Pain physician
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Randomized Controlled Trial Multicenter Study
Automatic adaptation of neurostimulation therapy in response to changes in patient position: results of the Posture Responsive Spinal Cord Stimulation (PRS) Research Study.
Variation in the intensity of neurostimulation with body position is a practical problem for many patients implanted with a spinal cord stimulation system because positional changes may result in overstimulation or understimulation. These posture-related changes in patients' perception of paresthesia can affect therapeutic outcomes of spinal cord stimulation therapy. An accelerometer-based algorithm that automatically adjusts spinal cord stimulation based on sensed body position or activity represents a potential solution to the problem of position-mediated variations in paresthesia perception. ⋯ Patients preferred automatic versus manual adjustment of stimulation amplitude in response to changes in paresthesia consequent to positional changes during in-clinic testing.
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Case Reports
An introduction to trialing intrathecal baclofen in patients with hemiparetic spasticity: a description of 3 cases.
Intrathecal baclofen has been an effective therapy in the management of spasticity. As interventional pain physicians are rapidly becoming the experts in intrathecal drug delivery, they are now frequently asked to trial and implant intrathecal baclofen therapy. While some physicians might be very comfortable with the process of trialing and implanting, others will have next to no experience until the first consult appears on their desks. While uncomplicated lower extremity spasticity can usually be trialed with a single-shot bolus injection, more complicated cases of upper and lower extremities or hemiparetic spasticity need a more delicate approach. This is the first case series in the literature reporting a trial using an indwelling temporary catheter and inpatient admission. Moreover, while the technical aspects of intrathecal therapy trialing and implantation might be familiar for the interventional physician, we review the indications and goals of therapy, about which the physician may be less familiar. ⋯ Trialing for baclofen is usually performed as a single shot bolus. For patients with severe hemiparetic spasticity or in patients where weakness in the unaffected limb might significantly affect quality of life, this trialing technique may be inadequate. In these patients, placement of a temporary intrathecal catheter and inpatient admission may be a more effective trial method.
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The International Classification of Diseases-10 (ICD-10 is a new system that is expected to be implemented effective on October 1, 2013. This new system is a federally mandated change affecting all payers and providers, and is expected to exceed both the Health Insurance Portability and Accountability Act (HIPAA) and Y2K in terms of costs and risks. However, the Administration is poised to implement these changes at a rapid pace which could be problematic for health care in the United States. ⋯ Opponents also argue that beyond financial expense, it is also costly in terms of human toll, hardware and software expenses and has the potential to delay reimbursement. There is also concern that an unintended consequence of granularity would be the potential for enhanced and unnecessary fraud and abuse investigations. The authors of this article favor postponing the implementation of the ICD-10 until such time as its necessity is proven and implications are understood.
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Multicenter Study Clinical Trial
Infection control practices (safe injection and medication vial utilization) for interventional techniques: are they based on relative risk management or evidence?
Recently, multiple regulations and recommendations for safe infection control practices and safe injection and medication vial utilization have been implemented. These include single dose and multi-dose vials for a single patient and regulations. It is a well known fact that transmission of bloodborne pathogens during health care procedures continues to occur because of the use of unsafe and improper injection, infusion, and medication administration. Multiple case reports have been published illustrating the occurrence of infections in interventional pain management and other minor techniques because of lack of safe injection practices, and noncompliance with other precautions. However, there are no studies or case reports illustrating the transmission of infection due to the use of single dose vials in multiple patients when appropriate precautions are observed. Similarly, the preparation standards for simple procedures such as medial branch blocks or transforaminal epidurals have not been proven to be essential. Further, the effectiveness or necessity of surgical face masks and hats, etc., for interventional techniques has not been proven. ⋯ There were no infections of any significance noted in approximately 3,200 patients with over 18,000 procedures performed during a 20-month period in an ambulatory surgery center utilizing simple precautions for clean procedures with the use of single dose vials for multiple patients and using safe injection practices.
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Review
Intramuscular botulinum toxin in complex regional pain syndrome: case series and literature review.
Pain associated with Complex Regional Pain Syndrome (CRPS) is frequently excruciating and intractable. The use of botulinum toxin for relief of CRPS-associated pain has not been well described. ⋯ Intramuscular injection of botulinum toxin in the upper limb girdle muscles was beneficial for short term relief of pain caused by CRPS. The incidence of complications was low (2.7%).