Pain physician
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There has been an explosive increase in procedures performed in surgery centers, with approximately 4,700 Medicare-certified surgery centers in the United States. Total ambulatory surgical center (ASC) payments have increased substantially: $1 billion in 1996, and $2.9 billion in 2006. In June 1998, the Healthcare Financing Administration (HCFA; CMS), proposed an ASC rule in which at least 60% of interventional procedures were eliminated from ASCs and the remaining 40% faced substantial cuts in payments. ⋯ Based on the new proposed rule, most interventional pain management procedures in ASCs will lose approximately 3% to 5% without taking into account that there have not been any increments since 2004, except for a few small increases for some procedures, along with the addition of office procedures, which can now be performed in an ASC setting. However, payments for procedures moved from the office setting to ASCs remain at the lower office rates, which face substantial cuts on their own. The proposed CMS rule will have widespread effects on physician payments, ASC payments, and particularly interventional pain management physicians.
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Clinical Trial
Transsacrococcygeal approach to ganglion impar block for management of chronic perineal pain: a prospective observational study.
The ganglion impar or ganglion of Walther is a solitary retroperitoneal structure at the level of sacrococcygeal junction. It provides the nociceptive and sympathetic supply to the perineal structures. Chronic Perineal Pain (CPP) has been effectively managed by ganglion impar block. In this study we analyze the feasibility, safety, and efficacy of ganglion impar block by transsacrococcygeal approach. ⋯ A transsacrococcygeal approach for a ganglion impar block is a technically feasible and safe technique. We recommend this technique for neurolysis or radiofrequency ablation of the ganglion impar and for diagnostic blocks, especially when the diagnosis and further plan of management is dependent on the response of the diagnostic block.
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Complications reported from percutaneous disc decompression (PDD) include discitis, anaphylaxis (with chemonucleolysis), instability, increased back pain, and reherniation. To the best of our knowledge, there is no report of epidural fibrosis occurring with any of the many types of PDD. ⋯ This case is the first reported occurrence of epidural fibrosis following percutaneous lumbar disc decompression.
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Spinal headache is an occasional, but painful complication of epidural injection procedures due to dural puncture that allows leakage of CSF from the thecal sac, thereby reducing intracranial pressure. In the event of failure of conservative management, (e.g. abdominal binder, fluids, acetaminophen), an epidural blood patch is often used. This case report describes a patient with spinal headache after a transforaminal selective epidural injection in a post laminectomy patient that was treated with a transforaminal epidural blood patch after the failure of conservative management. ⋯ Transforaminal epidural blood patch was performed utilizing 2 mL of autologous blood at each of the two sites. The patient recovered well without headache. In cases, with inability to perform interlaminar blood patch, a transforaminal approach may be considered.
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Caudal epidural steroid injections are commonly utilized to help reduce radicular pain in lumbar spinal stenosis. There have been studies done to evaluate the effectiveness of this procedure non-fluoroscopically guided. Search revealed no prospective studies evaluating the effectiveness of fluoroscopically guided caudal epidural injections on patients with bilateral radicular pain from degenerative lumbar spinal stenosis. ⋯ Fluoroscopically guided caudal epidural steroid injections may help reduce bilateral radicular pain and improve standing and walking tolerance in patients with DLSS.