Pain physician
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Complications of unintended intravascular penetration and subsequent injection of local anesthetics and/or other drugs occasionally are devastating. Multiple reports have related to unrecognized intravascular placement of the needle. The generally accepted technique during interventional techniques is intermittent fluoroscopy. ⋯ This case report involves description of digital subtraction to enhance visualization of contrast distribution during injection. Three series of images are included from atlanto-occipital joint, caudal epidural catheterization, and a cervical transforaminal injection. The case reports demonstrate that digital subtraction fluoroscopic imaging is superior to intermittent or live fluoroscopy in detecting intravascular injections with interventional techniques.
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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."
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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.
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Sacroiliac joint (SIJ) injection and arthrography have been described, yet no study has specifically categorized the morphological characteristics of SIJ arthrograms versus post arthrogram computerized tomography (CT). Forty-three patients with a mean age of 33 years (range 20-48 years) and an equal male to female distribution were studied radiographically for SIJ pathology. A total of 74 SIJ injections were performed using Image-intensifier-control and a posterior-inferior approach. ⋯ Conversely, plain film arthrography noted more diverticula compared to post arthrogram CT (McNemer's test, p<0.01). These findings demonstrate that a detailed radiographic analysis of the SIJ capsule is reasonable by either plain film arthrography or post arthrogram CT, with excellent agreement between the two techniques. Further, each test has specific regional benefits that may be appreciated in certain cases.
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The intervertebral disc is the focal point of pathology for most low back pain. Contained disc herniation is a common cause of low back pain and, when unresponsive to conservative measures, is often treatable by disc decompression. To evaluate the safety and efficacy of percutaneous disc decompression using Coblation (Nucleoplasty) in the treatment of back and/or leg pain associated with contained disc herniation, a prospective, nonrandomized cohort analysis was conducted in an interventional pain management practice. ⋯ Additionally, significant improvement was reported by 54%, 44%, and 49% of patients in sitting, standing and walking abilities, respectively, at 12 months. There were no instances of complications. These results indicate that disc decompression using Coblation (Nucleoplasty) is a safe and efficacious procedure for reducing discogenic low back pain with or without leg pain.