Pain physician
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A growing number of patients suffer from severe low back pain of discogenic origin that is not responsive to conservative medical management. These patients must consider the option of surgical spinal fusion or minimally-invasive intradiscal electrothermal therapy (IDET). ⋯ The majority of patients reported improvement in symptoms following both spinal fusion and the IDET procedure. The IDET procedure appears to offer sufficiently similar symptom amelioration to spinal fusion without the attendant complications.
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Recent years have been quite eventful for interventional pain physicians with numerous changes in the Medicare payment system with a view for the future and what it holds for interventional pain management for 2006 and beyond. On February 8, 2006, President Bush signed the Deficit Reduction Act of 2005, which cuts the federal budget by 39 billion dollars and Medicare and Medicaid by almost 11 billion dollars over five years. The Act contains a number of important provisions that effect physicians in general and interventional pain physicians in particular. ⋯ The law specifies a formula for calculating the SGR, based on changes in four factors: (1) estimated changes in fees; (2) estimated change in the average number of Part B enrollees (excluding Medicare Advantage beneficiaries); (3) estimated projected growth in real gross domestic product (GDP) growth per capita; and (4) estimated change in expenditures due to changes in law or regulation. Overall, the frequency of utilization of interventional procedures has increased substantially since 1998. In 2006 and beyond, interventionalists will face a number of evolving economic and policy-related issues, including reimbursement discrepancies, issues related to CPT coding, issues related to utilization, fraud, and abuse.
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We describe a case of perioperative Addisonian crisis induced by vertebral augmentation. While several complications of vertebral augmentation have been reported previously, related to the technical procedure, to our knowledge, perioperative Addisonian crisis from vertebral augmentation has not been reported in the literature. ⋯ Addisonian crisis may be triggered by vertebral augmentation. Practitioners need to recognize immediately this potentially lethal disorder in patients with known or suspected adrenal insufficiency and treat with intravenous hydrocortisone.
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To report about the safe use of a spinal cord stimulator (SCS) and a permanent cardiac pacemaker (PPM). ⋯ The simultaneous use of bipolar SCS in a patient with a PPM is not contraindicated. However, because false inhibition of a cardiac pacemaker may potentially lead to serious events, individual testing is mandatory to ascertain safety in each patient.
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Radiofrequency neurotomies are used to help reduce pain caused by structures innervated by the medial branch of the dorsal spinal nerve. The duration of effect may vary proportionally to the length of nerve coagulated. Techniques used to maximize the length of nerve within the radius of maximal heat include making multiple lesions, using larger needles, positioning the exposed needle parallel to the target nerve, and attempting more precise placement using 50 hertz test stimulation. A variation of the technique uses two needles that are simultaneously placed to lie parallel to one another and parallel to the probable area the target nerve is known to traverse. Heating both needles at the same time would be a faster method that theoretically might also include more tissue within the heating radius of the needle lengths. ⋯ This research confirms the efficacy of utilizing two needle electrodes during lumbar facet rhizotomy in an experimental model. Heating the two electrodes sequentially appears to coagulate a wider area and thus would be more likely to include a longer length of the target nerve and thus potentially could achieve better results in less time.