and related equipment from reputable brands that we are certain to have just the right equipment to suit all of your practice’s needs.

We would love to help you decide which ultrasound machine is right for your office and the needs of your patient family. Our National Ultrasound experts are trained in evaluating your requirements and options to fit you with exactly what you need at a great price. Contact us today to discuss your requirements or to get a quote on our ultrasound machines.

 

 

References:

• https://www.sportsmedtoday.com/the-benefits-of-ultrasound-guided-injections-va-177.htm
• https://www.orthocarolina.com/media/how-ultrasoundguided-injections-can-help-treat-pain
• https://ukhealthcare.uky.edu/orthopaedic-surgery-sports-medicine/resources/ultrasound-guided-injections-pain-management
• https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4976830/

[1] https://www.sportsmedtoday.com/the-benefits-of-ultrasound-guided-injections-va-177.htm

[2] https://www.cdc.gov/arthritis/basics/osteoarthritis.htm

[3] https://www.sportsmedtoday.com/the-benefits-of-ultrasound-guided-injections-va-177.htm

[4] https://www.sportsmedtoday.com/the-benefits-of-ultrasound-guided-injections-va-177.htm

[5] https://www.sportsmedtoday.com/the-benefits-of-ultrasound-guided-injections-va-177.htm

[6] https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4976830/

[7] https://www.orthocarolina.com/media/how-ultrasoundguided-injections-can-help-treat-pain

[8] https://ukhealthcare.uky.edu/orthopaedic-surgery-sports-medicine/resources/ultrasound-guided-injections-pain-management

[9] https://www.sportsmedtoday.com/the-benefits-of-ultrasound-guided-injections-va-177.htm

[10] https://www.sportsmedtoday.com/the-benefits-of-ultrasound-guided-injections-va-177.htm

[11] https://www.sportsmedtoday.com/the-benefits-of-ultrasound-guided-injections-va-177.htm

[12] https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4976830/