The Korean Journal of Pain

The Korean Pain Society (대한통증학회)
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Interventional Pain Management in Rheumatological Diseases - A Three Years Physiatric Experience in a Tertiary Medical College Hospital in Bangladesh

  • Siddiq, Md. Abu Bakar (Feni Diabetes Hospital (FDH)) ;
  • Hasan, Suzon Al (Physical Medicine and Rehabilitation Department, Rajshahi Medical College) ;
  • Das, Gautam (Daradia pain clinic (Centre of excellence in pain practice)) ;
  • Khan, Amin Uddin A. (Physical Medicine and Rehabilitation Department, Chittagong Medical College)
  • Received : 2011.08.08
  • Accepted : 2011.09.02
  • Published : 2011.12.01
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Abstract

Background: Interventional pain management (IPM) is a branch of medical science that deals with management of painful medical conditions using specially equipped X-ray machines and anatomical landmarks. Interventional physiatry is a branch of physical medicine and rehabilitation that treats painful conditions through intervention in peripheral joints, the spine, and soft tissues. Methods: A cross-sectional study was conducted using three years of hospital records (2006 to 2008) from the Physical Medicine and Rehabilitation Department at Chittagong Medical College Hospital in Bangladesh, with a view toward highlighting current interventional pain practice in a tertiary medical college hospital. Result: The maximum amount of intervention was done in degenerative peripheral joint disorders (600, 46.0%), followed by inflammatory joint diseases (300, 23.0%), soft tissue rheumatism (300, 23.0%), and radicular or referred lower back conditions (100, 8.0%). Of the peripheral joints, the knee was the most common site of intervention. Motor stimulation-guided intralesional injection of methylprednisolone into the piriformis muscle was given in 10 cases of piriformis syndrome refractory to both oral medications and therapeutic exercises. Soft tissue rheumatism of unknown etiology was most common in the form of adhesive capsulitis (90, 64.3%), and is discussed separately. Epidural steroid injection was practiced for various causes of lumbar radiculopathy, with the exception of infective discitis. Conclusion: All procedures were performed using anatomical landmarks, as there were no facilities for the C-arm/diagnostic ultrasound required for accurate and safe intervention. A dedicated IPM setup should be a requirement in all PMR departments, to provide better pain management and to reduce the burden on other specialties.

