Pain physician
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The intervertebral disc has been implicated as an etiology of chronic lumbar spine pain based on clinical, basic science, and epidemiological research. However, there is lack of consensus regarding the diagnosis and treatment of intervertebral disc disorders. Based on controlled evaluations, the lumbar intervertebral discs have been shown to be sources of chronic back pain without disc herniation in 26% to 39%. Lumbar provocation discography, which includes disc stimulation and morphological evaluation, is often used to distinguish a painful disc from other potential sources of pain. Despite the extensive literature, controversy continues about provocation lumbar discography. ⋯ Based on the current systematic review, lumbar provocation discography performed according to the IASP criteria with control disc (s) with minimum pain intensity of 7 of 10, or at least 70% reproduction of worst pain (i.e. worst spontaneous pain of 7 = 7 x 70% = 5) may be a useful tool for evaluating chronic lumbar discogenic pain. Discography is an important imaging and pain evaluation tool in identifying a subset of patients with chronic low back pain secondary to intervertebral disc disorders.
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Review Case Reports
The marginalization of chronic pain patients on chronic opioid therapy.
The realities of treating chronic pain do not reflect the attention that marginalization of patients taking opioids has received. Physicians continue the same prejudices and biases that were present decades ago. One theory proposed to explain this poor treatment has been titled, the "barriers to pain management." The barriers are not treated as moral issues, but rather as clinical aberrations and do not explain continued poor treatment. ⋯ It is proposed that there may be more complex psychosocial issues involved in the marginalization of chronic pain patients. This case series illustrates a ubiquitous problem demanding further examination and discussion. It is hoped that this case series will create interest in further research in this area.
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Historically, if a patient was dissatisfied with care, he or she could tell his or her friends and family. The criticism was limited to a small circle of people. If the patient was injured negligently, he or she could hire an attorney to prosecute a lawsuit. ⋯ Finally, the law has a very formal definition for libel, and a negative rating does not necessarily equate to "defamation." A novel method of addressing un-policed physician rating sites in the Internet age is described. The system embraces the use of mutual privacy contracts to provide physicians a viable remedy to anonymous posts. In exchange, patients receive additional privacy protections above and beyond that mandated by law.
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Physician impairment is a serious public health issue affecting not only physicians, but also their families, colleagues, and patients. Physician impairment is used most often to refer to substance use disorders, which involve both substance abuse and substance dependence and/or addiction. ⋯ Physician impairment is a real and significant public health concern; however, recovery is feasible and the data support favorable odds of recovery and a return to clinical practice among those seeking appropriate treatment, counseling, and relapse prevention strategies.
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Millions of patients suffer from medically refractory and disabling primary headache disorders. This problem has led to a search for new and innovative treatment modalities, including neuromodulation of the occipital nerves. ⋯ The Bion can be successfully inserted adjacent to the greater occipital nerve in an effort to treat refractory primary headache disorders. This microstimulator may provide effective occipital stimulation and headache control while minimizing the risks associated with percutaneous or paddle leads implanted subcutaneously in the occipital region.