Pain physician
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Epidural fibrosis is seen as a common phenomenon among postlumbar laminectomy syndrome patients, contributing to approximately 60% of symptom recurrence. Percutaneous epidural lysis of adhesions has been described as a modality to effectively manage chronic low back pain secondary to epidural fibrosis. Forty-five patients were randomly assigned, with fifteen patients in the control group, or Group I, who were treated with conservative modalities of treatments, including medication, physical therapy, and an exercise program; and, thirty patients in Group II, who were treated with percutaneous epidural adhesiolysis and hypertonic saline neurolysis. ⋯ The study also showed that overall health status improved significantly in the treatment group in all parameters with average pain, physical health, mental health, functional status, psychological status and narcotic intake. Analysis also showed that this is a cost-effective treatment, with cost for 1-year improvement of quality of life at $2693. In conclusion, epidural adhesiolysis with hypertonic saline neurolysis performed on a 1-day basis is an effective modality of treatment in managing chronic low back pain in patients who failed to respond to fluoroscopically directed epidural steroid injections and also were demonstrated not to have facet joint mediated pain.
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This study was designed to investigate the clinical efficacy of fluoroscopically guided therapeutic cervical selective nerve root blocks (SNRBs) in patients with whiplash induced cervical radicular pain. Study design was restrospective with independent clinical review. Twenty two patients were included. ⋯ Good or excellent results were observed in 14% of patients. In higher functioning individuals a significantly greater (F=.0427) improvement in pain of 48.9% was observed. In these initial findings suggest that fluoroscopically guided therapeutic SNRBs, except possibly for higher functioning individuals, are not effective in the treatment of whiplash induced cervical radicular pain.
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This randomized clinical trial was designed to determine the effectiveness of therapeutic lumbar facet joint nerve blocks. Two hundred patients were evaluated with controlled diagnostic blocks for the presence of facet joint mediated pain. Eighty four patients, or 42% were determined to have lumbar facet joint mediated pain. ⋯ Cumulative significant relief with one to three injections was 100% up to 1 to 3 months, 82% for 4 to 6 months, 21% for 7 to 12 months, and 10% after 12 months, with a mean relief of 6.5 +/- 0.76 months. There was significant improvement noted in overall health status with improvement not only in pain relief, but also with physical, functional, and psychological status, as well as return-to-work status. In conclusion, the results of this study demonstrate that medial branch blocks with local anesthetic and Sarapin, with or without steroids, are a cost effective modality of treatment, resulting in improvement in pain status, physical status, psychological status, functional status and return to work.
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Practice guidelines are not only an ancient tradition, but they are a fact of life. The first guidelines were developed in the 1840s, shortly after the use of anesthesia was first demonstrated. ⋯ In spite of the great potential of clinical practice guidelines, and the involvement of numerous medical societies and physician groups, there is still a great debate within the profession not only about the pros and cons of the development and usage of the guidelines, but also conflicting and controversial opinions on both sides of the issue, i.e., providers and patients vs payors. This article discusses the development, usage, advantages, disadvantages and the implications of practice guidelines to interventional pain medicine specialists.
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The practice guidelines for interventional techniques in the management of chronic pain are systematically developed statements to assist physician and patient decisions about appropriate health care related to chronic pain. These guidelines are professionally derived recommendations for practices in the diagnosis and treatment of chronic or persistent pain. They were developed utilizing a combination of evidence and consensus based techniques, to increase patient access to treatment, improve outcomes and appropriateness of care, and optimize cost-effectiveness. ⋯ These guidelines do not constitute inflexible treatment recommendations. It is expected that a provider will establish a plan of care on a case-by-case basis, taking into account an individual patient's medical condition, personal needs, and preferences, and the physician's experience. Based on an individual patient's needs, treatment different from that outlined here could be warranted.