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Standiford Helm

Publications and source records attributed to Standiford Helm.

7 recordsLinked to original sources
PubMed2006

Opioid guidelines in the management of chronic non-cancer pain.

BACKGROUND: Opioid abuse has increased at an alarming rate. However, available evidence suggests a wide variance in the use of opioids, as documented by different medical specialties, medical boards, advocacy groups, and the Drug Enforcement Administration (DEA). OBJECTIVES: The objective of these opioid guidelines by the American Society of Interventional Pain Physicians (ASIPP) is to provide guidance for the use of opioids for the treatment of chronic non-cancer pain, to bring consistency in opioid philosophy among the many diverse groups involved, to improve the treatment of chronic non-cancer pain, and to reduce the incidence of drug diversion. DESIGN: A policy committee evaluated a systematic review of the available literature regarding opioid use in managing chronic non-cancer pain. This resulted in the formulation of the essentials of guidelines, a series of potential evidence linkages representing conclusions, followed by statements regarding relationships between clinical interventions and outcomes. METHODS: Consistent with the Agency for Healthcare Research and Quality (AHRQ) hierarchical and comprehensive standards, the elements of the guideline preparation process included literature searches, literature synthesis, systematic review, consensus evaluation, open forum presentations, formal endorsement by the Board of Directors of the American Society of Interventional Pain Physicians (ASIPP), and blinded peer review. Evidence was designated based on scientific merit as Level I (conclusive), Level II (strong), Level III (moderate), Level IV (limited), or Level V (indeterminate). RESULTS: After an extensive review and analysis of the literature, the authors utilized two systematic reviews, two narrative reviews, 32 studies included in prior systematic reviews, and 10 additional studies in the synthesis of evidence. The evidence was limited. CONCLUSION: These guidelines evaluated the evidence for the use of opioids in the management of chronic non-cancer pain and recommendations for management. These guidelines are based on the best available scientific evidence and do not constitute inflexible treatment recommendations. Because of the changing body of evidence, this document is not intended to be a "standard of care."

Analgesics, Opioid↗
PubMed2004

Mini-surgical approach for spinal endoscopy in the presence of stenosis of the sacral hiatus.

Spinal endoscopy is a useful tool for the management of intractable low back or radicular pain originating from post lumbar laminectomy syndrome, epidural scarring, or disc protrusions, and non-responsive to conservative modalities and other interventional techniques including fluoroscopically directed epidural steroid injections and percutaneous adhesiolysis. Spinal endoscopy requires that the caudal canal be entered via the sacral hiatus. However, in a very small proportion of patients, access to the caudal canal is restricted because of stenosis or cartilaginous overgrowth of the hiatus. In such cases, the procedure is stopped because of the absence of an alternative approach to enter the epidural space with the spinal endoscope, resulting in non-availability of this treatment. This report describes a novel method of dealing with the problem of cartilaginous obstruction of the sacral hiatus, using a mini-surgical approach to decompress the hiatus, allowing access into the caudal canal.

Journal Article↗
PubMed2004

Information technology in the interventional pain practice: electronic medical records, practice management software, and document management.

Electronic medical records (EMR) can both replace the paper clinical chart and perform scheduling and billing tasks. EMRs are currently used in only a small proportion of medical practices; however, EMR adoption is expected to soar in a few years. Governmental and industry concerns about safety and quality, along with medical practice needs for increased productivity, are fueling this transition. Medical practices are likely to consider transitioning to EMRs. At this point, the marketplace is fragmented in terms of suppliers, and refinement of the software is continuing. Transitioning to an EMR is a step that offers enormous benefits to interventional pain management physicians, in terms of compliance, the ability to maintain quality, and the ability to manage practices, including larger and more complex practices. Transitioning to an EMR is also a major effort in terms of time and expense: the goal is to settle on a specific EMR and continue to use it. This review focuses on (1) why physicians are or are not transitioning to EMRs; (2) the benefits of a transition; and (3) factors to consider in evaluating the various competing software products. Although EMR technology continues to develop, the review also considers areas in which future development is necessary. The most important areas are seen in document management, data input, and outcomes analysis and decision support capability. The EMR market is evolving rapidly. However, this review should in no way serve as an endorsement of any particular system, vendor, or technology.

Journal Article↗
PubMed2004

California Workers' Compensation system: are Occupational Medicine Practice Guidelines sufficient for the treatment of chronic spinal pain or do they require supplementation by guidelines for interventional techniques?

BACKGROUND: The California Workers' Compensation system mandates the use of occupational medicine practice guidelines developed by the American College of Occupational and Environmental Medicine (ACOEM). These Guidelines cover the treatment of acute (less than three months' duration) injuries. The presence in the ACOEM Guidelines of references to procedures which may be of use after the three-month acute period creates ambiguity as to whether the ACOEM Guidelines are applicable after three months. ASIPP's "Evidence-Based Practice Guidelines for Interventional Techniques in the Management of Chronic Spinal Pain" are comprehensive, focusing on management of chronic spinal pain. ACOEM guidelines, mandated by the legislature, do not deal explicitly with chronic pain. Their application in managing chronic pain may result in denial of access to appropriate treatment. Thus, ASIPP guidelines may be supplemental to the ACOEM Guidelines. Evaluation of the two Guidelines may clarify which should be followed in the event of ambiguity or conflict. METHODS: The ACOEM and ASIPP Guidelines were evaluated to determine which more closely conformed with accepted standards for guideline creations; which was listed in the Agency for Health Care Research and Quality's (AHRQ) National Guideline Clearinghouse; and what the common references were, how these references were evaluated, how they supported the treatment guidelines offered, and how the ACOEM and ASIPP guidelines differed. RESULTS: The ASIPP Guidelines complied with 23 out of 25 elements of guideline creation, whereas ACOEM complied with only 12 out of 25. Only ASIPP is listed in the National Guideline Clearinghouse. ACOEM lists 154 references; ASIPP, 1175; only 20 appear in common. ASIPP's evaluation methodology more closely adhered to the AHRQ methodology. ASIPP's Guidelines are based upon a more robust, detailed analysis. CONCLUSION: The ASIPP Guidelines may be considered the applicable Guidelines for the treatment of work-related low back activity limitations persisting beyond three months.

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

Sacroiliac joint pain and dysfunction.

The purpose of this current opinion on sacroiliac joint pain and dysfunction is to assist interventional pain physicians to apply appropriate treatment decisions and rationale to their patients in pain. Discussion of relevant scientific data and controversial positions will be provided. This review is intended to help characterize the sacroiliac joint as a pain generator, and explore its contribution to the differential diagnosis of low back pain. Historical, technical, and current treatment practice will be characterized against current evidence. Discussion will provoke support or criticism of the relevant scientific data, and general recommendations for interventional pain management physicians should be considered within the context of the individual practitioners skill and practice patterns. Current Opinion is not intended to provide a standard of care.

Journal Article↗