Compression fx FJI vs RFA for post element tx
Is there any dif in doing a FJI vs Mbb/RFA in treating posterior elements for chronic compression fractures. I did a mbb and RFA on a patient with T11, T12 old comp fractures. Did pretty well with first RFA, 2nd RFA with less benefit. Saw a surgeon who said of course it didnt work do a facet injection instead. Not sure if there is any data on one being superior to the other specfically for treating posterior comp for chronic compression fx.
I havent found anything other then case...
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Source: Student Doctor Network - April 5, 2024 Category: Universities & Medical Training Authors: schmee90 Tags: Pain Medicine Source Type: forums
Annual steroid dose?
I've always limited total steroid doses per year to 4 for patients, and I try to count injections by other docs in this measure. I was just reviewing BCBS guidelines for ESIs, and they allow up to 6 per year. Does anybody do that many in a year? Am I being overly conservative? (Source: Student Doctor Network)
Source: Student Doctor Network - April 4, 2024 Category: Universities & Medical Training Authors: drrosenrosen Tags: Pain Medicine Source Type: forums
Repeat lumbar RFA time restrictions
I’ve been told and read in a few LCDs , but not all, that a patient needs repeat their RFA within 2 years or insurance won’t cover it.
So if a patient comes back after 3 years, they have to repeat MBB to ensure insurance will cover it.
Obviously If they have spine surgery in between, they need to repeat MBB.
But for folks at 2.5 years , 3.5 years post PFA, who did well for +2 years after RFA, how do you all handle this? (Source: Student Doctor Network)
Source: Student Doctor Network - April 3, 2024 Category: Universities & Medical Training Authors: bedrock Tags: Pain Medicine Source Type: forums
What would you do before you left a practice? Proactive steps.
Hey y’all ,
Looks like I’ll be leaving my current setup.
What do y’all suggest I do before I leave so I can hit the ground running for my next practice?
For example, copy all dot phrases and op notes, ask about malpractice for the next employer, copy my common orders, re-read the contract so I’m not breaking anything, get letters of recommendations, etc. (Source: Student Doctor Network)
Source: Student Doctor Network - April 3, 2024 Category: Universities & Medical Training Authors: CleanUp Tags: Pain Medicine Source Type: forums
Big hospital systems take over small docs and raise prices
At least Walmart lowers prices when they come into town and put mom and pops out of business. Not so with hospital systems.
CMS Invites Hospitals To Raise Prices And Buy Physician Practices
This scheme benefits hospitals, the state, and the Biden Administration, at the expense of workers, employers, independent physicians, and federal taxpayers.
www.forbes.com (Source: Student Doctor Network)
Source: Student Doctor Network - April 2, 2024 Category: Universities & Medical Training Authors: Pain Applicant1 Tags: Pain Medicine Source Type: forums
Concierge pain clinic opening
Nervous and excited. Wish me luck! (Source: Student Doctor Network)
Source: Student Doctor Network - April 1, 2024 Category: Universities & Medical Training Authors: Agast Tags: Pain Medicine Source Type: forums
Injections for patients with movement disorders
What do you all do for patients with significant tardive dyskinesia or choreiform movements? Does PO or IV sedation help keep them still enough to do ESI/MBBs/RFA? (Source: Student Doctor Network)
Source: Student Doctor Network - March 31, 2024 Category: Universities & Medical Training Authors: oneforfighting Tags: Pain Medicine Source Type: forums
Hiring Non-Residency Trained FMG's Instead of Mid-Levels...Implications for Pain?
More States Cut Training Requirements for Some International Medical Graduates
Alternative pathways to licensing for IMGs spreads beyond Tennessee
www.medpagetoday.com
Does anyone have experience with this? I'm aware of one pain group that hired a foreign neurosurgeon to be their in-house pain surgeon/first assist at their ASC.
"Bryan Carmody, MD, MPH, a pediatric nephrologist at Eastern Virginia Medical School in Norfolk, who has long studied data on residency and the Match process, said that the influx of labor would be good for academic me...
Source: Student Doctor Network - March 31, 2024 Category: Universities & Medical Training Authors: drusso Tags: Pain Medicine Source Type: forums
Persistent Pain Post TFESI
Did bilateral L3/L4 tfesi on a lady above level of fusion. Has significant scoliosis to the right, along with massive facet and degenerative disc at L3L4 causing severe stenosis. She got 100% relief for day of and day after of her right sided symptoms but then pain worsened. Mostly muscles spasms and tightness in buttock and hip region. Also maybe some new occasional pain at very specific location of medial knee although states that pain has reduced. No pain in between hip and specific area...
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Source: Student Doctor Network - March 30, 2024 Category: Universities & Medical Training Authors: Dansk2011 Tags: Pain Medicine Source Type: forums
Ability to do Bread and butter procedures coming out of fellowship
Current fellow here. 9 months in and starting to doubt myself on whether or not I know how to perform bread and butter procedures proficiently. Will struggle with the occasional LESI and even some lumbar medial branch blocks. Attendings don’t really give me a chance to correct myself and I continue to lose confidence daily. Haven’t done a cervical procedure in a while and I’ve only had the ability to see two cervical rfas in all of fellowship.
can anyone else relate coming out of fellowship? (Source: Student Doctor Network)
Source: Student Doctor Network - March 30, 2024 Category: Universities & Medical Training Authors: PMRorBUST Tags: Pain Medicine Source Type: forums
Acute CRPS treatment and surgery timing
Patient with hand injury requiring surgery. On initial eval, exam/appearance of hand was straightforward. On day of surgery, hand had RSD-type picture. Surgery delayed. Has had symptoms for 72 hours.
I honestly have never seen someone this early on. Is SGB indicated this early on? High dose steroids? Dosing of bisphosphinates? I’ve read that surgery should be delayed at least 12 months… what are your thoughts? Thanks. (Source: Student Doctor Network)
Source: Student Doctor Network - March 29, 2024 Category: Universities & Medical Training Authors: MD87 Tags: Pain Medicine Source Type: forums
post-operative knee pain ( > 1 year out)
Hi,
What is a good treatment for post-operative knee pain 1 year out (TKA), negative work-up of infection (3 phase scan, infecitous labs, no mechanical instability)
Assuming, no genicular nerve block/ablation is option, no pes-anserine bursa.
Does someone have streamlined approach to this? Would love review articles/approaches (Source: Student Doctor Network)
Source: Student Doctor Network - March 28, 2024 Category: Universities & Medical Training Authors: SpineandWine Tags: Pain Medicine Source Type: forums
Personal Injury and/or Worker ’s Comp Practices
What is unique about these practice models? I’m a current fellow and it seems as though these type of practices are almost frowned upon from the ivory tower fellowship attendings.
What is the workflow like for these patients? What are pitfalls of joining or partnering with a practice that sees a lot of these patients? Do these patients open you up to more litigation? Are the patients less motivated to get better? Is the medicine worse? (Source: Student Doctor Network)
Source: Student Doctor Network - March 28, 2024 Category: Universities & Medical Training Authors: AlvinKamara Tags: Pain Medicine Source Type: forums
fully workers comp/PI practice
Have been doing some job searching and came across a group that does 100% workers comp/personal injury. Wanted to see if any one has worked in such a setting (100% WC and PI) and what their experience has been - thanks! (Source: Student Doctor Network)
Source: Student Doctor Network - March 26, 2024 Category: Universities & Medical Training Authors: ChiSox Tags: Pain Medicine Source Type: forums
Re: Hypertriglyceridaemia and abdominal pain
(Source: BMJ Comments)
Source: BMJ Comments - March 26, 2024 Category: General Medicine Source Type: forums
