4:45 PM–5:45 PM Friday, February 28

Lumbar Facet Block and Radiofrequency Ablation International Consensus Guidelines Part 2 (214)

This symposium presents the findings of an international consortium of pain medicine and governmental organizations on the treatment of lumbar facet joint pain to include patient selection, performance and interpretation of diagnostic blocks, and optimization of radiofrequency ablation outcomes.

Minimizing Complications with Lumbar Facet Blocks

Samer Narouze

Should Facet Block Patients Routinely Be Sedated?

Robert Hurley

Differences Between Clinical Practice and Clinical Trials

Mark Wallace

Should a Trial of Conservative Care Be Mandatory Before Facet Blocks?

David Kennedy

Should Sensory and Motor Testing Be Used Before Radiofrequency Ablation?

Zirong Zhao

Learning Objectives:

  • Improve selection criteria for “diagnostic” facet blocks.
  • Learn how to maximize lesion size and its relationship to RF ablation success rate.
  • Identify the issues surrounding patient selection for clinical practice and clinical trials.
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Moderator:

Steven Cohen

Co-Presenters:

Samer Narouze

Robert Hurley

Mark Wallace

David Kennedy

Zirong Zhao

2:45 PM–3:45 PM Friday, February 28

Addressing Controversies Around Epidural Steroid Injections (212)

This session will explore the evidence for opioid sparing, improved function, and surgery prevention from treatment by epidural steroid injection (ESI) and explore other controversies around ESI.

Session Introduction

Samer Narouze

Evidence for Opioid Sparing, Improved Function, and Surgery Prevention

Dermot Maher

Transforaminal vs. Interlaminar Epidural Injection: When to Perform, When to Inject

David Kennedy

Should Anticoagulants Be Held Before ESI?

Susan Moeschler

Learning Objectives:

  • Analyze the literature regarding ESI outcomes: opioid sparing, improved function, and surgery prevention.
  • Develop a plan for when to perform TF vs. IL ESI and how to integrate it into a multimodal plan of care.
  • Assess the pros and cons of using nonparticulate vs. particulate steroids, and recognize the impact of managing anticoagulants with ESI.
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2:45 PM–3:45 PM Friday, February 28

Lumbar Facet Block and Radiofrequency Ablation International Consensus Guidelines Part 1 (210)

This symposium presents the findings of an international consortium of pain medicine and governmental organizations on the treatment of lumbar facet joint pain to include patient selection, performance and interpretation of diagnostic blocks, and optimization of radiofrequency ablation outcomes.

Guideline Questions, Methodology and Patient Selection: How Many Blocks, Cutoff for a Positive Block, and Are Medial Branch or Intra-Articular Injections Better?

Steven Cohen

Imaging and Facet Pain: Evidence for Pre-Block Imaging and Imaging for the Performance Facet Blocks

W. Michael Hooten

What is the Evidence for Larger Lesions and Parallel Electrode Orientation?

David Provenzano

What Volume(s) Should be Used for Medial Branch Blocks and Intra-Articular Injections?

Jee Youn Moon

Learning Objectives:

  • Review selection criteria for “diagnostic” facet blocks.
  • Assess how to maximize lesion size and its relationship to RF ablation success rate.
  • Identify the issues surrounding patient selection for clinical practice and clinical trials.
Read more...
1:30 PM–2:30 PM Friday, February 28

Frontiers in Denervation for Chronic Pain: Sacroiliac Joint Complex, Knee, Shoulder, and Hip (206)

This session presents and critically evaluates the best evidence and recent developments relevant to the use of radiofrequency ablation for the treatment of chronic sacroiliac joint complex, knee, shoulder, and hip joint pain.

Lateral Branch Nerve Radiofrequency Ablation: A Best-Evidence Update

Byron Schneider

Genicular Nerve Radiofrequency Neurotomy: What We Know and What Remains on the Horizon

Zachary McCormick

Terminal Sensory Articular Nerve Denervation: Anatomical Foundations and Emerging Techniques

Ameet Nagpal

The Hippest Procedure Yet: Current State of Denervation for Hip Pain

Patricia Zheng

Learning Objectives:

  • Describe appropriate workup and patient selection for radiofrequency ablation of the sacroiliac joint complex, knee, shoulder, and hip joint.
  • Summarize outcomes data regarding radiofrequency ablation for chronic pain of the sacroiliac joint complex, knee, shoulder, and hip joint.
  • Discuss current limitations in the current literature on radiofrequency ablation for chronic pain of the sacroiliac joint complex, knee, shoulder, and hip joint and potential areas of future growth and research.
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11:00 AM–12:00 PM Friday, February 28

Diagnostic and Prognostic Anesthetic Blocks for Facet, Sacroiliac, and Knee Joint Pain: An Evidence-Based Update (202)

This session discusses the evidence base for anesthetic nerve blocks as a tool to predict clinical outcomes following radiofrequency neurotomy for joint pain. The impact of nerve versus intra-articular block, number of blocks, anesthetic volume used, use of contrast agent, and variations in needle tip position will be reviewed.

