Dr Ian Wallbridge. Musculoskeletal Specialist Rotorua. 11:30-12:00 Managing Intractable Spinal pain
|
|
- Lorin Martin
- 5 years ago
- Views:
Transcription
1 Dr Ian Wallbridge Musculoskeletal Specialist Rotorua 11:30-12:00 Managing Intractable Spinal pain
2
3 2 years of pain
4 2 years of pain
5 2 years of pain
6 Intractable spinal pain KEY POINT #1 2 types: SOMATIC PAIN RADICULAR PAIN
7 Somatic pain Somatic referred pain Stimulation of peripheral endings of nociceptive afferent fibers From soma (latin) body typically facet /z joints
8 Somatic pain Z joint SI joint Somatic referred pain Stimulation of peripheral endings of nociceptive afferent fibers From soma (latin) body typically facet / SI joints
9 Radicular pain Neurogenic pain Stimulation or irritation of the nerve roots or dorsal root ganglion of a spinal nerve Typically prolapsed disc
10 Radicular pain Neurogenic pain Stimulation or irritation of the nerve roots or dorsal root ganglion of a spinal nerve Typically prolapsed disc
11
12
13
14
15 2 years of pain
16 2 years of pain
17 2 years of pain
18 FAD Key point #1 Fear/Frustration Depression/Dissatisfaction Anger/Anxiety
19
20
21
22
23
24
25
26
27
28
29
30
31 The correlation between abnormal radiological findings and pain is poor Bogduk N, McGuirk B. Management of Acute and chronic neck pain. An Evidence Based Approach. Elslvier Gore DR, Sepic SB, Gardner GM. Roentgenographic findings of the cervical spine in asymptomatic people. Spine 1986; 1: Elias F. Roentgen findings in the asymptomatic cervical spine. NY State J Med 1958; 58: Heller CA, Stanley P, Lewis-Jones B, Heller RF. Value of X-ray examinations of the cervical spine. Brit Med J 1983; 287: Van der Donk J, Schouten ISAG, Passchier J, van Romunde LKJ, Valkenburg HA. The associations of neck pain with radiological abnormalities of the cervical spine and personality traits in a general population. J Rheumatol 1991; 18: Fridenberg ZB, Miller WT. Degenerative disc disease of the cervical spine: a comparative study of asymptomatic and symptomatic patients. J Bone Joint Surg Am 1963; 45A:
32
33
34 Thoracic zygapophysial joints
35
36 The correlation between abnormal radiological findings and pain is poor Bogduk N, McGuirk B. Management of Acute and chronic neck pain. An Evidence Based Approach. Elslvier Gore DR, Sepic SB, Gardner GM. Roentgenographic findings of the cervical spine in asymptomatic people. Spine 1986; 1: Elias F. Roentgen findings in the asymptomatic cervical spine. NY State J Med 1958; 58: Heller CA, Stanley P, Lewis-Jones B, Heller RF. Value of X-ray examinations of the cervical spine. Brit Med J 1983; 287: Van der Donk J, Schouten ISAG, Passchier J, van Romunde LKJ, Valkenburg HA. The associations of neck pain with radiological abnormalities of the cervical spine and personality traits in a general population. J Rheumatol 1991; 18: Fridenberg ZB, Miller WT. Degenerative disc disease of the cervical spine: a comparative study of asymptomatic and symptomatic patients. J Bone Joint Surg Am 1963; 45A:
37 Cervical zygapophysial joints
38
39
40
41
42 KEY POINT #3 Can t diagnose clinically
43
44
45
46
47 C5,6 medial branch blocks
48 C5,6 medial branch blocks C5-6 zygapophysial joint
49
50 C5,6 medial branch blocks C5-6 zygapophysial joint
51 KEY POINT #3
52 KEY POINT #3 FACET JOINT PAIN ONLY DIAGNOSED BY MBB S
53 5 mm
54
55
56
57
58 lateral PA
59 lateral PA lateral PA
60 Randomised controlled trial 24 patients selected on the basis of 100% relief from placebo-controlled medial branch blocks The criteria for a successful outcome were complete relief of pain restoration of activities of daily living, and no need for continuing health care for neck pain. RF neurotomy Sham treatment Lord SM, Barnsley L, Wallis B, McDonald GM, Bogduk N. Percutaneous radio frequency neurotomy for chronic cervical zygapophyseal joint pain. N Eng J Med 1996;335:
61 Randomised controlled trial 24 patients selected on the basis of 100% relief from placebo-controlled medial branch blocks The criteria for a successful outcome were complete relief of pain restoration of activities of daily living, and no need for continuing health care for neck pain. Results, median duration of complete relief: RF neurotomy 263 days Sham treatment eight days Lord SM, Barnsley L, Wallis B, McDonald GM, Bogduk N. Percutaneous radio frequency neurotomy for chronic cervical zygapophyseal joint pain. N Eng J Med 1996;335:
62 James Borowczyk John MacVicar Christchurch cervical medial branch radiofrequency neurotomy published in the Pain Medicine journal (Vol 13, No 5, 2012).
