Pain physician
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Sacroiliac joint (SIJ) injection and arthrography have been described, yet no study has specifically categorized the morphological characteristics of SIJ arthrograms versus post arthrogram computerized tomography (CT). Forty-three patients with a mean age of 33 years (range 20-48 years) and an equal male to female distribution were studied radiographically for SIJ pathology. A total of 74 SIJ injections were performed using Image-intensifier-control and a posterior-inferior approach. ⋯ Conversely, plain film arthrography noted more diverticula compared to post arthrogram CT (McNemer's test, p<0.01). These findings demonstrate that a detailed radiographic analysis of the SIJ capsule is reasonable by either plain film arthrography or post arthrogram CT, with excellent agreement between the two techniques. Further, each test has specific regional benefits that may be appreciated in certain cases.
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The intervertebral disc is the focal point of pathology for most low back pain. Contained disc herniation is a common cause of low back pain and, when unresponsive to conservative measures, is often treatable by disc decompression. To evaluate the safety and efficacy of percutaneous disc decompression using Coblation (Nucleoplasty) in the treatment of back and/or leg pain associated with contained disc herniation, a prospective, nonrandomized cohort analysis was conducted in an interventional pain management practice. ⋯ Additionally, significant improvement was reported by 54%, 44%, and 49% of patients in sitting, standing and walking abilities, respectively, at 12 months. There were no instances of complications. These results indicate that disc decompression using Coblation (Nucleoplasty) is a safe and efficacious procedure for reducing discogenic low back pain with or without leg pain.
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Irritation of neural structures, specifically the brachial plexus outside of the cervical spine is capable of producing pain in the upper extremity. These pain patterns may be similar to pain originating from the cervical spine, presenting a diagnostic challenge. Brachial plexus block is performed at multiple levels, including interscalene, supraclavicular, infraclavicular, and axillary. ⋯ Relevant anatomy and proposed technique of brachial plexus block is described. The procedure is performed under fluoroscopy with contrast injection. It is concluded that the proposed technique of brachial plexus block is useful for brachial plexus blockade providing precision and specificity with minimal complications.
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This study sought to determine the efficacy of fluoroscopic caudal epidural steroid injections as a conservative treatment in patients with presumably chronic lumbar discogenic pain. ⋯ At greater than two year follow-up, the efficacy of fluoroscopically guided caudal epidural steroid injections in patients with chronic lumbar discogenic pain is poor. Patient satisfaction exceeds the reported rate of efficacy. Patients responding to injection have significantly lower pre-injection pain scores.
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Drug abuse with illicit drugs and licit drugs has been increasing steadily over the past decade. A recent National Household Survey on Drug Abuse found statistically significant increases between 2000 and 2001 in the use of multiple drugs, including marijuana, cocaine, and non-medical use of pain relievers and tranquilizers. Prescription controlled substance abuse is a major issue in chronic pain management. ⋯ Only one patient tested positive for a combined use of both marijuana and cocaine. This study showed that, in an interventional pain management setting, there is significant use of illicit drugs (16%) with 13% use of marijuana and 3% use of cocaine in patients who are considered as non-abusers of prescription controlled substances and those who are adherent to controlled substance agreements. However, if cocaine is considered as a hardcore drug in contrast to marijuana, abuse of hardcore illicit drugs is only 3%.