Clear Water Pain Clinic

Evidence for lumbar discography is strong for discogenic pain provided that lumbar discography is performed based on the history, physical examination, imaging data, and analysis of other precision diagnostic techniques.

Transforaminal Epidural Injections

The current evidence provides moderate evidence of this technique in the preoperative evaluation of patients with negative or inconclusive imaging studies and clinical findings of nerve root irritation.

Sacroiliac Joint Blocks

10 to 18.5% of patients with low back pain

The evidence for specificity and validity of SIJ diagnostic injections is moderate.

Therapeutic Interventional Techniques

Facet Joint Pain

1. Intraarticular Injections: The evidence provided moderate evidence of short-term relief and limited evidence of long-term relief of pain.

2. Medial Branch Blocks: The evidence provided strong evidence of short-term relief and moderate evidence of long-term relief of pain of facet joint origin.

3. Medial Branch Neurotomy: The evidence provided strong evidence of short-term relief and moderate evidence of long-term evidence of chronic spine pain of facet joint origin.

Epidural Injections

1. Caudal Epidural Injections: The evidence is strong for short-term relief and moderate for long-tern relief.

2. Interlaminar Epidural Injections: Evidence for overall effectiveness is moderate for short-term and limited for long-term relief

3. Transforaminal Epidural Injections: Provides strong evidence for short-term and long-term relief. Their effectiveness in post lumbar laminectomy syndrome and disc extrusions is inconclusive.

Epidural Adhesiolysis

1. Evidence of effectiveness of percutaneous adhesiolysis is moderate for short-term and long-term relief with repeat interventions.

2. Evidence for spinal endoscopy is moderate for short-term and limited for long-term relief

Intradiscal Therapies

1. IDET (Intradiscal electrothermal Therapy): Moderate evidence for short-term and limited evidence for long-term relief

2. Nucleoplasty: Evidence is limited showing the effectiveness of PLDD

Implantable Therapies

1. Spinal Cord Stimulation: Moderate for long-term pain relief

2. Implantable Itrathecal Drug Administration System: Moderate evidence of long-term effectiveness

Delivery Of Interventional Technology: (FREQUENCY based on safety, clinical effectiveness and cost effectiveness)

Facet joint Injections

1. In the diagnostic phase, a patient may receive injections no sooner than 1 week or, preferably, 2 weeks.

2. In the therapeutic phase the frequency would be 2 months or longer between injections, provided that at least 50% or greater relief is obtained for 6 weeks.

3. If the neural blockade is applied for different regions, it can be performed at intervals no sooner than 1-2 weeks for most types of blocks. Therapeutic frequency remains at 2 months for each region. It is suggested that all regions be treated at the same time.

4. In the therapeutic phase the interventional procedures are to be limited to a maximum of six times for a period of one year.

5. Under unusual circumstances with a recurrent injury or cervicogenic headache, blocks may be repeated at intervals of 6 weeks after stabilization in the treatment phase.

Medial Branch Neurolysis

1. The suggested frequency would be 3 months or longer between each procedure, provided that at least 50% or greater relief is obtained for 10 to 12 weeks.

2. If the neural blockade is applied for different regions, it may be performed at intervals no sooner than 1-2 weeks for most types of blocks. The therapeutic frequency for neurolytic blocks would remain at intervals of at least 3 months for each region.

Epidural Injections

1. Epidural injections include caudal, interlaminar, and transforaminal.

2. In the diagnostic phase, a patient may receive injections at intervals of 1-2 weeks except for blockade in cancer pain or when a continuous administration of local anesthetic is employed for reflex sympathetic dystrophy.

3. In the therapeutic phase, the suggested frequency would be 2 months or longer between each injection, provided that at least greater than 50% relief is obtained for 6-8 weeks.

4. If the neural blockade is applied for different regions, it may be performed at intervals of no sooner than 1-2 weeks for most types of blocks. The therapeutic frequency may remain at intervals at least 2 months for each region. It is further suggested that all regions be treated at the same time.

5. In the diagnostic phase, it is suggested number of injections would be limited to no more than 2 times except for reflex sympathetic dystrophy, in which case 3 times is reasonable.

6. In the therapeutic phase, the interventional procedures should be repeated only as necessary judging by the medical necessity criteria, and it is suggested that these be limited to a maximum of 6 times per year.

7. Under unusual circumstances with a recurrent injury, carcinoma, or reflex sympathetic dystrophy, blocks may be repeated at intervals of 6 weeks after diagnosis in the treatment phase.

Percutaneous Lysis of Adhesions

1. The number of procedures are limited to:

With a three-day protocol, 2 interventions per year

With a one-day protocol, 4 interventions per year

Spinal Endoscopy

1. The procedures are limited to a maximaum of 2 per year provided the relief was greater than 50% for more than 4 months.

Sacroiliac Joint Injections

1. In the diagnostic phase, a patient may receive injections at intervals of 1-2 weeks.

2. In the treatment phase, the suggested frequency would be 2 months or longer between each injection, provided that at least greater than 50% relief is obtained for 6 weeks.