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Biomedical subjects

Vijay Singh

Publications and source records attributed to Vijay Singh.

At least 37 records · Page 2Linked to original sources
PubMed2004

Role of percutaneous disc decompression using coblation in managing chronic discogenic low back pain: a prospective, observational study.

BACKGROUND: Percutaneous disc decompression using Coblation (Nucleoplasty trade mark) implements the principle of volumetric reduction to achieve disc decompression and reduce intradiscal pressure. Previous analyses have shown that Nucleoplasty achieves reduction in volume and intradiscal pressure with minimal damage to surrounding tissue in the treated disc. OBJECTIVE: To determine effectiveness of nucleoplasty in patients with discogenic back pain. STUDY DESIGN: A prospective, non-randomized, observational study. METHODS: Forty-seven patients presenting with predominant back pain undergoing treatment with the Nucleoplasty procedure using Coblation technology were included in this analysis. Patients were followed at 1 month, 3 months, 6 months, and 12 months after the procedure. A numeric pain scale of 0 to 10, percent pain relief, and improvement in functional status as determined on the basis of their ability to sit, stand, and walk. RESULTS: The proportion of patients who reported 50% or more pain relief was 80%, 74%, 63% and 53% at the 1, 3, 6 and 12 months follow-up time periods, respectively. Functional improvements were reported by 46% of patients for sitting ability, 41% for standing ability, and 49% for walking ability at 12 months. There were no complications observed due to the Nucleoplasty procedure. CONCLUSION: Nucleoplasty for disc decompression is one of the least-invasive techniques in the minimally invasive category, thus far exhibiting a very low incidence of complications. Although no long-term data are available, these preliminary results indicate that the Nucleoplasty procedure is a safe and moderately effective procedure for reducing pain in patients presenting with predominant discogenic low back pain associated with contained disc herniation.

Journal Article↗
PubMed2004

Thoracic discography.

Thoracic discography is performed much less frequently than either cervical or lumbar discography due to the relative infrequency of symptomatic thoracic disc pathology. Clinicians are less likely to ascribe thoracic pain to discogenic disease of the thoracic spine than to other more common etiologies, such as facet joint pain, muscle pain, skeletal pain or visceral pain. A comprehensive evaluation for pain includes having an index of suspicion that includes the thoracic disc as the cause of these symptoms. The purpose of thoracic discography is to identify or confirm a thoracic disc as a pain generator. The procedure itself has many similarities to the one used in the lumbar region; there are also similarities with the lumbar procedure with respect to patient selection and indications. Unintentional or inadvertent pleural puncture is a major risk of this procedure. It is a safe procedure when performed by an expert. Thoracic discography identifies the particular painful disc and provides a more complete description of thoracic disc pathology, correlated with MRI or CT findings.

Journal Article↗
PubMed2004

The role of cervical discography in interventional pain management.

Cervical discography, cervical disc puncture with contrast dye injection under fluoroscopic guidance, is a commonly used modality in the evaluation of patients with intractable neck pain. MRI and CT scans are the initial tests in the diagnostic evaluation of symptomatic cervical discs. These provide noninvasive and accurate assessment of disc anatomy and pathologic change. Since correlation of pain with abnormalities of structural anatomy is not always reliable, direct injection of cervical discs is done to precisely localize and identify painful discs. The improvements in contrast media, imaging technique, meticulous attention to aseptic technique combined with use of antibiotics have resulted in very low rates of complications. Cervical discography is a diagnostic procedure used in complementary fashion with other imaging techniques to yield the precise disc level responsible for pain and to aid in planning treatment.

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PubMed2004

Percutaneous disc decompression for the treatment of chronic atypical cervical discogenic pain.

Percutaneous disc decompression with the radiofrequency coblation technique has been described to treat contained, symptomatic lumbar disc herniations. In symptomatic cervical disc herniations it has been used very selectively. We report a 42-year-old female with cervical disc pathology, predominantly at C6/C7, treated with percutaneous disc decompression using coblation technology. Her complaint of cervicogenic cephalgia completely resolved, along with an 85% reduction of neck pain and upper extremity pain 6-months post-operatively. This is the first case report of chronic cervical discogenic pain being treated with this technique.

