Articles: pain-management.
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Appropriate documentation, billing and coding in interventional pain practice is a crucial issue with a wide arena of regulatory reforms. There have been reports of billions of dollars in losses in health care fraud. Office of Inspector General reports a massive war on health fraud. ⋯ This review describes the regulatory issues, steps in documentation of medical necessity, appropriate billing and coding, and examples of codes describing CPT 1999 and 2000 for a multitude of procedures. These illustrations and the information provide practical considerations for the use of interventional techniques in the management of chronic pain based on the current state of the art and science of interventional pain management, rules and regulations. However, this article and its descriptions do not constitute legal advice.
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Int J Obstet Anesth · Apr 2000
Randomized Controlled Trial Clinical TrialEffect of epidural clonidine added to epidural sufentanil for labor pain management.
Labor analgesia with intrathecal sufentanil has been shown to be prolonged by the addition of intrathecal clonidine. The current study was designed to determine if epidural clonidine would prolong labor analgesia provided by epidural sufentanil. Forty laboring primiparous women at less than 5 cm cervical dilation requesting epidural analgesia were enrolled. ⋯ Side-effects were similar between the two groups. There was no difference between the two groups in time from sufentanil administration to delivery, incidence of operative or assisted delivery, or cervical dilation at the time of redose. For early laboring patients, epidural sufentanil 20 microg after a lidocaine test dose provides analgesia comparable to that of sufentanil 20 microg with clonidine 75 microg; there was no significant difference in analgesic duration between the two groups.
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Facet joints, as a source of low back pain, have attracted considerable attention and been a source of controversy in recent years. Significant progress has been made in precision diagnosis of chronic low back pain with neural blockade. In the face of less than optimal diagnostic information offered by imaging and neurophysiologic studies, and in the face of mounting evidence showing lack of correlation between clinical features, physical findings, and diagnosis of facet joint mediated pain, controversial features have been described to validate the assumption of facet joint mediated pain by set criteria. ⋯ However, these six feature involved only a small number of patients. In conclusion, facet joint mediated pain is a common entity in patients suffering with chronic low back pain nonresponsive to conservative care, who present to a nonuniversity pain management practice. However, the history, clinical features, and radiological features are of no significance or assistance in making the diagnosis of facet joint mediated pain with certainty.
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An increasing number of patients are suffering from angina pectoris that is chronically refractory to standard anti-ischemic treatment such as pharmacological and surgical strategies. To improve the quality of life of these severely disabled patients, without adversely affecting their prognosis, a number of adjunct therapies are available. One of the most promising appears to be spinal cord stimulation. We will review the literature and discuss the efficacy, safety and mechanisms of neuromodulation as an adjuvant therapy for chronic refractory angina pectoris.
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The understanding of the mode of action of spinal cord stimulation (SCS) as treatment of neuropathic pain is still fragmentary. SCS evolved from the gate-control theory postulating a spinal modulation of noxious inflow, but there is little evidence that SCS influences nociceptive pain; pain relief in peripheral vascular disease and angina pectoris is presumably secondary to other SCS effects. In man, SCS may effectively abolish both continuous and evoked pain (tactile/thermal allodynia) whereas induced, acute nociceptive pain is unaffected. ⋯ Preliminary results indicate that gabapentin may have a similar effect. GABAergic and adenosine-related mechanisms conceivably represent only examples of a number of putative receptor systems involved in SCS. Clinical trials have been initiated exploring the possibility to improve the efficacy of SCS by concomitant pharmacotherapy.