Representatives of the Spine Intervention Society (SIS) and American Academy of Pain Medicine (AAPM) have convened to issue an expedited practice advisory providing immediate guidance during the current iodinated contrast media (ICM) shortage to physicians who perform interventional pain procedures.
This statement will be expanded in the coming weeks to include additional background information, evidentiary support, and to provide recommendations regarding appropriate use of iodinated contrast media for specific types of procedures. Physicians should carefully weigh the risks and benefits of performing procedures without ICM or using an alternative agent in the context of each unique patient’s situation and should involve patients in shared decision making before proceeding. Please refer to the SIS Practice Guidelines for the full details and standards related to each unique procedure.
In addition, the American Society of Regional Anesthesia (ASRA) and Pain Medicine has general recommendations which include the following:
- Risk stratify procedures that can be delayed until the supply resumes
- Consider alternative forms of visualization like ultrasound
- If contrast medium is deemed necessary, utilize the lowest possible effective dose based on currently published guidelines
- The use of gadolinium can be considered in non-neuraxial injections
- Lumbar interlaminar epidural injections, sacroiliac and facet joint injections, lumbar medial branch blocks, and radiofrequency denervation can be performed without contrast.