REGULAR CONTENT
Final ID
638
Type
Educational Exhibit-Poster Only
Authors
N Kokabi1, A Putnam2, D Silin2, M Johnson3
Institutions
1Yale School of Medicine, New Haven, CT, 2Yale University School of Medicine, New Haven, CT, 3Yale University School Of Medicine, New Haven, CT
Purpose
1.To review interventional pain procedures and the advantages they hold for patient management 2.To review case examples where IR and palliative care positively impact patient care and quality of life 3.To illustrate a model of where palliative care and IR clinicians work together to achieve rapid and improved pain control
Materials & Methods
A patient in severe pain is an emergency that needs to be evaluated and treated quickly - particularly for those with end-stage disease on the palliative care service. Large doses of opioids and adjuvants are the mainstay of treatment for many physicians unfamiliar with interventional options for therapy. Opioids are sedating and may be incompletely effective, particularly in patients with neuropathic pain. In such situations, an IR procedure may relieve pain far faster than the time it takes for radiation and/or chemotherapy to be effective. A pre-therapeutic IR pain procedure may allow the definitive treatment to be better tolerated and more likely to be completed.
Results
We present a series of clinical vignettes in which the palliative care clinician works closely with interventional radiology to provide better pain management than was possible with either therapy alone. The decision making process including patient selection, choice of procedure, equipment and follow-up are described. Case histories and diagnostic and procedural images are presented for each case. Cases will stress indications and contra-indications as well as risks, benefits, and complications. Procedures include: epidural steroid injections, nerve root and facet blocks, vertebral augmentation, celiac ganglion impar block for perineal and pelvic pain, trigeminal ganglion and sphenopalatine blocks for facial pain and spinal pumps and stimulators for pain and spasticity.
Conclusions
IR can play a significant role in optimal pain management of palliative care patients by providing better pain control and reducing narcotic dependence. It is incumbent on all IR physicians to have knowledge of the variety of procedures that can be offered and to collaborate with our palliative care colleagues to provide optimal care for all of our patients.
Final ID
638
Type
Educational Exhibit-Poster Only
Authors
N Kokabi1, A Putnam2, D Silin2, M Johnson3
Institutions
1Yale School of Medicine, New Haven, CT, 2Yale University School of Medicine, New Haven, CT, 3Yale University School Of Medicine, New Haven, CT
Purpose
1.To review interventional pain procedures and the advantages they hold for patient management 2.To review case examples where IR and palliative care positively impact patient care and quality of life 3.To illustrate a model of where palliative care and IR clinicians work together to achieve rapid and improved pain control
Materials & Methods
A patient in severe pain is an emergency that needs to be evaluated and treated quickly - particularly for those with end-stage disease on the palliative care service. Large doses of opioids and adjuvants are the mainstay of treatment for many physicians unfamiliar with interventional options for therapy. Opioids are sedating and may be incompletely effective, particularly in patients with neuropathic pain. In such situations, an IR procedure may relieve pain far faster than the time it takes for radiation and/or chemotherapy to be effective. A pre-therapeutic IR pain procedure may allow the definitive treatment to be better tolerated and more likely to be completed.
Results
We present a series of clinical vignettes in which the palliative care clinician works closely with interventional radiology to provide better pain management than was possible with either therapy alone. The decision making process including patient selection, choice of procedure, equipment and follow-up are described. Case histories and diagnostic and procedural images are presented for each case. Cases will stress indications and contra-indications as well as risks, benefits, and complications. Procedures include: epidural steroid injections, nerve root and facet blocks, vertebral augmentation, celiac ganglion impar block for perineal and pelvic pain, trigeminal ganglion and sphenopalatine blocks for facial pain and spinal pumps and stimulators for pain and spasticity.
Conclusions
IR can play a significant role in optimal pain management of palliative care patients by providing better pain control and reducing narcotic dependence. It is incumbent on all IR physicians to have knowledge of the variety of procedures that can be offered and to collaborate with our palliative care colleagues to provide optimal care for all of our patients.