Beyond Painkillers: How Sonography-Guided Procedures Can Help Manage Pain

People can experience pain in almost any part of their day, such as walking, physical activity, sleep, and work. Some medications are capable of temporarily relieving some pain, but they do not always cure the cause of the pain. Targeted methods like sonography-guided procedures can fit into contemporary orthopaedic and pain management in this way.  Dr Ankit Meshram takes a patient-centred view to assess the cause of musculoskeletal pain and whether image-guided procedures could be suitable. Real-time imaging can allow doctors to locate certain structures and guide them in a more precise manner in certain treatments.

What Is Ultrasound Sonography? 

Ultrasound sonography is a non-invasive imaging procedure that employs high-frequency sound waves to produce real-time images of tissues and structures within the body. Unlike X-rays, ultrasound is not a form of ionising radiation. In musculoskeletal medicine, ultrasound can assist the doctor to look:

• Muscles
• Tendons
• Ligaments
• Joints
• Soft tissues
• Certain nerves
• Fluid-filled areas

Since ultrasound imaging is in real time, it can also be used to guide some procedures. This helps the doctor see the area being treated and to position the needle or procedure.

How Can Sonography Procedures Help With Pain? 

Effective treatment of pain can depend on determining the cause of the pain. Pain can come from a joint, tendon, bursa, nerve or a different soft tissue source. With the sonography guided procedure, the doctor can guide the procedure to a specific anatomical area during real-time imaging. This can be an injection or other minimally invasive procedure, depending on the diagnosis. The objective is not to treat the whole body rather it's to treat the structure that relates to the symptoms the patient experiences.

Why Is Ultrasound Useful? 

Anatomical landmarks may be sometimes used for traditional injections. This is a suitable procedure in some cases, however in cases with ultrasound guidance, the doctor is offered real-time visual data. Potential advantages include:

• Graphical representation of the desired shape.
• More precise placement of needles
• Effective discrimination of the adjacent soft tissues
• Continuous monitoring during the process
• Treatment delivered / targeted delivery

The use of ultrasound guidance is patient and procedure dependent.

Which Conditions May Be Considered? 

Selected musculoskeletal and pain related conditions may be considered for sonography guided procedures. They can be employed in the treatment of some of the following conditions:

Joint Pain

This can cause persistent pain in a joint like the knee, shoulder, hip or ankle that can have a different cause. In some situations, soft tissues structures may be better seen on ultrasound and selected injections guided by ultrasound may be clinically appropriate.

Tendon Problems

Tendon related conditions can make moving and exercising painful. In some cases, ultrasound can also be used to evaluate any abnormality in the tendon and can further direct some treatments.

Bursitis

When a bursa becomes inflamed, it can lead to pain and limited mobility in the affected area. Ultrasound can be used to guide treatment in certain instances, and can help determine the area of tissue affected.

Sports Injuries

Injuries to muscles, tendons, ligaments and joints may occur in athletes or physically active people. Dynamic imaging is possible in selected soft tissues with ultrasound and it may be useful for some procedures.

Certain Nerve-Related Conditions

Doctors may also be able to use ultrasound to detect and see some peripheral nerves. This may assist in certain procedures including nerve block with ultrasound.

Can Sonography Replace Painkillers? 

Not necessarily. For some people, pain medication is an important aspect of treatment. A comprehensive approach to pain management, however, that is based on the underlying diagnosis is usually the most effective approach. Treatment can involve physiotherapy, exercise, activity modification, medication, injections, rehabilitation or surgery depending on the condition. Not all procedures can be completed via sonography. Rather, they may be a part of a personalized treatment regimen if clinically appropriate.

What Happens During an Ultrasound-Guided Procedure? 

It depends on the procedure that is being performed. Initially, the doctor assesses the symptoms, and examines the affected area. Skin is prepared and ultrasound probe is positioned above appropriate area. Using the real-time ultrasound image, the doctor finds the area of interest and adjacent tissue. When an injection or similar procedures that require guidance are indicated, the needle may be placed under the doctor's direct observation as it is being moved. The patient may be given specific guidelines for activity, rehabilitation and follow-up post procedure.

Is Ultrasound-Guided Treatment Safe? 

The use of ultrasound is not associated with ionising radiation and is broadly applied for diagnostic imaging. But of course, there is potential for risks with any invasive procedure, such as an injection. Some of these can be temporary discomfort, bleeding, infection or complications depending on the procedure and patient's health. This is why it is important that treatment is only advised following a proper clinical assessment. Patients must consult with their physician about the pros, cons, and options, and what to expect for recovery.

Why Proper Diagnosis Matters 

Pain is a symptom not a diagnosis. For instance, two people with a knee pain may have a totally different condition causing that pain. An orthopaedic specialist will review the patient's medical history and may consider the previous treatment, imaging, symptoms and physical exam before recommending a procedure. Dr Ankit Meshram will be able to assess these and decide if a sonography-guided procedure would be right for an individual patient.

A More Targeted Approach to Pain Management

The treatment of pain is becoming increasingly individualized and targeted. Assessment and selected image guided procedures can benefit from ultrasound sonography for the visualization of muscles, tendons, joints, nerves and other soft-tissue structures in real-time. If conservative treatment fails to relieve the pain, one option that should be discussed with an orthopaedic specialist may be a sonography-guided procedure. If you have constant pain in your joints, muscles, tendons or other musculoskeletal parts of your body, please discuss with Dr Ankit Meshram for appropriate evaluation. The first step to selecting the right and individual treatment plan is to know the cause of the pain.