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Which international pain procedures would you consider 'high risk'?
Same. I do none of those on his list but CESI (with CLO) also. I've done the hero thing. At this point, I'm okay with passing that baton and letting someone else be the hero.Good list by lig. I don't do anything on that list other than CESI, and I make patients fail a lot of conservative care before I will consider a CESI (at least a month of PT, NSAIDS, neuropathic meds, and a round of oral steroids before I will offer a CESI)
Once I figured out how little I got paid to do C1-C2 injections, I stopped doing those due to the combination of higher risk and minimal reimbursement. I send those to the local university now.
That's the interesting thing about ligaments list. None of those procedures pay remotely what they should for the risk, and I'm not going to legally expose myself for pennies.
The only one you can't really avoid is CESI. You can't not perform CESI and call yourself a pain physician, and get referrals if you don't offer one of the main procedures for the c-spine.
Holy crap this is soooo true. NNH is way higher for opioids than ANYTHING we do interventionlly. Also, higher cost to the insurers, higher cost to society as well.To put it all in perspective, however, none of these procedures may be as risky as starting a patient on COT...
Adenolysis of the pituitary surely must be the king!
Followed by trans-oral C2 vertebroplasty
Then V1 gasserian RFA
anterior C1-2 RFA
Hypoglossal nerve RFA at the styloid process
IT pump refills
IT opioid and LA trials
IT pump programming
Subrachnoid EtOH injection
RF Cordotomy
Cervical ILESI still scare me though I do them routinely. Contralateral oblique view has helped a lot.
CTFESI scare me more every year.
Granted many of the above are more NSX procedures but apparently some pain docs perform them. Other than those, I don't think we have any high risk procedures...???
can i ask why you hate lumbar plexus blocks?
do you do SGBs under fluoro or US?
thanks
Cervical discos. Get roped into a couple a year