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Pain management

The practice of contemporary pain medicine is laced with a number of significant ethical challenges. Considerable difficulties include the overutilization of interventional procedures, the application of under-evidenced treatment modalities, and potentially superfluous opioid prescribing.

As with many other fields in medicine, including orthopedic surgery, relationships with industry are both common and pervasive, and influence our medical practice through education, publications, and research.

• For treatments options there is a large gap in available evidence
• There are minimally availability of EBM regarding treatment
• Over employment of procedures as substitute for clinical diagnosis or to increase revenue can be a problem in the practice of pain mangement
• There is a lack of a true standard of care within the interventional world
• Benyamin highlighted the explosive growth of physicians performing these procedures( interventional techniques) without training .Therefore practicing physicians must self discipline to utilize the best available EBM to the fullest at the same time using strict criteria.
• Some perhaps in desperation to relieve pain may use a new technique before efficacy is proven.
• Diagnostic facet joint nerve( medial branch nerve) blocks have moderate to stronge evidence in diagnosis of axial lbp  based on studies using the strict criteria of 80% analgesia post procedure but many physicians use 50% or less or only use single block