63 Key Point # 4 Quebec task force clinical classification of whiplash associated disorders RF neurotomy is the gold standard for treatment against which all other treatments should be measured
64
65 Disc Facet joint SI joint Other source
66 Facet joint pain Z joint Noxious stimulation of the facet joints in normal volunteers provokes pain in the low back and referred to the lower limb. Chronic low back pain can be relieved by anaesthetising the facet joints in a number of patients with chronic low back pain
67 Facet joint pain In young patients with a history of injury, the prevalence of ZA joints as a cause of low back pain is about 15% (+/- 5%). In older patients attending a Rheumatology clinic, and in heterogenous patients attending a pain clinic, the prevalence was about 40%. Schwarzer AC, Aprill CN, Derby R, Fortin J, Kine G, Bogduk, N. Clinical features of pain stemming from the lumbar zygapophyseal joints. Is the lumbar facet joint syndrome a clinical entity? Spine 1994; 19: Schwarzer A, Wang S, Bogduk N, McNaught PJ, Laurent R. Prevalence and features of zygapophyseal joint pain: a study of an Australian population with chronic low back pain. Ann Rheum Dis 1995; 54: Manchikanti L, Pampati V, Fellows B, Backhit CE. Prevalence of zygopophyseal joint pain in chronic low back pain. Pain Phys 1999; 2: 59-64
68 Diagnosing facet joint pain KEY POINTS No clinical features help to distinguish facet joint pain from other causes of low back pain
69 Diagnosing facet joint pain KEY POINTS No clinical features help to distinguish facet joint pain from other causes of low back pain Facet joint pain can not be diagnosed by clinical examination
70 Diagnosing facet joint pain KEY POINTS No clinical features help to distinguish facet joint pain from other causes of low back pain Facet joint pain can not be diagnosed by clinical examination Facet joint pain can not be diagnosed by imaging
71 Diagnosing facet joint pain KEY POINTS No clinical features help to distinguish facet joint pain from other causes of low back pain Facet joint pain can not be diagnosed by clinical examination Facet joint pain can not be diagnosed by imaging The only reliable diagnosis is made using controlled medial branch blocks. Schwarzer et at 1994, Schwarzer et al 1995, Manchikanti et al 1999
72 declined
73 oblique
74 PA
75 lateral
76 James Borowczyk John MacVicar Christchurch, New Zealand Lumbar medial branch radiofrequency Neurotomy in NZ Pain Medicine 2013;14:
77 Sacroiliac joint pain SI joint Noxious stimulation of the SI joints in normal volunteers provokes low back pain. Fortin JD, Dwyer AP, West S, Pier J. Sacroiliac joint: pain referral maps upon applying a new injection/arthrography technique: Part 1: asymptomatic volunteers. Spine 1994; 19:
78 Sacroiliac joint pain Studies using controlled diagnostic blocks of this joint showed that the prevalence of pain arising from this joint in patients with chronic low back pain was between 13 and 19%. Schwarzer A, Aprill CN, Bogduk N. The sacroiliac joint in chronic low back pain. Spine 1995; 20: Maigne JY, Aivaliklis A, Pfefer, F. Results of sacroiliac joint block and value of sacroiliac pain provocation tests in 54 patients with low back pain. Spine 1996; 21:
79 Somatic or radicular referred pain? A B
80
81
82 Radicular pain TFI 2 year outcome 1/3 : 1/3 : 1/3 Best for small /moderate prolapse Radiation small 60 mgy EBM massive compared to CT guided
83 KEY POINTS Somatic vs Radicular
84 KEY POINTS Somatic vs Radicular History and pain maps ARE useful
85 KEY POINTS Somatic vs Radicular History and pain maps ARE useful Clinical tests and Radiology NOT useful
86 KEY POINTS Somatic vs Radicular History and pain maps ARE useful Clinical tests and Radiology NOT useful Needles NOT knives for diagnosis and (usually)treatment
87 FAD Fear/Frustration Depression/Dissatisfaction Anger/Anxiety
88 FADE Fear/Frustration Depression/Dissatisfaction Anger/Anxiety EXPECTATION
Dr Jim Borowczyk. Dr John Robinson. Dr Peter McKenzie. Dr John MacVicar
Dr Jim Borowczyk Musculoskeletal Physician Christchurch Dr Peter McKenzie Musculoskeletal Physician Nelson Dr John Robinson General Practitioner Otumoetai Doctors Tauranga Dr John MacVicar Medical Director
More informationINTERVENTIONAL TREATMENT FOR PAIN OF SPINAL ORIGIN
INTERVENTIONAL TREATMENT FOR PAIN OF SPINAL ORIGIN Dr John MacVicar, Medical Director Southern Rehab, Christchurch, NZ AOCPRM Nov 23 rd 2018 INTERVENTIONAL TREATMENT FOR PAIN OF SPINAL ORIGIN An evidence-based
More informationINTERVENTIONAL PAIN MEDICINE PAST, PRESENT, FUTURE. No conflicts of interest. The truth does not pay
INTERVENTIONAL PAIN MEDICINE PAST, PRESENT, FUTURE Professor Nikolai Bogduk Emeritus Professor of Pain Medicine University of Newcastle Australia No conflicts of interest The truth does not pay 1970 1980
More informationDr Jim Borowczyk. Dr John Robinson. Dr Peter McKenzie. Dr John MacVicar
Dr Jim Borowczyk Musculoskeletal Physician Christchurch Dr Peter McKenzie Musculoskeletal Physician Nelson Dr John Robinson General Practitioner Otumoetai Doctors Tauranga Dr John MacVicar Medical Director
More informationRe: Occipital Neuralgia and Headache Treatment, Policy Number: 2018T0080Y
