Villanueva Institute of Pain and Spine
Interventional Pain Management
Interventional pain management can help identify and treat specific sources of pain using targeted, image-guided procedures. If pain is interfering with your ability to move, sleep, work, drive, exercise, or participate in daily life, an indicated pain management procedure may help reduce inflammation, interrupt pain signals, clarify your diagnosis, or support a broader plan for better function.
I am Dr. John Villanueva, and at Villanueva Institute of Pain and Spine (VIPS), I approach interventional pain management as a double board-certified physician in both PM&R and interventional pain management. At VIPS, every recommendation starts with understanding the source of your pain. I review your symptoms, imaging, exam findings, and daily limitations, so we can choose a treatment plan that makes clinical sense and helps you move through life with more comfort and confidence.
Many patients come to VIPS after feeling rushed, dismissed, or unsure what to try next. Here, I want you to feel that your pain is being taken seriously. If an image-guided procedure may help, I will explain why. If another option, such as rehabilitation, medication management, diagnostic testing, or a surgical opinion, is more appropriate, I will tell you directly and explain the reason.
If you are looking for interventional pain management in Burbank, CA, call VIPS at (818) 669-8895 or request an appointment online today. We are located in Burbank and proudly serve patients visiting from Glendale, Pasadena, Van Nuys, Toluca Lake, Studio City, Sherman Oaks, North Hollywood, Sun Valley, La Cañada, La Crescenta, Los Feliz, Atwater Village, Silver Lake, Echo Park, and communities throughout the San Fernando Valley and greater Los Angeles area.
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What Is Interventional Pain Management?
Interventional pain management is a specialized area of medicine that uses targeted procedures to diagnose or treat pain. These procedures may involve injections, nerve blocks, radiofrequency ablation, regenerative medicine, advanced spine procedures, or neuromodulation for select chronic pain conditions.
The keyword is targeted. Interventional pain management is most useful when the procedure is chosen to match a suspected pain source. For example, pain from an irritated spinal nerve may require a different approach than pain from a facet joint, sacroiliac joint, arthritic knee, inflamed tendon, or compressed nerve.
At VIPS, I use fluoroscopy, which is live X-ray guidance, or ultrasound guidance when appropriate. I do not believe in blind injections when precision is needed. The goal is to place treatment where it is intended to go and use your response to guide the next step in care.
When Should You See an Interventional Pain Management Doctor?
You may benefit from interventional pain management if pain has not improved enough with rest, medication, physical therapy, activity changes, or prior treatment. You may also be referred by a primary care physician, spine surgeon, orthopedist, neurologist, physical therapist, or another provider when a more targeted evaluation is needed.
Interventional pain management may be appropriate for conditions such as:
- Chronic back pain
- Neck pain
- Sciatica
- Herniated discs
- Degenerative disc disease
- Spinal stenosis
- Facet joint pain
- Sacroiliac joint pain
- Arthritis-related joint pain
- Nerve pain
- Peripheral neuropathy
- CRPS
- Headaches and migraines
- Shoulder pain
- Hip pain
- Knee pain
- Muscle pain and trigger points
- Pain after spine surgery
- Cancer-related pain
You do not need to know which procedure you need before you come in. Many patients arrive with a symptom, a scan, or a referral, but not a clear explanation. My job is to connect your symptoms, exam, imaging, and goals so we can decide what makes sense.
How I Evaluate You Before Recommending a Procedure
Before recommending an interventional pain procedure, I want to understand your pain as completely as possible. Two patients may both have low back pain, but one may have nerve root irritation, another may have facet joint pain, another may have sacroiliac joint dysfunction, and another may need a surgical opinion.
During your consultation, I may:
- Listen to your history and how pain affects your daily life
- Review prior records, medications, procedures, and surgical history
- Personally review imaging such as X-rays, MRIs, or CT scans whenever available
- Perform a physical and neurological examination
- Recommend EMG/NCS testing when nerve or muscle function needs closer evaluation
- Explain which pain sources seem most likely and why
- Discuss whether an image-guided procedure may be appropriate
While written reports are helpful, the images themselves can show details that matter when deciding whether a procedure is likely to help. I use both for the most effective evaluation.
How Interventional Pain Management Fits Into Your Care
Interventional pain management is not meant to replace every other form of care. For many patients, it works best as part of a larger plan that may include rehabilitation, medication review, lifestyle changes, diagnostic testing, or coordination with another specialist.
