Category: Pain Medicine

Pain Injections Under the Microscope

Guest post by Dr. G Leibowitz:

The practice of pain management has a long history and has evolved over the years from anesthesiolgists running back and forth from the OR to the pain clinic to dedicated, fellowship-trained interventional pain physicians.  Then came the weekend course needle jockeys who desired to tap into the revenue that pain management  provided.  Hopefully this article will have them take pause and realize that a needle in the wrong place can indeed lead to disastrous consequences:

From Bloomberg:

A surge in steroid injections to alleviate back and neck pain in the U.S. is bringing with it an increase in severe and unexpected complications, including paralysis and death. Reports of the side effects have prompted the U.S. Food and Drug Administration to review the safety of steroid injections into the epidural space near the spinal cord, in consultation with an advisory group, the agency confirmed. Some 8.9 million Americans received the shots last year.

The article makes some eye-opening statements:

…pain, a market estimated to be as much as $300 billion a year. Epidurals are one of the interventional procedures — including implants of spinal cord stimulators and shots of pain killers — on which Americans spent $23 billion this year, 231 percent more than in 2002, according to Marketdata Enterprises

I’m aware of physicians of all specialties from Radiology to Family Medicine who have jumped on the bandwagon, took a weekend course and are now pain doctors.  I guess their share of $300 billion was to hard to resist.  Its quite sad really.  My guess is that once the money dries up the herd will go elsewhere (botox maybe?) and the real pain physicians will be left cleaning up their mess. 

 Image: digitalart / FreeDigitalPhotos.net

IV Acetaminophen approved.

Like many a drug, IV acetaminophen has been available outside of the United States for quite some time now.   The IV formulation of the “painkiller hospitals use most” has a proven track record of safety and efficacy and should have been available some time ago IMHO.  The opiod-sparing effects are of the most interest to us as anesthesia providers.  The drug-naming focus group really dropped the ball on this one though.  Ofirmev? Hurts my tongue to say it.  Doesn’t lessen my excitement to use it though.  Now just to get it on formulary.  My sources are saying around $12 per 1000 mg dose.

Package Insert

Anesthesia propaganda continues

Quite an inflammatory post over there at Slate.com.  Essentially the same same CRNA=MD drivel that has been coming out this past year.  This time it is directed at interventional pain physicians.  The factual errors will make any reader cringe regardless of your slant.  The comments are also worth a quick scroll. 
I hesitate to highight such nonsense but I figured its good to know what is being said about you.  Timmy Noah should have his crayons and scrap paper taken away.