Medial Branch Blocks: A Double-Edged Sword

Patricia Zheng

Lateral Branch Nerve Blocks: The Foundational Science and Elements yet to Be Defined

Byron Schneider

Genicular Nerve Blocks: Optimization for Accuracy and Inherent Limitations

Zachary McCormick

Learning Objectives:

  • Review the current diagnostic and clinical outcome literature that addresses medial branch nerve blocks in order to select patients for radiofrequency neurotomy in the treatment of refractory spinal pain of facet joint origin.
  • Describe the foundational literature that defined an anesthetic block paradigm of the lateral branch nerves in order to anesthetize the posterior sacroiliac joint/dorsal ligaments, and discuss the need for prognostic studies of lateral branch nerve blocks to determine if such blocks predict a positive outcome of radiofrequency denervation.
  • Review evidence updates for anesthetic genicular nerve blocks and the evolution in protocol optimization that is underway in current research efforts.
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3:00 PM–4:00 PM Saturday, February 29

Neuromodulation Pain Therapy from Bench to Bedside: 50 Years of Progress and Future Horizons (313)

Innovation in medical technologies to treat pain syndromes is changing the methods available to treat chronic pain. Many of these neuromodulation devices offer an opioid alternative and have sound scientific evidence supporting their use. We will examine the rationale, mechanisms of action, emerging applications, and future directions of neuromodulation approaches to treat pain.

Neuromodulation for Peripheral Neuropathies: What Is the Current Evidence?

Eellan Sivanesan

SCS: What Do We Know Regarding the Science?

Yun Guan

Optogenetic Neuromodulation: Silencing of Nociceptors

Robert Gereau

Learning Objectives:

  • Describe the obstacles and potential strategies to target treatment at the neural interface and the latest research on the mechanisms of pain control by neuromodulation.
  • Discuss the current evidence for neuromodulation to treat peripheral neuropathies.
  • Describe emerging neuromodulation pain therapies, variations now available for electrical stimulation, and new paradigms of therapy target selection.
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Moderator:

Eellan Sivanesan

Co-Presenters:

Yun Guan

Robert Gereau

1:45 PM–2:45 PM Saturday, February 29

Stellate Ganglion Block: Novel Uses to Prolong Efficacy Including PTSD, Innovative Technique, and Modern Pharmacology (312)

There is renewed interest in the stellate ganglion block and its role in treating post-traumatic stress disorder (PTSD) and ulcerative colitis. Putative mechanisms are presented and techniques to optimize the performance of the block are discussed.

Stellate Ganglion Block: More Than Merely a Treatment of Sympathetically Mediated Pain

Joshua Prager

Stellate Ganglion Block: In Post Traumatic Stress Disorder and Ulcerative Colitis

Eugene Lipov

Learning Objectives:

  • Assess the possible role of the stellate ganglion block in the treatment of post-traumatic stress disorder and ulcerative colitis and examine the putative mechanism of this treatment.
  • Analyze the use of modern imaging techniques to perform the stellate ganglion block, minimize medication administered, optimize efficacy, and minimize adverse events.
  • Identify possible ways to prolong the effect of the stellate ganglion block.
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Moderator:

Joshua Prager

Co-Presenters:

Eugene Lipov

1:45 PM–2:45 PM Saturday, February 29

Emerging Applications for Peripheral Nerve Stimulation for Subacute and Chronic Pain Syndromes (309)

The emerging field of peripheral nerve stimulation (PNS) has captivated practitioners in novel treatment ideas for postsurgical and chronic neuropathic pain patients. This session will be a comprehensive review of evidence, techniques, and mechanisms for PNS treatments in the pain population.

Mechanisms of Peripheral Nerve Stimulation

Amitabh Gulati

Indications and Novel Techniques for the Application of PNS

Einar Ottestad

Evidence for PNS in Post-Surgical and Neuropathic Pain Syndromes

Vafi Salmasi

Learning Objectives:

  • Identify the physiology of PNS systems on neural transmissions and improvement in the perception of pain.
  • Recognize the importance of technique, including ultrasound guidance, in optimizing the efficacy of PNS for pain patients.
  • Review the evidence for PNS treatments for postsurgical and chronic neuropathic pain patients.
Read more...
Moderator:

Amitabh Gulati

Co-Presenters:

Einar Ottestad

Vafi Salmasi

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