Some procedures are therapeutic, meaning they are intended to reduce pain or inflammation. Others are diagnostic, meaning they help confirm where pain is coming from. Some treatments do both. A medial branch block, for example, may provide temporary relief while helping determine whether radiofrequency ablation should be considered.
The right treatment should match the problem. After reviewing your symptoms, exam findings, imaging, and prior care, I will explain which options make sense and why. That may include an image-guided procedure, a different nonsurgical plan, or, in some cases, a surgical opinion.
Image Guided Procedures at VIPS
Precision matters in interventional pain management. Many pain-generating structures are small, deep, or located near important nerves, joints, blood vessels, or spinal anatomy. That is why I use fluoroscopy or ultrasound guidance when performing targeted procedures.
Image guidance helps confirm needle placement and supports a more controlled procedure. It also allows me to tailor the approach to your anatomy, diagnosis, and treatment goals.
The details of the procedure matter as well. Medication type, concentration, volume, and frequency should not be automatic. I individualize those decisions based on your diagnosis, prior response to treatment, medical history, and how the procedure fits into your larger care plan.
Interventional Pain Management Treatments That May Help
Interventional pain management includes many different procedures. At VIPS, the treatment plan is individualized based on your diagnosis, imaging, exam findings, prior response to care, medical history, and personal goals.
Epidural Steroid Injections
Epidural steroid injections may help when inflamed or irritated spinal nerves are contributing to neck, back, arm, or leg pain. They are commonly considered for conditions such as herniated discs, sciatica, spinal stenosis, and radicular pain.
Medial Branch Blocks and Facet Joint Injections
Medial branch blocks and facet joint injections help evaluate or treat pain coming from the small joints of the spine. These procedures may be considered for neck or back pain related to arthritis, degeneration, whiplash, mechanical spine pain, or pain that worsens with twisting, standing, or bending backward.
Radiofrequency Ablation
Radiofrequency ablation is often recommended when diagnostic blocks confirm that specific nerves are carrying pain from the facet joints or other targeted areas. For properly selected patients, RFA may provide longer-lasting relief than a temporary injection by quieting selected pain-carrying nerves.
Nerve Blocks
Nerve blocks may help diagnose or treat pain related to irritated, compressed, or overactive nerves. Depending on your condition, nerve blocks may be considered for spine related pain, CRPS, pelvic pain, abdominal pain, headaches, or other chronic pain patterns.
Joint, Bursa, and Trigger Point Injections
Joint injections may help pain from arthritis or inflammation in areas such as the shoulder, hip, knee, elbow, wrist, or sacroiliac joint. Bursa injections may help inflammation around joints, while trigger point injections may help painful muscle knots or myofascial pain.
Headache and Migraine Injections
Certain headache and migraine patterns may respond to targeted procedures such as Botox for migraines, occipital nerve blocks, SPG blocks, or other headache injections. The right option depends on your symptoms, diagnosis, and prior response to treatment.
PRP and Regenerative Medicine
PRP therapy uses a concentration of platelets from your own blood and may be considered for certain joint, tendon, ligament, muscle, or spine related conditions. Regenerative medicine is not appropriate for every patient, but it may be useful when tissue irritation, injury, or degeneration is part of the pain pattern.
Spinal Cord Stimulation
Spinal cord stimulation may be considered for select patients with chronic pain that has not responded well to other treatments. I use a device-agnostic approach, which means the platform should be selected based on your anatomy, lifestyle, pain pattern, and clinical needs rather than brand preference.
Intracept®
Intracept® may be an option for certain patients with vertebrogenic low back pain. This type of pain is associated with changes in the vertebral endplates of the spine, so careful imaging review is essential before deciding whether the procedure is appropriate.
MILD® Procedure
The MILD® procedure may help certain patients with lumbar spinal stenosis when thickened ligament tissue contributes to nerve compression. It may be considered for select patients with symptoms such as leg pain, heaviness, numbness, or difficulty standing and walking for longer periods.
What Happens During an Interventional Pain Procedure?
Before the procedure, I review your symptoms, imaging, medical history, and treatment plan, so you understand why the procedure is being recommended. My team will also review preparation instructions, medication guidance, and what to expect during your visit.