May 10, 2018 United Healthcare Medical Policy Department 9500 Bren Road East Minnetonka, MN 55343 via Email: mpq@uhc.com Re: Occipital Neuralgia and Headache Treatment, Policy Number: 2018T0080Y To Whom
More informationRe: Treatment Modalities for Facetogenic Pain, Policy #141
March 30, 2017 Blue Cross and Blue Shield of Alabama Attn: Health Management - Medical Policy P.O. Box 995 Birmingham, AL 35298-0001 Fax: 205-220-0878 Re: Treatment Modalities for Facetogenic Pain, Policy
More informationDr Peter Gendall. Mr Steve August. Professor Nik Bogduk. Musculoskeletal Radiologist Hamilton. Physiotherapist Dunedin
Professor Nik Bogduk Professor Pain Medicine University of Newcastle Mr Steve August Physiotherapist Dunedin Dr Peter Gendall Musculoskeletal Radiologist Hamilton 8:30-10:30 WS #5: Musculoskeletal Medicine
More informationMEDICAL HISTORY CHIRO PHYSICAL
Overview of Spinal Injection Procedures Blake A. Johnson, MD, FACR 1 PATIENT MANAGEMENT EVALUATION TREATMENT P.T. MEDICAL CHIRO S SURGICAL Effective treatment requires a precise diagnosis! HISTORY PHYSICAL
More informationSpinal and Referred Pain Terminology
Spinal and Referred Pain Terminology Concepts and Terms Jim Borowczyk and John MacVicar South GP CME 2017 Low Back Pain Lumbar Spinal Pain Is pain perceived as arising anywhere within a region bounded
More informationCigna Medical Coverage Policies Musculoskeletal Radiofrequency Joint Ablation/Denervation
Cigna Medical Coverage Policies Musculoskeletal Radiofrequency Joint Ablation/Denervation Effective January 1, 2016 Instructions for use The following coverage policy applies to health benefit plans administered
More informationRe: Adoption of ACOEM Guidelines on Cervical and Thoracic Spine Disorders
February 23, 2018 Division of Workers Compensation State of California PO Box 420603 San Francisco, CA 94142 via Email to: DWCforums@dir.ca.gov Re: Adoption of ACOEM Guidelines on Cervical and Thoracic
More informationNEUROABLATION FOR TREATMENT OF CHRONIC PAIN
NEUROABLATION FOR TREATMENT OF CHRONIC PAIN Coverage for services, procedures, medical devices and drugs are dependent upon benefit eligibility as outlined in the member's specific benefit plan. This Medical
More informationKey words: Rhizotomy, radiofrequency neurotomy, 2 needles, facet joint pain, low back pain, cadaveric tissue. Pain Physician 2010; 13:43-49
Pain Physician 2010; 13:43-49 ISSN 1533-3159 Cadaveric Study The Efficacy of Two Electrodes Radiofrequency Technique: Comparison Study Using a Cadaveric Interspinous Ligament and Temperature Measurement
More informationMEDICAL POLICY SUBJECT: RADIOFREQUENCY JOINT ABLATION / DENERVATION
MEDICAL POLICY SUBJECT: RADIOFREQUENCY JOINT PAGE: 1 OF: 5 If a product excludes coverage for a service, it is not covered, and medical policy criteria do not apply. If a commercial product (including
More informationOriginal Contribution
Original Contribution 354 Pain Physician, Volume 5, Number 4, pp 354-359 2002, American Society of Interventional Pain Physicians ISSN 1533-3159 Evaluation of the Prevalence of Facet Joint Pain in Chronic
More informationDiagnosis and Treatment of Back Pain; X - ray imaging increases precision in pain medicine. Robert Rapcan R Clinic Slovakia
Diagnosis and Treatment of Back Pain; X - ray imaging increases precision in pain medicine Robert Rapcan R Clinic Slovakia R - Clinic 1482 minimally invasive spine procedures (2010) 1378 minimally invasive
More information5/31/2013. Disclosures. Lumbar Facet Joint Pain: Evidence. I have nothing to disclose
Disclosures : Evidence I have nothing to disclose David J. Lee, MD Professor Pain Management Center Department of Anesthesia Facet Joint Pain Prevalence Spinal pain 54-80% lifetime 80-90% resolve in 6
More informationPERCUTANEOUS FACET JOINT DENERVATION
Status Active Medical and Behavioral Health Policy Section: Surgery Policy Number: IV-95 Effective Date: 10/22/2014 Blue Cross and Blue Shield of Minnesota medical policies do not imply that members should
More informationNECK PAIN WORKSHOP A Musculoskeletal Approach to managing Neck Pain An ALGORITHM, as a management guide
NECK PAIN WORKSHOP A Musculoskeletal Approach to managing Neck Pain An ALGORITHM, as a management guide Rick Bernau & Ian Wallbridge June 2010 THE PROCESS An interactive approach to the management of neck
More informationInterventional Pain. Judith Dunipace MD Board certified in Anesthesiology, Pain Management and Hospice and Palliative Care
Interventional Pain Judith Dunipace MD Board certified in Anesthesiology, Pain Management and Hospice and Palliative Care IASP Definition of Pain Pain is an unpleasant sensory or emotional experience associated
More informationLucy Holtzhausen Rotorua June 2014
Lucy Holtzhausen Rotorua June 2014 Case study: Bob the builder Bob is a 42 year old Married with three children Works as a Builder, self employed Smokes 10 per day, despite your best efforts Has mild hypertension,
More informationMEDICAL POLICY SUBJECT: RADIOFREQUENCY FACET DENERVATION
MEDICAL POLICY PAGE: 1 OF: 5 If the member's subscriber contract excludes coverage for a specific service it is not covered under that contract. In such cases, medical policy criteria are not applied.
