Pain physician
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Review Meta Analysis
Treatment of functional chest pain with antidepressants: a meta-analysis.
Recurrent Functional Chest pain (FCP) with normal coronary anatomy and no detectable gastroenterological and respiratory causes is a common problem that sometimes leads to excess use of medical care. ⋯ Antidepressant medications are associated with improvements in pain and psychological symptoms. The effects of factors including psychiatric co-morbidity, gender, age, ethnic group, and treating period on the outcomes should be checked further.
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Review Meta Analysis
Ozone therapy as a treatment for low back pain secondary to herniated disc: a systematic review and meta-analysis of randomized controlled trials.
Low back pain (LBP) is one of the most common and important health problems affecting the population worldwide and remains mostly unsolved. Ozone therapy has emerged as an additional treatment method. Questions persist concerning its clinical efficacy. ⋯ Ozone therapy appears to yield positive results and low morbidity rates when applied percutaneously for the treatment of chronic low back pain.
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Epidural steroid injection is a common treatment for the management of pain in a wide variety of patients. It is generally well tolerated and perceived to have few side effects, with a low risk of serious complications. Only a handful of reports exist that describe life-threatening complications such as subdural hematoma, respiratory depression, vasovagal response, and pneumocephalus. ⋯ To the best of our knowledge, this is the first report of such an arrest following a steroid injection in the cervical spinal region. There are several possible mechanisms for the immediate arrest, including cardioacceleratory center blockade, severe vasovagal response, iatrogenic pneumocephalus, and involvement of the phrenic nerve followed by apnea. Our conclusion in this case is that the most likely scenario was injection of the C6-C7 level led to a blockade of the cardiac accelerator fibers located just below in the T1-T4 spinal level, causing a sympathetic blockade and profound bradycardia, leading to cardiopulmonary arrest.
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The health care system in the United States has been criticized for skyrocketing expenditures and quality deficits. Simultaneously, health care providers and systems are under pressure to provide better and more proficient care. The landscape of the US health care system is shaped by federal and private payers which continue to develop initiatives designed to curtail costs. ⋯ Significant changes continue to occur in the payment systems with policies of paying a certain percent of hospital outpatient department payments to ASCs which declined from 63% in 2008 to 56% in 2011, with substantial reductions for add-on codes. The Centers for Medicare and Medicaid Services (CMS) evaluation of IPM codes also consists of multiple misvalued codes. In conclusion, overall the future of ASCs may appear optimistic, but in the near perspective, specifically in 2012 to 2014, there will be challenging times specifically for interventional pain management centers with the regulatory environment and rapid changes taking place with or without implementation of Affordable Care Act.