scholarly journals Understanding Psychological Aspects of Chronic Pain in Interventional Pain Management

2002 ◽  
Vol 1;5 (1;1) ◽  
pp. 57-82 ◽  
Author(s):  
Laxmaiah Manchikanti
Keyword(s):  
Chronic Pain ◽  
Pain Management ◽  
Psychological Aspects ◽  
Interventional Pain Management

scholarly journals Reassessment of Evidence Synthesis of Occupational Medicine Practice Guidelines for Interventional Pain Management

2008 ◽  
Vol 4;11 (8;4) ◽  
pp. 393-482
Author(s):  
Laxmaiah Manchikanti
Keyword(s):  
Chronic Pain ◽  
Pain Management ◽  
Strong Evidence ◽  
Guideline Development ◽  
Medial Branch ◽  
Low Back ◽  
Quality Of Evidence ◽  
Interventional Techniques ◽  
Interventional Pain Management

Background: Appropriately developed practice guidelines present statements of best practice based on a thorough evaluation of the evidence from published studies on the outcomes of treatments, which include the application of multiple methods for collecting and evaluating evidence for a wide range of clinical interventions and disciplines. However, the guidelines are neither infallible, nor a substitute for clinical judgment. While the guideline development process is a complex phenomenon, conflict of interest in guideline development and inappropriate methodologies must be avoided. It has been alleged that the guidelines by the American College of Occupational and Environmental Medicine (ACOEM) prevent injured workers from receiving the majority of medically necessary and appropriate interventional pain management services. An independent critical appraisal of both chapters of the ACOEM guidelines showed startling findings with a conclusion that these guidelines may not be applied in patient care as they scored below 30% in the majority of evaluations utilizing multiple standardized criteria. Objective: To reassess the evidence synthesis for the ACOEM guidelines for the low back pain and chronic pain chapters utilizing an expanded methodology, which includes the criteria included in the ACOEM guidelines with the addition of omitted literature and application of appropriate criteria. Methods: For reassessment, randomized trials were utilized as it was in the preparation of the guidelines. In this process, quality of evidence was assessed and recommendations were made based on grading recommendations of Guyatt et al. The level of evidence was determined utilizing the quality of evidence criteria developed by the U.S. Preventive Services Task Force (USPSTF), as well as the outdated quality of evidence criteria utilized by ACOEM in the guideline preparation. Methodologic quality of each individual article was assessed utilizing the Agency for Healthcare Research and Quality (AHRQ) methodologic assessment criteria for diagnostic interventions and Cochrane methodologic quality assessment criteria for therapeutic interventions. Results: The results of reassessment are vastly different from the conclusions derived by the ACOEM guidelines. The differences in strength of rating for the diagnosis of discogenic pain by provocation discography and facet joint pain by diagnostic facet joint nerve blocks is established with strong evidence. Therapeutic cervical and lumbar medial branch blocks and radiofrequency neurolysis, therapeutic thoracic medial branch blocks, cervical interlaminar epidural steroid injections, caudal epidural steroid injections, lumbar transforaminal epidural injections, percutaneous and endoscopic adhesiolysis, and spinal cord stimulation qualified for moderate to strong evidence. Additional insight is also provided for evidence rating for intradiscal electrothermal therapy (IDET), automated percutaneous disc decompression, and intrathecal implantables. Conclusion: The reassessment and reevaluation of the low back and chronic pain chapters of the ACOEM guidelines present results that are vastly different from the published and proposed guidelines. Contrary to ACOEM’s conclusions of insufficient evidence for most interventional techniques, the results illustrate moderate to strong evidence for most diagnostic and therapeutic interventional techniques. Key words: Guidelines, evidence-based medicine, systematic reviews, ACOEM, interventional pain management, interventional techniques, guideline development, workers’ compensation, chronic pain guidelines, low back pain guidelines

Interventional pain management techniques for chronic pain

2013 ◽  
pp. 474-485
Author(s):  
Navil F. Sethna ◽  
Pradeep Dinakar ◽  
Karen R. Boretsky
Keyword(s):  
Chronic Pain ◽  
Pain Management ◽  
Case Series ◽  
Pain Syndrome ◽  
Treatment Modalities ◽  
Neuraxial Blockade ◽  
Paediatric Case ◽  
Injection Techniques ◽  
Interventional Pain Management ◽  
Management Techniques

