A randomized, double-blind controlled trial of lumbar interlaminar epidural injections in central spinal stenosis: 2-year follow-up.

Background: While low back pain is the number one cause of disability in the United States, lumbar spinal stenosis along with intervertebral disc herniation and degenerative spondylolisthesis is one of the 3 most common diagnosis of low back and leg pain for which surgery is performed. Numerous modalities of treatments including drug therapy and complex surgical fusions have been recommended for treatment of central spinal stenosis. Epidural injections are one of the commonly performed nonsurgical interventions in managing central spinal stenosis; however, there has been paucity of literature in reference to efficacy of epidural injections in managing central spinal stenosis with lumbar interlaminar epidural injections.

Effect of fluoroscopically guided caudal epidural steroid or local anesthetic injections in the treatment of lumbar disc herniation and radiculitis: a randomized, controlled, double blind trial with a two-year follow-up.

Background: Lumbar disc herniation and radiculitis are common elements of low back and lower extremity pain. Among minimally invasive treatments, epidural injections are one of the most commonly performed interventions. However, the literature is mixed about their effectiveness in managing low back and lower extremity pain.

American Society of Interventional Pain Physicians (ASIPP) guidelines for responsible opioid prescribing in chronic non-cancer pain: Part 2--guidance.

Results: Part 2 of the guidelines on responsible opioid prescribing provides the following recommendations for initiating and maintaining chronic opioid therapy of 90 days or longer. 1. A) Comprehensive assessment and documentation is recommended before initiating opioid therapy, including documentation of comprehensive history, general medical condition, psychosocial history, psychiatric status, and substance use history.

American Society of Interventional Pain Physicians (ASIPP) guidelines for responsible opioid prescribing in chronic non-cancer pain: Part I--evidence assessment.

Background: Opioid abuse has continued to increase at an alarming rate since the 1990 s. As documented by different medical specialties, medical boards, advocacy groups, and the Drug Enforcement Administration, available evidence suggests a wide variance in chronic opioid therapy of 90 days or longer in chronic non-cancer pain. Part 1 describes evidence assessment.

Lumbar interlaminar epidural injections in central spinal stenosis: preliminary results of a randomized, double-blind, active control trial.

Background: Chronic, persistent low back and lower extremity pain is often caused by spinal stenosis. Surgery and other interventions, including epidural injections, have been used to relieve this pain. However, there is little in the medical literature to support interlaminar, or transforaminal epidural injections under fluoroscopy for managing lumbar pain of central spinal stenosis, while the caudal epidural approach has been studied.

A randomized, controlled, double-blind trial of fluoroscopic caudal epidural injections in the treatment of lumbar disc herniation and radiculitis.

Study Design: A randomized, controlled, double-blind trial.

Objective: To assess the effectiveness of fluoroscopically directed caudal epidural injections in managing chronic low back and lower extremity pain in patients with disc herniation and radiculitis with local anesthetic with or without steroids.

Summary Of Background Data: The available literature on the effectiveness of epidural injections in managing chronic low back pain secondary to disc herniation is highly variable.

A prospective evaluation of bleeding risk of interventional techniques in chronic pain.

Background: The role of antithrombotic therapy is well known for primary and secondary prevention of cardiovascular disease to decrease the incidence of acute cerebral and cardiovascular events. Data shows that the risk of coronary thrombosis after antiplatelet drug withdrawal is much higher than that of surgical bleeding if the antiplatelet drug therapy were continued. However, it has been a common practice to discontinue antiplatelet therapy prior to performing interventional techniques, which may potentially increase the risk of acute cerebral and cardiovascular events.

Protocol for accuracy of point of care (POC) or in-office urine drug testing (immunoassay) in chronic pain patients: a prospective analysis of immunoassay and liquid chromatography tandem mass spectometry (LC/MS/MS).

