Pain physician
-
The high prevalence of persistent low back pain and growing number of diagnostic and therapeutic modalities employed to manage chronic low back pain and the subsequent impact on society and the economy continue to hold sway over health care policy. Among the multiple causes responsible for chronic low back pain, the contributions of the sacroiliac joint have been a subject of debate albeit a paucity of research. At present, there are no definitive conservative, interventional or surgical management options for managing sacroiliac joint pain. It has been shown that the increases were highest for facet joint interventions and sacroiliac joint blocks with an increase of 310% per 100,000 Medicare beneficiaries from 2000 to 2011. There has not been a systematic assessment of the utilization and growth patterns of sacroiliac joint injections. ⋯ This study illustrates the explosive growth of sacroiliac joint injections even more than facet joint interventions. Furthermore, certain groups of providers showed substantial increases. Overall, increases from 2008 to 2010 were nominal with 1%, but some states showed over 20% increases whereas some others showed over 20% decreases.
-
Clinical Trial
The effect of lumbar sympathetic ganglion block on gynecologic cancer-related lymphedema.
Eighteen to 25% of patients after gynecological cancer treatment suffer from lower limb lymphedema (LLL) that decreases the quality of life of gynecological cancer survivors. Lumbar sympathetic ganglion block (LSGB) is widely used in practice for the evaluation and management of sympathetically mediated pain in the lower limbs. Several articles have suggested that sympathetic ganglion block could be an effective treatment for lymphedema. ⋯ We suggest that LSGB can be one of the treatment options for patients suffering from LLL after gynecologic cancer treatment. Our result could provide a basis for a randomized controlled trial in future investigations. The pain physicians can play an important role as one of the multidisciplinary team for a comprehensive treatment of LLL.
-
Cervical central stenosis (CCS) is a narrowing of the spinal canal that can cause mechanical compression of the spinal nerve and roots, leading to neck pain and/or radicular pain. Cervical epidural steroid injections are commonly used in the treatment of CCS. After failure of epidural steroid injections, the next sequential step is percutaneous adhesiolysis with a targeted drug delivery. ⋯ Percutaneous adhesiolysis utilizing local anesthetic steroids and hypertonic sodium chloride solution may be an effective management strategy in patients with chronic posterior neck and upper extremity pain due to cervical central spinal stenosis, although there is no correlation between therapeutic response and the grade of CCS.
-
Vertebral metastases are associated with significant pain, disability, and morbidity. Open surgery for fracture stabilization is often inappropriate in this cancer population due to a poor risk-benefit profile, particularly if life expectancy is short. Vertebroplasty and kyphoplasty are appealing adjunctive procedures in patients with malignancy for alleviation of intractable pain. However, these patients have a higher risk of serious complications, notably cement extravasation. ⋯ The Kiva System potentially represents a novel and effective minimally invasive treatment option for patients suffering from severe pain due to osteolytic vertebral metastases.