Pain physician
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The prevalence of illicit drug use by patients in a chronic pain management practice who concomitantly abuse prescription-controlled substances is not known. The purpose of this study was to determine the prevalence of illicit drug use by patients in an interventional pain management practice, based on whether or not there was evidence of simultaneous abuse of prescription drugs. One hundred and fifty patients in an interventional pain management practice who were prescribed controlled substances for pain treatment were selected for assessment of concomitant illicit drug use by urine drug testing. ⋯ Marijuana was the drug of choice in both groups, with 22% in the prescription abuse group and 10% in the non-abuse group. The second most commonly used illicit drug in both groups was cocaine. This study demonstrated a clinically significant use of illicit drugs, particularly marijuana and cocaine in an interventional pain management setting, in patients with or without evidence of concomitant abuse of prescription controlled substances.
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Lumbar zygapophyseal joints have long been considered a source of low back pain with or without leg pain. The objective of this prospective study was to investigate the therapeutic effectiveness of lumbar zygapophyseal joint radiofrequency denervation (RFD) followed by physical therapy, for the treatment of refractory lumbar zygapophyseal joint mediated low back pain secondary to lumbar zygapophyseal joint synovitis, in baseball pitchers. Participants included twelve male baseball pitchers with a diagnosis of lumbar zygapophyseal joint synovitis mediated low back pain and a subsequent difficulty in pitching. ⋯ Ten out of 12 (83%) athletes were able to return to pitching at a level attained prior to RFD. All 12 patients, experienced statistically significant low back pain relief, with a mean pre-RFD VAS of 8.4; mean post-RFD VAS of 1.7; mean pre-RFD R-M score of 12.3; and mean post-RFD R-M score of 22.3. In conclusion, athletes, experiencing lumbar zygapophyseal joint mediated low back pain secondary to zygapophyseal joint synovitis and have failed more conservative management may benefit from radiofrequency zygapophyseal joint denervation followed by a formal rehabilitation program.
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To evaluate radiation exposure to the spinal interventionalist performing lumbar discography. A prospective study on four spinal interventionalists who performed 106 consecutive lumbar discograms (levels) on 37 patients with low back pain. Radiation exposure was monitored with the assistance of a radiological technologist (RT) who allocated four (4) dosimetry badges to all spinal interventionalists performing Discograms on consecutive patients being referred for evaluation of possible discogenic pain. ⋯ The mean/cumulative exposure per procedure was 3.66(-/+0.915)/390(-/+9.750) mREM at the "ring" badge, 2.35(-/+0.635)/251(-/+6.275) mREM at the "outside apron" badge, 1.49(-/+0.373)/159(-/+3.975) mREM at the "glasses" badge. A statistically significant higher radiation exposure was found on discograms at the L5/S1 level compared to the L4/5 and L3/4 levels. Our study illustrates that radiation exposure to the spinal interventionalist performing lumbar discography is well within safety limits.
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Complications of unintended intravascular penetration and subsequent injection of local anesthetics and/or other drugs occasionally are devastating. Multiple reports have related to unrecognized intravascular placement of the needle. The generally accepted technique during interventional techniques is intermittent fluoroscopy. ⋯ This case report involves description of digital subtraction to enhance visualization of contrast distribution during injection. Three series of images are included from atlanto-occipital joint, caudal epidural catheterization, and a cervical transforaminal injection. The case reports demonstrate that digital subtraction fluoroscopic imaging is superior to intermittent or live fluoroscopy in detecting intravascular injections with interventional techniques.
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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.