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May/June 2005
Volume 1, Issue 1
In this Issue:
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Click on the icon to view the newsletter as a pdf. |
Questionnaire for Evaluation of Chronic Pain
An Original Contribution by Frank J. E. Falco, M.D.
The Pain Disability Questionnaire (PDQ), developed approximately three years ago, has demonstrated utility in the evaluation of chronic pain patients and not just those with chronic low back pain. The questionnaire appears to accurately assess all types of chronic pain conditions. The PDQ accurately predicts patient outcome and function with medical treatment. The PDQ has shown better consistency, precision, and predictability in regards to the physical component of more traditional pain questionnaires including the Million Visual Analogue Scale (MVAS), Oswestry Pain Questionnaire, and the Short-Form (SF) - 36 Physical Health Component. The psychosocial aspect of the PDQ correlated strongly with other psychosocial measures such as the Beck Depression Inventory (BDI), State-Trait Anxiety Inventory (STAI), and the SF-36 Mental Health Component.
The PDQ yields three different scores: physical function, psychosocial function and a total score. This pain questionnaire is easy to read and to understand by the patient and only requires a sixth grade education. The PDQ allows the clinician to identify those chronic pain patients that will be difficult to treat, which patients will require more careful monitoring, and those patients that will require additional treatment.
Click here to view or download the Pain Disability Questionnaire.
Treatment of the Recreational Athlete with Low Back Pain
An Original Contribution by Frank J. E. Falco, M.D.
The treatment of the recreational athlete with low back pain should be tailored to the specific type of injury and goal oriented for functional restoration. More serious injuries, such as ligamentous disruption, disc herniation or fracture, need to be ruled out. The athlete without a serious injury is encouraged to continue general activity within tolerance. Rehabilitation begins with low impact exercises to maintain mobility and fitness. More specific rehabilitation is applied to the athlete depending on the type of injury.
Rehabilitation progresses from static closed chain to open dynamic chain stabilization exercises emphasizing the spinal and trunk muscles. Athletes are progressed according to injury type and level of competition. The last step is sports specific training designed for the required level of play.The athlete is returned to play when capable of performing sports specific activity with full painless range of motion.
New Procedure for Spine Metastases
An Original Contribution by Frank J. E. Falco, M.D.
There have been significant advances in the treatment of cancer including the management of metastatic disease. One common site for metastases is the spine often seen with primary tumors located in the breast, lung, prostate, kidney and bowel. Spine metastases often result in pain and can lead to compression fractures that further increase pain and can lead to instability or progress into nearby structures.
The advent of vertebroplasty and kyphoplasty in the past 10 years has provided quick and effective pain relief for those with compression fractures stemming from osteoporosis, metastatic disease, hemangioma and trauma. These procedures involve the injection of cement into the vertebra, which reduces pain, improves stability, and in the case of kyphoplasty, restores height. One of the challenges in the past has been treating spine metastases without pushing the metastatic lesion into the vertebral canal and potentially compressing the spinal cord.
New technology now allows the physician to first debulk the vertebra of metastatic tumor through the application of radio frequency before injecting cement via kyphoplasty or vertebroplasty. This reduces the risk of displacing metastatic tumor into the spinal canal and allows a larger injection of cement into the vertebra leading to greater stability and pain relief.
The combination of radiosurgery with vertebroplasty was first used successfully in California earlier this year and recently for the second time at Mid Atlantic Spine. |
