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All Interventional Pain Management Articles

Posterior lumbar decompression and fusion (PLDF), also known as instrumental spinal fusion, to treat symptomatic spinal stenosis associated with degenerative spondylolisthesis is one of the most common surgical procedures performed.
Nearly 20 million Americans suffer from high-impact chronic pain that limits their ability to live their lives as they wish.1 Sadly, many of these patients are led to believe that medication is the only treatment path.
This article is part of a series on the use of light therapy for pain management.
The American Academy of Pain Medicine (AAPM) joined six other pain specialty societies in urging CMS to include coverage of epidural steroid injections (ESIs) for the management of chronic pain in Medicare recipients.
Osteoarthritis of the Knee: Prevalence and Treatment Gaps Knee osteoarthritis is a common problem in the US population, with 14 million Americans suffering from symptomatic disease.1 Development of knee osteoarthritis (OA) can be related to several risk factors, including a sedentary lifestyle, previous knee injury, female gender, obesity, and diabetes.2 Individu
A recently published study shows that spinal cord stimulation (SCS) relieves pain and improves motor symptoms in patients with Parkinson’s disease (PD) who have and have not received deep brain stimulation (DBS) therapy.1 PD is a progressive, multisystem neurodegenerative disease that leads to motor symptoms, such as tremor, bradykinesia, rigidity, and postural instability, and non-m
A Review of QL Blocks and Techniques Ultrasound guided fascial plane blocks have an extensive variety of applications in acute perioperative pain management as well as in the chronic pain management setting.
Radiofrequency ablation (RFA) of the genicular nerves is an increasingly common approach to managing chronic knee pain.
The Fast-Paced Growth of Neuromodulation The use of neuromodulation as a treatment in a wide array of pain-related disorders has expanded ever since the concept of spinal cord stimulation (SCS) was introduced and operationalized many years ago. Fellow PPM board member C.
Case Presentation: Herein, the authors report the use of a spinal cord stimulator to treat severe chronic intractable abdominal pain in a patient with an 18-year history of chronic pancreatitis. A stimulator with leads placed midline of T
Chronic pain, particularly neuropathic pain, is rarely treated adequately by pharmacotherapy. Spinal cord stimulation (SCS) therapy, which was introduced more than 50 years ago, is delivered by a neurostimulator implanted under the skin. It works by disrupting the pain signals traveling between the spinal cord and brain.
Stroke is a major cause of disability in the world; between 30% and 70% of people who survive a stroke experience a significant impairment of the affected arm and become functionally dependent on others for everyday activities.1,2 The shoulder is highly vulnerable to secondary musculoskeletal complications following stroke,3
Paradoxically, improved motor function was observed clinically by the authors several years ago after administering a small subanesthetic dose of lidocaine under sonographic guidance to reduce the pain associated with a common fibular nerve entrapment in a patient with almost no ability to dorsiflex their foot.
A recent cross-lagged systematic review1 demonstrated a bidirectional relationship between hyperarousal and pain that was linked to intrusive thoughts and catastrophizing.
A case study offers considerations for peripheral nerve stimulation (PNS) as an additional tool to help manage chronic pain.
The authors describe the use of neuromodulation to manage pain associated with advanced Keinbock Disease and comorbid symptoms of complex regional pain syndrome (CRPS).
Concepts in assessing and treating patients with various degrees of SIJ dysfunction.
A community pain practice study shows improved quality of life in patients with chronic pain after receiving local nerve blocks.
After an unfortunate complication of spinal cord compression resulting from a brief stimulator trial implantation, the authors share how they approached further care of the patient.
Another study showed that BurstDR revitalized pain relief in those switched from other spinal cord stimulation devices.
Surgical interventions, often used low back pain, were not effective in reducing chronic pain for some patients.
Trial will examine SynchroMed II as an opioid alternative for chronic back pain.
Researchers use an intercostal nerve block to aid diagnosis of slipping rib syndrome.
As steroids injected into the epidural space are not FDA-approved, clinicians must carefully outline the risks ahead of time.
