Pain medicine : the official journal of the American Academy of Pain Medicine
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Radiofrequency ablation (RFA) of the medial branch nerve is a commonly performed procedure for patients with facet syndrome. RFA has previously been demonstrated to provide long-term functional improvement in approximately 50% of patients, including those who had significant pain relief after diagnostic medial branch block. We sought to identify factors associated with success of RFA for facet pain. ⋯ This algorithm compares favorably to that of diagnostic medial branch block in terms of prediction accuracy (C-statistic of 0.764 vs. 0.57), suggesting that its use may improve patient selection in patients who undergo RFA for facet syndrome.
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Genicular nerve radiofrequency ablation (RFA) is not associated with known clinically significant complications. ⋯ Although genicular nerve RFA is generally considered a safe procedure, cases of septic arthritis, pes anserine tendon injury, third-degree skin burn, and clinically significant hematoma and/or hemarthrosis have been reported. As with any emerging procedure, other yet-to-be-reported complications are possible.
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Cancer-related pain is progressive and therefore requires a stepwise approach to management, such as the World Health Organization's Pain Ladder. This approach calls for increasingly strong pain medications in addition to interventional options for patients with medication-refractory pain or intolerable medication side effects. Here, we discuss a case involving cancer-related pain which ultimately required intrathecal drug delivery system placement for optimal pain management.
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Observational Study
The Resurrection of Interdisciplinary Pain Rehabilitation: Outcomes Across a Veterans Affairs Collaborative.
Despite empirical support for interdisciplinary pain rehabilitation programs improving functioning and quality of life, access to this treatment approach has decreased dramatically over the last 20 years within the United States but has grown significantly in the Department of Veterans Affairs (VA). Between 2009 and 2019, VA pain rehabilitation programs accredited by the Commission on Accreditation of Rehabilitation Facilities increased 10-fold in the VA, expanding from two to 20. The aim of this collaborative observational evaluation was to examine patient outcomes across a subset of six programs at five sites. ⋯ The adverse impacts of opioid use have highlighted the importance of chronic pain treatment approaches that emphasize team-based care focused on functional improvements. This study represents the first and largest analysis of outcomes across chronic pain rehabilitation programs and demonstrates the need for increased access to similar comprehensive approaches to pain management across the health care system. Further, it suggests that a variety of structures may be effective, encouraging flexibility in adopting this interdisciplinary approach.