Pain physician
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Fluoroscopy is an integral part of the practice of interventional pain management in present day modern medical practices. The major purpose of fluoroscopy in interventional pain management is correct needle placement to ensure target specificity and accurate delivery of the injectate. Fluoroscopy has become mandatory for multiple procedures based either on the definition of the procedure or the requirement of third parties. ⋯ The average exposure outside the apron was 1.345 mREM per patient and 0.778 mREM per procedure outside the apron and 0 mREM inside the apron. The levels of exposure are significantly below the annual limits recommended. It is concluded that it is feasible to perform all procedures under fluoroscopy in the described setting safely and effectively in interventional pain management.
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The role of zygapophysial (facet) joints in chronic thoracic pain has received very little attention with only a few publications discussing these joints as sources of pain. In contrast, facet joints have been implicated as responsible for chronic pain in a significant proportion of patients with chronic neck and low back pain. However, thoracic spinal pain, though less common, has been reported to be as disabling as neck and low back pain. ⋯ Results showed that 46 patients underwent single blocks with lidocaine and 36 of these patients, or 78%, were positive for facet joint pain, reporting a definite response. Confirmatory blocks with bupivacaine were performed in all patients who were lidocaine-positive, with 61%, or 48% of the total sample of the lidocaine-positive group, reporting a definite response with improvement in their pain. Thus, comparative local anesthetic blocks showed the prevalence of facet joint pain to be 48%, with single blocks carrying a false-positive rate of 58%.
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Among the chronic pain problems, pain emanating from cervical and lumbar regions, independently or in combination, constitutes a significant and frequently encountered problem in interventional pain management practices. This study was designed to test the assumption that patients presenting with chronic low back pain of lumbar facet joint origin may also present with chronic neck pain of facet joint origin. ⋯ The results showed prevalence of cervical facet joint pain in 67% of the patients with a false-positive rate of 63% with a single block, whereas the prevalence of lumbar facet joint pain was seen in 40% of the patients with a 30% false-positive rate with a single block in patients presenting with chronic low back and neck pain. There was also significant correlation noted with 94% of the patients with confirmed lumbar facet joint pain also presenting with cervical facet joint pain.
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Effectiveness of transforaminal epidural steroid injections in low back pain: a one year experience.
Transforaminal epidural steroid injections under fluoroscopy are an alternative treatment for lower back pain with radiculopathy. We followed 82 patients with a standardized telephone questionnaire at 2, 6, and 12 months after the first injection, in order to assess their effectiveness. Ninety-two patients with radiculopathic back pain due to spinal stenosis, herniated discs, spondylolisthesis, and degenerated discs, underwent transforaminal epidural steroid injections under fluoroscopy. ⋯ After one year, 36 patients did not take any pain medications. Greater than 50% improvement after one year was seen in 23% of Group I; 59% in Group II; 35% in Group III and 67% in Group IV. Transforaminal epidural steroid injections can offer significant pain reduction up to one year after initiation of treatment in patients with discogenic pain and possibly in patients with spinal stenosis.
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Clinical outcome data was analyzed for 67 patients with contained disc herniation who underwent percutaneous disc decompression procedure using Coblation(R) technology, also referred to as Nucleoplasty after failing to respond to conservative management. Patients presented with clinical symptoms of discogenic low back pain and/or leg pain and were not considered candidates for open surgery. Follow-up data was collected up to 12 months. ⋯ Average pre-procedure pain level for all patients was reported as 6.8 while average pain level was 4.1 at the 12 month follow-up period. Statistically significant improvement was observed in 62%, 59%, and 60% of patients in sitting, standing, and walking ability at 12 months, respectively. The results of this analysis indicated that PDD using Coblation technology, also referred to as Nucleoplasty, is an effective procedure for patients presenting with discogenic back and/or leg pain who have failed conservative therapies and are not considered candidates for open surgical interventions.