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8/17/2019 Pain Medicine Demystified - Presented at the British Orthopaedic Association 2015
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Pain Medicine Demystifed!Evidence or Spinal Interventions
Dr Sanjeeva Gupta
MD; Dip NB; "#; PM"#; IPP
"onsultant in Pain Medicine
Bradord $eac%in& 'ospitals N'Soundation $rust
Educational Meetin&s #dvisor ( aculty oPain Medicine
8/17/2019 Pain Medicine Demystified - Presented at the British Orthopaedic Association 2015
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Precision Dia&nosis andMana&ement o Pain
• 'istory
• P%ysical E)amination
• Investi&ations
• *+ to ,+- o spinal pain cannot .edia&nosed
• /it% Precision dia&nostic tec%ni0uesnearly *+- o spinal pain can .edia&nosed
8/17/2019 Pain Medicine Demystified - Presented at the British Orthopaedic Association 2015
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acet 1oint Mediated 2o3 Bac4 PainEvaluation( Medial Branc% Bloc4
• acet 1ointInjections
• Medial Branc%Bloc4
'i&% on t%e 5eye6 o t%e 5Scotty do&6
27
28
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C3
C4
C5
C6
ap
rvical acet 1oint Pain
"9
"7
"8
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2evel I Evidence o.tained rom multiple relevant %i&% 0ualityrandomi:ed controlled trials Evidence o.tained rom multiple %i&% 0uality dia&nosticaccuracy studies
2evel II Evidence o.tained rom at least one relevant %i&% 0ualityrandomi:ed controlled trial or multiple relevant moderateor lo3 0uality randomi:ed controlled trials Evidence o.tained rom at least one %i&% 0ualitydia&nostic accuracy study or multiple moderate or lo30uality dia&nostic accuracy studies
2evel III Evidence o.tained rom at least one relevant moderate orlo3 0uality randomi:ed controlled trial study Evidence o.tained rom at least one relevant %i&% 0ualitynon
8/17/2019 Pain Medicine Demystified - Presented at the British Orthopaedic Association 2015
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<t%e dia&nostic accuracy and utility o acet
joint nerve injections in c%ronic spinalpain? Pain P%ysician 9+@8; @,( E7A*
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evidence synt%esis o t%erapeutic acet joint interventions in mana&in& c%ronic
spinal pain? Pain P%ysician 9+@8; @,( E88<
E8,9
• 2evel II evidence or lon& termimprovement o 1 pain or
– 2um.ar and cervical radiore0uencyneurotomy
–
$%erapeutic acet joint nerve .loc4s incervical t%oracic and lum.ar spine
8/17/2019 Pain Medicine Demystified - Presented at the British Orthopaedic Association 2015
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Prevalence and Dia&nosis o SI1Pain
Prevalence o SI1pain 3as @+
8/17/2019 Pain Medicine Demystified - Presented at the British Orthopaedic Association 2015
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Evidence or SI1 InterventionsMeta
8/17/2019 Pain Medicine Demystified - Presented at the British Orthopaedic Association 2015
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adicular Pain
Dr $im Maus Mayo "li
8/17/2019 Pain Medicine Demystified - Presented at the British Orthopaedic Association 2015
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/%at "an ou SeeJ/ould ou Inject SteroidJ
S@ S@
8/17/2019 Pain Medicine Demystified - Presented at the British Orthopaedic Association 2015
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De) $riam De) $riam De) $riam
-Sur&ery
+ 9?*- @7?- @?9- @7?- @,?A-
8+ -
Painelie
@?*- 7?9- *?9- *- *?9- *8?*-
8+ -DIdecrease
9?,- 8?@- ,?9- *?- *+?*- 7?A-
2 Weeks 3 Months 6 Months
D1 Fennedy et al? Pain Medicine 9+@7; @8 K7L( 87,
8/17/2019 Pain Medicine Demystified - Presented at the British Orthopaedic Association 2015
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Spinal cord stimulation or c%ronicneuropat%ic pain
NI"E tec%nolo&y appraisal &uidance$#@8A• (pinal cord )tim*lation i) recommended for
per)i)tent chronic ne*ropathic of 6 month) or
more d*ration
8/17/2019 Pain Medicine Demystified - Presented at the British Orthopaedic Association 2015
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Britis% Pain Society Pain Pat%3ays2o3 Bac4 Pain O Specialist Mana&emen
Copyright © [2012] Map of Medicine Limited "ll rights reser#ed
8/17/2019 Pain Medicine Demystified - Presented at the British Orthopaedic Association 2015
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Good Practice Guidelineso t%e PM and BPS
https$%%&&&'ritishpainsocietyorg%static%uploads%resources%(les%spinal)inter#ention)"*)+inal)"pril)201*)1pdf
https$%%&&&'ritishpainsocietyorg%static%uploads%resources%(les%m'')201)-) +./"Lpdf http$%%&&&rcoaacu%node%220
https://www.britishpainsociety.org/static/uploads/resources/files/spinal_intervention_A5_Final_April_2015_1.pdfhttps://www.britishpainsociety.org/static/uploads/resources/files/mbb_2013_-_FINAL.pdfhttp://www.rcoa.ac.uk/node/2206http://www.rcoa.ac.uk/node/2206https://www.britishpainsociety.org/static/uploads/resources/files/mbb_2013_-_FINAL.pdfhttps://www.britishpainsociety.org/static/uploads/resources/files/mbb_2013_-_FINAL.pdfhttps://www.britishpainsociety.org/static/uploads/resources/files/spinal_intervention_A5_Final_April_2015_1.pdfhttps://www.britishpainsociety.org/static/uploads/resources/files/spinal_intervention_A5_Final_April_2015_1.pdf
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Summary
• $%ere is &ood evidence or – Dia&nostic spinal interventions
– adiore0uency denervation at lum.ar
and cervical levels – Spinal cord stimulation
– $ransoraminal Epidural steroid injections• 2ess c%ance o complications 3it%
De)amet%asone
– Pain Pat%3ays and t%e PM and BPS&ood practice &uidelines can %elp raisestandards
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$%an4 ou