Pain physician
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The lifetime prevalence of spinal pain has been reported as 54% to 80%, with as many as 60% of patients continuing to have chronic pain five years or longer after the initial episode. Spinal pain is associated with significant economic, societal, and health impact. Available evidence documents a wide degree of variance in the definition and the practice of interventional pain management. ⋯ These guidelines included the evaluation of evidence for diagnostic and therapeutic procedures in managing chronic spinal pain and recommendations for managing spinal pain. However, these guidelines do not constitute inflexible treatment recommendations. These guidelines do not represent "a standard of care".
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Percutaneous epidural adhesiolysis and spinal endoscopic adhesiolysis are interventional pain management techniques that play an active role in managing chronic intractable low back pain. There have not been any systematic reviews performed on this subject. ⋯ The evidence of effectiveness of percutaneous adhesiolysis with administration of hypertonic sodium chloride administration, and spinal endoscopic adhesiolysis with epidural steroid administration in managing chronic, refractory low back and lower extremity pain of post lumbar laminectomy syndrome or epidural fibrosis was moderate to strong.
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Facet joint interventions are used frequently for managing chronic spinal pain. Evidence continues to accumulate supporting the clinical effectiveness of these procedures and defining potential complications. ⋯ The evidence for facet joint interventions ranged from negative to strong.
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The sacroiliac joint is an accepted source of low back pain with or without associated lower extremity symptoms. The diagnosis and management of sacroiliac joint pain and the role of interventional techniques have been controversial. ⋯ The evidence for the specificity and validity of diagnostic sacroiliac joint injections was moderate.The evidence for therapeutic intraarticular sacroiliac joint injections was limited to moderate. The evidence for radiofrequency neurotomy in managing chronic sacroiliac joint pain was limited.
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Discogenic low back pain is a common cause of chronic low back pain that remains a treatment challenge. The innervation and transmission of nociceptive information from painful lumbar discs has only recently been better described. ⋯ Radiofrequency lesioning of the L2 ramus communicans seems to offer partial relief for patients suffering from discogenic pain. Further studies are needed to confirm our results.