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Peripheral Joint Injections
Peripheral joint injections are a common interventional treatment of peripheral joint –mediated pain, including arthritis, tendinopathy, and bursitis that are not responsive to conservative management. Degenerative changes of articular joints are often related to these symptoms through chronic inflammatory changes, which typically arise due to repetitive trauma, autoimmune disease, or metabolic abnormalities. The primary diagnosis for degenerative disease in the peripheral joints is osteoarthritis but can also include rheumatoid arthritis, gout, and other less common etiologies. Chronic inflammatory damage to the articul...
Source: Physical Medicine and Rehabilitation Clinics of North America - May 1, 2022 Category: Rehabilitation Authors: Austin Marcolina, Kevin Vu, George Chang Chien Source Type: research

Novel Technologies in Interventional Pain Management
This article comprehensively covers 3 major novel technologies and techniques in the management of chronic lower back pain. The first 2 procedures, percutaneous interspinous spacer implantation, and minimally invasive lumbar decompression have shown significant impact in the management of lumbar spinal stenosis (LSS), especially in patients who are not great surgical candidates or are otherwise not amenable to open spinal surgery. The wealth of data for these procedures continues to increase, with up to 4 to 6-year follow-up data recently being made available. A novel solution for vertebrogenic back pain is also discussed ...
Source: Physical Medicine and Rehabilitation Clinics of North America - May 1, 2022 Category: Rehabilitation Authors: Yashar Eshraghi, Jay D. Shah, Maged Guirguis Source Type: research

Peripheral Nerve Stimulation for Chronic Pain and Migraine
Interventional pain procedures offer treatments for chronic pain conditions refractory to conservative measures. Neuromodulation, including peripheral nerve stimulation (PNS), applies electrical stimuli to neural structures to treat pain. Here we review the literature on PNS for various chronic pain conditions including neuropathic pain, postamputation pain, musculoskeletal pain, migraine, and pelvic pain. (Source: Physical Medicine and Rehabilitation Clinics of North America)
Source: Physical Medicine and Rehabilitation Clinics of North America - May 1, 2022 Category: Rehabilitation Authors: Samantha C. Erosa, Roya S. Moheimani, Jessica C. Oswald, Joel P. Castellanos, Mickey E. Abraham, Nathaniel M. Schuster Source Type: research

Vertebroplasty and Kyphoplasty
This article highlights the different VAPs approaches—comparing the advantages, disadvantages, and potential side effects of each approach. (Source: Physical Medicine and Rehabilitation Clinics of North America)
Source: Physical Medicine and Rehabilitation Clinics of North America - May 1, 2022 Category: Rehabilitation Authors: Sherief Boss, Vidhan Srivastava, Magdalena Anitescu Source Type: research

Epidural Steroid Injections
Epidural steroid injections (ESI) can be an effective treatment of radicular pain, while also providing potential for functional improvement. There are 3 main interventional approaches including: interlaminar (IL), transforaminal (TF), and caudal. The risks and efficacy data vary between these routes of injection and the underlying pathology with the TF route having the most robust efficacy data. However, selecting an injection approach should be based on a patient ’s clinical presentation, pathology, anatomy, consideration of the natural course of pain, and the unique risks and benefits of the particular technique. (Sou...
Source: Physical Medicine and Rehabilitation Clinics of North America - May 1, 2022 Category: Rehabilitation Authors: Joseph William, Christian Roehmer, LeiLani Mansy, David J. Kennedy Source Type: research

Sympathetic Blocks for Visceral Pain
For patients with chronic pain or cancer-related pain, the most common indication for sympathetic block is to control visceral pain arising from malignancies or other alterations of the abdominal and pelvic viscera. When it is recalcitrant to conservative care, or if the patient is intolerant to pharmacotherapy, consideration of sympathetic blocks or neurolytic procedures is considered. Potential advantages of a neurolytic procedure, compared with spinal and epidural anesthetic infusions, include cost savings and avoidance of hardware. Interventional therapies that target afferent visceral innervation via the sympathetic g...
Source: Physical Medicine and Rehabilitation Clinics of North America - May 1, 2022 Category: Rehabilitation Authors: Kevin Vorenkamp, Peter Yi, Adam Kemp Source Type: research

Trigger Point Injections
Myofascial pain and myofascial pain syndromes are among some of the most common acute and chronic pain conditions. Many interventional procedures can be performed in both an acute and chronic pain setting to address myofascial pain syndromes. Trigger point injections can be performed with or without imaging guidance such as fluoroscopy and ultrasound; however, the use of imaging in years past has been recommended to improve patient outcome and safety. Injections can be performed using no injectate (dry needling), or can involve the administration of local anesthetics, botulinum toxin, or corticosteroids. (Source: Physical ...
Source: Physical Medicine and Rehabilitation Clinics of North America - May 1, 2022 Category: Rehabilitation Authors: Malathy Appasamy, Christopher Lam, John Alm, Andrea L. Chadwick Source Type: research