More informationFacet Joint Denervation. Populations Interventions Comparators Outcomes Individuals: With suspected facet joint pain
Protocol Facet Joint Denervation (701116) Medical Benefit Effective Date: 01/01/16 Next Review Date: 11/18 Preauthorization Yes Review Dates: 09/09, 09/10, 07/11, 07/12, 05/13, 05/14, 01/15, 11/15, 11/16,
More informationRadiofrequency neurotomy of the cervical & lumbar medial branches: evidence based review. September 2015
Radiofrequency neurotomy of the cervical & lumbar medial branches: evidence based review September 2015 Requested by: IPM Expert Group Business group: Clinical Services Directorate Date requested: December
More informationMEDICAL POLICY MEDICAL POLICY DETAILS POLICY STATEMENT. Page: 1 of 5
Page: 1 of 5 MEDICAL POLICY MEDICAL POLICY DETAILS Medical Policy Title RADIOFREQUENCY JOINT ABLATION/DENERVATION Policy Number 7.01.42 Category Technology Assessment Effective Date 10/18/01 Revised Date
More informationCorporate Medical Policy
Corporate Medical Policy File Name: Origination: Last CAP Review: Next CAP Review: Last Review: facet_joint_denervation 6/2009 4/2017 4/2018 4/2017 Description of Procedure or Service Facet joint denervation
More information2/5/2019. Facet Joint Pain. Biomechanics
Facet Arthropathy as a Pain Source Evaluation and Management Shelby Spine Jan 31 st Feb 2 nd, 2019 Kushagra Verma MD, MS Adult and Pediatric Scoliosis And Spine Deformity Beach Orthopaedics Specialty Institute
More informationUltrasound-guided Pulsed Radiofrequency of the Third Occipital Nerve
Case Report Korean J Pain 2013 April; Vol. 26, No. 2: 186-190 pissn 2005-9159 eissn 2093-0569 http://dx.doi.org/10.3344/kjp.2013.26.2.186 Ultrasound-guided Pulsed Radiofrequency of the Third Occipital
More informationFEP Medical Policy Manual
FEP Medical Policy Manual Effective Date: April 15, 2018 Related Policies: 6.01.23 Diagnosis and Treatment of Sacroiliac Joint Pain 7.01.120 Facet Arthroplasty Facet Joint Denervation Description Percutaneous
More informationRadiofrequency Denervation for Neck and Back Pain: A Systematic Review Within the Framework of the Cochrane Collaboration Back Review Group
Radiofrequency Denervation for Neck and Back Pain: A Systematic Review Within the Framework of the Cochrane Collaboration Back Review Group 1 Spine August 15, 2003; 28(16):1877-1888 Leena Niemistö, MD;
More informationTo: Manuel Suarez, M.D. Medical Director Neighborhood Health Plan Management Department 5757 Plaza Dr. Cyprus, CA Mailstop: CA
To: Manuel Suarez, M.D. Medical Director Neighborhood Health Plan Management Department 5757 Plaza Dr. Cyprus, CA 30630 Mailstop: CA124-01290 Subject: Denial of Cervical Spinal Injection Procedures Dear
More informationDiagnostic cervical and lumbar medial branch blocks
Considered Judgement Form This form is a checklist of issues that may be considered by the Purchasing Guidance Advisory Group when making purchasing recommendations Meeting date: 2 November 2015 Topic:
More informationGeneral Introduction
General Introduction Low back pain is a burden of our times and a challenge for medical scientists due to a large variability of complaints, differences in course and prognosis, and the lack of unambiguous
More informationAccuracy of Precision Diagnostic Blocks in the Diagnosis of Chronic Spinal Pain of Facet or Zygapophysial Joint Origin:
Boswell et al Diagnostic Facet Joint Blocks 449 Pain Physician. 2003;6:449-456, ISSN 1533-3159 A Systematic Review Accuracy of Precision Diagnostic Blocks in the Diagnosis of Chronic Spinal Pain of Facet
More informationGuideline Number: NIA_CG_301 Last Revised Date: March 2018 Responsible Department: Clinical Operations
Magellan Healthcare Clinical guidelines PARAVERTEBRAL FACET JOINT INJECTIONS OR BLOCKS (no U/S) CPT Codes: Cervical Thoracic Region: 64490 (+ 64491, +64492) Lumbar Sacral Region: 64493 (+64494, +64495)
More informationPhillip Weidner, DO, DABA, BCPM May 20th, 2014
Phillip Weidner, DO, DABA, BCPM May 20th, 2014 Introduction Comprehensive Pain Management Center Interventional therapies Epidural steroid injections Sacroiliac interventions Facet joint disease Who to
More informationMEDICAL POLICY STATEMENT INDIANA MEDICAID Original Issue Date Next Annual Review Effective Date 11/01/ /01/ /17/2017
MEDICAL POLICY STATEMENT INDIANA MEDICAID Original Issue Date Next Annual Review Effective Date 11/01/2017 11/01/2018 12/17/2017 Policy Name Policy Number Policy Type MEDICAL Administrative Pharmacy Reimbursement
More information후지내측지에대한경피적고주파신경차단술의예후인자 *
