When Regional Anesthesia is Mistaken for Pain Medicine: The Importance of Etiology-Driven Interventional Pain Management

Interventional pain medicine has evolved into a highly specialized discipline grounded in pathophysiological under- standing, diagnostic precision, and mechanism-based therapeutic strategies. Unlike regional anesthesia, which is primarily designed to temporarily interrupt nerve conduction, pain medicine seeks to identify and treat specific pain generators through targeted and etiologically appropriate interventions. However, an increasingly concerning trend has emerged in clinical practice: the indiscriminate use of peripheral nerve blocks in the management of chronic spinal pain conditions, such as cervical and lumbar radiculopathy, without regard for the underlying pathology. Peripheral nerve blocks, including brachial plexus blocks for cervicobrachialgia or sciatic nerve blocks for lumbar radiculopathy, are being used in situations in which the anatomical and pathophysiological origin of pain is proximal, such as nerve root compression due to disc herniation or foraminal stenosis. This practice reflects a fundamental misunderstanding of the principles underlying interventional pain medicine and risks compromising both patient outcomes and the credibility of the specialty. Interventional pain medicine is not defined by technical capability alone, but by the ability to select the appropriate intervention based on pathophysiological mechanisms.