(Needle) Jockeying for the Evidence
It is not unusual for physicians, including physiatrists, to question the role and utility of interventional procedures in the treatment of chronic pain. Much of this skepticism is driven by overutilization of these procedures, which has been well documented by analyses of Center for Medicare and Medicaid Services claims data.1-3 Those of us who perform these procedures are well aware of the improvement in pain and function that they have the potential to provide, but most of us are also aware that the data informing our use of these procedures are often inadequate. (Source: Physical Medicine and Rehabilitation Clinics of North America)
Source: Physical Medicine and Rehabilitation Clinics of North America - May 1, 2022 Category: Rehabilitation Authors: Ameet Nagpal Tags: Preface Source Type: research

Sympathetic Blocks for Sympathetic Pain
The sympathetic nervous system (SNS) is an integral component of the body ’s response to stress. Once activated, the SNS has broad-reaching effects on multiple organ systems that modulate pain, behavior, and mood. Blockade of the system can improve pain associated with multiple etiologies, including vascular, visceral, and neuropathic pain. Multiple techniques are avail able to block the SNS and provide options that improve analgesia and can be individualized to a particular patient’s needs and disease state. (Source: Physical Medicine and Rehabilitation Clinics of North America)
Source: Physical Medicine and Rehabilitation Clinics of North America - May 1, 2022 Category: Rehabilitation Authors: Melissa E. Phuphanich, Quinn Wonders Convery, Udai Nanda, Sanjog Pangarkar Source Type: research

Peripheral Joint Radiofrequency Ablation
This article provides a detailed description of peripheral joint radiofrequency ablation and its contemporary use in the treatment of chronic knee, hip, and shoulder pain. Special attention is given to anatomy and innervation of the joints discussed, technical approach, selection criteria, contraindications, and patient outcomes. (Source: Physical Medicine and Rehabilitation Clinics of North America)
Source: Physical Medicine and Rehabilitation Clinics of North America - May 1, 2022 Category: Rehabilitation Authors: Maxim S. Eckmann, Brian T. Boies, David J. Carroll, Lorne D. Muir Source Type: research

Peripheral Nerve Injections
Ultrasound techniques and peripheral nerve stimulation have increased the interest in peripheral nerve injections for chronic pain. The knowledge of anatomy and nerve distribution patterns is paramount for optimal use of peripheral nerve blocks in the management of chronic pain conditions. They are an important tool in an interventional pain physician ’s armamentarium and can be integrated into pain practices effectively to offer patients pain relief. (Source: Physical Medicine and Rehabilitation Clinics of North America)
Source: Physical Medicine and Rehabilitation Clinics of North America - May 1, 2022 Category: Rehabilitation Authors: Arti Ori, Aparna Jindal, Nenna Nwazota, Amy C.S. Pearson, Bhavana Yalamuru Source Type: research

Dorsal Root Ganglion Stimulation
The recent development and Food and Drug Administration approval in 2016 of dorsal root ganglion stimulation is a relatively new and novel form of target neuromodulation that promises improved outcomes compared with the current standard of care. Current literature is limited and dependent on industry evaluation. Future independent investigation will help clarify existing data and refine techniques to improve safety, effectiveness, and expand application. (Source: Physical Medicine and Rehabilitation Clinics of North America)
Source: Physical Medicine and Rehabilitation Clinics of North America - May 1, 2022 Category: Rehabilitation Authors: Steven T. Potter, Sean Welch, Faye Tata, Seth Probert, Ameet Nagpal Source Type: research

Comprehensive Evidence Analysis for Interventional Procedures Used to Treat Chronic Pain
PHYSICAL MEDICINE AND REHABILITATION CLINICS OF NORTH AMERICA (Source: Physical Medicine and Rehabilitation Clinics of North America)
Source: Physical Medicine and Rehabilitation Clinics of North America - May 1, 2022 Category: Rehabilitation Authors: Ameet Nagpal Source Type: research

Copyright
ELSEVIER (Source: Physical Medicine and Rehabilitation Clinics of North America)
Source: Physical Medicine and Rehabilitation Clinics of North America - May 1, 2022 Category: Rehabilitation Source Type: research

Contributors
SANTOS F. MARTINEZ, MD, MS (Source: Physical Medicine and Rehabilitation Clinics of North America)
Source: Physical Medicine and Rehabilitation Clinics of North America - May 1, 2022 Category: Rehabilitation Source Type: research