As part of multidisciplinary management of paediatric chronic pain, interventional pain management techniques can play an important role when pain is unrelieved by conventional treatment modalities. Many procedures and indications are extrapolated from adult studies, and evidence for long-term efficacy in paediatric populations is limited. Interventions range from injection techniques with local anaesthetic and/or corticosteroids to neuraxial blockade with implanted catheters. Paediatric case series have reported benefit in selected patients with complex regional pain syndrome and cancer-related pain.

scholarly journals Triaging Interventional Pain Procedures During COVID-19 or Related Elective Surgery Restrictions: Evidence-Informed Guidance from the American Society of Interventional Pain Physicians (ASIPP)

2020 ◽  
Vol 4S;23 (8;4S) ◽  
pp. E183-S204
Author(s):  
Christopher Gharibo
Keyword(s):  
Chronic Pain ◽  
Pain Management ◽  
Surgical Procedures ◽  
Task Force ◽  
Elective Surgery ◽  
Interventional Techniques ◽  
Elective Surgical Procedures ◽  
Chronic Pain Patients ◽  
Interventional Pain Management ◽  
Pain Patients

Background: The COVID-19 pandemic has worsened the pain and suffering of chronic pain patients due to stoppage of “elective” interventional pain management and office visits across the United States. The reopening of America and restarting of interventional techniques and elective surgical procedures has started. Unfortunately, with resurgence in some states, restrictions are once again being imposed. In addition, even during the Phase II and III of reopening, chronic pain patients and interventional pain physicians have faced difficulties because of the priority selection of elective surgical procedures. Chronic pain patients require high intensity care, specifically during a pandemic such as COVID-19. Consequently, it has become necessary to provide guidance for triaging interventional pain procedures, or related elective surgery restrictions during a pandemic. Objectives: The aim of these guidelines is to provide education and guidance for physicians, healthcare administrators, the public and patients during the COVID-19 pandemic. Our goal is to restore the opportunity to receive appropriate care for our patients who may benefit from interventional techniques. Methods: The American Society of Interventional Pain Physicians (ASIPP) has created the COVID-19 Task Force in order to provide guidance for triaging interventional pain procedures or related elective surgery restrictions to provide appropriate access to interventional pain management (IPM) procedures in par with other elective surgical procedures. In developing the guidance, trustworthy standards and appropriate disclosures of conflicts of interest were applied with a section of a panel of experts from various regions, specialties, types of practices (private practice, community hospital and academic institutes) and groups. The literature pertaining to all aspects of COVID-19, specifically related to epidemiology, risk factors, complications, morbidity and mortality, and literature related to risk mitigation and stratification was reviewed. The evidence -- informed with the incorporation of the best available research and practice knowledge was utilized, instead of a simplified evidence-based approach. Consequently, these guidelines are considered evidence-informed with the incorporation of the best available research and practice knowledge. Results: The Task Force defined the medical urgency of a case and developed an IPM acuity scale for elective IPM procedures with 3 tiers. These included emergent, urgent, and elective procedures. Examples of emergent and urgent procedures included new onset or exacerbation of complex regional pain syndrome (CRPS), acute trauma or acute exacerbation of degenerative or neurological disease resulting in impaired mobility and inability to perform activities of daily living. Examples include painful rib fractures affecting oxygenation and post-dural puncture headaches limiting the ability to sit upright, stand and walk. In addition, urgent procedures include procedures to treat any severe or debilitating disease that prevents the patient from carrying out activities of daily living. Elective procedures were considered as any condition that is stable and can be safely managed with alternatives. Limitations: COVID-19 continues to be an ongoing pandemic. When these recommendations were developed, different stages of reopening based on geographical regulations were in process. The pandemic continues to be dynamic creating every changing evidence-based guidance. Consequently, we provided evidence-informed guidance. Conclusion: The COVID-19 pandemic has created unprecedented challenges in IPM creating needless suffering for pain patients. Many IPM procedures cannot be indefinitely postponed without adverse consequences. Chronic pain exacerbations are associated with marked functional declines and risks with alternative treatment modalities. They must be treated with the concern that they deserve. Clinicians must assess patients, local healthcare resources, and weigh the risks and benefits of a procedure against the risks of suffering from disabling pain and exposure to the COVID-19 virus. Key words: Coronavirus, COVID-19, interventional pain management, COVID risk factors, elective surgeries, interventional techniques, chronic pain, immunosuppression

scholarly journals Analysis of Growth of Interventional Techniques in Managing Chronic Pain in the Medicare Population: A 10-Year Evaluation from 1997 to 2006

