Interventional Flashcards
Medical documentation when considering an interventional technique
1) evaluation including history and physical exam
2) physiological and functional assessment (as necessary)
3) indication and necessity
including - suspected organic problem, non responsiveness to less invasive modalities - exceptions include acute disc herniation, CRPS, etc
4)pain and disability -mod to severe
5) no contraindications
6) indication of previous responsivenes
structures responsible for pain in spine
intervertebral discs, spinal cord, nerve roots, facet joints, ligaments, muscles and sacroiliac joints
pain caused by the intervertebral disc
disc herniation is small percentage, but degeneration of disc frequently results in primary discogenic pain
postlaminectomy syndrome
failed back surgery - 20-30% with some estimates as high as 60% related to surgery being inadequate, incorrect or uneccasary
-also central processing component of pain ignored.
frequency of injections (epidural)
typically 1-2weeks in diagnostic phase and no more frequent than 2 months for ongoing (usually longer,
Facet Joint blocks
diagnostic - local anesthetic injection into two adjacent levels - if pain relieved may be thought to be joint – however false positives (cervical 27-63%).
Also issue of other sources of pain True positive response is about 85% confident
Medial branch neurotomy
after repeated facet blocks – and then using neurolytic substance or by radio frequency
sacroiliac joint
joint includes a joint capsule, synovial fluid and hyaline cartilage -
How useful is technology in determining origin of low back pain?
only 15% of patients (without disc herniation or neurological deficts) will have the MRI, CT, neurophysiologic testing clearly show the cause.
common sources of spinal pain
facet joint, discogenic, and scroiliac joint
actions of coritcosteroids
membrane stabilization, inhibition of neural peptide synthesis and action, blockade of phopholipase aw activity, prolonged suppression of ongoing neuronal discharge, suppression of dorsal horn neurons.
tension type headache
most common type – most people have at least one… more problematic is the chronic form - 180+ a year.
Symptoms - intermitent or persisting bilateral pain, squeezing pressure/ tight band around head. – often involves temporal, occipital regions, Does not have prodromal symptoms or associated with N/V. Intensity varies - not usally incapacitating.
Often occurs durring stress, anxiousness, can have organic causes (cerivcal spine, head, necktrauma, TMJ,)
treatment of tension type headaches
nonpharm, muscle relaxants, massage, stress management, OTC, caffeine combinations,
Chronic - prophylactic management - sedatives, relaxants, NSAIDs, antidepressants, TCA or SSRI - manual manipulation, soft tissue massage,
migraine
chronic, neurogenic disorder - recurring attacks of head pain that includes gastrointestinal, visual and auditory disturbances.
unilateral , pulsating, moderate to severe, aggravated with physical activity,
migraine triggers
common ones include - fasting, change in eating habits, over/ undersleeping exercise, cold beverages ice cream, drugs (common diclofenac, estrogen, H2 receptor blockers, indomethacin, niacin, nitroglycerin, nitrates) stress, emotions allergies, loud noises, smoke, sun glare weather changes
