Pain physician
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Epidural steroid injections are the most commonly used procedures to manage chronic low back pain in interventional pain management settings. Approaches available to access the epidural space in the lumbosacral spine include the interlaminar, transforaminal, and caudal. The overall effectiveness of epidural steroid injections has been highly variable. ⋯ The study also showed cost effectiveness of this treatment, with a cost of $ 2550 for 1-year improvement of quality of life. In conclusion, caudal epidural injections with steroids or Sarapin are an effective modality of treatment in managing chronic, persistent low back pain that fails to respond to conservative modalities of treatments and is also negative for facet joint pain. The treatment is not only effective clinically but also is cost effective.
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While drug therapy is one of the most commonly used modalities of treatment in managing persistent or chronic pain, controversy continues with regards to the appropriate use of controlled substances, specifically opioid analgesics, in interventional pain medicine settings. This study included 100 randomly selected patients receiving opioids in an interventional pain medicine setting. The patient's controlled substance profile was evaluated using multiple means. ⋯ There were no significant differences noted either in demographic characteristics or psychological characteristics, except for a higher prevalence of depression in the abuse group. In conclusion, there was significant abuse of opioids in an interventional pain medicine setting, with an incidence of 24%, with frequent abuse seen in almost half of these patients. Thus, it is important for interventional pain physicians to recognize this possibility and also to recognize that there is no definite physiologic, psychologic or demographic information to suggest abuse, even though depression was more prevalent in abuse patients.
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This study was designed to investigate radiation exposure to a physician performing fluoroscopically guided caudal epidural steroid injections. The prospective study design included 100 consecutive fluoroscopically guided caudal epidural steroid injections performed on patients with radiculitis from either herniated nucleus pulposus or lumbar spinal stenosis. Radiation exposure was monitored with the assistance of a radiological technologist (RT) who allocated four dosimetry badges to all physicians performing fluoroscopically guided caudal epidural steroid injections on consecutive patients being treated for radicular pain. ⋯ The RT's average exposure during these procedures was below the limit of detectability. Radiation exposure to the physician needs to be considered and minimized in the performance of spinal interventional procedures. Our study demonstrates that radiation exposure to the physician performing fluoroscopically guided caudal epidural steroid injections is well within safety limits when he/she adheres to proper technique.
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The increasing proportion of elderly patients, coupled with increasing longevity, causes the problem of lumbosacral pain secondary to spinal stenosis of the lumbar spine to be an important issue. Symptoms of spinal stenosis are caused by entrapment and compression of intraspinal vascular and nervous structures; which may lead to inactivity, loss of productivity, and potential loss of independence, particularly in the elderly. Surgical decompression is considered as the natural treatment. ⋯ The results showed significant improvement with reduction of pain; with improvement of physical health, mental health, and functional status. Improvement in psychological status was also noted, with decrease in narcotic intake. Epidural adhesiolysis with hypertonic saline neurolysis is a safe and probably effective modality of treatment in managing symptomatic moderate to severe lumbar spinal canal stenosis.
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An attempt was made to determine the relative contribution of various structures to chronic low back pain, including facet joint(s), disc(s), and sacroiliac joint(s) in a prospective evaluation. Precision diagnostic blocks, including disc injections, facet joint blocks, and sacroiliac joint injections, are frequently used. ⋯ One hundred and twenty patients with a chief complaint of low back pain were evaluated with precision diagnostic injections, which included medial branch blocks, provocative discography and sacroiliac joint injections. In 40% (95% CL, 31%, 49%), of the patients, facet joint pain was diagnosed; and in 26% (95% CL, 18%, 34%) of the patients discogenic pain was diagnosed; and 2% of the patients were diagnosed with sacroiliac joint pain.