KISEP Clinical Article J Korean Neurosurg Soc 3351-55, 2003 후지내측지에대한경피적고주파신경차단술의예후인자 * 죠훈 하성곤 김세훈 임동준 박정율 서중근 Prognostic Factors of Percutaneous Radiofrequency Neurotomy on the Posterior Primary Ramus
More informationAmerican College of Radiology ACR Appropriateness Criteria
American College of Radiology ACR Appropriateness Criteria Date of origin: 1998 Last review date: 2005 Clinical Condition: Variant 1: Patient of any age, without or with a history of previous trauma, first
More informationA Randomized, Prospective, Double-Blind, Placebo-Controlled Evaluation of the Effect of Sedation on Diagnostic Validity of Cervical Facet Joint Pain
Manchikanti et al Effect of Sedation on Diagnostic Validity of Cervical Facet Joint Pain 301 Pain Physician. 2004;7:301-309, ISSN 1533-3159 A Randomized Evaluation A Randomized, Prospective, Double-Blind,
More informationContractor Information. Proposed/Draft LCD Information
PROPOSED/DRAFT Local Coverage Determination (LCD): Facet Joint Injections, Medial Branch Blocks, and Facet Joint Radiofrequency Neurotomy (DL33842) Please note: This is a Proposed/Draft policy. Proposed/Draft
More informationAlthough the variety of specialists
Interventional Pain Management: An Overview for Primary Care Physicians Stephen S. Boyajian, DO Image-guided spine intervention is used primarily for its precise diagnostic capabilities. This article reviews
More informationA Best-Evidence Systematic Appraisal of the Diagnostic Accuracy and Utility of Facet (Zygapophysial) Joint Injections in Chronic Spinal Pain
Pain Physician 2015; 18:E497-E533 ISSN 2150-1149 Systematic Review From: 1 Department of Anesthesiology and Perioperative Medicine, University of Louisville, Louisville, KY; 2 Pain Management Center of
More informationMedical Policy An independent licensee of the Blue Cross Blue Shield Association
Facet Joint Denervation Page 1 of 20 Medical Policy An independent licensee of the Blue Cross Blue Shield Association Title: Facet Joint Denervation Professional Institutional Original Effective Date:
More informationClinical Policy Title: Radiofrequency ablation treatment for spine pain
Clinical Policy Title: Radiofrequency ablation treatment for spine pain Clinical Policy Number: 03.02.02 Effective Date: June 1, 2013 Initial Review Date: March 21, 2013 Most Recent Review Date: March
More informationCigna Medical Coverage Policies Musculoskeletal Facet Joint Injections/Medial Branch Blocks
Cigna Medical Coverage Policies Musculoskeletal January 15, 2018 Instructions for use The following coverage policy applies to health benefit plans administered by Cigna. Coverage policies are intended
More informationIJP International Journal of Pain
ORIGINAL ARTICLE IJP International Journal of Pain International Journal of Pain 2014;5:11-17 pissn 2233-4793 / eissn 2233-4807 Received: November 18, 2014 Accepted: December 12, 2014 Measurement of Sacroiliac
More informationPainful GP dilemmas Low Back Pain Leg Pain. Dr. Rajiv Chawla Consultant in Pain Medicine The Walton Centre Liverpool
Painful GP dilemmas Low Back Pain Leg Pain Dr. Rajiv Chawla Consultant in Pain Medicine The Walton Centre Liverpool Low back Pain Up to 80% of all adults will eventually experience back pain, and it is
More informationMedical Policy An independent licensee of the Blue Cross Blue Shield Association
Facet Joint Denervation Page 1 of 22 Medical Policy An independent licensee of the Blue Cross Blue Shield Association Title: Facet Joint Denervation Professional Institutional Original Effective Date:
More informationvia
October 24, 2017 Maurice Smith Blue Cross and Blue Shield of Illinois 300 East Randolph Street Chicago, IL 60601-5099 via Email: maurice_smith@bcbsil.com Re: Facet Joint and Sacroiliac Joint Denervation,
More informationCervicogenic headache is characterized by a chronic unilateral
Review Article Cervicogenic Headache Sithapan Munjupong, MD 1,2 Abstract Cervicogenic headache is characterized by chronic unilateral headache that is radiated from the upper cervical spine. The trigeminocervical
More informationNader M. Hebela, MD Fellow of the American Academy of Orthopaedic Surgeons Cleveland Clinic Abu Dhabi
Nader M. Hebela, MD Fellow of the American Academy of Orthopaedic Surgeons http://orthodoc.aaos.org/hebela Cleveland Clinic Abu Dhabi Cleveland Clinic Abu Dhabi Neurological Institute Al Maryah Island
More informationCLINICAL GUIDELINES. CMM-201: Facet Joint Injections/Medial Branch Blocks. Version Effective October 22, 2018
CLINICAL GUIDELINES CMM-201: Facet Joint Injections/Medial Branch Blocks Version 20.0.2018 Effective October 22, 2018 Clinical guidelines for medical necessity review of speech therapy services. CMM-201:
More informationClinical Policy Title: Radiofrequency ablation treatment for spine pain
Clinical Policy Title: Radiofrequency ablation treatment for spine pain Clinical Policy Number: 03.02.02 Effective Date: June 1, 2013 Initial Review Date: March 21, 2013 Most Recent Review Date: March
More informationFacet Joint Denervation. Description
Section: Surgery Effective Date: April 15, 2015 Subject: Facet Joint Denervation Page: 1 of 14 Last Review Status/Date: March 2015 Facet Joint Denervation Description Facet joint denervation is performed
More informationCigna Medical Coverage Policies Musculoskeletal Facet Joint Injections/Medial Branch Blocks
Cigna Medical Coverage Policies Musculoskeletal January 15, 2019 Instructions for use The following coverage policy applies to health benefit plans administered by Cigna. Coverage policies are intended
More informationClinical Policy Title: Radiofrequency ablation treatment for spine pain
Clinical Policy Title: Radiofrequency ablation treatment for spine pain Clinical Policy Number: 03.02.02 Effective Date: June 1, 2013 Initial Review Date: March 21, 2013 Most Recent Review Date: February
More informationSurgical Treatment for Sacroiliac Joint Pain
Surgical Treatment for Sacroiliac Joint Pain Policy Number: 6.01.23 Last Review: 5/2014 Origination: 5/2013 Next Review: 5/2015 Policy Blue Cross and Blue Shield of Kansas City (Blue KC) will not provide
More informationCERVICAL SPINE TIPS A
CERVICAL SPINE TIPS A Musculoskeletal Approach to managing Neck Pain An ALGORITHM, as a management guide Rick Bernau & Ian Wallbridge June 2010 THE PROCESS An interactive approach to the management of
More informationInfluence of Psychological Variables on the Diagnosis of Facet Joint Involvement in Chronic Spinal Pain
Pain Physician 2008; 11:145-160 ISSN 1533-3159 Retrospective Evaluation Influence of Psychological Variables on the Diagnosis of Facet Joint Involvement in Chronic Spinal Pain Laxmaiah Manchikanti, MD,
More informationCervical Zygapophysial Joint Pain Maps
Blackwell Publishing IncMalden, USAPMEPain Medicine526-2375American Academy of Pain Medicine? 200684344353 Original ArticleCervical Zygapophysial Joint Pain PatternsCooper et al. PAIN MEDICINE Volume 8
More informationComprasion of Effectiveness of CT vs C-arm Guided Percutaneous Radiofrequency Lumbar Facet Rhizotomy
Original Article Korean J Pain 2010 June; Vol. 23, No. 2: 137-141 pissn 2005-9159 eissn 2093-0569 DOI:10.3344/kjp.2010.23.2.137 Comprasion of Effectiveness of CT vs C-arm Guided Percutaneous Radiofrequency
More informationSystematic Review of Diagnostic Utility and Therapeutic Effectiveness of Cervical Facet Joint Interventions
Pain Physician 2009; 12:323-344 ISSN 1533-3159 Systematic Review Systematic Review of Diagnostic Utility and Therapeutic Effectiveness of Cervical Facet Joint Interventions Frank J.E. Falco, MD 1, Stephanie
More informationFigure 1A. Distraction SIJ pain provocation test. Figure 1B. Thigh thrust SIJ pain provocation test. The current study was conceived to examine the ut
Diagnosing painful sacroiliac joints: A validity study of a McKenzie evaluation and sacroiliac provocation tests Mark Laslett 1, Sharon B Young 2, Charles N Aprill 3 and Barry McDonald 4 1 Linköpings Universitet,
More informationIncidence of Cervicogenic Headache Following Lower Cervical Radiofrequency Neurotomy
Pain Physician 2019; 22:E127-E132 ISSN 2150-1149 Observational Study Incidence of Cervicogenic Headache Following Lower Cervical Radiofrequency Neurotomy Joseph LaGrew, MD, Pavel Balduyeu, MD, Terrie Vasilopoulos,
More informationIndications for Spinal Injections in the Chronic Pain Patient
PAIN MEDICINE Volume 9 Number S1 2008 Indications for Spinal Injections in the Chronic Pain Patient Milton H. Landers, DO, PhD Department of Anesthesiology, School of Medicine, University of Kansas, Wichita;
More informationMEDICAL POLICY EFFECTIVE DATE: 08/15/13 REVISED DATE: 07/17/14 SUBJECT: SPINAL INJECTIONS (EPIDURAL AND FACET INJECTIONS) FOR PAIN MANAGEMENT
MEDICAL POLICY SUBJECT: SPINAL INJECTIONS (EPIDURAL AND PAGE: 1 OF: 7 If the member's subscriber contract excludes coverage for a specific service it is not covered under that contract. In such cases,
More informationTopic: Pulsed Radiofrequency for Chronic Spinal Pain Date of Origin: April Section: Surgery Last Reviewed Date: December 2013
Medical Policy Manual Topic: Pulsed Radiofrequency for Chronic Spinal Pain Date of Origin: April 2008 Section: Surgery Last Reviewed Date: December 2013 Policy No: 156 Effective Date: March 1, 2014 IMPORTANT
More informationInnovative Interventional Approaches to Pain Management in the Elderly
