S168 S290
PAIN & SPINE MEDICINE POSTER HALL: ORIGINAL RESEARCH
Poster 99:
Cervical C2 and C3 Spinal Dorsal Rami
Radiofrequency Ablation for Occipital Headache
Priyanca Mody, Linqiu Zhou, MD, David A. Janerich, DO
Disclosures:
Priyanca Mody: I Have No Relevant Financial Relation-
ships To Disclose
Objective:
To evaluate the efficacy of radiofrequency (RF) ablation of
C2 and branches of C3 spinal dorsal rami in the treatment of occipital
headache.
Design:
Retrospective chart review.
Setting:
Academic and private practice pain clinics.
Participants:
24 patients (12 males, 12 females) ages 31-81 years old
(average 52 years old). All patients had a clinical history of occipital
neuralgia with headache symptoms 3 weeks-10 years (average 39.5
months). 14 patients were treated for a right-sided, 8 for a left-sided,
and 2 for a bilateral headache. All patients failed conservative
treatment, medication and physical therapy. Occipital nerve blocks
provided temporary relief. All patients received more than 50% pain
reduction from C2 and the branches of C3 spinal dorsal rami injection.
Interventions:
Under fluoroscopic guidance, a 20 gauge/10 cm RF
needle was inserted until contacting the C2 spinal dorsal ramus and
the first and second branches of the C3 spinal dorsal ramus (based on
patient-reported pain occurring with less than 0.7mV of sensory nerve
stimulation). 1cc of 0.25% bupivacaine was injected before the RF
ablation. The ablation was performed at 90 C for 2 minutes. Then, 1cc
of 0.25% betamethasone solution (Celestone) was injected to prevent
RF-induced neuritis.
Main Outcome Measures:
Pain reduction, duration of pain relief, and
complication from the RF procedure.
Results:
23 patients had 50-100% occipital headache reduction lasting
from 3 months-2 years (average 9.5 months). One patient had only 20-
30% of pain reduction. One of the 24 patients developed RF-induced
neuritis, characterized by skin hypersensitivity over the site of inter-
vention, which resolved 2-3 weeks after the procedure. There were no
other adverse effects.
Conclusions:
The treatment options for occipital neuralgia include
manipulation, medication, injection, surgical decompression, and
peripheral nerve stimulation. Radiofrequency ablation of C2 Spinal
dorsal ramus and the branches of C3 spinal dorsal ramus is minimally
invasive, safe, and can provide significant sustained pain relief.
Level of Evidence:
Level IV
Poster 102:
Short and Long Term Efficacy of Ultrasound Guided
Sacroiliac Joint Injections When Combined with
Physical Examination and Point of Maximal
Tenderness
Douglas E. Hemler, MD (Sports and Orthopedic Rehab PLLC),
Patrick J. Wallace, OMS-III, Laurie M. Bezjian, OMS-III, Kyle C. Morgan,
DO
Disclosures:
Douglas Hemler: I Have No Relevant Financial Relation-
ships To Disclose
Objective:
Demonstrate the short and long term efficacy of a new
technique for diagnosing and treating low back pain originating from
the SI joint utilizing a combination of ultrasound guided injections,
physical examination, and Point of Maximal Tenderness (PMT).
Design:
Retrospective chart analysis.
Setting:
Private outpatient clinic.
Participants:
26 patients between the ages of 18 and 80 years old with
a diagnosis of sacroiliitis (M46.1).
Interventions:
Charts were evaluated from a period between January
1, 2015 and July 31, 2016. Patients included in the study had previously
received an SI joint injection of 2mL 1% lidocaine, 2mL 0.25% bupi-
vacaine, and 1mL triamcinolone 40mg/mL under ultrasound guidance
in conjunction with physical examination and PMT.
Main Outcome Measures:
Numeric Rating Scale for Pain (NRS) to re-
cord patient pain levels pre-injection, immediately post-injection, and
1-3 months post-injection. Immediate percentage of pain relief post-
injection was also documented.
Results:
This study analyzes both the early phase (lidocaine) and late
phase (corticosteroid) responses from an SI joint injection. Patients
showed a statistically significant decrease in pain (NRS) immediately
post-injection compared to pre-injection pain levels, p
<
.0001. There
was a less statistically significant decrease in pain levels at 1 to 3
months post-injection (p
¼
.0515, p
<
.05 was considered statistically
significant). The percentage of immediate post-injection pain relief
was very statistically significant, p
<
.0001, compared to no interven-
tion (0% pain relief).
Conclusions:
The ultrasound guided injection method combined with
physical exam and PMT showed to be an effective modality in correctly
identifying the SI joint as the pain generator as well as reducing pain
among patients with SI joint dysfunction.
Level of Evidence:
Level III
Poster 103:
Opioid Reduction Tool in the Acute Rehabilitation
Setting
Kunj G. Patel, MD (Emory University SOM, Atlanta, GA, United States),
Casey M. Leong, MD, Anna McCrate, MD, Bejamin A. Abramoff, MD,
Mairin A. Jerome, MD, Leila Ettefagh, MD, Mike Reed, RPh,
Dale C. Strasser, MD, FAAPMR
Disclosures:
Kunj Patel: I Have No Relevant Financial Relationships To
Disclose
Objective:
Background: CDC guidelines discourage the use of
chronic opioid therapy, with particular attention to regimens with a
Morphine Equivalent Dose (MED) greater than 50, due to the
increased risk of addiction, abuse, and death. This study aims to
decrease the opioid burden among patients admitted to an acute
rehabilitation hospital.
Design:
Methods: MED on admission and at discharge was calculated
at an acute rehabilitation hospital during a two-month period in
2016. Didactics on MED charts were then given to house staff and
attending physicians. Subsequently, MED charts of common orders
were posted in clinical work areas. MED calculations for admissions
and discharges for the next two months were repeated. Calcula-
tions of MEDs and trends were emailed weekly to the physiatry
team. The primary outcome of the study was to identify the num-
ber of discharged patients with MED less than or equal to 50. The
secondary outcome was noting the change in MED from admission to
discharge.
Setting:
Acute rehabilitation hospital.
Participants:
All patients admitted to the acute rehabilitation hospi-
tal over a two-month period.
Interventions:
Didactics on MED charts were given. MED charts were
posted at clinical work areas. MED calculations were submitted to
physiatry team to evaluate weekly trends.
Main Outcome Measures:
The primary outcome of the study was to
identify the number of discharged patients with MED less than or equal
to 50. The secondary outcome was noting the change in MED from
admission to discharge.
Results:
After posting MED charts around the rehabilitation hospi-
tal, only 12% were discharged with MED greater than 50, compared
with 23% before the intervention. Furthermore, the decrease
in MED (expressed as a percent change) from admission to
discharge was significantly greater in the post-intervention group.
(p
<
.001).
S168
Abstracts / PM R 9 (2017) S131-S290