ASIPP Practice Guidelines - Pain Physician
ASIPP Practice Guidelines - Pain Physician
ASIPP Practice Guidelines - Pain Physician
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Manchikanti et al • <strong>ASIPP</strong> <strong>Practice</strong> <strong>Guidelines</strong><br />
39<br />
Patient with radicular pain<br />
Post surgery<br />
Transforaminal<br />
or<br />
caudal epidural<br />
Positive<br />
Negative<br />
Repeat<br />
transforaminal<br />
or<br />
caudal<br />
Percutaneous<br />
non-endoscopic<br />
adhesiolysis<br />
Good relief<br />
Good<br />
response<br />
Inadequate<br />
response<br />
Repeat after 2 to 4 weeks<br />
if pain returns<br />
Repeat if<br />
pain returns<br />
Endoscopic<br />
adhesiolysis<br />
(lumbar only)<br />
Good relief<br />
No relief<br />
Positive<br />
Negative<br />
Repeat<br />
and<br />
stabilize<br />
Percutaneous<br />
non-endoscopic<br />
adhesiolysis<br />
No treatment<br />
Discography<br />
Good<br />
response<br />
Inadequate<br />
response<br />
Positive<br />
Negative<br />
Repeat if<br />
pain returns<br />
Endoscopic<br />
adhesiolysis<br />
(lumbar only)<br />
Contained<br />
disc displacement<br />
Annular fissure<br />
Discography with<br />
post CT scan<br />
(optional)<br />
Follow somatic<br />
pain algorithm<br />
(facet joint or SI joint<br />
mediated pain)<br />
Positive<br />
Negative<br />
Laser discectomy<br />
(lumbar only)<br />
or surgical referral<br />
IDET<br />
Thermocoagulation<br />
(lumbar only)<br />
Positive<br />
Negative<br />
No treatment<br />
Discography<br />
Treatment<br />
as described<br />
Spinal cord<br />
stimulation<br />
Intrathecal<br />
pump<br />
Positive<br />
Negative<br />
Contained<br />
disc displacement<br />
Annular fissure<br />
Discography with<br />
post CT scan<br />
(optional)<br />
Follow somatic<br />
pain algorithm<br />
(facet joint or SI joint<br />
mediated pain)<br />
Laser discectomy<br />
(lumbar only)<br />
or surgical referral<br />
IDET<br />
Thermocoagulation<br />
(lumbar only)<br />
Positive<br />
Negative<br />
Treatment<br />
as described<br />
Spinal cord<br />
stimulation<br />
Intrathecal<br />
pump<br />
Fig. 3A. A suggested algorithm for application of interventional techniques in conservative care of chronic spinal pain:<br />
A patient with radicular pain<br />
<strong>Pain</strong> <strong>Physician</strong> Vol. 4, No. 1, 2001
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