Pain physician
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Multiple randomized controlled trials (RCTs) and systematic reviews have been conducted to summarize the evidence for administration of local anesthetic (lidocaine) alone or with steroids, with discordant opinions, more in favor of equal effect with local anesthetic alone or with steroids. ⋯ Overall, the present meta-analysis shows moderate (Level II) evidence for epidural injections with lidocaine with or without steroids in managing spinal pain secondary to disc herniation, spinal stenosis, discogenic pain, and post-surgery syndrome based on relevant, high-quality RCTs. Results were similar for lidocaine, with or without steroids.
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The interventional pain management community saw the COVID-19 pandemic decimate elective interventional procedures and new patient visits across the United States until the reopening of America and the restarting of interventional procedures and elective surgical procedures began again. Health care providers, along with essential workers and patients, continue to be concerned about functioning in a safe and responsible manner. Consequently, a level of comfort is created by the testing health care workers with long exposure to new patients and patients undergoing interventions in high risk environments. As the United States and the world suffers from an ongoing infodemic, there are substantial amounts of misinformation, and some appropriate information being produced on molecular, antigen and antibody testing. Consequently, this manuscript is undertaken to describe the value and validity of coronavirus antibody testing. ⋯ Antibody tests have been developed to detect IgG only, both IgG and IgM, or total antibodies. At present, multiple antibody tests are available for use in the United States. In a review of 54 available studies through the end of April, mostly from China, the accuracy of pooled results for combination IgG/IgM tests was 91.4% (95% CI, 87.0 - 96.6) for 15 to 21 days post-symptom onset. Thus, antibody tests provide a promise and a peril in the ongoing Covid-19 pandemic.
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The unexpected COVID-19 crisis has disrupted medical education and patient care in unprecedented ways. Despite the challenges, the health-care system and patients have been both creative and resilient in finding robust "temporary" solutions to these challenges. It is not clear if some of these COVID-era transitional steps will be preserved in the future of medical education and telemedicine. ⋯ Many of the technological changes imposed so abruptly on the health-care system by the COVID-19 pandemic may be positive and it may be beneficial that some of these transitions be preserved or modified as we move forward. Clinicians must be objective in assessing these changes and retaining those changes that clearly improve health-care education and patient care as we enter the COVID era.
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The COVID-19 pandemic has worsened the pain and suffering of chronic pain patients due to stoppage of "elective" interventional pain management and office visits across the United States. The reopening of America and restarting of interventional techniques and elective surgical procedures has started. Unfortunately, with resurgence in some states, restrictions are once again being imposed. In addition, even during the Phase II and III of reopening, chronic pain patients and interventional pain physicians have faced difficulties because of the priority selection of elective surgical procedures.Chronic pain patients require high intensity care, specifically during a pandemic such as COVID-19. Consequently, it has become necessary to provide guidance for triaging interventional pain procedures, or related elective surgery restrictions during a pandemic. ⋯ The COVID-19 pandemic has created unprecedented challenges in IPM creating needless suffering for pain patients. Many IPM procedures cannot be indefinitely postponed without adverse consequences. Chronic pain exacerbations are associated with marked functional declines and risks with alternative treatment modalities. They must be treated with the concern that they deserve. Clinicians must assess patients, local healthcare resources, and weigh the risks and benefits of a procedure against the risks of suffering from disabling pain and exposure to the COVID-19 virus.