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References

  1. Santhos A, Thomas DO, Walsh MC. Interventional pain management: a comprehensive approach to chronic pain. 2010 Jan 2 [2011 Feb 23]. Available at: http://www. spineuniverse.com.
  2. Johnson EW. The interventional physiatrist: a new subspecialist has been born! Am J Phys Med Rehabil 2001; 80: 1-3. https://doi.org/10.1097/00002060-200101000-00001
  3. Carrino JA, Morrison WB, Parker L, Schweitzer ME, Levin DC, Sunshine JH. Spinal injection procedures: volume, provider distribution, and reimbursement in the U.S. medicare population from 1993 to 1999. Radiology 2002; 225: 723-9. https://doi.org/10.1148/radiol.2253011401
  4. Boswell MV, Shah RV, Everett CR, Sehgal N, McKenzie Brown AM, Abdi S, et al. Interventional techniques in the management of chronic spinal pain: evidence-based practice guidelines. Pain Physician 2005; 8: 1-47.
  5. Drusso. Interventional PM&R. 2002 Jul 7 [2011 Apr 5]. Available at: http://forums.studentdoctor.net/archive/index.php/ t-40131.html.
  6. Dougados M, van der Linden S, Juhlin R, Huitfeldt B, Amor B, Calin A, et al. The European Spondylarthropathy Study Group preliminary criteria for the classification of spondyspondylarthropathy. Arthritis Rheum 1991; 34: 1218-27. https://doi.org/10.1002/art.1780341003
  7. van der Linden S, Valkenburg HA, Cats A. Evaluation of diagnostic criteria for ankylosing spondylitis. A proposal for modification of the New York criteria. Arthritis Rheum 1984; 27: 361-8. https://doi.org/10.1002/art.1780270401
  8. Arnett FC, Edworthy SM, Bloch DA, McShane DJ, Fries JF, Cooper NS, et al. The American Rheumatism Association 1987 revised criteria for the classification of rheumatoid arthritis. Arthritis Rheum 1988; 31: 315-24. https://doi.org/10.1002/art.1780310302
  9. Altman R, Asch E, Bloch D, Bole G, Borenstein D, Brandt K, et al. Development of criteria for the classification and reporting of osteoarthritis. Classification of osteoarthritis of the knee. Diagnostic and Therapeutic Criteria Committee of the American Rheumatism Association. Arthritis Rheum 1986; 29: 1039-49. https://doi.org/10.1002/art.1780290816
  10. Solomon L, Warwick D, Nayagam S. Apley's system of orthopaedics and fractures. 8th ed. New York, Oxford University Press. 2001, pp 399-400.
  11. Sinaki M, Mokri B. Low back pain and disorders of the lumbar spine. In: Randall's textbook of physical medicine and rehabilitation. Edited by Braddom RL. Philadelphia, WB Saunders. 1996, pp 813-50.
  12. Canoso JJ. Aspiration and injection of joints and periarticular tissues. In: Practical rheumatology. 3rd ed. Edited by Hochberg MC, Silman AJ, Smolen JS, Weinblatt ME, Weisman MH. Philadelphia, Mosby Elsevier. 2004, pp 73-84.
  13. Kreder HJ. The knee. In: Musculoskeletal examination and joint injections techniques. Edited by Fam AG, Lawry GV, Kreder HJ. Philadelphia, Mosby Elsevier. 2006, pp 83-4.
  14. Abram SE. Treatment of lumbosacral radiculopathy with epidural steroids. Anesthesiology 1999; 91: 1937-41. https://doi.org/10.1097/00000542-199912000-00047
  15. Weinstein SM, Herring SA; NASS. Lumbar epidural steroid injections. Spine J 2003; 3(3 Suppl): 37S-44S. https://doi.org/10.1016/S1529-9430(02)00560-0
  16. Gonzalez P, Pepper M, Sullivan W, Akuthota V. Confirmation of needle placement within the piriformis muscle of a cadaveric specimen using anatomic landmarks and fluoroscopic guidance. Pain Physician 2008; 11: 327-31.
  17. Burgos-Vargas R. The juvenile-onset spondyloarthritides. In: Ankylosing spondylitis and the spondyloarthropathies. Edited by Weisman MH, van der Heijde D, Reveille JD. Philadelphia, Mosby Elsevier. 2006, pp 96-7.
  18. Chamberlain MA, Corbett M. Carpal tunnel syndrome in early rheumatoid arthritis. Ann Rheum Dis 1970; 29: 149-52. https://doi.org/10.1136/ard.29.2.149
  19. Dougados M, Gueguen A, Nakache JP, Velicitat P, Veys EM, Zeidler H, et al. Ankylosing spondylitis: what is the optimum duration of a clinical study? A one year versus a 6 weeks non-steroidal anti-inflammatory drug trial. Rheumatology (Oxford) 1999; 38: 235-44. https://doi.org/10.1093/rheumatology/38.3.235
  20. Buttgereit F, Straub RH, Wehling M, Burmester GR. Glucocorticoids in the treatment of rheumatic diseases: an update on the mechanisms of action. Arthritis Rheum 2004; 50: 3408-17. https://doi.org/10.1002/art.20583
  21. Peters ND, Ejstrup L. Intravenous methylprednisolone pulse therapy in ankylosing spondylitis. Scand J Rheumatol 1992; 21: 134-8. https://doi.org/10.3109/03009749209095085
  22. Arramon JY, Bergamasco P, Blasco G, Vincent P. Intraarticular sodium hyaluronate (Arthrum(R)H 2.0%) in the treatment of patients with knee osteoarthritis: a multi-centric, randomized, comparative clinical trial. Minerva Ortopedica e Traumatologica 2008; 59: 69-79.
  23. Al-Jaziri AA, Mahmoodi SM. Painkilling effect of ozoneoxygen injection on spine and joint osteoarthritis. Saudi Med J 2008; 29: 553-7.
