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 />
42<br />
Patient with somatic pain<br />
Discogenic pain<br />
Sacroiliac joint<br />
mediated pain<br />
Discography<br />
Diagnostics<br />
SI joint blocks<br />
Positive<br />
Negative<br />
Positive<br />
Negative<br />
Contained disc<br />
displacement<br />
Annular fissure<br />
Discography<br />
post CT scan<br />
(optional)<br />
Follow facet<br />
joint mediated<br />
pain algorithm<br />
Sacroiliac<br />
joint blocks, etc.<br />
Follow facet<br />
joint mediated<br />
pain algorithm<br />
Laser discectomy<br />
(lumbar only)<br />
or<br />
surgical referral<br />
IDET<br />
Thermocoagulation<br />
(lumbar only)<br />
Diagnostic facet<br />
joint injections<br />
Positive<br />
Negative<br />
Facet joint<br />
nerve blocks<br />
Diagnostic SI<br />
joint block(s)<br />
Good relief<br />
(1-2 weeks)<br />
Temporary<br />
relief (local<br />
anesthetic<br />
duration)<br />
Positive<br />
Negative<br />
Repeat block<br />
as needed<br />
Radiofrequency<br />
or<br />
cryoneurolysis<br />
SI joint<br />
blocks, etc.<br />
Follow radicular<br />
pain algorithm<br />
Good relief<br />
Temporary<br />
relief<br />
Repeat block<br />
as needed<br />
Radiofrequeny<br />
or<br />
cryoneurolysis<br />
Fig. 4B. A suggested algorithm for application of interventional techniques in conservative care of chronic<br />
spinal pain: A patient with somatic pain<br />
<strong>Pain</strong> <strong>Physician</strong> Vol. 4, No. 1, 2001
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