Pain physician
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Review
Facts, fallacies, and politics of comparative effectiveness research: Part I. Basic considerations.
While the United States leads the world in many measures of health care innovation, it has been suggested that it lags behind many developed nations in a variety of health outcomes. It has also been stated that the United States continues to outspend all other Organisation for Economic Co-operation and Development (OECD) countries by a wide margin. Spending on health goods and services per person in the United States, in 2007, increased to $7,290 - almost 2(1/2) times the average of all OECD countries. ⋯ Of all the available agencies, the National Institute for Health and Clinical Excellence (NICE) of the United Kingdom is the most advanced, stable, and has provided significant evidence, though based on rigid and proscriptive economic and clinical formulas. While CER is making a rapid surge in the United States, supporters and opponents are expressing their views. Part I of this comprehensive review will describe facts, fallacies, and politics of CER with discussions to understand basic concepts of CER.
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Comparative Study
Comparison of clonazepam compliance by measurement of urinary concentration by immunoassay and LC-MS/MS in pain management population.
Physicians determine patient compliance with their medications by use of urine drug testing. It is known that measurement of benzodiazepines is limited by immunoassay specificity and cutoff limits and therefore does not offer physicians an accurate picture of their patients' compliance with these medications. A few studies have used lower cutoffs to demonstrate patient compliance. ⋯ The difference in positivity rate between the immunoassay and the LC-MS/MS result showed that the nominal 200 ng/mL cutoff of the immunoassay did not apply to 7-aminoclonazepam. This low immunoassay positivity rate is inconsistent with the manufacturer's published cross reactivity data for clonazepam and 7-aminoclonazepam. These data illustrate the limitations of using a 200 ng/mL cutoff to monitor clonazepam compliance and suggest that a cutoff of 40 ng/mL or less is needed to reliably monitor use of this drug.
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The utilization of spinal cord stimulation (SCS) to treat intractable pain has increased substantially in recent years. Integral to this therapy, the fluoroscope assists with requisite mapping protocols during trialing procedures to identify topographical dermatomal representations of spinal segments, and its use demands measurements of radiation exposure. However, such data is not found in the literature. ⋯ Various lead placement options are available to the spinal interventionalist to treat pain with SCS. Our data set provides first steps to obtain benchmark reference estimates on fluoroscopy times and radiation exposure during SCS trialing procedures/spinal segment mapping. Fluoroscopy times for such interventions may be considerable when compared to more commonly performed pain medicine procedures; however, skin injury is improbable.