Journal Article↗
PubMed2003

Serum insulin-like growth factor-I and insulin-like growth factor binding protein-3 following chemotherapy for advanced breast cancer.

BACKGROUND: Insulin-like growth factor-I (IGF-I) and IGF binding protein-3 (IGFBP-3) appear to influence the growth of breast cancer cells in vitro, and epidemiological studies suggest higher serum IGF-I levels increase the risk of breast cancer. IGF-I and IGFBP-3 have therefore been measured in women with advanced breast cancer to determine if changes in serum levels predict the response to treatment by chemotherapy. METHODS: Serum IGF-I and IGFBP-3 levels were measured in 14 patients before and after 1 week of chemotherapy. Changes in serum levels were compared with duration of survival. RESULTS: Mean basal serum levels of IGF-I and IGFBP-3 were not significantly different between patients with advanced breast cancer and controls or women with early breast cancer. Serum IGFBP-3 fell significantly 1 week after initiation of chemotherapy. Patient survival was not significantly related to baseline IGF-I or IGFBP-3 levels, but when the fall in serum levels 1 week after starting treatment was expressed either as absolute change or as a percentage of baseline, those individuals with a decrease in IGFBP-3 greater than the median had significantly poorer survival (median survival 5.5 months vs 18 months). These results were independent of other prognostic variables such as previous disease-free survival, and were also unaffected by the change in serum albumin with treatment. The fall in IGF-I and IGFBP-3 with chemotherapy mainly occurred in those with hepatic metastases, but prediction of survival was explained solely by the extent of the fall in IGFBP-3. CONCLUSIONS: This preliminary study has shown that serum IGFBP-3 falls significantly following initiation of chemotherapy and the extent of reduction significantly predicts the response to treatment.

Adult↗
PubMed2003

Corn-milling pretreatment with anhydrous ammonia.

Exposure to anhydrous ammonia has been suggested as a pretreatment for corn milling. Batches of corn were exposed to ammonia under controlled conditions. The amounts of ammonia absorbed and reacted with the corn were measured. The amounts were not more than are needed as nutritional supplement for yeast fermentation to ethanol. Loosening of the hull was observed qualitatively, and subsequent shearing in a disk mill followed by steeping for 2, 4, 6, or 8 h showed that germ could be recovered at higher yield and after a shorter steeping time compared to untreated control batches. Quality of oil was not affected by treatment with ammonia.

Agriculture↗
PubMed2003

Screening for controlled substance abuse in interventional pain management settings: evaluation of an assessment tool.

There is a need for an assessment tool to identify drug abuse behaviors in patients in pain treatment practices. Many assessment tools are complex, lengthy, lack external validation, and/or are difficult to administer. This prospective evaluation was undertaken to provide external validation for an assessment tool with 12 sections and 27 items. The test was applied in a prospective fashion to 500 consecutive patients: 100 patients in a drug abuse group and 400 patients in a non-abuse group. Drug abuse was defined as the misuse of controlled substances in a clinical setting, including obtaining controlled substances from other physicians or other identifiable sources, dose escalation with inappropriate use, and/or violation of controlled substance agreements. This study was performed in an interventional pain management setting with patients who were in stable therapy and were followed for at least one year. Results identified 8 of 12 parameters to be useful in identifying patients with drug abuse. Three factors were particularly useful, allowing correct identification of patients with abuse behavior in 90% of cases (odds ratios greater than 100 and P values of 0.001 or less). Important factors identified included excessive opiate needs, deception or lying to obtain controlled substances, and current or prior intentional doctor shopping. Together, these factors appear to identify 90% of patients with drug abuse. This tool provides a simple, reliable, and cost effective means of screening for drug abuse during the clinical evaluation of patients in interventional pain management settings.

Journal Article↗
PubMed2003

Accuracy of precision diagnostic blocks in the diagnosis of chronic spinal pain of facet or zygapophysial joint origin.

