Korean J Pain.  2011 Dec;24(4):205-215. 10.3344/kjp.2011.24.4.205.

Interventional Pain Management in Rheumatological Diseases: A Three Years Physiatric Experience in a Tertiary Medical College Hospital in Bangladesh

• Siddiq MA
• Hasan SA
• Das G
• Khan AU

• KMID: 2074015
• DOI: http://doi.org/10.3344/kjp.2011.24.4.205

Abstract

BACKGROUND
Interventional pain management (IPM) is a branch of medical science that deals with management of painful medical conditions using specially equipped X-ray machines and anatomical landmarks. Interventional physiatry is a branch of physical medicine and rehabilitation that treats painful conditions through intervention in peripheral joints, the spine, and soft tissues.
METHODS
A cross-sectional study was conducted using three years of hospital records (2006 to 2008) from the Physical Medicine and Rehabilitation Department at Chittagong Medical College Hospital in Bangladesh, with a view toward highlighting current interventional pain practice in a tertiary medical college hospital.
RESULTS
The maximum amount of intervention was done in degenerative peripheral joint disorders (600, 46.0%), followed by inflammatory joint diseases (300, 23.0%), soft tissue rheumatism (300, 23.0%), and radicular or referred lower back conditions (100, 8.0%). Of the peripheral joints, the knee was the most common site of intervention. Motor stimulation-guided intralesional injection of methylprednisolone into the piriformis muscle was given in 10 cases of piriformis syndrome refractory to both oral medications and therapeutic exercises. Soft tissue rheumatism of unknown etiology was most common in the form of adhesive capsulitis (90, 64.3%), and is discussed separately. Epidural steroid injection was practiced for various causes of lumbar radiculopathy, with the exception of infective discitis.
CONCLUSIONS
All procedures were performed using anatomical landmarks, as there were no facilities for the C-arm/diagnostic ultrasound required for accurate and safe intervention. A dedicated IPM setup should be a requirement in all PMR departments, to provide better pain management and to reduce the burden on other specialties.

Keyword

interventional pain management; rheumatological diseases; physiatry

MeSH Terms

Bangladesh
Bursitis
Cross-Sectional Studies
Exercise
Hospital Records
Injections, Intralesional
Joint Diseases
Joints
Knee
Methylprednisolone
Muscles
Pain Management
Physical and Rehabilitation Medicine
Piriformis Muscle Syndrome
Radiculopathy
Rheumatic Diseases
Spine
Methylprednisolone

Figure

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  Fig. 1 Interventional pain management in different rheumatological conditions. DJD: degenerative peripheral joint disorders, STR: soft tissue rheumatism, IRC: inflammatory rheumatological conditions, R.LBP: radicular low back pain.

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