Pain physician
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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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Randomized Controlled Trial
Combined Infraclavicular-Suprascapular Nerve Blocks Compared With Interscalene Block for Arthroscopic Rotator Cuff Repair: A Prospective, Randomized, Double-blind, and Comparative Clinical Trial.
The gold standard postoperative analgesia protocol for arthroscopic rotator cuff repair procedures is the interscalene block (ISB), which prevents the significant consequences of phrenic nerve block associated with hemidiaphragmatic paralysis (HDP). The infraclavicular brachial plexus block (BPB) combined with the suprascapular nerve block (SSNB) had the same analgesic efficacy as the infraclavicular BPB alone, with no effect on respiration. ⋯ The employment of the costoclavicular block in combination with the suprascapular block may provide a comparable analgesic potency to the sole use of the standard ISB with no HDP.
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Randomized Controlled Trial
Comparison of the Low Back Pain Relief and Spread Level After Upper and Lower Lumbar Erector Spinae Plane Block.
The erector spinae plane block (ESPB), which was introduced to manage the thoracic pain, is an ultrasound-guided technique that is relatively easy, less invasive, and safer. In spite of its technical ease and safety of ESPB, few studies have explored the analgesic efficacy and the exact spread level of injected local anesthetics. ⋯ Both the L2 and L4 ESPB groups demonstrated a significant reduction in low back pain and improvement in disability. The L2 ESPB group demonstrated a significantly increased spread level compared to the L4 ESPB group.
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Multicenter Study Observational Study
Results From a Prospective, Clinical Study (US-nPower) Evaluating a Miniature Spinal Cord Stimulator for the Management of Chronic, Intractable Pain.
Chronic, intractable, neuropathic pain is readily treatable with spinal cord stimulation (SCS). Technological advancements, including device miniaturization, are advancing the field of neuromodulation. ⋯ This clinical study demonstrated profound leg and low back pain relief in terms of overall pain reduction, as well as the proportion of therapy responders. The study patients reported the wearable aspects of the system to be very comfortable.
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Orthobiologics have shown promise in repair, restoration and regeneration of damaged and degenerated spine, joint and musculoskeletal tissues. The role of MSCs is to reduce inflammation, gliosis, and oxidative stress, while encouraging angiogenesis, neuronal proliferation, cell survival, and differentiation. While autologous MSCs have homologous advantages, they present with challenges related to donor predisposition, harvesting skills, and processing times. In this regard, allogenic MSCs show promise, but face ethical challenges, contamination, and survival risks. Ongoing efforts to overcome challenges and enhance performance include bioprinting, tissue engineering, artificial intelligence, nanotechnology, and microenvironmental alteration, among many others. Genetically programmed MSCs are being explored and tissue regeneration is now considered a real possibility. In this article, we discuss some of the leading-edge technologies in the process of being developed and perfected for widespread clinical application. ⋯ The role of MSCs in regenerative medicine is still emerging, but their promise for spinal cord injury and other disorders of the spine is clear. Using allogenic or autologous MSCs can help stimulate healing and neural regeneration remains a tantalizing possibility.