September 14, 2022
2 min learn
Christo PJ. Panorama of wonders: Injections, nerve blocks, pumps and neuromodulation. Offered at: PAINWeek; Las Vegas; Sept. 9-12, 2022.
Christo studies monetary relationships with Eli Lilly, Exicure, GlaxoSmithKline Client Healthcare, Neurana, Neumentum and Y mAbs.
LAS VEGAS — CDC pointers issued in response to the opioid disaster have led to many well being care suppliers decreasing or eliminating ache management with opioids, Paul J. Christo, MD, MBA, mentioned at PAINWeek 2022.
“The rules recommended nonpharmacological therapies and nonopioid therapies,” Christo, affiliate professor of anesthesiology and important care drugs at Johns Hopkins Medication, mentioned. “We’ve seen an curiosity in procedural interventions and the variety of procedural interventions being carried out.”
The CDC’s ideas of nonpharmacological procedures embody train, weight reduction, psychological and sleep interventions, and procedures, he mentioned.
“Injections may be useful,” Christo mentioned. “We do them for the therapeutic worth, diagnostic worth, prognostic worth and expectations.”
Christo recommended epidural steroid injection (ESI) as one various ache administration choice.
ESI is indicated for neck, again, leg and capturing arm or thoracic ache, he mentioned. The supply is nerve root irritation, compression or spinal narrowing from herniated discs or spinal stenosis.
Candidates for ESI embody, “sufferers with radicular ache attributable to herniated nucleus pulposus, sufferers with shorter length of ache, extra leg ache than again ache, intermittent ache, youthful [age], no psychological overlay,” Christo mentioned.
These with ache length longer than 6 months, degenerative disc illness or spinal stenosis, again ache greater than leg ache, poor imaging correlation, failed interventions, fixed ache, unemployment resulting from ache and psychological overlay have unfavorable prognoses.
“Pointers on when to supply an ESI would say to make use of conservative therapies first,” Christo mentioned, “comparable to acetaminophen and train.”
Acute ache is taken into account to be ache that lasts 4 to six weeks; after 12 weeks it’s continual, he mentioned.
Sixty p.c of greater than 40 scientific trials point out that ESI has short-term advantages, Christo mentioned.
“For acute ache, interact in conservative therapies,” he mentioned, “however, personally, if I had radicular ache, I’d wish to have these earlier. It’s not simple to operate with capturing leg ache that lasts a month.”
Unwanted effects are usually minimal and embody post-injection headache and a few nausea.
“The danger of postdural puncture is fairly low,” he mentioned. “Sufferers with diabetes might even see an escalation of blood glucose ranges. Based mostly on retrospective research, there’s a slight improve vertebral fracture danger.”
Christo mentioned he’s unaware of any constant pointers or randomized scientific trials addressing frequency.
“Some will say not more than three injections in the identical location in a 12-month interval,” he mentioned. “The reason being as a result of danger of hypothalamic-pituitary-adrenal axis suppression, which may result in issues. There is no such thing as a consensus. I’d preserve it to 4 per yr in the event you can.
“Additionally with ESI, we don’t have pointers on the dose of steroids and which one,” he continued. “It’s a mix. We don’t have randomized scientific trials on easy methods to carry out these and the perfect dose.”
Christo additionally mentioned side blocks, radiofrequency denervation, sacroiliac joint injection, neuromodulation, spinal wire stimulation, dorsal root ganglion stimulation, peripheral nerve stimulation and intrathecal drug supply as different options to opioids.