Employer Perspective on Pain Fellowship Education: A Survey to Understand the Current State of Pain Medicine Training.

Background: Pain medicine care has expanded to encompass a wider range of conditions, necessitating updated education and training for pain specialists to utilize emerging technologies effectively. A national survey was conducted through several verified Pain organizations regarding pain physician employers' perspectives on pain medicine fellowship training and education. The survey aimed to gather insights from a diverse range of geographic locations, practice types (academic and private practice), and practice settings.

The current state of training in pain medicine fellowships: An Association of Pain Program Directors (APPD) survey of program directors.

Introduction: The Accreditation Council for Graduate Medical Education (ACGME) approved the first pain medicine fellowship programs over three decades ago, designed around a pharmacological philosophy. Following that, there has been a rise in the transition of pain medicine education toward a multidisciplinary interventional model based on a tremendous surge of contemporaneous literature in these areas. This trend has created variability in clinical experience and education amongst accredited pain medicine programs with minimal literature evaluating the differences and commonalities in education and experience of different pain medicine fellowships through Program Director (PD) experiences.

Radiofrequency Ablation for Chronic Lumbar Zygapophyseal Joint Pain Using a V-Shaped Active Tip Needle: An Observational Retrospective Study.

Background: Lumbar zygapophyseal joint dysfunction represents one of the major sources of chronic low back pain. Radiofrequency ablation (RFA) using a V-shaped active tip needle may offer a larger lesion of the medial branch nerves, improving clinical outcome. The aim of our study is to evaluate the efficacy and the feasibility of RFA using V-shaped active tip needles.

Interventional Pain Procedures: A Narrative Review Focusing On Safety and Complications. PART 2 Interventional Procedures For Back Pain.

In patients where conservative approaches have failed to relieve from chronic pain, interventional procedures may be an option in well selected patients. In recent years there has been an increase in the use and development of invasive procedures. Concomitantly, there has also been an increase in the complications associated with these procedures.

Bipolar Pulsed Radiofrequency for Trigeminal Neuralgia: A Report of Two Cases.

Background: Trigeminal neuralgia (TN) is the most common cause of facial pain, leading to significant disability and impacting a patient's quality of life. Percutaneous procedures like continuous radiofrequency, pulsed radiofrequency (PRF), and combined continuous and pulsed radiofrequency have been studied in past years comparing different voltages in order to find more effective therapies with fewer complications (eg, numbness and masseter muscle weakness). With regard to young patients, there is still insufficient evidence on the most appropriate procedure in this patient population.

The anatomy of the peridural membrane of the human spine.

A peridural membranous layer exists between the bony wall of the spinal canal and the dura mater, but reports on the anatomy of this structure have been inconsistent. The objective of this study is to give a precise description of the peridural membrane (PDM) and to define it unambiguously as a distinct and unique anatomical entity. Thirty-four cadaveric sections of human thoraco-lumbar spines were dissected.

The peridural membrane of the spine has characteristics of synovium.

The peridural membrane (PDM) is a well-defined structure between dura mater and the wall of the spinal canal. The spine may be viewed as a multi-segmented joint, with the epidural cavity and neural foramina as joint spaces and PDM as synovial lining. The objective of this investigation was to determine if PDM has histological characteristics of synovium.

2015 Young Investigator Award Winner: Cervical Nerve Root Displacement and Strain During Upper Limb Neural Tension Testing: Part 2: Role of Foraminal Ligaments in the Cervical Spine.

Study Design: A cross-sectional cadaveric examination of the mechanical effect of foraminal ligaments on cervical nerve root displacement and strain.

Objective: To determine the role of foraminal ligaments by examining differences in cervical nerve root displacement and strain during upper limb neural tension testing (ULNTT) before and after selective cutting of foraminal ligaments.

Summary Of Background Data: Although investigators have determined that lumbar spine foraminal ligaments limit displacement and strain of lumbosacral nerve roots, similar studies have not been conducted to prove that it is true for the cervical region.

2015 Young Investigator Award Winner: Cervical Nerve Root Displacement and Strain During Upper Limb Neural Tension Testing: Part 1: A Minimally Invasive Assessment in Unembalmed Cadavers.

Study Design: A cross-sectional cadaveric examination of displacement and strain measured at the level of the cervical nerve roots during upper limb neural tension testing (ULNTT) with median nerve bias.

Objective: To determine the displacement and strain of cervical nerve roots C5-C8 during ULNTT with minimal disruption of surrounding tissues.

Summary Of Background Data: Clinical examination of neural pathology involving cervical nerve roots is difficult because of the transient nature of pathologies, such as cervical radiculopathy, entrapment neuropathies, and thoracic outlet syndrome.