During the procedure, our team will position you so that I can safely access the targeted area. Your skin will be cleaned, and a local anesthetic may be used to numb the area. I then use fluoroscopy or ultrasound guidance to direct the needle or treatment to the intended location.
After the procedure, you may be monitored for a short time before going home. I will give you instructions regarding activity levels, medications, and what symptoms to watch for. In some cases, I may also ask you to track your pain response because the timing, amount, and duration of relief can help guide future treatment.
What Results Can You Expect?
Results depend on your diagnosis, the procedure performed, your anatomy, your overall health, and how your body responds. Some patients feel relief quickly, especially when a local anesthetic is used. Others may notice improvement over several days as inflammation calms. Some procedures are designed mainly to provide diagnostic information, while others are intended to provide longer-lasting relief.
I will always try to give you realistic expectations before treatment. Rather than promising that pain will disappear completely, I’ll help you understand what we are trying to accomplish, whether that means reducing inflammation, confirming a diagnosis, improving mobility, helping you tolerate rehabilitation, or supporting a better quality of life.
Why Choose VIPS for Interventional Pain Management?
Double board-certified expertise
I am double board-certified in PM&R and interventional pain management, which allows me to evaluate pain from both a functional and procedural perspective. My PM&R training helps me understand how pain affects movement, strength, daily activity, and rehabilitation, while my interventional pain training allows me to perform targeted procedures when appropriate. My qualifications extend beyond double-board certification. As a Certified Life Care Planner, I have advanced specialized training in evaluating the long-term medical, rehabilitation, and future care needs of individuals with complex injuries and disabilities, further strengthening the expertise I bring to medical-legal consulting and expert witness services.
A thorough diagnosis before treatment
I review symptoms, exam findings, imaging, medical history, prior treatments, and goals before recommending an injection, nerve block, ablation, regenerative treatment, or advanced procedure.
Image-guided precision
I use fluoroscopy or ultrasound guidance for targeted procedures rather than blind injections. The goal is to direct treatment to the intended area with accuracy and care.
Individualized treatment planning
Two patients with similar pain may need very different plans. I tailor recommendations based on the likely pain source, your medical history, your response to prior care, and what you want to be able to do again.
Honest guidance about your next step
If a procedure makes sense, I will explain why. If medication management, rehabilitation, diagnostic testing, another procedure, or a surgical opinion is more appropriate, I will tell you directly.
A warm, unhurried experience
Many patients come to VIPS after feeling rushed, dismissed, or unsure where to turn next. My team and I want you to feel heard, informed, and comfortable asking questions before any procedure is performed.
Interventional Pain Management FAQs
If pain is limiting how you move, work, sleep, drive, exercise, or participate in daily life, interventional pain management may help identify the source of your symptoms and clarify the next step in care.
To schedule an interventional pain management consultation in Burbank, CA, call (818) 669-8895 or conveniently contact VIPS online today.
Will I need imaging before an interventional pain procedure?
In many cases, yes. Imaging, such as X-rays, MRI, or CT scans, can help identify structural problems and guide treatment planning. I prefer to review the actual images whenever possible because the details can affect which procedure is most appropriate.
Are interventional pain procedures image-guided?
Yes. At VIPS, targeted procedures are performed with fluoroscopy or ultrasound guidance when appropriate. Image guidance helps confirm placement and supports a more precise procedure.
How do I know which injection or procedure I need?
That depends on your symptoms, exam findings, imaging, diagnosis, prior treatments, and goals. For example, nerve-related leg pain may require a different procedure than facet-related back pain or arthritis-related joint pain. I will explain which option makes sense and why.
Can interventional pain management help prevent surgery?
Sometimes. Interventional pain procedures may help reduce pain and improve function without surgery when a nonsurgical plan is medically appropriate. However, they are not a replacement for surgery when surgery is truly needed. If your imaging or neurological findings suggest that a surgical opinion should be considered, I will tell you directly.
How long do results from interventional pain procedures last?
The duration of relief depends on the procedure, diagnosis, medication used, and your body’s response. Some injections provide short-term relief, some procedures provide longer-lasting improvement, and some diagnostic blocks are valuable even if the relief is temporary because they help guide future care.
Is interventional pain management right for chronic pain?
It can be. Many chronic pain patients benefit from interventional pain management when a specific pain generator can be identified and targeted. For other patients, medication management, rehabilitation, diagnostic testing, or a broader multidisciplinary plan may be more appropriate.