Pain physician
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The lifetime prevalence of spinal pain has been reported as 65% to 80% in the neck and low back. In the US each year, 500,000 - 1,000,000 spine surgeries and 2 to 5 million interventional procedures are estimated to be performed. The burden created by chronic pain is enormous on the patient and society. ⋯ The optimal course of care requires an integrated delivery system involving a variety of specialists. Due to the complexities of diagnosis and management, patients are best managed utilizing a multidisciplinary approach under an umbrella of services offered by a spinal diagnostic and interdisciplinary pain center. This review identifies various pain syndromes and conditions and provides a model for the establishment of an interdisciplinary pain center as well as the resources, guidelines, and infrastructure required for operating a successful pain center in any setting; free-standing, hospital-based, or academic.
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The objective of this paper is to review the literature of cervical transforaminal injections, resulting complications, and to suggest a safe technique. ⋯ The review of the literature revealed: 1. There is a paucity of literature regarding cervical transforaminal injections; 2. There is no accepted standard technique for performing cervical transforaminal injections; and 3. More research and study must be performed regarding the risk versus benefit, technique, and outcome of cervical transforaminal injections.
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Facet (zygapophysial) joint pain can be diagnosed by anesthetization of the medial branch divisions of the dorsal rami. In accordance with the criteria established by the International Association for the Study of Pain, lumbar facet (zygapophysial) joints have been implicated as the source of chronic pain in 15% to 45% of the patients with chronic low back pain. The reasons for the wide variations have not been systematically evaluated. ⋯ A false-positive rate of 17% in patients with low back pain only and 21% in patients with involvement of multiple regions of the spine was demonstrated with single blocks. This study demonstrated a lower incidence of facet joint pain in patients with spinal pain of a single region in the low back compared to the patients with multiple region involvement of the spine (21% vs 41%), in an interventional pain management setting. These results may not be extrapolated to the general population or chronic low back pain population at large.
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To determine the long-term efficacy of IDET in the treatment of chronic lumbar discogenic pain. ⋯ IDET appears to be an effective treatment for chronic lumbar discogenic pain in a well-selected group of patients with favorable long-term outcome.
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Interventional pain management dates back to the origins of neural blockade and regional analgesia. Over the years, it evolved into a distinct specialty with the application of interventional techniques beyond those of simple neural blockade. The first therapeutic nerve block in pain management was described in 1899 by Tuffer. ⋯ Diagnostic blockade in pain management was pioneered by von Gaza with the use of procaine for determining the pathways of obscure pain. Interventional pain management has entered into the modern era in the twenty-first century, driven by contributions from pioneers including Bonica, Winnie, Raj, Racz, Bogduk, and others. This historical review examines the origins of interventional pain management, its pathophysiologic basis, the role of precision diagnostic interventional techniques, therapeutic interventional techniques, and the future of interventional pain management.