Articles: pain-clinics.
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The aim of this study was to develop equations by which the costs could be compared of various models of performing diagnostic blocks for spinal pain. ⋯ Best practice, using placebo-controlled diagnostic blocks before neurosurgical therapy of zygapophysial joint pain, is not encouraged and rewarded in the United States. In Australia it is compensated only in the context of lumbar zygapophysial joint pain. In the interests of short-term financial savings, the US fee structure sacrifices the majority of patients to failed treatment because of lack of proper diagnosis. Clinical absurdity, rather than evidence-based, best practice is encouraged.
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Comparative Study
Sickle cell anemia day hospital: an approach for the management of uncomplicated painful crises.
Painful crisis episodes are poorly treated in sickle cell anemia, both in timeliness and appropriateness of care. Delayed treatment in Emergency Departments, unrelieved pain, frequent admissions, and prolonged hospitalizations are common. We established a Day Hospital (DH) to determine if an alternative care delivery system could improve pain relief and reduce unnecessary hospital admissions for patients with uncomplicated painful crises. ⋯ The length of stay (LOS) for inpatients followed by the DH staff decreased by 1.5 days, while the LOS for patients followed by non-DH staff remained unchanged. Reduction of admissions and LOS represented a savings of approximately $1.7 million. We conclude that a dedicated facility provides the kingpin for effective and rapid painful crisis management, reduces hospitalizations, and facilitates integration of the approach into other areas of care. (Blood. 2000;95:1130-1136)
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Chronic pain is an individually variable experience, incorporating physical, psychological and social dimensions. Chronic pain occurs in a broad spectrum of severity; therefore, a grading procedure is of crucial importance in clinical research and in epidemiologic studies. The Mainz Pain Staging System is an interview-administered, multi-dimensional measure of chronic pain severity. The system suggests grading chronic pain in terms of 4 axes: time (persistence), spreading of pain site, medication use, and health care utilization. The whole scale consist of 10 items. The resulting score is used to classify the pain problem in three stages (I, II, III). Analysing the broader validity and parametric properties of the staging system is the purpose of the present study. ⋯ Given the high prevalence of recurrent and chronic pain as well as the broadness of severity, an important issue on further research is identification of factors which influence the chronification process. For this purpose improved measures of graded classification of pain status are needed.
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Journal of anesthesia · Jan 2000
Unanswered and uncounted items of the illness behavior questionnaire count: a comparison between patients who answered all the items in the questionnaire and those who left one or more items unanswered in a pain management program.
This study aimed to understand the significance of unanswered and uncounted items on the illness behavior questionnaire (IBQ) in the setting of the Mayo Clinic pain management program for patients with chronic pain. ⋯ Unanswered and uncounted items of the IBQ seem to count toward a better understanding of patients' pain behavior.
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Percutaneous epidural adhesiolysis, lysis of epidural adhesions, percutaneous neuroplasty, or epidural neurolysis is an interventional pain management technique which emerged during the latter part of the 1980s. It is becoming established as a common treatment modality in managing chronic low back pain that is nonresponsive to other modalities of treatment. ⋯ Percutaneous lysis of epidural scar tissue, followed by the injection of hypertonic saline neurolysis, has been shown to be cost effective in multiple studies. This review discusses various aspects of percutaneous nonendoscopic adhesiolysis and hypertonic saline neurolysis including clinical effectiveness, complications, rationale, and indications.