Pain physician
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Comparative Study
Comparison of clonazepam compliance by measurement of urinary concentration by immunoassay and LC-MS/MS in pain management population.
Physicians determine patient compliance with their medications by use of urine drug testing. It is known that measurement of benzodiazepines is limited by immunoassay specificity and cutoff limits and therefore does not offer physicians an accurate picture of their patients' compliance with these medications. A few studies have used lower cutoffs to demonstrate patient compliance. ⋯ The difference in positivity rate between the immunoassay and the LC-MS/MS result showed that the nominal 200 ng/mL cutoff of the immunoassay did not apply to 7-aminoclonazepam. This low immunoassay positivity rate is inconsistent with the manufacturer's published cross reactivity data for clonazepam and 7-aminoclonazepam. These data illustrate the limitations of using a 200 ng/mL cutoff to monitor clonazepam compliance and suggest that a cutoff of 40 ng/mL or less is needed to reliably monitor use of this drug.
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Review Comparative Study
Considerations and methodology for trialing ziconotide.
Before long-term intrathecal analgesic therapy is initiated, patients often undergo a spinal analgesia trial. Ziconotide is a nonopioid intrathecal analgesic used to manage severe chronic pain, and a variety of methods have been used to trial ziconotide. ⋯ All 3 methods of ziconotide trialing appear to be viable options, and no method can be considered superior on the basis of the evidence presented in this review. Controlled studies comparing ziconotide trialing methods may be warranted.
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The United States leads the world in many measures of health care innovation. However, it has been criticized to lag behind many developed nations in important health outcomes including mortality rates and higher health care costs. The surveys have shown the United States to outspend all other Organisation for Economic Co-operation and Development (OECD) countries with spending on health goods and services per person of $7,290 - almost 2(1/2) times the average of all OECD countries in 2007. ⋯ While CER is taking a rapid surge in the United States, supporters and opponents are emerging expressing their views. Since interventional pain management is a new and evolving specialty, with ownership claimed by numerous organizations, at times it is felt as if it has many fathers and other times it becomes an orphan. Part 2 of this comprehensive review will provide facts, fallacies, and politics of CER along with discussion of potential outcomes, impact of CER on health care delivery, and implications for interventional pain management in the United States.
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Comparative Study
The efficacy of two electrodes radiofrequency technique: comparison study using a cadaveric interspinous ligament and temperature measurement using egg white.
One technique in radiofrequency neurotomies uses 2 electrodes that are simultaneously placed to lie parallel to one another. Comparing lesions on cadaveric interspinous ligament tissue and measuring the temperature change in egg white allows us to accurately measure quantitatively the area of the lesion. ⋯ Heating the 2 electrodes simultaneously appears to coagulate a wider area and potentially produce better results in less time.
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Case Reports
C-arm fluoroscopic cone beam CT for guidance of minimally invasive spine interventions.
Isocentric C-arm fluoroscopic cone beam CT (CBCT) is a new technique for near real time 3-D volume imaging guidance of percutaneous interventional procedures. In combination with digital flat panel detectors, CBCT has high spatial resolution with isotropic voxel size, allowing for high resolution image reconstruction in any plane, including 3D rotational reconstructions. CBCT combines the advantages of conventional CT imaging guidance with the improved spatial resolution, patient positioning, and access of fluoroscopy. ⋯ Isocentric C-arm fluoroscopic cone beam CT (CBCT) is a new technique for 3D volume imaging guidance of interventional procedures of the spine with the capability to produce near real time high resolution image reconstructions in any plane. Compared to conventional CT and biplane fluoroscopy, CBCT offers improved anatomic visualization allowing high accuracy instrumentation placement, improving procedure results and minimizing risk of complications.