Pain physician
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On July 12, 2018, the Centers for Medicare and Medicaid Services (CMS) released the proposed 2019 Medicare physician fee schedule and quality payment program, combining these 2 rules for the first time. This occurred in a milieu of changing regulations that have been challenging for interventional pain management specialists. The Affordable Care Act (ACA) continuous to be amended by multiple administrative changes. ⋯ The only significant change noted is for spinal cord stimulator implant leads when performed in office setting with 19.2% increase. However, epidural codes, which have been initiated with a lower payment, continue to face small reductions for physician portion. This review describes the effects of the proposed policy on interventional pain management reimbursement for E&M services, procedural services by physicians and procedures performed in office settings.
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Previous surveys have identified variations in practice patterns related to epidural steroid injections. Since then, the United States Food and Drug Administration (FDA) has required the addition of drug warning labels for injectable corticosteroids. Updated evidence, as well as scrutiny from regulatory agencies, may affect practice patterns. ⋯ Epidural injection, epidural steroids, survey, low back pain, neck pain, technique.
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Percutaneous vertebroplasty (PVP) is widely used to treat osteoporotic vertebral compression fractures (OVCFs). The influence of timing (early vs. late) of PVP on the development of adjacent vertebral fractures (AVF) has rarely been discussed. ⋯ Percutaneous vertebroplasty, osteoporosis, osteoporotic vertebral compression fracture, adjacent vertebral fracture.
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Abdominal pain from primary cancer or metastatic disease is a significant cause of pain for patients undergoing treatment for the disease. Patient's pain may be resistant to conventional analgesics. The need for timely pain relief in order to facilitate further care in the cancer treatment plan should be a priority. ⋯ Celiac plexus, neurolytic, abdominal cancer pain, pain, retrocrural, cancer pain.
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Endoscopy has replaced open surgery, especially in spinal surgery. Among them, image-guided epiduroscopy allows pain generators to be identified, including epidural adhesion, fibrotic tissues, root compression, and spinal stenosis. However, the heavy lead apron worn by pain physicians to avoid exposure to radiation can induce occupational hazards, such as orthopedic complications and radiation-induced cancer. Hence, we developed a robotic system to address these problems. ⋯ Epiduroscopy, robotic system, spine, pig, animal model.