2009 ◽  
Vol 1;12 (1;1) ◽  
pp. 9-34 ◽  
Author(s):  
Laxmaiah Manchikanti
Keyword(s):  
Chronic Pain ◽  
Pain Management ◽  
Ambulatory Surgery ◽  
Facet Joint ◽  
Medicare Beneficiaries ◽  
Interventional Techniques ◽  
Ambulatory Surgery Center ◽  
Interventional Pain Management ◽  
Joint Injections ◽  
Surgery Center

Background: Recent reports of the United States Government Accountability Office (GAO), the Medicare Payment Advisory Commission (MedPAC), and the Office of Inspector General (OIG) expressed significant concern with overall fiscal sustainability of Medicare and exponential increase in costs for interventional pain management techniques. Interventional pain management (IPM) is an evolving specialty amenable to multiple influences. Evaluation and isolation of appropriate factors for increasing growth patterns have not been performed. Study Design: Analysis of the growth of interventional techniques in managing chronic pain in Medicare beneficiaries from 1997 to 2006. Objective: To evaluate the use of all interventional techniques. Methods: The standard 5% national sample of the CMS carrier claim record data for 1997, 2002, and 2006 was utilized. This data set provides information on Medicare enrollees in the feefor-service Medicare program. Current procedural technology (CPT) codes for 1997, 2002, and 2006 were used to identify the number of procedures performed each year, and trends in expenditures. Results: Interventional techniques increased significantly in Medicare beneficiaries from 1997 to 2006. Overall, there was an increase of 137% in patients utilizing IPM services with an increase of 197% in IPM services, per 100,000 Medicare beneficiaries. The majority of the increases were attributed to exponential growth in the performance of facet joint interventions. There was a 13.9-fold difference in the increase between the state with the lowest rate and the state with the highest rate in utilization patterns of interventional techniques (California 37% vs. Connecticut 514%), with an 11.6-fold difference between Florida and California (431% vs. 37% increase). In 2006, Florida showed a 12.7-fold difference compared to Hawaii with the lowest utilization rate. Hospital outpatient department (HOPD) expenses constituted the highest increase with fewer patients treated either in an ambulatory surgery center (ASC) or in-office setting. Overall HOPD payments constituted 5% of total 2006 Medicare payments, in contrast to 57% of total IPM payments, an 11.4-fold difference. Limitations: The limitations of this study include a lack of inclusion of Medicare participants in Medicare Advantage plans and potential documentation, coding, and billing errors. Conclusion: This study shows an overall increase of IPM services of 197% compared to an increase of 137% in patients utilizing IPM services from 1997 to 2006. Key words: Interventional techniques, interventional pain management, facet joint injections, epidural steroid injections, sacroiliac joint injections, chronic pain, chronic spinal pain, ambulatory surgery center (ASC), hospital outpatient department (HOPD)

scholarly journals The role of home healthcare in managing cancer-related pain during COVID-19 pandemic: ‘The Triple Triage Protocol’

2021 ◽  
Vol 25 (1) ◽  
pp. 1-4
Author(s):  
Tolga Ergönenç ◽  
Jalan Şerbetçigil Ergönenç ◽  
Eve Yamak Altınpulluk
Keyword(s):  
Chronic Pain ◽  
Clinical Practice ◽  
Pain Management ◽  
Cancer Pain ◽  
Healthcare Services ◽  
Home Healthcare ◽  
Human Right ◽  
Triage Protocol ◽  
Interventional Pain Management

