Articles: pain-clinics.
-
The lifetime prevalence of spinal pain has been reported as 54% to 80%, with as many as 60% of patients continuing to have chronic pain five years or longer after the initial episode. Spinal pain is associated with significant economic, societal, and health impact. Available evidence documents a wide degree of variance in the definition and the practice of interventional pain management. ⋯ These guidelines included the evaluation of evidence for diagnostic and therapeutic procedures in managing chronic spinal pain and recommendations for managing spinal pain. However, these guidelines do not constitute inflexible treatment recommendations. These guidelines do not represent "a standard of care".
-
Facet joint interventions are used frequently for managing chronic spinal pain. Evidence continues to accumulate supporting the clinical effectiveness of these procedures and defining potential complications. ⋯ The evidence for facet joint interventions ranged from negative to strong.
-
Randomized Controlled Trial Clinical Trial
Preparing for pain management: a pilot study to enhance engagement.
A significant proportion of individuals fail to engage in cognitive-behavioral treatments for pain. The aim of this pilot study was to develop and evaluate a Preparation for Pain Management Intervention administered before community-based therapy (CBT) pain management workshops. Participants (N = 78) were randomly assigned to a treatment group receiving a 2-session intervention including assessment and feedback based on the Preparation for Pain Management Profile (PPMP) or to a control group receiving assessment (treatment as usual) and an attention placebo interview in place of the feedback session. The interviews were conducted with both groups before patients were offered participation in pain management workshops. Results demonstrate that participants in the treatment group were significantly more likely to attend workshops than were participants in the control group (P < .01). ⋯ This paper describes a randomized controlled trial assessing a brief motivational intervention aimed at increasing engagement in community-based pain management workshops.
-
The sacroiliac joint is an accepted source of low back pain with or without associated lower extremity symptoms. The diagnosis and management of sacroiliac joint pain and the role of interventional techniques have been controversial. ⋯ The evidence for the specificity and validity of diagnostic sacroiliac joint injections was moderate.The evidence for therapeutic intraarticular sacroiliac joint injections was limited to moderate. The evidence for radiofrequency neurotomy in managing chronic sacroiliac joint pain was limited.
-
To assess whether unilateral L2 infiltration with local anesthetic can be used to identify patients who will have negative discograms and thus eliminate the need for the discogram. Discogenic low-back pain is considered to have afferent pathways in the sinuvertebral nerves, mainly originating from the ventral rami of the spinal nerves. There is evidence that pain arising from the lower lumbar intervertebral discs may be transmitted through the sympathetic afferent fibers contained in the L2 spinal nerve root. Provocative discography, within the context of other clinical data, is the current "gold standard" by which to diagnose discogenic low-back pain, but a far more invasive procedure than L2 infiltration. ⋯ The results showed that unilateral L2 infiltration is not predictive of discogenic low-back pain when compared to discography, the current "gold-standard" for diagnosis.