A clinical audit of interventional pain procedures performed as part of the newly initiated pain service in a local neurosurgical centre (original) (raw)
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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.
Interventional Management of Chronic Pain
Journal of Oral and Maxillofacial Surgery, 2009
Chronic non-cancer pain is a common clinical condition affecting a significant part of the population. This article aims to review the interventional options for non-cancer pain. Multiple searches using Medline were carried out and additional searches were made using reference lists of published papers and book chapters. The article discussed procedures ranging from selective nerve root or zygapophyseal (facet) joint block with local anaesthetics to irreversible neurodestruction with radiofrequency energy or neurolytic agents and neuromodulation with spinal cord stimulation. Other techniques include intraspinal delivery of analgesics. There is evidence that these interventional procedures are valuable both diagnostically and therapeutically.
International Journal of Clinical Practice
Background: Perioperative pain assessment and management in neurosurgical patients varies widely across the globe. There is lack of data from developing world regarding practices of pain assessment and management in neurosurgical population. This survey aimed to capture practices and perceptions regarding perioperative pain assessment and management in neurosurgical patients among anesthesiologists who are members of the Indian Society of Neuroanaesthesiology and Critical Care (ISNACC) and evaluated if hospital and pain characteristics predicted the use of structured pain assessment protocol and use of opioids for postoperative pain management. Methods: A 26-item English language questionnaire was administered to members of ISNACC using Kwiksurveys platform after ethics committee approval. Our outcome measures were adoption of structured protocol for pain assessment and opioid usage for postoperative pain management. Results: The response rate for our survey was 55.15% (289/524). One hundred eighteen (41%) responders informed that their hospital setup had a structured pain protocol while 43 (15%) responders reported using opioids for postoperative pain management. Predictors of the use of structured pain protocol were private setup (odds ratio [OR] 2.64; 95% confidence interval [CI] 1.52-4.59; p=0.001), higher pain intensity (OR 0.37; 95% CI 0.21-0.64; p<0.001) and use of pain scale Accepted Article This article is protected by copyright. All rights reserved (OR 7.94; 95% CI 3.99-15.81; p<0.001) while availability of structured pain protocol (OR 2.04; 95% CI 1.02-4.05; p=0.043) was the only significant variable for postoperative opioid use. Conclusions: Less than half of the Indian neuroanesthesiologists who are members of ISNACC use structured protocol for pain assessment and very few use opioids for postoperative pain management in neurosurgical patients.
Pain research and treatment, 2017
Interventional Pain Management (IPM) is performed in multidisciplinary chronic pain clinics (MCPC), including a range of invasive techniques to diagnose and treat chronic pain (CP) conditions. Current patterns of use of those techniques in MCPC have not yet been reported. We aimed to describe quantitatively and qualitatively the use of IPM and other therapeutic procedures performed on-site at four Portuguese MCPC. A prospective cohort study with one-year follow-up was performed in adult patients. A structured case report form was systematically completed at baseline and six and 12 months. Among 808 patients referred to the MCPC, 17.2% had been prescribed IPM. Patients with IPM were on average younger and had longer CP duration and lower levels of maximum pain and pain interference/disability. The three main diagnoses were low back pain (n = 28), postoperative CP, and knee pain (n = 16 each). From 195 IPM prescribed, nerve blocks (n = 108), radiofrequency (n = 31), and viscosupplemen...
Pain assessment index: Evaluationfollowing multidisciplinary pain treatment
Journal of Pain and Symptom Management, 1987
The Pain Assessment Index is a weighted composite of MMPI scales which has been shown to be useful in predicting surgical outcome for chronic pain patients, hz this stud)~ 48 patients treated at a nonsurgical multidisciplinary pain clinic were categorized into predicted success (N = 23) or predicted failure (N = 25) groups based on their PAl scores. The groups did not differ on any of the pretreatment variables, and they differed on only one follow-up outcome measure. More patients in the predicted failure group reported using narcotics than did their predicted success group counterparts, hnplicatious of these results and recommendations for future research are discussed.
Fundamentals of Interventional Pain Medicine
The Neurologist, 2005
Chronic pain is one of the most common and challenging medical problems facing our society. The specialty of pain medicine has grown steadily in recent years, largely because of the recognition that multiple factors contribute to chronic pain. The practice of pain medicine is multidisciplinary in approach, incorporating modalities from various specialties to ensure the comprehensive evaluation and treatment of the pain patient. The integration of various specialties such as anesthesiology, neurology, neurologic surgery, orthopedic surgery, physical medicine, and psychiatry is essential to treating patients with chronic pain and to establishing continuity of care. Research in the last 30 years has developed a variety of alternatives or adjuncts to opiates for chronic pain, including neuroactive medications, counterstimulation methods, and cognitive-behavioral therapies. Pain medicine specialists have provided leadership in the development of the practice, with the application of a wide verity of central and peripheral nerve blocks, sympathetic and neurolytic blocks, intradiscal procedures, neuromodulation techniques, intrathecal infusion systems, and other technical procedures that are firmly linked to a biomedical model of pain.
Interventional pain management: evolving issues for 2003
Pain physician, 2003
The new millennium has seen the introduction of an array of new Current Procedural Terminology(R) (CPT) codes and the expansion of interventional techniques. Among the many issues of interest to physicians practicing interventional pain management in 2003 are CPT coding, correct coding issues, and utilization. The CPT developed and updated by the American Medical Association, is the most important and commonly used coding system for interventional pain physicians in the United States. A recent development in the CPT system has been to include Category I, Category II, and Category III CPT codes. Inclusion of a code in Category I is generally based on the procedure being consistent with contemporary medical practice and being performed by many physicians in clinical practice in multiple locations. In contrast, CPT Category III, also known as emerging technology codes, is a set of temporary codes for emerging technology, services, and procedures. There have been many new codes since 20...
Interventional Approaches to Pain Management
Anesthesiology Clinics, 2007
Interventional approaches remain a mainstay of chronic pain treatment despite the many challenges to the study of their efficacy. When less invasive analgesic modalities provide inadequate relief, these techniques often play a complementary role. Interventional strategies typically target the neural structures that are presumed to mediate the experience of pain. The varied mechanisms of action range from reversible blockade with local anesthetics, to augmentation with spinal cord stimulation, and ablation with radiofrequency energy or neurolytic agents. Other techniques access intraspinal routes of medication delivery to improve an effective drug's therapeutic index. Many of the most common approaches are uniquely suited to offer rapid, potent, local control of pain with reduced systemic side effects.