  24. Reeves KD, Hassanein K. Randomized prospective doubleblind placebo-controlled study of dextrose prolotherapy for knee osteoarthritis with or without ACL laxity. Altern Ther Health Med 2000; 6: 68-74, 77-80.
  25. Fam AG. Principles of joint and periarticular aspirations and injections. In: Musculoskeletal examination and joint injections techniques. Edited by Fam AG, Lawry GV, Kreder HJ. Philadelphia, Mosby Elsevier. 2006, pp 128-31.
  26. Hudson N, Fitzcharles MA, Cohen M, Starr MR, Esdaile JM. The association of soft-tissue rheumatism and hypermobility. Br J Rheumatol 1998; 37: 382-6. https://doi.org/10.1093/rheumatology/37.4.382
  27. Solomon L, Warwick D, Nayagam S. Apley's system of orthopaedics and fractures. 8th ed. New York, Oxford University Press. 2001, pp 247-53.
  28. Dalton SE. The shoulder. In: Practical rheumatology. 3rd ed. Edited by Hochberg MC, Silman AJ, Smolen JS, Weinblatt ME, Weisman MH. Philadelphia, Mosby Elsevier. 2004, pp 198-9.
  29. Reveille JD. Soft-tissue rheumatism: diagnosis and treatment. Am J Med 1997; 102: 23S-9S. https://doi.org/10.1016/S0002-9343(97)00413-0
  30. Smythe H. Links between fibromyalgia and myofascial pain syndromes. J Rheumatol 1992; 19: 842-3.
  31. Thompson JS, Phelps TH. Repetitive strain injuries. How to deal with 'the epidemic of the 1990s'. Postgrad Med 1990; 88: 143-9. https://doi.org/10.1080/00325481.1990.11704775
  32. Kivi P. The etiology and conservative treatment of humeral epicondylitis. Scand J Rehabil Med 1983; 15: 37-41.
  33. Clarke MT, Lyall HA, Grant JW, Matthewson MH. The histopathology of de Quervain's disease. J Hand Surg Br 1998; 23: 732-4.
  34. Yosipovitch G, Yosipovitch Z, Karp M, Mukamel M. Trigger finger in young patients with insulin dependent diabetes. J Rheumatol 1990; 17: 951-2.
  35. Borenstein DG. Low back pain and lumbar spinal stenosis. In: Practical rheumatology. 3rd ed. Edited by Hochberg MC, Silman AJ, Smolen JS, Weinblatt ME, Weisman MH.Philadelphia, Mosby Elsevier. 2004, p 178.
  36. Jeon SY, Moon HS, Han YJ, Sung CH. Post-radiation piriformis syndrome in a cervical cancer patient -a case report-. Korean J Pain 2010; 23: 88-91. https://doi.org/10.3344/kjp.2010.23.1.88
  37. Boyajian-O'Neill LA, McClain RL, Coleman MK, Thomas PP. Diagnosis and management of piriformis syndrome: an osteopathic approach. J Am Osteopath Assoc 2008; 108: 657-64. https://doi.org/10.7556/jaoa.2008.108.11.657
  38. Kaplan M, Derby R. Epidural corticosteroid injections: When, why, and how. J Musculoskel Med 1998; 15: 39-46.
  39. Weinstein JN, Lurie JD, Tosteson TD, Hanscom B, Tosteson AN, Blood EA, et al. Surgical versus nonsurgical treatment for lumbar degenerative spondylolisthesis. N Engl J Med 2007; 356: 2257-70. https://doi.org/10.1056/NEJMoa070302
  40. Byeon GJ, Kim KH. Piriformis syndrome in knee osteoarthritis patients after wearing rocker bottom shoes. Korean J Pain 2011; 24: 93-9. https://doi.org/10.3344/kjp.2011.24.2.93
  41. Fishman LM, Anderson C, Rosner B. BOTOX and physical therapy in the treatment of piriformis syndrome. Am J Phys Med Rehabil 2002; 81: 936-42. https://doi.org/10.1097/00002060-200212000-00009
  42. van Kleef M, Barendse GA, Kessels A, Voets HM, Weber WE, de Lange S. Randomized trial of radiofrequency lumbar facet denervation for chronic low back pain. Spine (Phila Pa 1976) 1999; 24: 1937-42. https://doi.org/10.1097/00007632-199909150-00013
  43. Slipman CW, Bhat AL, Gilchrist RV, Issac Z, Chou L, Lenrow DA. A critical review of the evidence for the use of zygapophysial injections and radiofrequency denervation in the treatment of low back pain. Spine J 2003; 3: 310-6. https://doi.org/10.1016/S1529-9430(03)00025-1
  44. Muto M, Andreula C, Leonardi M. Treatment of herniated lumbar disc by intradiscal and intraforaminal oxygen-ozone (O2-O3) injection. J Neuroradiol 2004; 31: 183-9. https://doi.org/10.1016/S0150-9861(04)96989-1
  45. Barr JD, Barr MS, Lemley TJ, McCann RM. Percutaneous vertebroplasty for pain relief and spinal stabilization. Spine (Phila Pa 1976) 2000; 25: 923-8. https://doi.org/10.1097/00007632-200004150-00005
  46. Saal JA, Saal JS. Intradiscal electrothermal therapy for the treatment of chronic discogenic low back pain. Clin Sports Med 2002; 21: 167-87. https://doi.org/10.1016/S0278-5919(03)00064-4
  47. Botwin KP, Gruber RD, Bouchlas CG, Torres-Ramos FM, Freeman TL, Slaten WK. Complications of fluoroscopically guided transforaminal lumbar epidural injections. Arch Phys Med Rehabil 2000; 81: 1045-50. https://doi.org/10.1053/apmr.2000.7166
  48. Bakshi S, Abrahamsen GW. Lumbar facet and median branch block. In: Interventional pain management a practical approach. Edited by Baheti DK, Bakshi S, Gupta S, Gehdoo RP. New Dehli, Jaypee Brothers Medical Publishers Ltd. 2009, p 196.

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