Interventional Pain Management in A Patient with Cardiac Implantable Electronic Device- Our Experience.

Abstract

The number of patients with cardiac implantable electronic device (CIED) for pace maker dysfunction is on the rise. These patients with CIED pose unique challenges when they present for interventional pain relieving procedures. These challenges are CIED related, diagnosis related and treatment related. CIED related challenges include knowing about the type, functionality, battery life and chambers paced. The diagnosis related challenge is the inability to perform MRI and sole dependence on diagnostic blocks to arrive at the cause of pain. The treatment related challenges include the dilemma whether to change the pacemaker to asynchronous mode or not during the procedure and the inability to do radiofrequency ablation of the pain generator. Additionally in the presence of CIED (due to shortage of trained professionals and equipments for handling patients with CIED) it would be preferable to perform multiple pain relieving blocks at one sitting, thereby making it a therapeutic option rather than a diagnostic option. Considering the age and medical condition of this patient, we felt that the pain relief from low back ache would take precedence over narrowing on the pain generator. We would like to share our experience in the management of low back ache of a patient with CIED.