Alec L. Meleger

Radiation safety in pain medicine

Pain specialists frequently employ fluoroscopy to guide injection procedures. Although safe use of fluoroscopy requires an understanding of basic principles of radiation, radiation safety remains underrepresented in the information available to pain specialists. For example, the US Food and Drug Administration (FDA) has reported 26 cases of radiation-induced burns to patients from fluoroscopically guided procedures in the period from 1992 to 1995.1 As a result of these occasional, but severe injuries, the FDA issued an advisory in 1994 regarding the need for proper training for all personnel involved with fluoroscopy.2 It has been reported that physicians who performed radiography and fluoroscopy in the first half of the 20th century had higher rates of cancer-related deaths than any other physicians.3 We have come a long way since then, but we face similar risks if recommendations are not heeded. Radiation safety involves consideration of physics, biology, engineering, and legal issues. The following is an overview of these basic considerations of radiation safety for the pain specialist.

Prolotherapy Versus Corticosteroid Injections for the Treatment of Lateral Epicondylosis: A Randomized Controlled Trial

To compare the efficacy of prolotherapy versus corticosteroid injection for the treatment of chronic lateral epicondylosis.

Safety and Efficacy of Percutaneous Neuromodulation Therapy in the Management of Subacute Radiating Low Back Pain

Objective: Percutaneous neuromodulation therapy (PNT) is a new minimally invasive, office‐based treatment for low back pain in which electrical stimulation is delivered to the paraspinal peripheral nerves. The purpose of this study was to determine the safety, tolerability, and clinical efficacy of PNT in a population of patients with subacute low back pain with radiation to the lower extremity.

Structural Integration as an Adjunct to Outpatient Rehabilitation for Chronic Nonspecific Low Back Pain: A Randomized Pilot Clinical Trial

Structural Integration (SI) is an alternative method of manipulation and movement education. To obtain preliminary data on feasibility, effectiveness, and adverse events (AE), 46 outpatients from Boston area with chronic nonspecific low back pain (CNSLBP) were randomized to parallel treatment groups of SI plus outpatient rehabilitation (OR) versus OR alone. Feasibility data were acceptable except for low compliance with OR and lengthy recruitment time. Intent-to-treat data on effectiveness were analyzed by Wilcoxon rank sum, n = 23 per group. Median reductions in VAS Pain, the primary outcome, of −26 mm in SI + OR versus 0 in OR alone were not significantly different (P = 0.075). Median reductions in RMDQ, the secondary outcome, of −2 points in SI + OR versus 0 in OR alone were significantly different (P = 0.007). Neither the proportions of participants with nor the seriousness of AE were significantly different. SI as an adjunct to OR for CNSLBP is not likely to provide additional reductions in pain but is likely to augment short term improvements in disability with a low additional burden of AE. A more definitive trial is feasible, but OR compliance and recruitment might be challenging. This trial is registered with ClinicalTrials.gov (NCT01322399).

Nonpharmacologic Options for Treating Acute and Chronic Pain.

This article provides a broad overview of the clinical nonpharmacologic treatment options for managing acute and chronic pain. Physical therapy and modalities, interventional techniques, emerging regenerative medicine, and cognitive behavioral paradigms of treatment are presented. Recommendations are evidence‐based and are a practical resource for the musculoskeletal pain and sports medicine practitioner.

Poster 371 Nontraumatic Bilateral Pedicle Fractures in the Setting of Biphosphonate Therapy: A Case Report

tive pain following the diagnostic third occipital nerve block. The post-neurolysis procedure pain scores were analyzed and found that in the subjects that had neurolysis completed, there was a 60.01% decrease in subjective pain within the first month. Conclusions: There is predictive value in the percentage change following diagnostic third occipital nerve block and the decision to proceed with the neurolysis protocol. This predictive value can be utilized to develop a risk-benefit stratification pyramid. The pyramid has three levels or groups. One group (Level 1) that will gain no benefit from neurolysis, one group (Level 2) that may gain benefit from neurolysis, and one group (Level 3) that will gain benefit from neurolysis, based on reported post-procedure pain score decrease less than of 25%, 25-33%, greater than 33%, respectively. Despite a small change in subset group variation, the individual variation is large and limits any predictive value of the post-neurolysis pain score based on post-procedure pain score.