Stimwave has received FDA clearance for the WaveCrest Mobile iOS platform patient controller for opioid-free pain management.
FDA has approved Medtronic's myPTM, which works with the company's SynchroMed II intrathecal drug delivery system.
Research is showing that dorsal root ganglion stimulation provides long-term relief with few complications.
Despite its prevalent use, little evidence is shown to warrant the treatment of epidural steroid injections.
New guidelines have been released for ketamine infusions when used as a chronic pain treatment.
The recent potential of SCS means clinicians are looking to implement them earlier in a patient's treatment plan.
This non-invasive treatment offers an interesting pathway to future research for chronic lower back pain.
New wearable neurostimulation device helps to manage opioid withdrawal symptoms.
High-frequency stimulation improved chronic neuropathic pelvic pain in this case series review.
Promising results of GAE means future interventions in clinical settings.
An overview of current approaches in intrathecal drug delivery for cancer pain management.
Visualizing and pain mapping complicated chronic pain conditions may help treatment approaches. A case study model is presented.
With the COMPEL study, more clinical data is provided for prolonged use of botox injections for migraine treatment.
When chronic pain begins to affect sleep patterns, induce depression, challenge functionality, or determine medication use, a comprehensive care plan may help to ward off suicidal thoughts.
Step-by-step instructions for how to perform superficial radial nerve injection using cross-linked hyaluronic acid (Restylane or Juvéderm) for treatment of neuropathic pain.
Case report of the use of cross-linked hyaluronic acid injection technique to treat postsurgical neuropathic pain that provided prolonged, significant relief without adverse side effects.
For patients with chronic radicular pain, axial pain, and patients who are not candidates for surgery, spinal cord stimulation can be a safe and effective therapy. Learn more about patient selection and screening.
Treating chronic neuropathic pain syndromes with a novel, nonpharmacologic approach: scrambler therapy, that offers patients a non-invasive, individualized technique for significantly reducing pain.
Case presentations demonstrate effectiveness of AmnioFix, a micronized dehydrated amniotic allograft, in reducing foot and ankle pain when conservative therapies fail to help.
One emergency department in New Jersey has taken the lead in fighting the opioid epidemic. St. Joseph’s Regional Medical Center in Paterson, New Jersey, launched the Alternatives to Opiates (ALTO) program in January 2016 to drastically cut the use of opioids in the ED without sacrificing pain relief.
Case report of young man with CRPS treated with a peripheral nerve block with complete resolution of pain.
Harnessing the power of electricity to help heal. Learn how pulsed electromagnetic field therapy can help reduce pain and inflammation in patients with diabetic neuropathy.
Sota Omoigui, MD has developed an alternative injection technique using a short needle. Learn more about the new technique used for intramuscular and procedural injections.
Researchers are rediscovering the sphenopalatine ganglion block as a simple, inexpensive procedure that provides a relatively low-risk option for the treatment of chronic migraines.
The case of the cat who avoided contact with his owner when the owner's high-frequency spinal cord stimulator was turned on.
Retrospective case series finds reduced pain scores following pulsed radiofrequency energy (PRFE) treatments. Learn more about this non-ablative option for pain management
Percutaneous electrical neurostimulation can accomplish a safe, cost-effective, and rapid reduction in the use of opioids, even when previous weaning methods have been unsuccessful.
Combined electrochemical treatment uses local anesthetic blocks in conjunction with electric cell signaling treatment (EST) to successfully treat neuropathies of all causes. Learn more about this innovative treatment technique.
Cranial Electrotherapy Stimulation (CES) has the potential to improve pain and headache outcomes. Learn how to incorporate this techniques, either as an adjunct to traditional treatment or as a stand-alone option, for the management of pain and headache.
Learn more about the role of neurostimulators, specifically spinal cord stimulators, in pain management.
Selective spinal and joint injections are being performed with increasing frequency in the management of acute and chronic disorders of the musculoskeletal system. Effective treatment of chronic spine and joint pain requires accurate identification of the correct pain source.