CONTEXT: Facet or zygapophysial joint blocks are used extensively in the evaluation of chronic spinal pain. However, there is a continuing debate about the value and validity of facet joint blocks in the diagnosis of chronic spinal pain. The value of diagnostic facet joint injections may have been overlooked in the medical literature. OBJECTIVES: To determine the accuracy of facet joint blocks in the diagnosis of chronic spinal pain of facet joint origin and also determine the rationale, principles, false-positive rate, and diagnostic utility of facet joint blocks as well as prevalence of facet joint pain. METHODS: Relevant literature was identified through searches of MEDLINE, EMBASE (Jan 1966- Mar 2003), manual searches of bibliographies of known primary and review articles, and abstracts from scientific meetings. Studies were selected if they were either placebo-controlled or comparative local anesthetic blocks and met 3 of the 5 criteria established by the Agency for Healthcare Research and Quality. Information extracted from each study included the details about the study, type, design, patient eligibility criteria, and statistical analysis. Studies were excluded from analysis if they were simply a review or descriptive or involved only a single-block. RESULTS: The data showed that there was conclusive evidence demonstrating that facet joints have a nerve supply and are capable of causing pain with provocation in normal volunteers that reproduces typical pain attribution clinically to facet joints. The studies demonstrated a prevalence of facet joint pain in chronic spinal pain patients of 15% to 45% in lumbar spine, up to 48% in thoracic spine, and 54% to 67% in the cervical spine. Single diagnostic blocks showed a false-positive rate of 27% to 63%. CONCLUSION: The diagnostic accuracy of controlled local anesthetic facet joint blocks is high in the diagnosis of chronic spinal pain.

Journal Article↗
PubMed2003

Evidence-based practice guidelines for interventional techniques in the management of chronic spinal pain.

Evidence-based practice guidelines for interventional techniques in the management of chronic spinal pain are systematically developed and professionally derived statements and recommendations that assist both physicians and patients in making decisions about appropriate health care in the diagnosis and treatment of chronic or persistent pain. The guidelines were developed utilizing an evidence-based approach to increase patient access to treatment, to improve outcomes and appropriateness of care, and to optimize cost-effectiveness. All types of relevant and published evidence and consensus were utilized. The guidelines include a discussion of their purpose, rationale, and importance, including descriptions of the patient population served, the methodology, and the pathophysiologic basis for intervention. Multiple diagnostic and therapeutic interventional techniques are included in this document. Strong evidence was shown for diagnostic facet joint blocks for the diagnosis of facet joint pain, and lumbar provocative discography for discogenic pain. Moderate evidence was shown for sacroiliac joint blocks in the diagnosis of sacroiliac joint pain, and for transforaminal epidural injections in the preoperative evaluation of patients with negative or inconclusive imaging studies, but with clinical findings of nerve root irritation. Moderate to strong evidence was shown for multiple therapeutic interventional techniques including medial branch blocks and medial branch neurotomy; caudal epidural steroid injections and transforaminal epidural steroid injections; lumbar percutaneous adhesiolysis; and implantable therapies. These guidelines do not constitute inflexible treatment recommendations. It is expected that a provider will establish a plan of care on a case-by-case basis, taking into account an individual patient's medical condition, personal needs, and preferences, and the physician's experience. Based on an individual patient's needs, treatment different from that outlined here could be warranted. These guidelines do not represent "standard of care."

Journal Article↗
PubMed2003

Methods for evidence synthesis in interventional pain management.

Healthcare decisions are increasingly being made on research-based evidence, rather than on expert opinion or clinical experience alone. Consequently, the process by which the strength of scientific evidence is evaluated and developed by means of evidence-based medicine recommendations and guidelines has become crucial resulting in the past decade in unprecedented interest in evidence-based medicine and clinical practice guidelines. Systematic reviews, also known as evidence-based technology assessments, attempt to minimize bias by the comprehensiveness and reproducibility of the search for and selection of articles for review. Evidence-based medicine is defined as the conscientious, explicit and judicious use of the current best evidence in making decisions about the care of individual patients. Thus, the practice of evidence-based medicine requires the integration of individual clinical expertise with the best available external evidence from systematic research. To arrive at evidence-based medicine decisions all valid and relevant evidence should be considered alongside randomized controlled trials, patient preferences and resources. However, many systematic reviews in interventional pain management fail to follow evidence-based medicine principles. Clinical practice guidelines are systematically developed statements that assist clinicians, consumers and policy makers to make appropriate healthcare decisions. The complex processes of guideline development depend on integration of a number of activities, from collection and processing of scientific literature to evaluation of the evidence, development of evidence-based recommendations or guidelines and implementation and dissemination of the guidelines to relevant professionals and consumers. Guidelines are being designed to improve the quality of healthcare and decrease the use of unnecessary, ineffective or harmful interventions. This review describes various aspects of evidence-based medicine, systematic reviews in interventional pain management, evaluation of the strength of scientific evidence, differences between systematic and narrative reviews, rating the quality of individual articles, grading the strength of the body of evidence and appropriate methods for searching for the evidence.

