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2.
Pain Med ; 23(7): 1266-1271, 2022 07 01.
Article in English | MEDLINE | ID: mdl-34850180

ABSTRACT

OBJECTIVE: Using stringent inclusion criteria, a double-blinded study protocol, and fluoroscopically guided injections, we compare intra-articular sacroiliac joint platelet-rich plasma injections with intra-articular steroids. DESIGN: Double-blind, randomized controlled trial. SETTING: Two large university-based interdisciplinary spine centers. SUBJECTS: A total of 26 patients with a positive diagnostic block (>80% relief). METHODS: Subjects who had a positive diagnostic block were randomized to undergo either a fluoroscopically guided intra-articular injection of steroid or a platelet-rich plasma injection. Follow-up was at 1 month, 3 months, and 6 months. Outcomes included level of pain, as indicated on a 0- to 100-mm numeric pain rating scale, and functional disability score, obtained via the Oswestry Disability Index (ODI). RESULTS: At 1, 3, and 6 months, both groups improved; however, subjects who received steroid injections reported lower pain scores than did subjects who received platelet-rich plasma. Using categorical data, we observed significantly more responders (defined as pain scores that improved by 50% or more from baseline) at 1 and 3 months in the group who received steroids than in the group who received platelet-rich plasma. CONCLUSION: Although both groups showed improvements in pain and function, the steroid group had significantly greater response and significantly more responders than did the platelet-rich plasma group.


Subject(s)
Low Back Pain , Platelet-Rich Plasma , Adrenal Cortex Hormones/therapeutic use , Arthralgia , Double-Blind Method , Humans , Injections, Intra-Articular/methods , Low Back Pain/diagnosis , Low Back Pain/drug therapy , Pelvic Pain , Sacroiliac Joint , Steroids , Treatment Outcome
4.
Pain Med ; 22(7): 1496-1502, 2021 07 25.
Article in English | MEDLINE | ID: mdl-33624827

ABSTRACT

OBJECTIVE: Examine how interventional pain physicians navigated the early phase of reopening practices during the coronavirus disease 2019 (COVID-19) pandemic. METHODS: In June/July 2020, Spine Intervention Society members were queried about practice demographics, perception of COVID-19 prevalence, financial impact, and implementation of new tools and procedures when re-opening practices. RESULTS: Of the 2,295 members approached, 195 (8%) completed the survey. A majority (71%) reported using risk stratification tools and changing scheduling patterns. Nearly 70% performed initial assessments via telehealth and 87% for follow-up encounters. More than 80% performed symptom/temperature checks upon in-person clinic/facility entrance, and 63% screened patients via phone. Most (58%) did not test patients for COVID-19 for office visits, while 38% tested only if symptomatic. For epidural injections, intra-articular injections, and radiofrequency neurotomy procedures, 43% reported not testing patients, while 36% tested patients only if symptomatic. Most (70%) required patients to wear a mask upon entering the clinic/facility. For nonprocedure encounters, respondents used surgical masks (85%), gloves (35%), face shields/goggles (24%), N95 respirators (15%), and gowns (6%). Some (66%) discussed unique COVID-19 risks/complications and 26% provided written information. Most did not make changes to steroid dosage (67%) or peri-procedural anticoagulation management (97%). The vast majority (81%) estimated that COVID-19 will have a moderate-severe financial impact on their practice. CONCLUSIONS: COVID-19 has dramatically affected interventional pain practices with regard to telehealth, in-clinic precautions, screening/testing protocols, and patient counseling. Practice patterns will continue to evolve as we learn more about the disease and improve methods to provide safe and effective care.


