Chronic Pain: Anesthesia for Procedures Magdalena Anitescu, MD, PhD INTRODUCTION Whether pain is chronic or arises immediately after a surgical intervention, it is the symp- tom most feared by patients. In particular, patients suffering from chronic pain are often afraid of embracing interventional procedures fearing aggravation of their symptoms. Therefore, in order to alleviate anxiety associated with various pain techniques and to improve patient satisfaction while treating chronic pain syndromes, pain physicians may use various anesthetic techniques for interventional pain-relieving procedures. This article describes the anesthesia techniques commonly used in pain practices. HISTORY OF INTERVENTIONAL PAIN MANAGEMENT Although medical management of pain has been used for thousands of years, inter- ventional techniques to treat chronic, refractory, or unrelenting pain are much more recent, concomitant with the discovery, development, and advances in neural blockade and regional analgesia. Koller’s discovery in 1884 that cocaine numbs the tongue 1,2 prompted physicians to use this product in a variety of interventional tech- niques aimed to relieve pain, such as caudal epidural injections (Cushing, 3 1902), tri- geminal ganglion block (Schloesser, 4 1903), spinal anesthesia, and epidural analgesia using loss of resistance techniques. Identifying specific pain generators was the next step in the evolution of interventional pain management as a medical subspecialty. Disclosure: The author has no financial interest in any of the materials discussed. Pain Management Fellowship Program, Department of Anesthesia and Critical Care, University of Chicago Medical Center, 5841 South Maryland Avenue, MC 4028, Chicago, IL, USA E-mail address: manitescu@dacc.uchicago.edu KEYWORDS  Interventional pain-relieving procedures  Anesthesia for pain interventions  Complications in pain management KEY POINTS  Pain management is an evolving field of medical specialty that uses increasingly complex procedures to diagnose and treat refractory and unrelenting chronic pain.  To increase patient satisfaction and relieve anxiety associated with advanced pain- relieving procedures, physicians use anesthetic techniques ranging from local anesthetic infiltrations to general anesthesia.  Balancing patient safety and comfort during anesthesia for pain-relieving procedures is becoming essential for the successful treatment of various and difficult pain conditions. Anesthesiology Clin - (2014) -–- http://dx.doi.org/10.1016/j.anclin.2014.02.001 anesthesiology.theclinics.com 1932-2275/14/$ – see front matter Ó 2014 Elsevier Inc. All rights reserved.