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Interventional Pain Medicine in the Treatment of Chronic Noncancer Pain—An Update
Published in Gary W. Jay, Clinician’s Guide to Chronic Headache and Facial Pain, 2016
Zhou et al. (60) looked at quality assurance for interventional pain management procedures and noted that a good QA program was helpful. They did a survey of 566 patients and found that the majority had immediate pain relief after a procedure. No follow-up was done, however, to determine if the decrement in pain persisted, or for how long. A number of different interventional pain management procedures were involved.
Interventional Pain Medicine in the Treatment of Chronic Non-Cancer Pain
Published in Gary W. Jay, Chronic Pain, 2007
Zhou et al. (55) looked at quality assurance for interventional pain management procedures and noted a good QA program was helpful. They did a survey of 566 patients and found that the majority had immediate pain relief after a procedure. No follow-up was done, however, to determine if the decrement in pain persisted, or for how long. A number of different interventional pain management procedures were involved.
Guidelines for the Practice of Interventional Techniques
Published in Mark V. Boswell, B. Eliot Cole, Weiner's Pain Management, 2005
Laxmaiah Manchikanti, Vijay Singh, Andrea M. Trescot, Timothy R. Deer, Mark V. Boswell
There is no consensus among interventional pain management specialists with regards to type, dosage, frequency, total number of injections, or other interventions, yet significant attention in the literature seems to be focused on the complications attributed to the use of epidural steroids in the entire arena of interventional pain management. Thus, various limitations of interventional techniques, specifically neural blockade, have arisen from basically false impressions. Based on the available literature and scientific application, the most commonly used formulations of long-acting steroids (see Table 57.1), which include methylprednisolone (Depo-Medrol®), triamcinolone diacetate (Aristocort®), triamcinolone acetonide (Kenalog®), and betamethasone acetate and phosphate mixture (Celestone Soluspan®), appear to be safe and effective.10 Based on the present literature, it appears that if repeated within 2 weeks, betamethasone probably would be the best choice in avoiding side effects; whereas if treatment is carried out at 6-week intervals or longer, any one of the four formulations would be safe and effective.
Role of interventional pain management in patients with chronic pelvic pain
Published in Baylor University Medical Center Proceedings, 2020
Jamal Hasoon, Ivan Urits, Vwaire Orhurhu, Omar Viswanath, Musa Aner
A 51-year-old woman had CPP in her lower abdomen and pelvic region, which she described as severe and cramping. She was managed by her primary care physician for the disorder for several years with conservative management including oral contraceptives and pain medications such as nonsteroidal anti-inflammatory drugs. She was referred to several specialists including gastroenterology, urology, and gynecology for further assistance with her condition. The patient underwent several invasive diagnostic tests and surgeries including laparoscopy, biopsies, and lysis of adhesions. She was diagnosed with endometriosis based on diagnostic laparoscopy and biopsies suggestive of the disease. These surgeries established the diagnosis but were unsuccessful in treating her CPP. She was started on stronger pain medications, including neuropathic agents and opioids. She was taking >90 morphine milligram equivalents, which is not recommended for the treatment of nonmalignant pain.5 After several years of struggling with this condition, the patient was referred to interventional pain management.
Pain chronification: what should a non-pain medicine specialist know?
Published in Current Medical Research and Opinion, 2018
Bart Morlion, Flaminia Coluzzi, Dominic Aldington, Magdalena Kocot-Kepska, Joseph Pergolizzi, Ana Cristina Mangas, Karsten Ahlbeck, Eija Kalso
Acknowledging the multidimensional factors which can contribute to the development of chronic pain, Müller-Schwefe and colleagues recently highlighted the need to change the focus of treatment for chronic low back pain to individually tailored multimodal management (i.e. integrated multidisciplinary therapy with coordinated somatic and psychotherapeutic options) that reflects the underlying pain mechanisms94. A multimodal approach for chronic low back pain may potentially include the use of pharmacotherapy (including nonsteroidal anti-inflammatory drugs, cyclooxygenase-2 inhibitors, tricyclic antidepressants, opioids and anticonvulsants)95, in combination with appropriate non-pharmacological options (including exercise programs, manual therapies, behavioral therapies, interventional pain management, physical therapies and traction), and recognizing that, in carefully selected individuals, surgery may be an appropriate option94. This comprehensive, multidisciplinary team-driven approach to the prevention or management of chronic pain, involving all stakeholders, has been endorsed elsewhere; however, despite acknowledgement that comprehensive multidisciplinary management based on the biopsychosocial model of pain has been shown to be clinically effective and cost-efficient, it is still not available widely96.
High-frequency spinal cord stimulation at 10 kHz for widespread pain: a retrospective survey of outcomes from combined cervical and thoracic electrode placements
Published in Postgraduate Medicine, 2019
There must be a failure of adequate outcomes from all appropriate conservative treatment modalities including optimization of medication therapy and other interventional pain management therapy such as epidural and sleeve injection and radiofrequency procedures. We generally (but not always) require that high-dose opiates have been tapered to less than 150 mg morphine equivalents per day.