RFA needle sizing for local anesthesia (without sedation)?
At my current setup, we only offer local anesthesia (no sedation) for procedures. RFA cannula sizing is 20g (lumbar) and 22g (cervical), MDT Accurian (no cooled RF setup). Needles are placed parallel to medial branch nerve with 90 seconds initial burn followed by a 180 degrees rotation for a 2nd burn. Patients do well with local and don't need sedation. Results are pretty good but I'm always wondering if I could optimize the outcome more by upsizing the needle gauge.
For those...
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Source: Student Doctor Network - February 24, 2024 Category: Universities & Medical Training Authors: CarabinerSD Tags: Pain Medicine Source Type: forums
Oregon is an addict
It will be interesting to see where we're at as a nation with regard to drug use in 5-6 yrs.
Seems there's a lot of buyer's remorse in Oregon.
https://www.reuters.com/world/us/hard-hit-by-us-opioid-crisis-oregon-reconsiders-decriminalization-2024-02-18/
Friday, after a long week I'm sitting on my backporch drinking a whiskey and smoking a cigar and came across an article on Doximity.
The Consequences of Our War on Opioids: The Consequences of Our War On Opioids
There's a...
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Source: Student Doctor Network - February 19, 2024 Category: Universities & Medical Training Authors: MitchLevi Tags: Pain Medicine Source Type: forums
Dummies doing business analysis Boston Scientific
Have you guys used that Fixate suturing thing from Boston Scientific?
They didn’t invent them - they bought the company that invented them.
But oh my gosh, they are super cool and great.
But I can’t imagine a single person ever uses them. They cost something like $700 a piece. That is an extra $1400 cost to an implant.
Who the crap priced those? Are they horrible at math?
I suspect that if they were $50-100, EVERYONE would use them every time. They are really great if you haven’t...
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Source: Student Doctor Network - February 19, 2024 Category: Universities & Medical Training Authors: epidural man Tags: Pain Medicine Source Type: forums
USAF HPSP pitfalls
After spending 13 years enlisted, 8 of it AD, in aviation maintenance I entered a US MD program on an HPSP scholarship. During April of my second year I was diagnosed with NHL after presenting with back pain and pending paraplegia. I underwent an emergent laminectomy followed by EBRT and chemotherapy. January of my fourth year I was notified that my scholarship was being terminated for being unfit to serve. I was never allowed to meet a medical board. I graduated with my class and completed...
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Source: Student Doctor Network - February 17, 2024 Category: Universities & Medical Training Authors: MT Doc Tags: Military Medicine Source Type: forums
NICE guidance update on use of on sterile water injections as a pain relief option for women experiencing backpain in labour
(Source: BMJ Comments)
Source: BMJ Comments - February 16, 2024 Category: General Medicine Source Type: forums
Botox for neuropathic pain
Has anyone here successfully used Botox (subcutaneous) for neuropathic pain (e.g. diabetic neuropathy).
The Europeans have been using for some time and there are numerous good studies
https://www.thelancet.com/journals/laneur/article/PIIS1474-4422%2816%2900017-X/fulltext
I don't think Botox is approved here for this indication but one could do off-label, cash pay?
Thoughts? (Source: Student Doctor Network)
Source: Student Doctor Network - February 15, 2024 Category: Universities & Medical Training Authors: drg123 Tags: Pain Medicine Source Type: forums
SCS multiple procedure reduction
Hello:
I’m in a hospital employed wRVU-based compensation model. I’ve been reviewing my coding and the system is applying a 50% reduction in wRVU to 63685 when doing an SCS implant.
My understanding was that 63650x2 and 63685 are submitted without a -51 modifier. Do any know if Medicare/payers are subjecting the 63685 payment to a multiple procedures reduction?
Thanks (Source: Student Doctor Network)
Source: Student Doctor Network - February 15, 2024 Category: Universities & Medical Training Authors: Logano2230 Tags: Pain Medicine Source Type: forums
“Timely” documentation
Recently my practice has instituted a policy where clinic notes and procedure notes need to
Be completed within 24 hours.
they said it was a Medicare requirement
But… is it?
