Pain physician
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Review Case Reports
Spinal cord stimulation for refractory angina pectoris and peripheral vascular disease.
Spinal cord stimulation has been used in clinical practice for more than three decades. The primary use of this therapy has been in spine-related disorders. ⋯ Increasingly, interest has piqued in using this mode of treatment for refractory angina and ischemic pain secondary to peripheral vascular disease. In this publication, we review the current literature on these two indications and present case examples of both therapies.
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Review Case Reports
Goal-Directed Health Care and the chronic pain patient: a new vision of the healing encounter.
We introduce a new way to engage the patient with chronic pain, Goal-Directed Health Care (G-DHC). Identifying the patient's major life goals during the medical interview is the key element of this approach along with connecting these life goals to specific health-related goals. The implementation of G-DHC is a shift in process from the usual focus on disease-related goals such as relief of pain, titrating narcotic refills, and working on condition management to broader, long-term, personal goals. ⋯ Utilizing these life goals as a point of reference, discussion, and motivation makes clearer what specified health goals mean, whether or not the patient is ready to work on them, and most significantly, what the underlying motivation is to participate in their own care. We anticipate such a model of patient-centered care will shift the dynamic of the medical encounter with the patient with chronic pain to one that is ultimately more productive and satisfying for both patient and physician. Illustrations of cases, questions to ask patients, and a detail of the process may allow the reader to adopt this method into their practice.
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This comprehensive health policy review of the prescription drug abuse epidemic is based on the written and oral testimony of witnesses at a July 26, 2006 Congressional Hearing, including that of Laxmaiah Manchikanti, MD, the chief executive officer of the American Society of Interventional Pain Physicians and additions from review of the literature. Honorable Mark E. Souder, chairman of the Subcommittee on Criminal Justice, Drug Policy, and Human Resources, introduced the issue as follows: "Prescription drug abuse today is second only to marijuana abuse. ⋯ Stephen J. Pasierb presented startling statistics on teen drug abuse and various educational programs to deter abuse. Laxmaiah Manchikanti, MD presented an overview of prescription drug abuse, strategies to prevent drug abuse, including immediate funding and rapid implementation of NASPER, education at all levels and improving relations with the DEA and the provider community.
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Review
The BiP Test: a modified loss of resistance technique for confirming epidural needle placement.
Correct identification of the epidural space minimizes complications and ensures successful epidural blockade. The loss of resistance technique is the most common technique used for identification of the epidural space. However, sometimes loss of resistance occurs when the needle is not actually in the epidural space. The injection in this instance will result in the medication not being deposited in the epidural space. At other times, loss of resistance is not definitive. Further advancement of the needle may predispose to a wet tap. ⋯ This technique adds a useful confirmatory test to the already well-known loss of resistance technique used to verify the position of the epidural needle.