The use of telemedicine to support interventional pain care: case series and commentary

Incorporating indicated interventions in a multimodal approach to manage musculoskeletal pain has become standard of care. For example, in patients with radicular pain associated with intervertebral disc herniation or lumbar spinal stenosis, epidural steroid injections (ESI) are commonly used and often improve pain and function while avoiding more invasive surgical approaches. Recently, the coronavirus disease 2019 (COVID-19) pandemic has allowed remote evaluations to mitigate COVID-19 transmission using telemedicine. In this article, we review our experience in using telemedicine for interventional pain care and current literature, providing a framework for current practice and future study. During restrictive periods of COVID-19 mitigation, patients were referred for ESI, evaluated by telemedicine, and then seen in-person for a physical exam and possible ESI. After a chart review of these patients, we found that telemedicine evaluation was successfully used to support decision making about the ESI. The majority of patients referred received an ESI. During the interval between telemedicine evaluation and ESI, there was no evidence of progression of disease or neurologic deterioration. There were no emergency room visits due to pain complaints. In our literature review, similar case series supported the use of telemedicine in planning and supporting procedural care in several clinical specialties, including interventional pain management. Future research in larger cohorts will help rigorously evaluate safety and query satisfaction for both patients and providers. In conclusion, we suggest that using telemedicine to support procedural care requires more research but shows promise in increasing access to interventional pain care. The use of telemedicine has recently seen a sharp increase in frequency due to the ongoing global COVID-19 pandemic. According to the World Health Organization, telemedicine represents "healing at a distance"1 . They define telemedicine as "the delivery of healthcare services…by health care professionals using information and communication technologies for the exchange of valid information for the diagnosis, treatment, and prevention of disease and injuries." Telemedicine has become an important and effective option for providing patient care. However, the use of telemedicine in the context of procedural therapies for pain management is new and rapidly evolving. In this commentary, we aimed to review literature and share our experience in integrating telemedicine in procedural care.


PMID: 34086929 DOI: 10.1093/pm/pnab183