Innovative Interventional Approaches to Pain Management in the Elderly Michael Bottros, MD Assistant Professor of Anesthesiology Department of Anesthesiology, Division of Pain Medicine Washington University
More informationNational Imaging Associates, Inc. Clinical guidelines FACET JOINT INJECTIONS, MEDIAL BRANCH BLOCKS, AND FACET JOINT RADIOFREQUENCY NEUROTOMY
National Imaging Associates, Inc. Clinical guidelines FACET JOINT INJECTIONS, MEDIAL BRANCH BLOCKS, AND FACET JOINT RADIOFREQUENCY NEUROTOMY CPT Codes: Refer to pages 5 and 6 LCD ID Number: L35936 J K
More informationInterventional Pain Management. Dr C Hearty 2016
Interventional Pain Management Dr C Hearty 2016 Introduction Multiple Stakeholders GP Physiotherapy Surgery Radiology Oncology First described in 1899 Von Gaza (procain) Grew out of necessity Heretofore
More informationDr Rick Bernau, Musculoskeletal Medicine, Tauranga Dr Ian Wallbridge, Musculoskeletal Physician, Rotorua Dr Charlie Ng, Musculoskeletal Physician,
Dr Rick Bernau, Musculoskeletal Medicine, Tauranga Dr Ian Wallbridge, Musculoskeletal Physician, Rotorua Dr Charlie Ng, Musculoskeletal Physician, Auckland Gajendra Singh, Musculoskeletal Physician, Wanganui
More informationFACET JOINT INJECTIONS Version 18.0; Effective
evicore healthcare. Clinical Decision Support Tool Diagnostic Strategies This tool addresses common symptoms and symptom complexes. Imaging requests for patients with atypical symptoms or clinical presentations
More informationNimbus Electrosurgical RF Multi-tined Expandable Electrode
Nimbus Electrosurgical RF Multi-tined Expandable Electrode Robert E. Wright, MD, DABPM January 2013 Introduction The Nimbus radiofrequency multi-tined expandable electrode aims to improve radiofrequency
More informationDiscussion Points 10/17/16. Spine Pain is Ubiquitous. Interventional Pain Management
Interventional Pain Management Blake Christensen, D.O. Fellowship Trained Interventional Pain Management Board Eligible in Anesthesiology and Interventional Pain Management Oklahoma Interventional Pain
More informationBack and Neck Injuries: Surgical Advances and Treatment
Back and Neck Injuries: Surgical Advances and Treatment Ara Deukmedjian, MD Board Certified Neurosurgeon June 8, 2017 1 2 Spinal Joints: Anatomy Two types of Spinal Joints: Spinal (intervertebral) disc
More informationThe Benefit of Therapeutic Medial Branch Blocks after Cervical Operations
Pain Physician 2010; 13:527-534 ISSN 1533-3159 Retrospective Study The Benefit of Therapeutic Medial Branch Blocks after Cervical Operations Stephan Klessinger, MD From: Nova Clinic, Biberach, Germany
More informationManagement of Neuropathic pain
Management of Neuropathic pain Ravi Parekodi Consultant in Anaesthetics and Pain Management 08/04/2014 Ref: BJA July2013, Map of Medicine2013, Pain Physician 2007, IASP 2012, Nice guideline 2013 Aims Highlight
More informationHELPING THE OLDER ADULT PATIENT MANAGE CHRONIC PAIN: INTERVENTIONAL HIGH TECH INJECTIONS
HELPING THE OLDER ADULT PATIENT MANAGE CHRONIC PAIN: INTERVENTIONAL HIGH TECH INJECTIONS Lawrence M. Kutz, DO The CORE Institute Learning Objectives: Explain to patients different potential treatment options
More informationControlled medial branch anesthetic block in the diagnosis of chronic lumbar facet joint pain: the value of a three-month follow-up
CLINICAL SCIENCE Controlled medial branch anesthetic block in the diagnosis of chronic lumbar facet joint pain: the value of a three-month follow-up Ivan Dias da Rocha, Alexandre Fogaça Cristante, Raphael
More informationInnovative Interventional Approaches to Pain Management in the Elderly
Innovative Interventional Approaches to Pain Management in the Elderly Michael Bottros, MD Disclosure Nothing to disclose 1 Objectives Describe the treatments for facet-mediated arthropathy Explain the
More informationMEDICAL POLICY EFFECTIVE DATE: 08/15/13 REVISED DATE: 07/17/14, 06/18/15, 05/25/16, 05/18/17
MEDICAL POLICY SUBJECT: SPINAL INJECTIONS (EPIDURAL AND PAGE: 1 OF: 10 If a product excludes coverage for a service, it is not covered, and medical policy criteria do not apply. If a commercial product,
More informationPulsed Dose Radiofrequency Before Ablation of Medial Branch of the Lumbar Dorsal Ramus for Zygapophyseal Joint Pain Reduces Postprocedural
Pain Physician 2016; 19:477-484 ISSN 1533-3159 Randomized Trial Pulsed Dose Radiofrequency Before Ablation of Medial Branch of the Lumbar Dorsal Ramus for Zygapophyseal Joint Pain Reduces Postprocedural
More informationClinical Policy: Facet Joint Interventions
