Pain physician
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Chronic pain, especially low back pain and hip pain, has been a growing public health concern that affects over 100 million Americans annually. Radiofrequency ablation (RFA) has distinct advantages over other chronic pain management modalities and its use has been increasing over the past decade. Among the growing population with comorbid conduction disorders and persistent pain, RFA and its potential interference with implantable cardiac devices is of concern.RFA is becoming a foundational element of persistent pain management and has been shown to be effective in a multitude of chronic pain syndromes. Cardiac implantable electronic devices (CIED), such as cardiac pacemakers or implantable cardioverter defibrillators, have been used in the treatment of cardiac conduction diseases for a number of decades. With our aging population, these diseases have increased in both incidence and prevalence. Chronic pain and cardiac conduction diseases are both common in our increasingly aging population. ⋯ This study provides evidence that bipolar RFA can be safely used in patients with CIEDs for chronic pain provided that proper precautions are employed. Considerations for safe use are provided.
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Diagnostic injections (blocks) are a valuable tool in the management of chronic noncancer pain. By precise blockade of specific neural structures and observation of pain responses, pain mechanisms can be accurately defined. With such information, therapeutic procedures targeting neural structures are possible. Fibromyalgia is a disorder of pain processing with characteristic symptoms. The 2010 American College of Rheumatologists fibromyalgia diagnostic criteria evaluates these symptoms in a scoring system, allowing more objectivity in the diagnosis. We hypothesize that patients with fibromyalgia phenotype fulfilling the 2010 American College of Rheumatologists criteria may respond to diagnostic blocks differently when compared to patients without fibromyalgia phenotype. ⋯ We conclude that after physician selection, the presence of fibromyalgia phenotype does not influence the outcome from diagnostic block. It is likely therefore that fibromyalgia phenotype should not influence the decision to perform diagnostic blocks if indicated based on assessment by an experienced pain physician.
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Case Reports Meta Analysis
Infections Following Interventional Spine Procedures: A Systematic Review.
Interventional spine procedures, such as discography, epidural steroid injections (ESIs), facet joint procedures, and intradiscal therapies, are commonly used to treat pain and improve function in patients with spine conditions. Although infections are known to occur following these procedures, there is a lack of comprehensive studies on this topic in recent years. ⋯ Based on our systematic review, the risk of infections following interventional spine procedures appears to be low overall. More studies focusing on infectious complications with larger sample sizes are needed, particularly for intradiscal therapies, in which the microbiome may be an underlying cause of disc infection. To achieve a true incidence of the risk of infections with these procedures, large prospective registries that collect complication rates are necessary.