Background: Therapeutic use, overuse, abuse, and diversion of controlled substances in managing chronic non-cancer pain continues to be an issue for physicians and patients. It has been stated that physicians, along with the public and federal, state, and local government; professional associations; and pharmaceutical companies all share responsibility for preventing abuse of controlled prescription drugs. The challenge is to eliminate or significantly curtail abuse of controlled prescription drugs while still assuring the proper treatment of those patients.

Preliminary results of a randomized, equivalence trial of fluoroscopic caudal epidural injections in managing chronic low back pain: Part 2--Disc herniation and radiculitis.

Background: The pathophysiology of lumbar radicular pain is a subject of ongoing research. The prevalence of sciatica or radiculitis ranges from 1.2% to 43%.

Evaluation of lumbar facet joint nerve blocks in the management of chronic low back pain: preliminary report of a randomized, double-blind controlled trial: clinical trial NCT00355914.

Background: The prevalence of persistent low back pain with the involvement of lumbar facet or zygapophysial joints has been described in controlled studies as varying from 15% to 45% based on the criteria of the International Association for the Study of Pain. Therapeutic interventions utilized in managing chronic low back pain of facet joint origin include intraarticular injections, medial branch nerve blocks, and neurolysis of medial branch nerves.

Objective: To determine the clinical effectiveness of therapeutic lumbar facet joint nerve blocks in managing chronic low back pain of facet joint origin.

Prevalence of facet joint pain in chronic low back pain in postsurgical patients by controlled comparative local anesthetic blocks.

Objective: To evaluate the prevalence of facet joint pain in patients with chronic low back pain (CLBP) after surgical intervention(s).

Design: A prospective, nonrandomized, consecutive study.

Setting: An ambulatory interventional pain management setting.

Controlled substance abuse and illicit drug use in chronic pain patients: An evaluation of multiple variables.

Background: Opioids are used extensively for chronic pain management in the United States. The frequency of opioid use prior to presenting to interventional pain management settings and in interventional pain management settings has been shown to be above 90%. Opioid abuse has been demonstrated in 9% to 41% of patients receiving chronic pain management.

Is there correlation of facet joint pain in lumbar and cervical spine? An evaluation of prevalence in combined chronic low back and neck pain.

Among the chronic pain problems, pain emanating from cervical and lumbar regions, independently or in combination, constitutes a significant and frequently encountered problem in interventional pain management practices. This study was designed to test the assumption that patients presenting with chronic low back pain of lumbar facet joint origin may also present with chronic neck pain of facet joint origin. Considering that many studies show the prevalence of facet joint involvement in chronic low back pain as ranging from 15% to 45% compared to prevalence of involvement of cervical facets in chronic neck pain, ranging from 54% to 60%, we sought to evaluate the correlation between lumbar facet joint to cervical facet joint pain.

Evaluation of the prevalence of facet joint pain in chronic thoracic pain.

The role of zygapophysial (facet) joints in chronic thoracic pain has received very little attention with only a few publications discussing these joints as sources of pain. In contrast, facet joints have been implicated as responsible for chronic pain in a significant proportion of patients with chronic neck and low back pain. However, thoracic spinal pain, though less common, has been reported to be as disabling as neck and low back pain.

Prevalence of illicit drug use in patients without controlled substance abuse in interventional pain management.

Drug abuse with illicit drugs and licit drugs has been increasing steadily over the past decade. A recent National Household Survey on Drug Abuse found statistically significant increases between 2000 and 2001 in the use of multiple drugs, including marijuana, cocaine, and non-medical use of pain relievers and tranquilizers. Prescription controlled substance abuse is a major issue in chronic pain management.

A comparative evaluation of illicit drug use in patients with or without controlled substance abuse in interventional pain management.

The prevalence of illicit drug use by patients in a chronic pain management practice who concomitantly abuse prescription-controlled substances is not known. The purpose of this study was to determine the prevalence of illicit drug use by patients in an interventional pain management practice, based on whether or not there was evidence of simultaneous abuse of prescription drugs. One hundred and fifty patients in an interventional pain management practice who were prescribed controlled substances for pain treatment were selected for assessment of concomitant illicit drug use by urine drug testing.