Clinical Policy: Reference Number: CP.MP.171 Last Review Date: 07/18 Coding Implications Revision Log See Important Reminder at the end of this policy for important regulatory and legal information. Description
More informationCLINICAL GUIDELINES. CMM-201 ~ Facet Joint Injections. Version 19.0 Effective August 11, 2017
CLINICAL GUIDELINES CMM-201 ~ Facet Joint Injections Version 19.0 Effective August 11, 2017 evicore healthcare Clinical Decision Support Tool Diagnostic Strategies:This tool addresses common symptoms and
More informationElectrical Stimulation Induced Cervical Medial Branch Referral Patterns
Windsor et al Cervical Medial Branch Stimulation Referral Patterns 411 Pain Physician. 2003;6:411-418, ISSN 1533-3159 An Original Contribution Electrical Stimulation Induced Cervical Medial Branch Referral
More informationPERCUTANEOUS RADIO-FREQUENCY NEUROTOMY FOR CHRONIC CERVICAL ZYGAPOPHYSEAL-JOINT PAIN
PERCUTANEOUS RADIO-FREQUENCY NEUROTOMY FOR CHRONIC CERVICAL ZYGAPOPHYSEAL-JOINT PAIN PERCUTANEOUS RADIO-FREQUENCY NEUROTOMY FOR CHRONIC CERVICAL ZYGAPOPHYSEAL-JOINT PAIN SUSAN M. LORD, B.MED., PH.D., LESLIE
More informationCLINICAL GUIDELINES. Update Summary
CLINICAL GUIDELINES CDI Quality Institute Anticoagulation and Antiplatelet Guidelines for Patients Undergoing Percutaneous Image-Guided Needle Procedures: An Update Concerning Facet Joint Injections, Medial
More informationComparison of Intraarticular Pulsed Radiofrequency and Intraarticular Corticosteroid Injection for Management of Cervical Facet Joint Pain
Pain Physician 2017; 20:E961-E967 ISSN 2150-1149 Observational Study Comparison of Intraarticular Pulsed Radiofrequency and Intraarticular Corticosteroid Injection for Management of Cervical Facet Joint
More informationPlacename CCG. Policies for the Commissioning of Healthcare. Policy for Managing Back Pain- Spinal Injections
Placename CCG Policies for the Commissioning of Healthcare Policy for Managing Back Pain- Spinal Injections 1 Introduction 1.1 This document is part of a suite of policies that the CCG uses to drive its
More informationCT-guided pulsed radio frequency treatment of the lumbar dorsal root ganglion (DRG) in patients with acute and subacute radicular low back pain
CT-guided pulsed radio frequency treatment of the lumbar dorsal root ganglion (DRG) in patients with acute and subacute radicular low back pain Poster No.: B-1263 Congress: ECR 2017 Type: Authors: Keywords:
More informationMedical Policy Facet Joint Denervation. Effective Date February 15, Subsection. 7.0 Surgery. Next Review Date December 2015
7.01.116 Facet Joint Denervation Section 7.0 Surgery Subsection Effective Date February 15, 2015 Original Policy Date February 14, 2001 Next Review Date December 2015 Description Percutaneous radiofrequency
More informationCMM-201~Facet Joint Injections- Medical Branch Blocks
MedSolutions, Inc. Clinical Decision Support Tool Diagnostic Strategies This tool addresses common symptoms and symptom complexes. Requests for patients with atypical symptoms or clinical presentations
More informationLow back pain, radiculopathy left leg icd 10 code
Home Search Low back pain, radiculopathy left leg icd 10 code 2018 ICD - 10 code for Radiculopathy is M54.1. Lookup the complete ICD 10 Code details for M54.1.. Low back pain ; M54.6 - Pain in thoracic
More informationOriginal Policy Date
MP 6.01.14 Diagnosis and Treatment of Sacroiliac Joint Pain Medical Policy Section Radiology Issue 12:2013 Original Policy Date 12:2013 Last Review Status/Date Reviewed with literature search/12:2013 Return
More informationFacet Joint Denervation. Description
Section: Surgery Effective Date: April 15, 2014 Subject: Facet Joint Denervation Page: 1 of 16 Last Review Status/Date: March 2014 Facet Joint Denervation Description Facet joint denervation is performed
More informationPulsed Versus Conventional Radio Frequency Ablation for Lumbar Facet Joint Dysfunction
Curr Phys Med Rehabil Rep (2014) 2:61 65 DOI 10.1007/s40141-013-0040-z INTERVENTIONAL PAIN MANAGEMENT (DE FISH, SECTION EDITOR) Pulsed Versus Conventional Radio Frequency Ablation for Lumbar Facet Joint
More informationMedical Affairs Policy
Medical Affairs Policy Service: Back and Nerve Pain Procedures - Radiofrequency Ablation, Facet and Other Injections PUM 250-0035-1706 Cryoablation Medial Branch Neuroablation Radiofrequency Neuroablation
More informationInterventional Pain Management
Spinal Injections Can be beneficial for both chronic and acute pain depending on pathology Contraindications: Patient refusal Active infection Platelets less than 75 or inability to stop anticoagulation
More information