The coronavirus disease 2019 (COVID-19) can be responsible for severe acute respiratory syndrome and death. To limit the infection spread, non-urgent surgical procedures, day procedures, including interventional pain management, and patient visits, have been postponed or interrupted during the COVID-19 pandemic. Pain management is defined as a fundamental human right, but the rapidly changing nature of the COVID-19 outbreak requires revisions in clinical practice for chronic pain. This article describes the role of home healthcare services in managing cancer pain based on clinical practice during the COVID-19 pandemic and emphasizes the triple triage concept and the use of telemedicine. Key words: Coronavirus; COVID-19; Telemedicine; Home care; Cancer Pain Citation: Ergönenç T, Ergönenç JS, Altınpulluk EY. The role of home healthcare in managing cancer-related pain during COVID-19 pandemic: ‘The Triple Triage Protocol’. Snaesth. Pain intensive care 2021;25(1):1-4. DOI: 10.35975/apic.v25i1.1430 Received: 4 January 2021, Reviewed & Accepted:  8 January 2021

scholarly journals Utilization of Interventional Techniques in Managing Chronic Pain in the Medicare Population: Analysis of Growth Patterns from 2000 to 2011

2012 ◽  
Vol 6;15 (6;12) ◽  
pp. E969-E982 ◽  
Author(s):  
Laxmaiah Manchikanti
Keyword(s):  
Chronic Pain ◽  
Pain Management ◽  
Sacroiliac Joint ◽  
Facet Joint ◽  
Medicare Beneficiaries ◽  
Interventional Techniques ◽  
Geometric Average ◽  
Interventional Pain Management ◽  
Facet Joint Interventions ◽  
Joint Injections

Background: Reports from the United States Government Accountability Office (GAO), the Institute of Medicine (IOM), the Medicare Payment Advisory Commission (MedPAC), and the Office of Inspector General (OIG) continue to express significant concern with the overall fiscal sustainability of Medicare and the exponential increase in costs for chronic pain management. Study Design: The study is an analysis of the growth of interventional techniques in managing chronic pain in Medicare beneficiaries from 2000 to 2011. Objective: To evaluate the use of all interventional techniques in chronic pain management. Methods: The study was performed utilizing the Centers for Medicare and Medicaid Services (CMS) Physician Supplier Procedure Summary Master Data from 2000 to 2011. Results: Interventional techniques for chronic pain have increased dramatically from 2000 to 2011. Overall, the increase of interventional pain management (IPM) procedures from 2000 to 2011 went up 228%, with 177% per 100,000 Medicare beneficiaries. The increases were highest for facet joint interventions and sacroiliac joint blocks with a total increase of 386% and 310% per 100,000 Medicare beneficiaries, followed by 168% and 127% for epidural and adhesiolysis procedures, 150% and 111% for other types of nerve blocks and finally, 28% and 8% increases for percutaneous disc procedures. The geometric average of annual increases was 9.7% overall with 13.7% for facet joint interventions and sacroiliac joint blocks and 7.7% for epidural and adhesiolysis procedures. Limitations: The limitations of this study included a lack of inclusion of Medicare participants in Medicare Advantage plans, as well as potential documentation, coding, and billing errors. Conclusion: Interventional techniques increased significantly in Medicare beneficiaries from 2000 to 2011. Overall, there was an increase of 177% in the utilization of IPM services per 100,000 Medicare beneficiaries, with an annual geometric average increase of 9.7%. The study also showed an exponential increase in facet joint interventions and sacroiliac joint blocks. Key words: Interventional techniques, interventional pain management, facet joint injections, epidural steroid injections, sacroiliac joint injections, chronic pain, chronic spinal pain

scholarly journals The role of interventional pain management in chronic pain

2004 ◽  
Vol 18 (1) ◽  
pp. 29-35
Author(s):  
Alex Cahana ◽  
Philippe Mavrocordatos ◽  
Elisabeth Van Gessel ◽  
Setsuro Ogawa
Keyword(s):  
Chronic Pain ◽  
Pain Management ◽  
Interventional Pain Management

scholarly journals COVID-19 Pandemic: Implications on Interventional Pain Practice—a Narrative Review