Journal Article↗
PubMed2003

Interventional pain management: evolving issues for 2003.

The new millennium has seen the introduction of an array of new Current Procedural Terminology(R) (CPT) codes and the expansion of interventional techniques. Among the many issues of interest to physicians practicing interventional pain management in 2003 are CPT coding, correct coding issues, and utilization. The CPT developed and updated by the American Medical Association, is the most important and commonly used coding system for interventional pain physicians in the United States. A recent development in the CPT system has been to include Category I, Category II, and Category III CPT codes. Inclusion of a code in Category I is generally based on the procedure being consistent with contemporary medical practice and being performed by many physicians in clinical practice in multiple locations. In contrast, CPT Category III, also known as emerging technology codes, is a set of temporary codes for emerging technology, services, and procedures. There have been many new codes since 2000, along with changes in the definitions of the codes and vignettes. In order for the correct coding initiative to be effective, it is essential that the coding describes what actually transpires at each patient encounter. When multiple procedures are performed at the same session, the procedure and post-procedure work do not have to be repeated for each procedure, and, therefore, a comprehensive code describing the multiple services commonly performed together can be used. Thus, many activities which are integral to a procedure are considered as generic activities and are assumed to be included as acceptable medical/surgical practice and, while they couldn't be performed separately, they should not be considered as such when a code narrative is defined. Under this initiative, almost all interventional techniques are affected. The utilization of interventional techniques in the modern era is the final issue. Utilization has been increasing gradually. Thus, it is important for interventional pain physicians to understand the utilization patterns across the nation and for various techniques. This review will discuss the issues of CPT coding, correct coding, and utilization as they pertain to interventional techniques.

Journal Article↗
PubMed2003

Guidelines for the use of controlled substances in the management of chronic pain.

Controlled substance abuse has increased at an alarming rate. However, available evidence suggests a wide variance in the use of controlled substances, as documented by different medical specialties, medical boards, advocacy groups, and the Drug Enforcement Administration. The primary objective of controlled substance guidelines by American Society of Interventional Pain Physicians (ASIPP) is to provide guidance for the use of controlled substances for the treatment of chronic pain. It is anticipated that these practical guidelines will improve quality of care, patient access, and quality of life. Additional benefits include improved treatment efficiency and efficacy, and cost containment by improving the risk-benefit ratio of treating patients with chronic pain. Further goals of this manuscript are to bring consistency in opioid philosophy among the many diverse groups involved, to improve the treatment of chronic pain patients with medically appropriate controlled substances, and to reduce the incidence of drug diversion. These guidelines also reinforce the need for systematic evaluation and ongoing care of patients with chronic or persistent pain. ASIPP controlled substance guidelines also provide a discussion of the epidemiology of chronic pain, the role of controlled substances in treating chronic pain, various aspects of drug abuse, pharmacological considerations, clinical effectiveness of controlled substances, options for treatment monitoring and drug testing and a review of terminology used in addiction medicine. These guidelines do not constitute inflexible treatment recommendations. It is expected that a provider will establish a plan of care on a case-by-case basis, taking into account an individual patient's medical condition, personal needs, and preferences, and the physician's experience. Based on an individual patient's needs, controlled substance prescribing and treatment different from that outlined here may be warranted. These guidelines do not represent "standard of care."

Journal Article↗
PubMed2003

Evaluation of percutaneous disc decompression using coblation in chronic back pain with or without leg pain.

