L32: MSK Intervention Flashcards
1
Q
Pain
A
- acute – trauma
- chronic
- inflammatory
- lack of activity
- anxiety
- mood changes
- depression
2
Q
Pain Intervention Indications
A
- failed conservative managements
- side effects – systemic therapies
- patient desire to avoid systemic therapy
- pain crisis
3
Q
What imaging modalities are used for guidance during pain intervention?
A
- CT
- fluoroscopy – x-ray in real-time
4
Q
How are CT scans used for guidance during pain intervention?
A
for visualizing something that is stable
- documentation of needle
- accuracy and safety
- thoracic NRB
- atlantoaxial (C1-2) facet injection – arterial puncture
- therapeutic cyst rupture
- radiation, procedure time
- no real-time visualization
5
Q
How is fluoroscopy used for guidance during pain intervention?
A
for visualizing movement – x-ray in real-time
- detector rotation
- real-time visualization
- multiple procedures
6
Q
Describe the pathophysiology (mechanism) of inflammation/pain.
A
- spondylosis, radiculopathy – chemical and mechanical irritation
- phospholipase A2 and enzymes
- inflammatory cascade – prostaglandins and leukotrienes
7
Q
What do corticosteroids do?
A
inhibit the release of cytokines and the synthesis of prostaglandins, thereby suppressing the physiologic response (inflammation/pain)
8
Q
What are some pain procedures for MSK?
A
- epidural injections – caudal, transforaminal, translaminar
- facet joint injections
- SI joint injections
- medial branch blocks
- radiofrequency nerve ablation
- vertebroplasty/kyphoplasty
9
Q
What are the goals of treatment?
A
cancer – spread (metastasis)
primary goal: pain relief
secondary goals:
- local disease control – especially when used with ablation
- prevent fracture/fracture progression with instability – symptom exacerbation and local damage (ie. cord compression)
- prevent worsening deformity, respiratory compromise, self-esteem loss, appetite loss, sleep disturbance
- prevent complications of NSM (opioid, bed rest, reduced activity)