Transcranial direct current stimulation (tDCS) is a non-invasive, painless brain stimulation technique that is showing promise in the treatment of depression and chronic pain.1 tDCS is delivered through a battery-operated device that transfers electrical current of low intensity (1-2 mA) to the surface of the head, typically with 2 large (20-35 cm2) saline-soaked sponge-el
After a reader's brother went blind following a epidural steroid injection, our Editorial Board examines the safety of epidural steroid injections.
There are several evidence-based (EB) guidelines that address the use of epidural injections for the treatment of low back pain. But how influential are these guidelines to the everyday decision-making of physicians?
While the frequency of serious complications due to ESI is undefined, certain pharmaceutical characteristics of corticosteroids (ie, particulate vs nonparticulate) are thought to contribute to overall risk.
Spinal cord stimulation should no longer be considered the treatment of “last resort.” Long-term success rates reach 85% if SCS is performed within 2 years of symptom onset.
Despite improved understanding of pain mechanisms, interpretation of pain signals, and development of new analgesic techniques, the under-treatment of postoperative pain continues.
Opioid intrathecal therapy offers the advantage of delivering medication directly to the dorsal horn of the spinal cord—increasing potency and reducing the systemic exposure—thus reducing side effects.
For patients with chronic migraine, botulinum neurotoxin injections have helped reduce the frequency, duration, and disability of headaches.
Interventional pain specialists offer an overview of spinal cord stimulation (dorsal column neuromodulation) fundamentals that referring physicians can use in clinical practice.
Candidates for spinal cord stimulator implantation are typically referred for psychological assessment as part of the screening process to evaluate the likelihood of successful outcomes. The authors review the various assessment tools and discuss which may be most beneficial for chronic pain patients.
This case challenge discusses the activation of latent Lyme disease following a lumbar epidural steroid injection.
Many physicians who treat pain have been hesitant to perform invasive procedures on patients who are taking warfarin sodium due to the potential risk of complications. Article examines these safety concerns.
The past decade has seen a revolution in minimally invasive techniques to improve surgical outcomes, including minimally invasive spine surgery.
Article reviews different types of radiofrequency neuroablation, or lesioning, and their use in the treatment of back and neck pain.
Review options for in-office electromagnetic devices to treat chronic pain patients.
Pain after TKA is reported to be a problem in an estimated 20% of cases. It is described as a surgical risk and is often accepted as an unfortunate outcome of the procedure. However, careful physical examination of the diagnostic evaluation can reveal soft tissue pathologies that can be successfully managed.
For more than 40 years, clinicians have been using and developing implantable technologies for the control of severe pain. Article reviews 3 types of implantable technology.
This article describes a new electromagnetic device and its use in combination with local anesthetic therapy to treat pain problems.
Corticosteroids are a common component of nearly all therapeutic injections for pain management that physicians perform. Read about possible complications of epidural steroid injections. Important pain management article to read.
Article includes a discussion of monitored anesthesia care and conscious sedation during pain therapies and interventional pain management procedures.
I have been asked to write a regular column on the subject of interventional pain treatment. The editors of Practical Pain Management made this request with the goal of keeping readers as current as possible on the many exciting developments in the field of interventional therapies.
Article discusses a retrospective review of the rate of dural punctures as a complication of lumbar epidural steroid injections—with and without guiding fluoroscopy.
A survey of the "science" behind exclusionary psychological assessment finds that supporting empirical data is virtually non-existent and may be unduly limiting access to those patients for whom this treatment represents their only chance for comfort and a reasonable quality of life.
Article provides an overview and case study of spinal cord (dorsal column) stimulation in a spine-centered/orthopaedic clinical practice setting.
As a cost-effective intervention, neurostimulation can play an important role in chronic pain patients who don't respond well to more conservative treatment approaches.
This retrospective study of pain outcomes for radiofrequency neuroablation patients confirms the viability of this modality where conservative, traditional treatments for chronic low back pain have failed.
Botulinum toxin type A appears to have potential as an effective chronic pain treatment in a variety of painful conditions.
Implantable devices in the epidural space provides selected patients with control in managing a wide variety of painful disorders.