2020 ◽  
Vol 4S;23 (8;4S) ◽  
pp. S311-S318
Author(s):  
Sudhir Diwan
Keyword(s):  
Chronic Pain ◽  
Immune System ◽  
Pain Management ◽  
Personalized Medicine ◽  
Regenerative Medicine ◽  
Key Words ◽  
Normal Saline ◽  
Local Anesthetics ◽  
The Future ◽  
Interventional Pain Management

Background: The COVID-19 pandemic has emerged and has challenged us to look for alternatives to bring about a paradigm shift in interventional chronic pain management. As the disease lowers the body’s immune system, the use of medications that suppress the immune system are not recommended during the COVID-19 pandemic. Objective: The purpose of this study was to review medications other than steroids used for interventional pain management and the emphasis on mitigation of the untoward consequences of steroid injections on the immune system during the COVID-19 pandemic. Literature Search: The literature was searched for articles in English with key words COVID-19, immunity, steroid for pain management injections with steroid, local anesthetics, dextrose water, normal saline, pain and genetic medicine, pain, and regenerative medicine. The sources of articles were PubMed, Embase, and open Google search. Literature Review: The medications used for interventional pain management include steroids and opioids. The side effects of these medications are well known but have never been looked at as critically as they are now. Many other medications have been used for interventional pain procedures to relieve pain, such as dextrose water, normal saline solution, local anesthetics, and many adjuvants. Regarding regenerative therapy, despite plenty of evidence in literature, we have not yet considered it as a routine therapy for chronic pain injections. It is now time to move on beyond steroids and consider other types of medications and treatment options. The use of these medications in clinical practice is less auspicious, and thus more research is needed on the practical applications. Further areas for research include studies to determine definitive efficacy and safety assessment and determine whether or not the analgesic effects of these drugs are duration or dose-dependent. The optimal identification of candidates, volume, concentration, and intervals of injection are essential for routine application in interventional chronic pain practice. Conclusions: The future of interventional pain practice is trending toward regenerative medicine and genetic research. Numerous scientific studies have been conducted to investigate the genetic basis of phenotypic variability in individuals with different ethnic groups in terms of susceptibility to chronic pain, as well as response to treatment for the personalized medicine model. Despite the preliminary data on genetic variations, there is no evidence for the use of a pharmacogenomicsbased approach to personalized medicine for patients with chronic pain. The field of medicine therefore needs further research in pharmacogenetics, including large-scale prospective studies that focus on pain pathways. However, recent research, including larger studies and larger-scale genomic perspectives, may yield more promising findings in the future. The COVID-19 pandemic proved the need for medications with the most impact and least complications. Key words: COVID-19, steroid, pain injections, chronic pain, immune system, regenerative medicine

scholarly journals Impact of the COVID-19 pandemic on chronic pain management

2021 ◽  
Vol 2 (3) ◽  
pp. 197-212
Author(s):  
Andrew Auyeung ◽  
Hank Wang ◽  
Iulia Pirvulescu ◽  
Nebojša Knežević
Keyword(s):  
United States ◽  
Chronic Pain ◽  
Pain Management ◽  
The United States ◽  
Chronic Pain Management ◽  
Steroid Use ◽  
Chronic Pain Patients ◽  
Interventional Pain Management ◽  
Tools And Techniques ◽  
Pain Patients

Introduction: The COVID-19 pandemic has generated considerable turmoil in the interventional pain management (IPM) community. Due to IPM being classified as 'elective', numerous pain practices across the United States were forced to close during the pandemic, leaving chronic pain patients untreated for indefinite periods, and IPM physicians with increased stress and burnout. Results: In response to these detrimental effects, various re-opening tools and techniques have been created to facilitate a cautious resumption of in-person interventional pain practice. Due to their ability to minimize person-to-person contact, telehealth and pharmacotherapy played a more significant role in IPM during the pandemic, but their increased utilization has also led to the exacerbation of substance abuse and the opioid epidemic. The interplay between steroid use and its immunosuppressive effects, in relation to the COVID-19 infection and the COVID-19 vaccine, has also arisen as an issue of concern. Conclusion: As practices begin to safely re-open throughout the United States, the effects felt by chronic pain patients during the pandemic must be emphasized and not ignored. This review emphasizes the struggles pain patients have had to face during the pandemic and the need to update and redefine regulations regarding interventional and chronic pain management.

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