Spinal endoscopic adhesiolysis in the management of chronic low back pain: a preliminary report of a randomized, double-blind trial.

Epidural adhesiolysis with spinal endoscopy is an emerging interventional pain management technique in managing chronic refractory low back and lower extremity pain. However, there is a lack of significant data demonstrating the effectiveness of spinal endoscopic adhesiolysis. This randomized, double-blind controlled trial was undertaken to determine the ability of spinal endoscopic adhesiolysis to reduce pain and improve functional and psychological status.

Screening for controlled substance abuse in interventional pain management settings: evaluation of an assessment tool.

There is a need for an assessment tool to identify drug abuse behaviors in patients in pain treatment practices. Many assessment tools are complex, lengthy, lack external validation, and/or are difficult to administer. This prospective evaluation was undertaken to provide external validation for an assessment tool with 12 sections and 27 items.

Evaluation of fluoroscopically guided caudal epidural injections.

Objective: To evaluate accuracy of needle placement and flow patterns of fluoroscopically guided caudal epidural injections.

Design: A prospective observational study of patients with low back pain undergoing caudal epidural injections under fluoroscopy.

Background: Epidural administration of corticosteroids is one of the commonly used interventions in managing chronic low back pain.

Evaluation of variables in illicit drug use: does a controlled substance abuse screening tool identify illicit drug use?

Study Design: A retrospective, case-controlled study.

Objective: To identify variables in patients with or without illicit drug use.

Background Information: Studies documenting a high incidence of controlled substance abuse in chronic pain continue to increase.

A double-blind, controlled evaluation of the value of sarapin in neural blockade.

Objective: To demonstrate the effectiveness of Sarapin in prolonging the action of neural blockade with improved pain relief.

Design: Prospective, continuous, double-blind trial including 500 consecutive patients undergoing either caudal epidural injections; cervical, thoracic, lumbosacral facet joint nerve blocks; and/or intercostal nerve blocks or a combination thereof.

Background: Sarapin has been reported as an agent to provide pain relief without motor weakness with an excellent risk/ benefit ratio in neural blockade.

Evaluation of lumbar transforaminal epidural injections with needle placement and contrast flow patterns: a prospective, descriptive report.

Background: Transforaminal epidural steroid injection is one of the commonly employed modalities of treatment in managing nerve root pain. However, there have been no controlled prospective evaluations of epidural and nerve root contrast distribution patterns and other aspects of fluoroscopically directed lumbosacral transforaminal epidural steroid injections.

Objectives: To evaluate contrast flow patterns and intravascular needle placement of fluoroscopically guided lumbosacral transforaminal epidural injections.

Effectiveness of cervical medial branch blocks in chronic neck pain: a prospective outcome study.

Background: The high prevalence of persistent neck pain due to involvement of cervical facet joints has been described in controlled studies. Therapeutic interventions utilized in managing chronic neck pain of facet joint origin include intraarticular injections, medial branch nerve blocks, and neurolysis of medial branch nerves by means of radiofrequency.

Objective: The objective of this prospective evaluation was to determine the clinical effectiveness of cervical medial branch blocks for therapeutic purposes.

One day lumbar epidural adhesiolysis and hypertonic saline neurolysis in treatment of chronic low back pain: a randomized, double-blind trial.

Background: Chronic, refractory low back pain is a common problem. Percutaneous adhesiolysis with hypertonic saline neurolysis was described in the management of chronic refractory low back pain, non-responsive to conservative modalities of management.

Objective: To determine the ability of percutaneous adhesiolysis and hypertonic saline administration to reduce pain and improve functional and psychological status in patients with chronic low back pain.

Patterns of illicit drug use and opioid abuse in patients with chronic pain at initial evaluation: a prospective, observational study.

Background: Over the years, there has been a shift toward the increased reliance on opioids for the treatment of chronic pain. It is well known that some patients do not provide an appropriate history or underestimate their drug intake, and may exaggerate reported pain levels. Numerous studies have documented the incidence of illicit drug use and abuse of opioids in chronic pain patients.