Article on using cranial electrotherapy stimulation to treat chronic pain patients: should you be using it in your practice?
Postoperative pain control after surgery of the joint can be obtained through the use of intraarticular injections.
The basic properties, reactions and applications of corticosteroid use should be reviewed prior to treating chronic pain patients with corticosteroid injections.
Thoracic facet-mediated pain may be more common than previously thought and, due to potentially confounding pain patterns of competing structures in and around the thoracic spine, the gold standard for diagnosing facet-mediated pain is intraarticular injection.
Article offers suggestions for being prepared to handle complications during spinal interventional procedures.
This article helps practitioners identify and avoid complications associated with spinal interventions and offers suggestions for resuscitation should a severe complication occur.
Spinal cord stimulation has been one of the major advances in the efficacious and cost-effective treatment of chronic pain patients with multiple different pain processes—particularly of cervical and lumbar spinal origin.
This article discusses the results of a follow-up study of patients who completed a pre-implant psychological evaluation and had a surgical implant of a pain management device.
Administering a continuous lumbar epidural infusion of corticosteroid and normal saline via an indwelling epidural catheter/infusion pump over a 3-day period offers a minimally-invasive option for treatment of lumbar radiculopathy.
A retrospective study showed that pulsed radiofrequency is effective as a replacement for both epidural steroid injections and surgery in the treatment of radicular pain as well as cases of peripheral nerve damage.
Cranial electrotherapy stimulation (CES) can be used to treat chronic pain patients. Author presents experience with 5 patients who had CES.
Intradermal Botulinum Toxin in painful dysfunction of the muscles of mastication (MMD) suggest an excellent ability of BTX-A to reduce nocioceptive symptoms by mechanism(s) other than motor inhibition of muscle contraction.
A trialing protocol before initiation of long-term ziconotide intrathecal therapy is presented.
Iontophoresis has been shown to effectively manage painful symptoms associated with superficial tissue structures in a wide variety of patients.
Cranial electrotherapy stimulation studies demonstrate that this modality is effective, safe, and easy to use as a stand-alone or complementary, cost effective, non-medication treatment for the management of pain.
This article explains cranial electrotherapy stimulation in the treatment of mild traumatic brain injury. Article also includes case summary discussions.
A review of of BTX-A including a discussion of its mode of action and case studies illustrating its use in treatment of a variety of pain conditions.
The high efficacy of cranial electrotherapy stimulation (CES) and lack of side effects make this an excellent option for the treatment of depression, alone or in combination with antidepressants.
Is local or heavy sedation safer for intraspinal injections? A review of clinical arguments regarding sedation in certain interventional procedures and its ramifications for patient safety.
Cranial electrotherapy stimulation (CES) is an effective, established treatment for insomnia that avoids polypharmacy interactions for pain patients taking medications while simultaneously reducing anxiety, depression, and pain.
Retrospective case studies in intrathecal drug therapy patients with severe chronic pain demonstrate the safety and efficacy of ziconotide in improving pain management while reducing (or even halting) oral and intrathecal narcotic pain medications.
Cranial electrotherapy stimulation (CES) is a safe, efficacious, cost-effective intervention for addictions. As such, CES should be added to all addiction treatment programs.
Minimally-invasive electrical nerve stimulation of the greater and/or lesser occipital nerves may be extremely effective in treating refractory migraine.
SCS Treatment Of Painful Diabetic Peripheral Neuropathy
This second article, of a two-part series on the efficacy of Cranial Electrotherapy Stimulation (CES) in treating depression, reviews the results of meta-analysis conducted on CES studies.
Practical Issues of Reimbursement for IT Drug Delivery: The Ziconotide Model
CES in the Treatment of Anxiety Disorders, Part 2
Are Intrathecal Therapy Trials Necessary?
When Should Spinal Cord Stimulation (SCS) be Considered?
Despite significant, positive advances in opioid formulations ranging from long-acting tablets to lollipops, the most potent way to administer opioids is by the intrathecal route. Editor of Practical Pain Management discusses the underutilization of intrathetcal treatments (such as spinal pumps).
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