Pain physician
-
Epidural adhesiolysis with spinal endoscopy is an emerging interventional pain management technique in managing chronic refractory low back and lower extremity pain. However, there is a lack of significant data demonstrating the effectiveness of spinal endoscopic adhesiolysis. This randomized, double-blind controlled trial was undertaken to determine the ability of spinal endoscopic adhesiolysis to reduce pain and improve functional and psychological status. ⋯ Based on the definition that less than 6 months of relief is considered as short-term and longer than 6 months is considered as long-term, a significant number of patients obtained long-term relief. The results showed significant improvement in patients undergoing spinal endoscopic adhesiolysis at 1-month, 3-months, and 6-months, compared to baseline measurements, as well as compared to the control group without adhesiolysis. Spinal endoscopic adhesiolysis with targeted injection of local anesthetic and steroid, is an effective treatment in a significant number of patients without major adverse effects at 6-month follow-up.
-
Controlled substance abuse has increased at an alarming rate. However, available evidence suggests a wide variance in the use of controlled substances, as documented by different medical specialties, medical boards, advocacy groups, and the Drug Enforcement Administration. The primary objective of controlled substance guidelines by American Society of Interventional Pain Physicians (ASIPP) is to provide guidance for the use of controlled substances for the treatment of chronic pain. ⋯ It is expected that a provider will establish a plan of care on a case-by-case basis, taking into account an individual patient's medical condition, personal needs, and preferences, and the physician's experience. Based on an individual patient's needs, controlled substance prescribing and treatment different from that outlined here may be warranted. These guidelines do not represent "standard of care."
-
Epidural injections with or without steroids are used extensively in the management of chronic spinal pain. However, evidence is contradictory with continuing debate about the value of epidural steroid injections in chronic spinal syndromes. The objective of this systematic review is to determine the effectiveness of epidural injections in the treatment of chronic spinal pain. ⋯ Further, evidence was moderate for caudal epidural injections in managing lumbar radicular pain. The evidence in management of chronic neck pain, chronic low back pain, cervical radiculopathy, spinal stenosis, and post laminectomy syndrome was limited or inconclusive. In conclusion, the evidence of effectiveness of transforaminal epidural injections in managing lumbar nerve root pain was strong, whereas, effectiveness of caudal epidural injections in managing lumbar radiculopathy was moderate, while there was limited or inconclusive evidence of effectiveness of epidural injections in managing chronic spinal pain without radiculopathy, spinal stenosis, post lumbar laminectomy syndrome, and cervical radiculopathy.
-
It is estimated that over 50% of approximately 4 million interventional procedures performed annually in the United States are performed utilizing fluoroscopy. Fluoroscopy offers validity to interventional techniques by providing precise localization of anatomic target areas and facilitating accurate delivery of injectate. Exposure to ionizing radiation is an unavoidable consequence while performing fluoroscopic procedures. ⋯ Results of this study showed an average exposure per patient of 8.9 -/+ 0.4 seconds and per procedure of 4.9 -/+ 0.11 seconds. Scatter radiation exposure was higher outside the lead aprons compared to inside the lead aprons. Scatter radiation exposure at groin level was similar with or without lead shielding from the table to the floor.
-
The prevalence of illicit drug use by patients in a chronic pain management practice who concomitantly abuse prescription-controlled substances is not known. The purpose of this study was to determine the prevalence of illicit drug use by patients in an interventional pain management practice, based on whether or not there was evidence of simultaneous abuse of prescription drugs. One hundred and fifty patients in an interventional pain management practice who were prescribed controlled substances for pain treatment were selected for assessment of concomitant illicit drug use by urine drug testing. ⋯ Marijuana was the drug of choice in both groups, with 22% in the prescription abuse group and 10% in the non-abuse group. The second most commonly used illicit drug in both groups was cocaine. This study demonstrated a clinically significant use of illicit drugs, particularly marijuana and cocaine in an interventional pain management setting, in patients with or without evidence of concomitant abuse of prescription controlled substances.