Interventional pain management: evolving issues for 2003 (original) (raw)
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The practice guidelines for interventional techniques in the management of chronic pain are systematically developed statements to assist practitioner and patient decisions about appropriate health care related to chronic pain. These guidelines are professionally derived recommendations for practices in the diagnosis and treatment of chronic or persistent pain. They were developed utilizing a combination of evidence and consensus to improve quality of care, increase patient access, improve patient outcomes, improve appropriateness of care, improve efficiency and effectiveness, and achieve cost containment.
The Role of Guidelines in Interventional Pain Medicine: Let Us Separate Apples and Oranges
Pain Physician, 2001
Practice guidelines are not only an ancient tradition, but they are a fact of life. The first guidelines were developed in the 1840s, shortly after the use of anesthesia was first demonstrated. Even though practice guideline development has spawned an impressive and overaggressive literature of its own, many unanswered questions exist with regard not only to practice parameters and guidelines in general, but in particular with the application of interventional techniques in managing persistent pain. In spite of the great potential of clinical practice guidelines, and the involvement of numerous medical societies and physician groups, there is still a great debate within the profession not only about the pros and cons of the development and usage of the guidelines, but also conflicting and controversial opinions on both sides of the issue, ie, providers and patients vs payors. This article discusses the development, usage, advantages, disadvantages and the implications of practice guidelines to interventional pain medicine specialists.
Pain Physician, 2010
Background: Clinical guidelines are a constructive response to the reality that practicing physicians require assistance in assimilating and applying the exponentially expanding, often contradictory, body of medical knowledge. They attempt to define practices that meet the needs of most patients under most circumstances. Ideally, specific clinical recommendations contained within practice guidelines are systematically developed by expert panels who have access to all the available evidence, have an understanding of the clinical problem, and have clinical experience with the procedure being assessed, as well as knowledge of relevant research methods. The recent development of American Pain Society (APS) guidelines has created substantial controversy because of their perceived lack of objective analysis and recommendations perceived to be biased due to conflicts of interest. Objectives: To formally and carefully assess the APS guidelines’ evidence synthesis for low back pain for thera...
Pain practice : the official journal of World Institute of Pain, 2007
I would first like to thank the World Institute of Pain President Gabor B. Racz for inviting me to deliver this lecture. My lecture is titled "Interventional Pain Management: The Past, Present, and Future." It is not only appropriate but timely to use this topic for the Raj Distinguished Lecture. Many know that interventional pain management is a new specialty with its own identity and definition dating back to 2003, at least in the United States. However, interventional pain management is not new to Dr. Raj. Since the 1970s, along with Drs. John Bonica, Gabor Racz, Nik Bogduk, and others, he has nurtured and has elevated interventional pain management to an energetic, emerging, credible specialty. 2-20 While John Bonica is considered the father of the field of pain management as we know it today, Dr.
A review and survey of policies utilized for interventional pain procedures: a need for consensus
Journal of Pain Research, 2017
Background: Other than the newly published anticoagulation guidelines, there are currently few recommendations to assist pain medicine physicians in determining the safety parameters to follow when performing interventional pain procedures. Little information exists regarding policies for oral intake, cumulative steroid dose limits, driving restrictions with and without sedation, and routine medication use for interventional procedures. Methods: A 16-question survey was developed on common policies currently in use for interventional pain procedures. The questionnaire was distributed through the American Society of Regional Anesthesia and Pain Medicine and American Academy of Pain Medicine. We sought to statistically analyze the range of policies being used by pain medicine physicians and to determine if there are any commonly accepted standards. Results: A total of 337 physicians out of 4037 members responded to our survey with a response rate of 8.4%. A total of 82% of these respondents used a sedative agent while performing an interventional pain procedure. The majority of respondents required drivers after procedures, except after trigger points. A total of 47% indicated that they have an nil per os (NPO) policy for procedures without sedation. A total of 98% reported that they had an anticoagulation policy before an interventional procedure. A total of 17% indicated that the interval between steroid doses was <2 weeks, while 53% indicated that they waited 2-4 weeks between steroid doses. Conclusion: Our study has clearly demonstrated a wide variation in the current practice among physicians regarding sedation, NPO status, steroid administration, and the need for designated drivers. There was much higher endorsement of policies regarding anticoagulation. There is an obvious need for evidence-based guidelines for these aspects of interventional pain care to improve patient safety and minimize the risk of adverse events. Keywords: interventional pain procedures policies, steroids in pain procedures, driver policy in interventional pain procedures, NSAIDs and anticoagulants in interventional pain procedures Aim The aim of this study was to assess the range of current safety practices implemented by interventional pain medicine physicians across USA through a 16-question survey.
Peri-Procedural Protocols for Interventional Pain Management Techniques: A Survey of US Pain Centers
Pain Physician, 2005
Interventional pain management techniques (IPMTs) are becoming increasingly important in the comprehensive management of chronic pain. Although morbidity from these procedures is generally low (1, 2) sequelae such as permanent neurological damage and death have been reported (3-5). IPMTs are currently performed in various settings, including physicians' offices, ambulatory surgery centers, and operating rooms. Pain practitioners from both anesthesia and nonanesthesia backgrounds must now provide peri-procedural care for patients that have IPMTs. Decisions must be made regarding NPO status, peri-operative mon
Pain physician
Clinical guidelines are defined as systematically developed statements to assist practitioner and patient decisions about appropriate health care for specific clinical circumstances. The clinical guideline industry has been erupting even faster than innovation in health care, constantly adding unhealthy perspectives with broad and complex mandates to health care interventions. Clinical guidelines are based on evidence-based medicine (EBM) and comparative effectiveness research (CER). Multiple issues related to the development of clinical guidelines are based on conflicts of interest, controversies, and limitations of the guideline process. Recently, the American Pain Society (APS) developed and published multiple guidelines in managing low back pain resulting in multiple publications. However, these guidelines have been questioned regarding their development process, their implementation, and their impact on various specialties. To reassess the APS guidelines' evidence synthesis...
Advanced Procedures for Pain Management
Advanced Procedures for Pain Management, 2018
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