Pain physician
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Telemedicine is an increasingly important tool in outpatient pain management. Telemedicine can be implemented through various strategies and a multitude of approaches have been described in existing literature. ⋯ Current literature describes telemedicine implementation with various levels of technological and logistical support. Models of telemedicine represented in current literature include: standard visits with on-site support, standard visits without on-site support, and structured/integrated pain management programs. Presently, no literature has directly compared outcomes from these different approaches. Choice of model will depend on the specific goals and available resources. Patient satisfaction was studied most frequently and generally demonstrated positive results. Though current literature is heterogeneous and lacks RCTs, it consistently demonstrates benefits of telemedicine to patient satisfaction, pain, and access to care.
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Evaluation of new and established patients is an integral part of interventional pain management. Over the last 3 decades, there has been significant confusion over the proper documentation for evaluation and management (E/M) services in general and for interventional pain management in particular. Interventional pain physicians have learned how to evaluate patients presenting with pain on the basis of their specialty training. ⋯ This is in contrast to prior guidelines wherein for new patients, all 3 elements with history, physical examination and MDM , and for established patients have been met. For ease of appreciation, an algorithmic approach created by the American Medical Association (AMA), and Centers for Medicare and Medicaid Services (CMS) approved a new MDM table outlining all of the appropriate criteria. This review systematically describes the changes and provides an algorithmic approach for application in interventional pain management practices.
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Many patients suffer from abdominal and thoracic pain syndromes secondary to numerous underlying etiologies. Chronic abdominal and thoracic pain can be difficult to treat and often refractory to conservative management. In this systematic literature review, we evaluate the current literature to assess radiofrequency ablation's (RFA) efficacy for treating these debilitating chronic pain conditions in the thoracic and abdominal regions. ⋯ A systematic review of the literature supports RFA as a viable option for managing abdominal and thoracic pain. Future randomized controlled trials are needed to investigate the efficacy of the various RFA modalities to ensure RFA is the source of pain relief as a large body of the current literature focuses only on observational studies.