Subject(s)
COVID-19 , Telemedicine , Humans , Pain , Pandemics , SARS-CoV-2
5.
Pain Med ; 22(4): 994-1000, 2021 04 20.
Article in English | MEDLINE | ID: mdl-33605425

ABSTRACT

MYTH: Corticosteroid injection for the treatment of pain and inflammation is known to decrease the efficacy of the messenger ribonucleic acid (mRNA) vaccines for coronavirus disease 2019 (COVID-19). FACT: There is currently no direct evidence to suggest that a corticosteroid injection before or after the administration of an mRNA COVID-19 vaccine decreases the efficacy of the vaccine.However, based on the known timeline of hypothalamic-pituitary-adrenal (HPA) axis suppression following epidural and intraarticular corticosteroid injections, and the timeline of the reported peak efficacy of the Pfizer-BioNTech and Moderna vaccines, physicians should consider timing an elective corticosteroid injection such that it is administered no less than 2 weeks prior to a COVID-19 mRNA vaccine dose and no less than 1 week following a COVID-19 mRNA vaccine dose, whenever possible.


Subject(s)
Adrenal Cortex Hormones/administration & dosage , COVID-19 Vaccines/administration & dosage , COVID-19 , Pain/drug therapy , Vaccines, Synthetic/administration & dosage , Humans , Time Factors , mRNA Vaccines
6.
Pain Med ; 22(2): 518-519, 2021 02 23.
Article in English | MEDLINE | ID: mdl-33517427

ABSTRACT

MYTH: Genicular nerve radiofrequency ablation (RFA) is not associated with known clinically significant complications. FACT: Although genicular nerve RFA is generally considered a safe procedure, cases of septic arthritis, pes anserine tendon injury, third-degree skin burn, and clinically significant hematoma and/or hemarthrosis have been reported. As with any emerging procedure, other yet-to-be-reported complications are possible.


Subject(s)
Catheter Ablation , Osteoarthritis, Knee , Radiofrequency Ablation , Humans , Knee , Knee Joint/surgery , Osteoarthritis, Knee/surgery , Radiofrequency Ablation/adverse effects
12.
Pain Med ; 2020 May 06.
Article in English | MEDLINE | ID: mdl-32374374
14.
Pain Med ; 21(5): 1078-1079, 2020 05 01.
Article in English | MEDLINE | ID: mdl-32384161
17.
Pain Med ; 21(3): 472-487, 2020 03 01.
Article in English | MEDLINE | ID: mdl-31343693

ABSTRACT

OBJECTIVE: To determine the effectiveness of lumbar transforaminal injection of steroid for the treatment of radicular pain. DESIGN: Comprehensive systematic review. OUTCOME MEASURES: The primary outcome of interest was the proportion of individuals with reduction of pain by ≥50%. Additional outcomes of interest were a more-than-two-point reduction in pain score, patient satisfaction, functional improvement, decreased use of pain medication, and avoidance of spinal surgery. RESULTS: For patients with disc herniations, using the criterion of ≥50% reduction in pain, success rates across included studies (range) were 63% (58-68%) at one month, 74% (68-80%) at three months, 64% (59-69%) at six months, and 64% (57-71%) at one year. For patients with lumbar spinal stenosis, success rates across included studies (range) were 49% (43-55%) at one month, 48% (35-61%) at three months, 43% (33-53%) at six months, and 59% (45-73%) at one year, but there was a lack of corroboration from appropriately controlled studies. CONCLUSIONS: There is strong evidence that lumbar transforaminal injection of steroids is an effective treatment for radicular pain due to disc herniation. There is a lack of high-quality evidence demonstrating their effectiveness for the treatment of radicular pain due to spinal stenosis, though small studies suggest a possible benefit. Lumbar transforaminal injection of nonparticulate steroids is as effective as injections with particulate steroids.


Subject(s)
Adrenal Cortex Hormones/administration & dosage , Intervertebral Disc Displacement/drug therapy , Neuralgia/drug therapy , Spinal Stenosis/drug therapy , Female , Humans , Injections, Epidural , Intervertebral Disc Displacement/complications , Lumbar Vertebrae , Male , Neuralgia/etiology , Radiculopathy/drug therapy , Radiculopathy/etiology , Spinal Stenosis/complications
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