Justin Hata

Ultrasound Guided Piriformis Injection with Confirmation of Needle Placement Through Electromyography

Dear Editor: Piriformis syndrome is a controversial topic that consists of a constellation of symptoms that may mimic spondylosis, radiculopathy, sacroiliac joint pain, and facet arthropathy [1]. One of the modalities of piriformis syndrome treatment is direct injection of medication into the piriformis muscle belly [2]. Previous authors have reported various methods in performing piriformis injections: fluoroscopically, motor stimulation, and most recently, ultrasound (US) guidance [3–5]. We describe a case presentation and, to our knowledge, the first report of combined use of US with electromyography (EMG) confirmation of muscle placement for piriformis muscle injection. A 60-year-old male presented to our clinic with lower back, left hip, and left buttock pain for 6 years. The pain was sharp in quality and radiated toward the left lateral buttock and hip. The pain was rated 6/10 at initial presentation and was aggravated by prolonged sitting, squatting, and bending over. Pain was improved with rest. On examination, the patient demonstrated mild tenderness along the left lumbar spine and paraspinal muscles, as well as tenderness to palpation in the left lateral buttock area. Straight leg raise test was positive in the left lower extremity. Motor examination revealed full …

Interventional pain management skills competency in pain medicine fellows: a method for development and assessment.

ABSTRACT The purposes of this project were to propose an educational module to instruct pain medicine fellows in the appropriate performance of interventional pain management techniques and to verify procedural competency through objective evaluation methodology. Eight board-certified pain medicine physicians spanning two fellowship programs trained seven fellows using a standardized competency-based module. Assessment tools address the basic competencies outlined by the Accreditation Council for Graduate Medical Education (American Board of Anesthesiology Pain Medicine Content Outline). The seven fellows demonstrated proficiency in every segment of the evaluation module. Objective measures compared the fellows’ performance on standardized procedure checklists administered 9 mos into training; fellows in the 2012-2013 academic year also received testing at the 3-mo mark. Support for the assessment module is demonstrated by appropriate performance of interventional procedures, with improvement noted from 3-mo to 9-mo testing, successful completion of chart-stimulated oral examinations, proper performance of relevant physical examination maneuvers, and completion of program-specific medical knowledge written tests. The fellows were evaluated via patient surveys and 360-degree global rating scales, maintained procedure logs, and completed two patient-care reports; these were reviewed by program directors to ensure adequate completion. The standardized educational module and evaluation methodology presented provide a potential framework for the definition of baseline competency in the clinical skill area of interventional pain management.

Improving Trainee Competency and Comfort Level with Needle Driving Using Simulation Training.

OBJECTIVE To assess whether a combination of lecture and model simulation improves resident competency and comfort level with needle driving for interventional pain medicine procedures. DESIGN Prospective, observational study. METHOD Trainees who rotated through the University of California, Irvine, outpatient pain medicine clinic were recruited for the study. Subjects were given a brief lecture and completed a survey with questions regarding their level of comfort with interventional pain medicine procedures. This was followed by a timed trial on a training simulator where the objective was to drive a needle to the target. After the trial, the subject was then given a 30-minute practice session with the simulation model. The subject was then asked to repeat the timed trial and complete a post-simulation survey. RESULTS All measures of the level of comfort increased significantly after subjects underwent the simulation training. In addition, subjects were able to significantly decrease their entrance time (P= 0.002), total time (P= 0.033), and vertical (P≤ 0.001) and horizontal deviation (P≤ 0.001) from the final target point after the simulation training. CONCLUSIONS Our study demonstrates that simulation training may improve both trainee comfort level and competency with needle driving. After a brief lecture and a 30-minute training session with the simulator, subjective comfort measures and competency measures (more subjects were able to reach the target, vertical and horizontal deviations from the target decreased) were significantly improved. This suggests that simulation may be a helpful tool in teaching needle driving skills.

Physical and Occupational Therapy in Palliative Care

Rehabilitation in palliative care addresses physical limitations caused either by a severely debilitating or life-threatening illness. Physical limitations may be caused by tumor mass effects or by the treatments used for palliation of that illness. Palliative rehabilitation can be divided into three categories: preventative, restorative, and supportive. Preventative rehabilitation attempts to address and prevent functional decline by addressing and correcting morbidity caused by cancer or its treatment. When long-term impairment can be avoided, restorative rehabilitation attempts to return patients to their premorbid functional status. Supportive rehabilitation attempts to maximize function after permanent impairments caused by cancer and/or its treatment [Javier and Montagnini. J Palliat Med. 14(5):638–648, 2011].