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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

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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

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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

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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

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Prevalence and Dia&nosis o SI1Pain

Prevalence o SI1pain 3as @+

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Evidence or SI1 InterventionsMeta

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adicular Pain

Dr $im Maus Mayo "li

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/%at "an ou SeeJ/ould ou Inject SteroidJ

S@ S@

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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,

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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

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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

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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