Can’t seem to find this online anywhere. They haven’t yet shown me any proof but to be fair i just asked them a few hours ago.
Have yall heard of anything like this? (Source: Student Doctor Network)
Source: Student Doctor Network - February 14, 2024 Category: Universities & Medical Training Authors: gaspasser127 Tags: Pain Medicine Source Type: forums
Lateral Cervical MBB Flow
Multiple cervical MBB threads discussing prone vs lateral and approach therein which I've seen over the years.
A few questions for those doing lateral approach balancing safety and efficiency.
Presently doing a one needle per level technique. So if doing C3-C5, will place one 25 Ga needle for each location without local at entry. AP shots down to bone. Once on bone, will do lateral for confirmation. Administer contrast at each location separately to confirm not intravascular then...
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Source: Student Doctor Network - February 13, 2024 Category: Universities & Medical Training Authors: agolden1 Tags: Pain Medicine Source Type: forums
Scheduling MBB 2 weeks in between?
It looks like Medicare requires a min of 2 weeks between MBBs trials. Is this the same for the PPO payors for your locality too? (Source: Student Doctor Network)
Source: Student Doctor Network - February 13, 2024 Category: Universities & Medical Training Authors: CarabinerSD Tags: Pain Medicine Source Type: forums
Bunch of weirdos
Awake Total Neuromuscular Blockade as Experienced by Anesthesiologist Volunteers
Accidental awareness during general anesthesia can be profoundly traumatizing, even in the absence of pain.1,2 Neuromuscular blocking drugs are implicated in almost all cases of accidental awareness, yet despite having been in clinical use for more than 70 years, the subjective experience of...
pubs.asahq.org
Apparently people like larger tidal volumes.
These are the same folks who videotaped paralyzed volunteers doing arithmetic with BIS<50...
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Source: Student Doctor Network - February 11, 2024 Category: Universities & Medical Training Authors: nimbus Tags: Anesthesiology Source Type: forums
Dilaudid aint good enough
Safer supply too weak for most street-drug users, says Island Health doctor
Dr. Randal Mason, regional medical director for Island Health’s Addiction Medicine and Substance Use program, says expanding to stronger drugs like heroin could have practical benefits
www.timescolonist.com
Policy proposed by a family doc who did a 2 year family med residency. Hardly should have any input on addictions management, government opioid policy.
His idea is give them street strength legal drugs. (Source: Student Doctor Network)
Source: Student Doctor Network - February 9, 2024 Category: Universities & Medical Training Authors: TheLoneWolf Tags: Pain Medicine Source Type: forums
Guam as Civilian Physician Spouse
Reaching out for advice/leads/help as civilian physician spouse hoping to practice interventional pain/sports/spine in Guam. Wife and I are PCSing late September. Appreciate any help in advance! (Source: Student Doctor Network)
Source: Student Doctor Network - February 8, 2024 Category: Universities & Medical Training Authors: poppinfresh123 Tags: Military Medicine Source Type: forums
Collections contract review - new attending
Soon to be newly graduating pain fellow starting contract review.
In regards to collections models, what makes a good contract?
What percentage of collections should I be taking home?
In todays market, what would a fair collections threshold number be for a 350k base? 400k base?
Is a graded collections better or a a percentage of straight collections better?
I am looking to be a FTE and be fairly productive. PP has existing referral sources.
Looking at midwest PP groups. (Source: Student Doctor Network)
Source: Student Doctor Network - February 6, 2024 Category: Universities & Medical Training Authors: NRT109 Tags: Pain Medicine Source Type: forums
Someone explain to me
I do a procedure, say an L5-S1 intralaminar epidural, and patient says they got 80% relief, but they are here for their legacy monthly refill of ms contin 15mg BID and morphine IR 15 QID for their 8/10 pain. Don't worry... It's under 90 OME so that means that it is okay. They are getting their alprazolam from their psychiatrist, I'm not the one writing it, so it's obviously okay. It makes no sense. There are only a few cases where the medication management doesn't essentially seem like I'm...
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Source: Student Doctor Network - February 5, 2024 Category: Universities & Medical Training Authors: OuttaLuckMove Tags: Pain Medicine Source Type: forums
