Articles: outcome.
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Many commissions and groups throughout the world have proposed clinical guidelines on the management of low back pain, spinal pain, and chronic pain. Practice guidelines are systematically developed statements to assist the practitioner and patient decisions about appropriate healthcare for specific clinical circumstances. The American Society of Interventional Pain Physicians developed practice guidelines for interventional techniques which are professional practice recommendations for practices for prevention, diagnosis and treatment of acute and chronic painful disorders, and in some cases, disability management. ⋯ The results consistently showed decrease in number of visits from 1999 to 2000 and 2001 with 5.5 +/- 0.18, 5.1 +/- 0.17, and 4.3 +/- 0.15 respectively. The average expenditure also decreased from per visit of $872 in 1999 to $891 in 2000, to $810 to 2001. further, the average expenditure per year also decreased as expected due to decrease in frequency of visits, as well as the average expenditure per visit from $4751 +/- $231 in 1999 to $4505 +/- $214 in 2000 and to $3514 +/- $193 in 2001 even without consideration of inflation. Thus, it is concluded that guidelines describing the interventional techniques in the management of chronic pain are effective in reducing the cost and frequency of visits with improvement or at least maintenance of similar outcomes, physician decision making abilities, and patient preferences.
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Facet arthropathy is a common cause of spine-related pain. Typically resulting from spondylosis, trauma, including surgical trauma or post surgical stress is also a significant cause. Radiofrequency thermocoagulation or neurolysis may be an effective modality providing long-term improvement. ⋯ In summary, 85% of cervical and 71% of lumbar RFTC cases had at least a 50% improvement in symptoms for extended periods. RFTC of median branches for facet arthropathy is a safe and efficacious modality with the potential for long-term benefit.
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The illness behavior questionnaire (IBQ) is a test battery developed by Pilowsky to detect what he has termed abnormal illness behavior, which includes malingering. The IBQ has been widely utilized in patients with chronic pain (PWCP). Clayer developed a 21-item scale out of the IBQ, which he termed the conscious exaggeration (CE) scale. He proposed that the CE scale could detect conscious deception, i.e., malingering. The purpose of the present study is to test the CE scale in PWCP alleged to have secondary gain and thereby at greater risk for poor pain treatment outcome. It was postulated that the CE scale should generate scores in these groups significantly different from a comparison group and should predict treatment outcome in the secondary gain groups. ⋯ PWCP characterized by the alleged secondary gain variables of Workers' compensation status, litigation, and having a lawyer did not differentially respond to the CE scale versus the comparison group. The CE scale, therefore, does not appear to be a valid instrument for identifying exaggeration in PWCP.
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The aim of this work is to assess quality of treatment and to monitor drawbacks of SCS implantation systems through a National Observational Center. Data were obtained through a questionnaire sent by post or via telephone to each patient. All patients were affected by chronic-'vascular' and "neuropathic" pain. ⋯ We conclude that the methodology used is consistent with that of previous studies on nonmalignant chronic pain. The data obtained also reveal implantation hardware reliability, regardless of clinical outcome. A low percentage of complications and a high degree of patient satisfaction are also to be stressed.
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Poisoning is an uncommon but potentially fatal outcome of toxic alcohol ingestion. The toxic alcohols methanol, ethylene glycol and isopropyl alcohol are commonly found in household and commercial products. Because the toxic effects are caused by the metabolites of methanol and ethylene glycol rather than the agents themselves, there is often a substantial delay between ingestion and onset of clinical toxicity. ⋯ The pitfalls of using these tests to rule out alcohol ingestion are reviewed. Ethanol infusion is the traditional therapy for such overdoses. In addition to the pathophysiology and clinical findings in poisoning, recent evidence for the use of fomepizole and adjuvant therapies is reviewed.