The intervertebral disc is the focal point of pathology for most low back pain. Contained disc herniation is a common cause of low back pain and, when unresponsive to conservative measures, is often treatable by disc decompression. To evaluate the safety and efficacy of percutaneous disc decompression using Coblation (Nucleoplasty) in the treatment of back and/or leg pain associated with contained disc herniation, a prospective, nonrandomized cohort analysis was conducted in an interventional pain management practice. Patients were followed for twelve months post procedure. Eighty patients who presented with discogenic low back pain with or without radicular pain associated with contained disc herniation underwent percutaneous disc decompression using Coblation technology (Nucleoplasty) after failing at least 3 months of conservative and injection therapies. Overall, 75% of patients indicated a decrease in their numeric pain scores at 12 months with a statistically significant reduction in numeric pain scores of 2.43 +/- 2.47 (p<0.0001) compared to baseline. A total of 54% of patients indicated pain relief of 50% or more at twelve months. Additionally, significant improvement was reported by 54%, 44%, and 49% of patients in sitting, standing and walking abilities, respectively, at 12 months. There were no instances of complications. These results indicate that disc decompression using Coblation (Nucleoplasty) is a safe and efficacious procedure for reducing discogenic low back pain with or without leg pain.

Journal Article↗
PubMed2003

Are diagnostic lumbar medial branch blocks valid? Results of 2-year follow-up.

The precise cause of low back pain based on clinical history, physical examination, radiological imaging, and electrophysiological testing can be identified in only 15% of patients in the absence of disc herniation and neurological deficit. The prevalence of chronic lumbar zygapophysial (facet) joint pain ranges from 15% to 45% utilizing comparative local anesthetic blocks in controlled settings in accordance with the criteria established by the International Association for the Study of Pain. Currently, facet joint injection procedures are considered as the gold standard in the diagnosis of facet joint pain. Facet blocks have been criticized as lacking diagnostic validity, along with other tests, including discography, neurophysiologic tests, stress radiographs, x-ray studies, bone scintigraphy, thermography and diagnostic ultrasound. However, these assumptions have been based on biased evaluations without consideration of the criteria of the International Association for the Study of Pain, as well as the nature of controlled diagnostic blocks. Utilizing the criteria established by the Agency for Healthcare Research and Quality (AHRQ) for Systems to Rate the Strength of Scientific Evidence, it was shown that the validity, specificity, and sensitivity of facet joint nerve blocks are considered strong in the diagnosis of facet joint pain. The accuracy of a diagnostic test is best determined by comparing it to an appropriate reference standard, such as biopsy, surgery, autopsy or long-term follow-up. Since we are unable to apply reference standards of biopsy, surgery, or autopsy, and pain relief has been argued as an inconsistent feature, long-term follow-up has been considered as the best indicator. This study was undertaken to evaluate stability of the diagnosis of lumbar facet joint pain following comparative local anesthetic blocks at a follow-up after 2 years. The results showed that 85% of the patients available for follow-up withstood the diagnosis of facet joint pain at the end of 2 years, whereas this proportion decreased to 75%, if all the patients in the study were included in the analysis.

Journal Article↗
PubMed2003

Correlates of non-physiological behavior in patients with chronic low back pain.

It is widely believed that the extent of a patient's subjective complaints are often based on developmental, psychological, social, and cultural factors rather than structural or physical pathology. In patients presenting with chronic low back pain, underlying behavioral problems may not be immediately apparent. These behavioral or non-physiological issues may be secondary to a deliberate deception or may be associated with psychological distress. Waddell et al developed a standardized assessment of behavioral or non-organic signs and symptoms in hopes that such an evaluation of the patient could lead to better utilization of surgical and diagnostic procedures. Multiple authors have described varying results correlating excessive pain behavior with psychological disorders. This study was designed to evaluate psychological correlates of pain behavior in 120 chronic low back pain patients in an interventional pain management setting with 60 men and 60 women. Patients were evaluated with completion of a physical examination, which included Waddell's non-physiological symptoms and signs, and psychological evaluation by Pain Patient Profile (P-3). Results showed that 27 patients (22%) presented with non-physiological symptoms, 34 patients (28%) with non-physiological signs, and 19 patients (16%) with combined presence of non-physiological signs and symptoms. Overall there was significant correlation of non-physiological signs with depression, anxiety, and somatization, both by diagnosis of depression, diagnosis of anxiety and elevated scores. However, correlation was present for non-physiological symptoms only with elevated scores of anxiety and somatization.

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