Interventional Pain Management

It was noted that the patient has neck pain, facet arthropathy and spondylosis, suggestive of facer joint origin, 80% relief from previous facet nerve injection/block, prior rhizotomy more than 6 months and cervical/thoracic facet medial branch nerve block which has been helpful, failed conservative treatments with nonsteroidal anti-inflammatory medications (NSAIDS), PT, chiropractic care and home exercises.

Long term condition (LTC) is a health problem that cannot be cured, at present, but can be managed by medication or therapies’ (Snodden., 2010: p1). There are more than 15 million people in England that are suffering from long term conditions (Department of Health., 2013). Long-term conditions are more common in older people. The percentages of people of over 60 having a LTC is 58 per cent compared to under that is 14 per cent (Department of Health, 2012). LTC is also more predominant in more deprived groups, such as the poorest social class as it has 60 per cent higher prevalence than of those in the richest social class. (Department of Health, 2012).

CA MTUS supports facet injections for non-radicular facet mediated pain. In addition, ODG criteria for facet injections include documentation of low-back pain that is non-radicular, failure of conservative treatment (including home exercise, PT, and NSAIDs) prior to the procedure for at least 4-6 weeks, no more than 2 joint levels to be injected in one session, and evidence of a formal plan of additional evidence-based activity and exercise in addition to facet joint therapy. This is an appeal to a previously denied request on 02/09/16. The latest note and the appeal letter stated that the reviewing doctor denied the joint injections because there was no documentation of ruling out radiculopathy. The bottom line is that this patient has MRI scan evidence of both disc pathology and facet arthropathy. It was noted that the patient has been symptomatic since 2005. He has continued back pain with a recent 10/12/15 date of

Patient was encouraged to continue with heat, followed by his home exercise program and ice. He will continue with his transcutaneous electrical nerve unit (TENS). Patient was given an ice pack to use, to reduce pain. He was given a 60 mg Toradol injection on this visit.

Per the medical report dated 07/18/16, patient is being seen for her lower backache, rated 7/10 with medications and 10/10 without medications. Current medications include Ambien 10mg; Maxalt-MLT 10mg; Norco 10/325mg; Evzio 0.4mg; orphenadrine 100 mg and gabapentin 600 mg.

A physician with a wealth of experience in the fields of anesthesiology and pain management, Dr. Daniel Kendall has served as an interventional pain medicine specialist with National Spine and Pain Centers for 17 years. He treats patients out of National Spine and Pain’s Arlington location near his home town of Vienna, Virginia. Before assuming his current position, Dr. Daniel Kendall served as chief fellow of pain management at Johns Hopkins Hospital in Baltimore, Maryland. His experience with Johns Hopkins included training in advanced modalities such as sympathetic blocks, vertebroplasty, intrathecal pumps, IDET, radiofrequency ablation, and spinal cord stimulation.

On admission, Mr. Fountain complained of low back pain, ranging in intensity between 7 and 10, on a pain scale where 0 is no pain and 10 is the worst possible pain. He subjectively described this pain as a constant ache that permeates down into both legs, anteriorly and posteriorly, but at times can be stabbing, sharp, and burning. Sitting, standing, walking or lying down for prolonged periods can aggravate his back pain, while treatment modalities such as medications, nerve block injections, medical cannabis, TENS therapy, massage, and application

The first 48 hours of pain analysis and treating the pain of the patient to the hospice (or end-of-life patient in any other stetting) are crucial. However, the patient may be unable to speak and articulate his pain, or may be able to inadequately express the symptoms. One of the major concerns for those who are at the end of life is

The strength of this recommendation is inconclusive. As practitioners, we should have minimum restraint in following this recommendation and should be on the lookout for new evidence in addition to strongly listening to patient preference. This recommendation is based upon three RCT’s. Two of these studies were of high strength and one was of moderate strength with regard to quality. All three of these studies had moderate applicability. In these studies, pain improvement was not consistently statistical significant (MD = .81, 95% CI -1.76, .14; MD = 2.26, p<.001; MD = -.82, 95% CI -1.247, -.39), and neither was function (MD = 3, 95% CI -1.05, 7.05; MD = 6.54, p=.001). In addition, the authors concluded the clinical significance of these findings were

Chronic, acute, somatic and oncologic are all types pain - each with their own symptoms, reliefs, and evaluations. As pain has been explored, we have learned more about it; however, it remains an anomaly. In the postoperative setting, nurses are the first line of pain management. Their assessments of the patient’s pain, including questions and scaling is imperative when dosing medications and evaluating the patient. Studies continue to determine that healthcare providers undertreat and mismanage pain control and assessment. According, to the American Society of Interventional Pain Physicians, “80% to 90% of physicians have had no formal training in prescribing controlled substances, and only five out of one hundred thirty-three medical schools in the U.S. have required courses on pain management” (Glowacki, p. 37). The American Nurse Credentialing Center reported that “as of 2013, only one thousand six hundred seventy two registered nurses in the U.S. were certified in pain management” (Glowacki, p. 37). According to the CDC, about 50% of postoperative patients report unrelieved pain (Centers for Disease Control and Prevention, 2013). Effective postoperative pain control is necessary for successful care and treatment. Inadequate relief of postoperative pain can contribute to postoperative complications such as atelectasis, deep vein thrombosis, and delayed wound healing (Francis &

Current request is for 1 Left Lumbar Transforaminal Epidural Steroid Injection at the L5 Level under IV Sedation and Fluoroscopy between 12/23/2015 and

There are four classes of medications used to relieve back pain. First class are analgesics, analgesics only used to ease the pain, stiffness, and swelling. These medications are, Ibuprofen, Ketoprofen, and Naproxen (Bodger 127). Second, muscle relaxants “to reduce the pain from muscle spasm or tightness”. Methocarbamol, cyclobenzaprine, orphenadrine citrate, and carisoprodol are prescribed medications that do not work only on the affected area, but on all muscles (Bodger 129). Third, tranquilizers “anxiety prescriptions can achieve the same effect as muscle relaxants at the same time as they relieve anxiety, which can be the exacerbator—if not the sole cause—of muscle tension”, include alprazolam, Librium, and diazepam (Bodger 129). Fourth, Anti-depressants “very low doses of antidepressant medications—lower than would have an effect on psychological disorders—are sometimes prescribed to relax muscle, reduce pain, and aid the sleep of those with chronic backache”. Those drugs are clomipramine, imipramine, and amitriptyline hydrochloride (Bodger 129). “Oral administration of steroid medication may provide similar anti-inflammatory activity, it does not require an MRI or radiation exposure, can be delivered quickly by primary care physicians, carries less risk, and would be much less expensive than an [epidural steroid injection]”

Septoplasty, for symptomatic deviated nasal septum, is a commonly practiced surgery in ENT. After septal operations, nasal packing helps to minimize the dead space and bleeding from surgery site. In addition to prevent nasal bleeding, these materials also support the septal mucoperichondrial flaps and minimize the risk of formation of septal hematomas and adhesions.2

Don’t suffer with back pain. Talk to your doctor to find out if you should explore a surgical option. If so, make an appointment with us at Brain & Spine Center of Texas to discuss spine surgery in DFW. Call us at (972) 943-9779 or visit us online at

a) Patient preparation is a vital part of anesthesia. It begins by taking an accurate history and performing a physical examination. The patient is given a physical status classification based on their current condition. This classification recommends diagnostic tests. The minimum testing includes PCV, TS, and renal testing. Once the history, exam, and diagnostic testing are complete, the patient is ready for anesthesia.