Articles: pain-management-methods.
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Irritation of neural structures, specifically the brachial plexus outside of the cervical spine is capable of producing pain in the upper extremity. These pain patterns may be similar to pain originating from the cervical spine, presenting a diagnostic challenge. Brachial plexus block is performed at multiple levels, including interscalene, supraclavicular, infraclavicular, and axillary. ⋯ Relevant anatomy and proposed technique of brachial plexus block is described. The procedure is performed under fluoroscopy with contrast injection. It is concluded that the proposed technique of brachial plexus block is useful for brachial plexus blockade providing precision and specificity with minimal complications.
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Healthcare decisions are increasingly being made on research-based evidence, rather than on expert opinion or clinical experience alone. Consequently, the process by which the strength of scientific evidence is evaluated and developed by means of evidence-based medicine recommendations and guidelines has become crucial resulting in the past decade in unprecedented interest in evidence-based medicine and clinical practice guidelines. Systematic reviews, also known as evidence-based technology assessments, attempt to minimize bias by the comprehensiveness and reproducibility of the search for and selection of articles for review. ⋯ The complex processes of guideline development depend on integration of a number of activities, from collection and processing of scientific literature to evaluation of the evidence, development of evidence-based recommendations or guidelines and implementation and dissemination of the guidelines to relevant professionals and consumers. Guidelines are being designed to improve the quality of healthcare and decrease the use of unnecessary, ineffective or harmful interventions. This review describes various aspects of evidence-based medicine, systematic reviews in interventional pain management, evaluation of the strength of scientific evidence, differences between systematic and narrative reviews, rating the quality of individual articles, grading the strength of the body of evidence and appropriate methods for searching for the evidence.
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Evidence-based practice guidelines for interventional techniques in the management of chronic spinal pain are systematically developed and professionally derived statements and recommendations that assist both physicians and patients in making decisions about appropriate health care in the diagnosis and treatment of chronic or persistent pain. The guidelines were developed utilizing an evidence-based approach to increase patient access to treatment, to improve outcomes and appropriateness of care, and to optimize cost-effectiveness. All types of relevant and published evidence and consensus were utilized. ⋯ It is expected that a provider will establish a plan of care on a case-by-case basis, taking into account an individual patient's medical condition, personal needs, and preferences, and the physician's experience. Based on an individual patient's needs, treatment different from that outlined here could be warranted. These guidelines do not represent "standard of care."
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In a companion article, we synthesized current clinical and preclinical data to formulate hypotheses about the etiology of drug administration catheter-tip inflammatory masses. In this article, we communicate our recommendations for the detection, treatment, mitigation, and prevention of such masses. ⋯ Attentive follow-up and maintenance of an index of suspicion should permit timely diagnosis, minimally invasive treatment, and avoidance of neurological injury from catheter-tip inflammatory masses. Whenever it is feasible, positioning the catheter in the lumbar thecal sac and/or keeping the daily intrathecal opioid dose as low as possible for as long possible may mitigate the seriousness, and perhaps, reduce the incidence of such inflammatory masses.
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Scar formation in the epidural space due to previous operations or presence of inflammation in and around the nerve roots or spinal nerves in patients with back pain or radiculopathy have been documented in patients suffering from spinal pain. Several methods targeting the scar formation and inflammation have been used. Epidural neuroplasty is one of the recently used methods. ⋯ The most commonly seen complications of epidural neuroplasty are due to the procedure or the drugs administered. Complications relating to the procedure are usually seen immediately, while complications relating to drug administration are typically seen later. In this article, we discuss not only the possible complications during epidural neuroplasty, but their prevention and management as well.