Landmark Studies in Pain Management

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No_Pain_No_Gain

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What would you consider to be some of the most important studies in pain management?

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The article published in the New England Journal that said epidural steroid injections were worthless and a scam

I think PCPs went along with it until they realized not referring out meant having to continue prescribing narcotics themselves
 
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this is actually worth discussing since a lot of denials can be combatted with evidence. Some crap insurances here frequently quote that MBBs/RFAs are not supported by evidence, and is therefore experimental.
 
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Find me a study showing something works, and I’ll find you one that shows it doesn’t.
 
SCS doesn't work for radic



Scs doesn't work for back pain



Epidurals don't work



Non-opioids don't work



Opioids don't work



Vertebroplasty doesn't work



CBT works a little

 
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SCS doesn't work for radic



Scs doesn't work for back pain



Epidurals don't work



Non-opioids don't work



Opioids don't work



Vertebroplasty doesn't work



CBT works a little

Nice try, insurance guy.
 
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SCS doesn't work for radic



Scs doesn't work for back pain



Epidurals don't work



Non-opioids don't work



Opioids don't work



Vertebroplasty doesn't work



CBT works a little

Or he will
 
SCS doesn't work for radic
not exactly what that study says.

it actually states that burst is no different than placebo stim.

of note, both burst and placebo groups did get 9.3-10 point reduction compared to baseline in oswestry score. likewise, for NRS, baseline was 7.3, and burst was 5.9 and placebo 6.1. what was noteworthy is that burst wasnt statistically significant from placebo, which begets the next point...

i did not find anywhere in the article what were the exact measurements/parameters of "placebo stimulation". not once in the article did it say it was zero stim, interestingly.

Scs doesn't work for back pain
while i agree with this premise and conclusion, the article was basically a meta-analysis.

and one of the authors has a significant preconceived bias.

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Epidurals don't work
not a meta-analysis. a review article.

the article does not say "epidurals dont work." it specifically states "Long-term benefits from epidural steroid injections have not been established."

which we are well aware of.

Non-opioids don't work
Vertebroplasty doesn't work

2 Cochrane reviews, that seem fairly well done.

Opioids don't work
would agree, but the study is about the SPACE trial, which is pertaining to radiotherapy for stage 1 cancer....

SPACE (Stereotactic Precision And Conventional radiotherapy Evaluation) is the first randomized phase II trial comparing SBRT and conventional fractionated radiotherapy (3DCRT).
 
A 2 point NRS or a 20 point VAS reduction is considered a clinically significant pain reduction.
Failure to meet those numbers means treatment did not work for that outcome measure.
 
A 2 point NRS or a 20 point VAS reduction is considered a clinically significant pain reduction.
Failure to meet those numbers means treatment did not work for that outcome measure.

So I had a peer-to-peer today. I marked a decrease in pain from a 10 to a 6 on the NRS. Reviewer said that only correlates to a 400% reduction in pain and therefore doesnt meet the 80% or more criteria. Are they expecting a drop to 1/10 or 2/10 for all patients? seems wild
 
80% relief for 3 months is standard minimum relief. Don't all your patients meet this criteria?
 
Yes, you have to say 80% decrease in the index pain we attempting to treat or something like that.
 
Just play along, it's the only way to survive
 
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80% for MBB.

for duration of agent used, so dont use steroids.

50% for ESI or RFA.

for 6 months.

or improved functioning of at least 50% of improved painful activity or ADLs. which a couple of my insurers have used as reason for denial (Medicaid)
 
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