1 / 17

When & How to Utilize Interventional Procedures Utility and Predictive Factors

When & How to Utilize Interventional Procedures Utility and Predictive Factors. N. Camden Kneeland, M.D., D.A.B.A. The Montana Center for Wellness & Pain Management Kalispell, MT. Disclosures . Research Stipend from St. Jude Medical. Objectives .

rufus
Télécharger la présentation

When & How to Utilize Interventional Procedures Utility and Predictive Factors

An Image/Link below is provided (as is) to download presentation Download Policy: Content on the Website is provided to you AS IS for your information and personal use and may not be sold / licensed / shared on other websites without getting consent from its author. Content is provided to you AS IS for your information and personal use only. Download presentation by click this link. While downloading, if for some reason you are not able to download a presentation, the publisher may have deleted the file from their server. During download, if you can't get a presentation, the file might be deleted by the publisher.

E N D

Presentation Transcript

  1. When & How to Utilize Interventional ProceduresUtility and Predictive Factors N. Camden Kneeland, M.D., D.A.B.A. The Montana Center for Wellness & Pain Management Kalispell, MT

  2. Disclosures • Research Stipend from St. Jude Medical

  3. Objectives • Present evidence regarding the predictive value of psychosocial evaluation in chronic pain patients undergoing interventional procedures • Define the role of diagnostic and therapeutic interventional pain management procedures in an interdisciplinary pain management paradigm

  4. Psychosocial Background • Biopsychosocial complexity of chronic pain cannot be underappreciated • 41% with Axis I disorder • 200-300% increased association with depression and anxiety • Cost of chronic pain treatment annually exceeds $600 Billion annually • Daubs, MD SPINE Volume 36, Number 21S, pp S96–S109

  5. Fusion Versus Nonoperative Care for Chronic Low Back Pain • Systematic review of randomized controlled trials • 18 Studies met inclusion criteria for the period 1990-2010 • Beck Depression Inventory, Fear Avoidance Belief Questionaire, Zung Depression Scale, Spielberger Trait Anxiety Inventory, and Distress and Risk Assessment Method • Patients with a personality disorder appear to respond more favorably to conservative management and those without a personality disorder more favorably to fusion • Daubs, MD SPINE Volume 36, Number 21S, pp S96–S109 2011

  6. Can theOutcome of Spinal Cord Stimulation in Chronic Complex Regional Pain Syndrome Type I Patients BePredicted by Catastrophizing Thoughts? • 32 Patients • Prospective Cohort study • Dutch version of the Pain Catastrophizing Scale • Efficacy of SCS was not predicted by pain catastrophizing • Lame´ et al, Anesthesia and Analgesia 109(2):592-9 2009

  7. Psychological Risk Factors for Poor Outcome of SpineSurgery and Spinal Cord Stimulator Implant: A Review ofthe Literature and Their Assessment With the MMPI-2-RF • 197 patients • Prospective cohort study • Spine surgery and spinal cord stimulation • No significant difference between groups • Depression, anxiety, pain sensitivity, and anger were associated with poor outcomes • Block, AR. Psychological Risk Factors for Poor Outcome of Spine Surgery and Spinal Cord Stimulator Implant: A Review of the Literature and Their Assessment With the MMPI-2-RF, The Clinical Neuropsychologist, 27:1, 81-107 2013

  8. The Impact of Psychological Factors on Outcomes for Spinal Cord Stimulation: An Analysis with Long-term Follow-up • Retrospective Analysis • 60 patients • Hospital Anxiety and Depression Test and Pain Disability Index • No significant difference in PDI scores with successful and unsuccessful SCS implants • No significant difference in HADS scores with successful and unsuccessful SCS implants • Wolter et al, Pain Physician 16(3) 265-75 2013

  9. Prognostic Value of Psychological Testing in Patients Undergoing Spinal Cord Stimulation: A Prospective Study • Prospective study • MMPI • 58 patients • Some statistically significant association between high indices of depression and trial period, but no association with permanent implant • North R,Neurosurgery Issue: Volume 39(2), pp 301-311 1996

  10. Psychology and the Diagnosis of Facet Joint Pain • Retrospective Analysis • 438 patients • Survey based on DSM IV criteria for depression, anxiety, and somatization disorder • No statistically significant influence of depression, anxiety, somatization disorder, or a combination of the above on the prevalence of facet joint pain • Response to comparative medial branch blocks with different anesthetics • Manchikanti et al, Pain Physician, 11(2) 145-60 2008

  11. Summary • Limited Data for Screening outside SCS • Mixed Results • Common Sense • When in doubt, evaluate, but don’t sacrifice patient care • Comprehensive Approach

  12. The Role of Interventions • Diagnostic Value • Physician and Patient Education • Better Treatment Plans • Variety of Pain Generators = Variety of Interventions • Breaking the Cycle of Pain • Improving Function

  13. Interventional Pearls • Radicular Pain vs. Axial vs. Diffuse Pain • Shotgun Approach • Safety of Epidural Steroids • Adhesive arachnoiditis <1000 cases in 2002* • Myofascial/Musculoskeletal Pain • Interspinous Ligment *Rice M, et al, BJA 92:1 109-120

  14. Interventional Pearls • Facet Pain • Second most common source of axial spine pain

  15. Interventional Pearls • Lumbar Myofascial Pain • Iliopsoas & Quadratus Lumborum

  16. Interventional Pearls • Sacroiliac Joint Pain • Lateral Branch Blocks • Cooled RF Ablation

  17. Summary • Use interventional approach diagnostically and to break pain cycles • Long term analgesia and cure is possible • Informed consent is critical

More Related