Prevalence of adverse reactions to radiopaque contrast reported by patients presenting for interventional pain procedure.

Introduction: Adverse reactions to radiopaque contrast media (RCM) are well documented with a wide range of incidences reported. The objective of this study was to determine how many patients in a sample of 200 who presents for interventional pain treatments report a history of adverse reactions to RCM.

Methods: Data from 200 outpatients were collected using a self-administered questionnaire.

Hyaluronidase: a review of approved formulations, indications and off-label use in chronic pain management.

Importance Of The Field: Hyaluronidase for injection is an adjuvant that increases the absorption and dispersion of other injected drugs or fluids (hypodermoclysis); and improves absorption of radiopaque agents in subcutaneous urography. Ovine hyaluronidase is approved for the treatment of vitreous hemorrhages.

Areas Covered In This Review: We review approved indications for injectable hyaluronidase and off-label uses as well as safety, efficacy and dosing information.

Neurogenic bladder: a complication after endoscopic adhesiolysis with return of bladder function while using nitrofurantoin.

We describe the case of a 73-year-old woman with a history of chronic low back pain and 2 previous lumbar fusions who presented with complaints of worsening back and leg pain. Having previously undergone multiple interventions, physical therapy, and oral analgesics with limited pain relief, the patient opted for endoscopic lysis of adhesions for severe scarring of the epidural space. Subsequently, the patient developed a neurogenic bladder with urinary retention.

Evidence-based interventional pain medicine according to clinical diagnoses. 3. Persistent idiopathic facial pain.

Persistent idiopathic facial pain, previously known as atypical facial pain, is described as a persistent facial pain that does not have the classical characteristics of cranial neuralgias and for which there is no obvious cause (International Classification of Headache Disorders in 2004). According to these criteria, the diagnosis is possible if the facial pain is localized, present daily, and throughout all or most of the day. By definition, neurological and physical examination findings in persistent idiopathic facial pain should be normal.

Recent advancements in the treatment of lumbar radicular pain.

Purpose Of Review: Lumbar radicular pain is a common and often difficult condition to treat. Current literature supports the theory that radicular pain is at least in part due to an inflammatory process involving cytokines, including tumor necrosis factor alpha and interleukins. This review summarizes some of the most recent research concerning the use of tumor necrosis factor alpha antagonists and interleukin receptor antagonists in the treatment of lumbar radicular pain.

Ziconotide: an update and review.

Background: Ziconotide is the only N-type calcium channel blocker approved by the US FDA for the treatment of chronic pain. The approved indication is for the management of severe chronic pain in patients for whom intrathecal therapy is warranted and who are intolerant of or refractory to other treatments such as systemic analgesics, adjunctive therapies or intrathecal morphine.

Objective: The purpose of this article was to review the available safety, efficacy and dosing information for ziconotide.

Sympathetic blocks: the evidence.

The sympathetic nervous system has been implicated in numerous pain syndromes ranging from neuropathic pain to vascular pain to visceral pain. In light of this, sympathetic ganglia have been the target of local anesthetic blockade to determine the sympathetic role in the transmission of pain. If analgesia is afforded with local anesthetic blockade, chemical or thermal neurolysis have been utilized to attempt to provide long-term relief.

Predictive value of intrathecal narcotic trials for long-term therapy with implantable drug administration systems in chronic non-cancer pain patients.

This study retrospectively investigated the predictive value of intrathecal narcotic trials for long-term drug utilization via implantable pumps in chronic non-cancer patients. Data were derived from 86 patients who were categorized according to the intrathecal narcotic dose that resulted in the optimal trial response. The response during the trial period and the pattern of long-term utilization of morphine was studied, as was the impact of age, gender and diagnosis.

Sharp versus blunt needle: a comparative study of penetration of internal structures and bleeding in dogs.

Background And Objectives: Complications associated with interventional pain procedures have raised questions regarding the relative safety of sharp vs. blunt needles. It has been speculated that the incidence of hemorrhage, intraneural and/or intravascular injections may be reduced by the use of blunt needles.

Sphenopalatine ganglion pulsed radiofrequency treatment in 30 patients suffering from chronic face and head pain.

This study evaluated the efficacy of sphenopalatine ganglion pulsed radiofrequency (SPG-PRF) treatment in patients suffering from chronic head and face pain. Thirty patients were observed from 4 to 52 months after PRF treatment. The primary efficacy measures were the reduction in oral medication use, including opioids, time-to-next-treatment modality for presenting symptoms, duration of pain relief, and the presence of residual symptoms.