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 />
40<br />
Patient with radicular pain<br />
No surgery<br />
Transforaminal,<br />
caudal or<br />
interlaminar epidural<br />
Good relief<br />
No relief<br />
or<br />
poor response<br />
Repeat if<br />
pain returns<br />
Percutaneous lysis<br />
of adhesions<br />
Good relief<br />
Good<br />
response<br />
Poor<br />
response<br />
Repeat<br />
and<br />
stabilize<br />
Repeat<br />
if pain returns<br />
Discography<br />
Positive<br />
Negative<br />
Contained disc<br />
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<br />
described<br />
Surgical<br />
indication(s)<br />
Surgical<br />
candidate<br />
Not a<br />
surgical<br />
candidate<br />
Surgery<br />
Spinal cord<br />
stimulation or<br />
intrathecal pump<br />
Fig. 3B. 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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