Abstract Details

Title Needle in the Neuro Clinic: Access to an Intervention Pain Physician in Outpatient Neurology, a 1-year Sample.

Topic General Neurology

Presentation(s) P3 - Poster Session 3 (12:00 PM-1:00 PM)

Poster/Presentation
Number 6-003

Objective To assess outpatient procedures performed when an interventional pain physician is accessible and available in the outpatient neurology clinic.

Background While interventional pain is an available ACGME accredited fellowship for neurology, neurologists represent a small percentage of board-certified pain physicians.

Design/Methods A 1-year retrospective sample of the neurology outpatient procedures and outcomes was assessed after full establishment of an in-clinic interventional pain physician, with electronic and in-person access (2016).

Results More than 600 procedures were performed for the outpatient neurology clinic. For lumbar puncture (LP), 141 were ordered and 121 patients came for their LP (86%). Latency from web-based order to LP procedure was 3.3 weeks (+/- 2.9 STD). 100% of LPs were successful, with fluoroscopy available. The diagnostic questions were idiopathic intracranial hypertension (IIH, n=69) with 34 patients (49%) having an opening pressure ≥ 25 cm of H2O; Neurosyphilis (n=20) was vDRL positive in 3 patients (15%); Multiple sclerosis (MS, n=14) had greater than 5 oligoclonal bands in 9 patients (64%), Normal pressure hydrocephalous (NPH, n=7) had improved gait after LP in 3 patients (43%); other diagnostic questions (n=31) had LP and CSF findings in 8 patients (26%). Six lumbar punctures required blood patches, with 100% efficacy. Clinic nerve block requests were typically done same day or within 2 weeks: 99 occipital nerve blocks, 13 peripheral trigeminal nerve blocks, 30 carpal tunnel injections, 7 ulnar-cubital tunnel injections, and 11 meralgia paresthetica blocks. Peripheral nerve blocks gave patients >50% sustained pain benefit in ~70% of cases. For musculoskeletal pain, 240 trigger point injections and 79 intraarticular joint injections were done.

Conclusions The accessible presence of an intervention pain doctor in the Neurology clinic leads to more therapeutic and diagnostic options and shortens wait times associated with traditional referral to external specialists.

Authors/Disclosures
Steven Soler, MD (Boston Medical Center) PRESENTER	No disclosure on file
Alexis A. Clay, MD (USC KECK HOSPITAL)	No disclosure on file
	No disclosure on file
Michael D. Perloff, MD, PhD	Dr. Perloff has received personal compensation in the range of $10,000-$49,999 for serving as an Expert Witness for several law firms/Universities.

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