Chronic pain
Switch pain off at its source — image-guided blocks, ablations and augmentation.
OVERVIEW
Dr Marios Agathangelou performs image-guided interventional pain treatment in Nicosia and Limassol, Cyprus — covered by GESY, €0 for GESY beneficiaries. When pain has a precise anatomical source, it can be treated precisely. Image guidance places medication, radiofrequency energy or bone cement exactly where it is needed: a facet joint, a nerve root, a collapsed vertebra.
Options range from diagnostic and therapeutic nerve blocks to radiofrequency ablation of pain-carrying nerves and vertebral augmentation for painful spinal fractures — each through a needle, none through an incision.
WHO IT’S FOR
- Chronic back or neck pain with an identified source
- Painful vertebral compression fractures
- Joint or nerve pain unresponsive to conservative care
BENEFITS
GESY COVER
The procedure is fully covered by GESY. It is done as an inpatient admission, and that admission includes the treatment — you pay nothing for the procedure.
Separately, the outpatient visit — the initial assessment, where it is decided whether the treatment suits you — may carry a small co-payment, usually €0–10, as any specialist visit within GESY does.
The co-payment is per activity, and it stops once your total co-payments for the year reach €150 — past that you pay nothing. Some categories of beneficiary have different limits.
Both need a valid referral, from your personal doctor or from a specialist.
Outside GESY, or with private insurance? We provide the documentation your insurer asks for, and a clear cost estimate at your consultation, before you decide anything.
FINDING THE SOURCE
Chronic back pain does not always have one cause visible on imaging. Before a treatment that targets a nerve, there has to be evidence that this nerve is the source: diagnostic blocks with local anaesthetic are done first, and if the pain clearly subsides we know where to aim. If it does not, the treatment will not help and should not be done.
WHAT THE EVIDENCE SAYS
For radiofrequency treatment of the spinal facet joints, the randomised evidence is of moderate certainty: it helps a significant proportion of correctly selected patients, and the selection criteria matter more than the technique.
For vertebroplasty — cement into a fractured vertebra — the picture is more complicated, and it is worth knowing. Two randomised trials against a sham procedure found no difference from placebo, while other trials found benefit, particularly in recent fractures. The debate internationally is still open. We will tell you where your own case sits within that picture, not only the side that suits us.
RISKS
The risks are not the same for every procedure on this page. A nerve block with local anaesthetic and neurolysis carry little; injecting cement into a broken vertebra carries the real ones.
Cement escaping outside the vertebra is common. A systematic review of 532 vertebroplasties recorded it in 39.3% of cases, and across all 1,025 procedures examined not one of those leaks caused neurological injury, pulmonary embolism, or the need for emergency decompression.
The leak that matters is the one that reaches the spinal canal. In a single-centre series of 3,175 patients it occurred in 26 of them, and four of the 3,175 needed surgical decompression.
In the same series, cement embolism to the lungs requiring oxygen did not occur at all when less than three and a half cubic centimetres were injected, and reached 0.9% when seven were exceeded. The volume is a decision made in the moment, not a feature of the patient.
Where in the spine also matters. In the thoracic spine, where the canal is narrower, three of nine posterior leaks needed surgery; in the lumbar spine, one of seventeen.
The hardest finding is not about the procedure itself. In a pooled analysis of seven studies and 1,240 patients with a single-level fracture, the risk of a new vertebral fracture was about double after vertebral augmentation compared with conservative treatment, and the difference was larger with follow-up beyond one year.
In an analysis of 26 studies and 7,604 patients, one of the factors that raises the risk of an adjacent fracture is having no osteoporosis treatment after the procedure. Vertebroplasty stabilises one vertebra; it does not treat the bone that broke it.
For neurolysis of the spinal joints and for blocks, serious complications are rare. What is usual is tenderness at the needle site for a few days and, in some cases, temporary numbness over the area the treated nerve supplies.
Choosing none of this is always an option. Across a network of forty-six studies and 5,660 patients, conservative treatment did worse on pain and on function, but carried the lowest probability of an adjacent fracture of any form of vertebral augmentation. The question is not whether cement stabilises the vertebra, but what you gain and what you lose.
COMMON QUESTIONS
Dr Marios Agathangelou, an interventional radiologist, treats chronic pain from a precise source using image-guided injections, radiofrequency and vertebral procedures in Nicosia and Limassol. It is covered by GESY — €0 for GESY beneficiaries.
We do not, until a diagnostic block shows it. If numbing the nerve clearly relieves your pain, that nerve is the source and treating it makes sense. If it does not, we say so rather than proceed.
Then the pain is coming from somewhere else, and treating that nerve would not help you. That is a useful answer — it stops you having a procedure that was never going to work.
It is done with local anaesthesia, with sedation if you need it. Most people feel pressure rather than pain, and some soreness for a few days afterwards.
It varies, and nerves can regenerate over time, so relief is not necessarily permanent. Treatment can usually be repeated if the pain returns in the same pattern.
Some people reduce them considerably; others do not. Any change to your medication is decided with the doctor who prescribes it, not here.
Not necessarily. It treats pain from a specific source; it does not correct a structural problem that needs an operation. Where surgery is the right answer, we will say so.
Nothing, if you are a GESY beneficiary. GESY covers the procedure in full: it is done as an inpatient admission, and that admission includes the treatment. The outpatient visit where it is decided whether the treatment suits you may carry the usual small GESY co-payment, and you need a valid referral from your personal doctor or from a specialist. Outside GESY, or with private insurance, you get a clear cost estimate at your consultation, before you decide anything.
SOURCES
Clinical statements on this page follow published randomised trials and systematic reviews of image-guided pain treatments, including the sham-controlled vertebroplasty trials, a 2025 network meta-analysis of interventional procedures for chronic spine pain, and systematic reviews of cement leakage and of new fractures after vertebral augmentation. They describe these treatments in general; they are not advice about your case.