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Article ; Online: Oral opioid analgesics vs. spinal steroid injections in the treatment of low back pain syndromes.

Nampiaparampil, Devi E / Nampiaparampil, Geetha M / Nampiaparampil, Robert G

American journal of physical medicine & rehabilitation

2012 Volume 91, Issue 2, Page(s) 162–176

Abstract: Objective: The aim of this study was to examine the outcomes related to analgesia, function, mortality, and adverse effects of oral opioid analgesics and spinal steroid injections on low back pain syndromes.: Design: Databases including Medline, ... ...

Abstract	Objective: The aim of this study was to examine the outcomes related to analgesia, function, mortality, and adverse effects of oral opioid analgesics and spinal steroid injections on low back pain syndromes. Design: Databases including Medline, EMBASE, PubMed, and Cochrane Library were searched in September 2009 using combinations of terms related to spinal pain and its treatment. A systematic review was performed of randomized controlled trials that enrolled patients with low back pain syndromes and that evaluated patient outcomes after intervention using either oral opioids or spinal steroid injections. Results: Eight high-quality and ten moderate-quality randomized controlled trials were identified. One high-quality study on oral opioid therapy showed significant improvements in pain relief and patient function. Those on spinal steroid injections had a decreased Visual Analog Scale pain score by 7.18 (95% confidence interval, 2.21-12.1) points more than the control group at 1 mo or less and by 0.429 (95% confidence interval, -4.41 to 5.27) points at 1-3 mos. At more than 6 mos, there was no significant benefit: 0.930 (95% confidence interval, -5.03 to 6.89). Spinal steroids decreased the Oswestry Disability Index by 3.53 (95% confidence interval, 0.480-6.57) at 1 mo or less, by -0.281 (95% confidence interval, -3.18 to 2.62) at 1-3 mos, by -11.0 (95% confidence interval, -14.8 to -7.16) at 3-6 mos, and by -0.205 (95% confidence interval, -3.50 to 3.09) compared with the control group at 6 mos or more, suggesting that there was improvement in function. All-cause mortality was low in our analysis of patients attending specialty clinics. It was difficult to assess the adverse effects of opioid therapy because they influenced up to 28% of patients to withdraw from the original studies. In terms of spinal steroid injections, headache appeared to be the most common adverse effect. However, there was no significantly increased risk of headaches associated with spinal steroids compared with control injections: odds ratio, 1.29 (95% confidence interval, 0.69-2.39). Conclusions: Oral opioid therapy may be helpful for the treatment of low back pain, but it is unclear from the high-quality literature whether there are limitations from adverse effects. Spinal steroid injections are beneficial for low back pain and disability in the short-term. The high dropout rates caused by insufficient pain relief and adverse effects suggest that opioids may not be as effective as spinal steroid injections. There is more high-quality literature to support the use of spinal steroid injections compared with oral opioids in this condition.
MeSH term(s)	Administration, Oral ; Analgesics, Opioid/administration & dosage ; Analgesics, Opioid/adverse effects ; Disability Evaluation ; Glucocorticoids/administration & dosage ; Glucocorticoids/adverse effects ; Headache/chemically induced ; Humans ; Injections, Spinal ; Low Back Pain/drug therapy ; Pain Measurement ; Randomized Controlled Trials as Topic
Chemical Substances	Analgesics, Opioid ; Glucocorticoids
Language	English
Publishing date	2012-02
Publishing country	United States
Document type	Journal Article ; Review
ZDB-ID	219390-5
ISSN	1537-7385 ; 0002-9491 ; 0894-9115
ISSN (online)	1537-7385
ISSN	0002-9491 ; 0894-9115
DOI	10.1097/PHM.0b013e318238a028
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Article ; Online: A response to two recent reviews of epidural steroid injections.

Nampiaparampil, Devi E / Engel, Andrew J

Pain medicine (Malden, Mass.)

2013 Volume 14, Issue 6, Page(s) 954–955

MeSH term(s)	Adrenal Cortex Hormones/administration & dosage ; Humans ; Lumbar Vertebrae ; Pain/drug therapy ; Pain/epidemiology ; Radiculopathy/drug therapy ; Radiculopathy/epidemiology ; Sciatica/drug therapy ; Steroids/administration & dosage
Chemical Substances	Adrenal Cortex Hormones ; Steroids
Language	English
Publishing date	2013-06
Publishing country	England
Document type	Comment ; Letter
ZDB-ID	2015903-1
ISSN	1526-4637 ; 1526-2375
ISSN (online)	1526-4637
ISSN	1526-2375
DOI	10.1111/pme.12124
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Article ; Online: Prevalence of chronic pain after traumatic brain injury: a systematic review.

Nampiaparampil, Devi E

JAMA

2008 Volume 300, Issue 6, Page(s) 711–719

Abstract: Context: The Centers for Disease Control and Prevention estimates that approximately 1.4 million US individuals sustain traumatic brain injuries (TBIs) per year. Previous reports suggest an association between TBI and chronic pain syndromes (eg, ... ...

Abstract	Context: The Centers for Disease Control and Prevention estimates that approximately 1.4 million US individuals sustain traumatic brain injuries (TBIs) per year. Previous reports suggest an association between TBI and chronic pain syndromes (eg, headache) thought to be more common in patients with mild TBI and in those who have sustained brain injury from violent rather than unintentional trauma. Comorbid psychiatric disorders such as posttraumatic stress disorder (PTSD) may also mediate chronic pain symptoms. Objectives: To determine the prevalence of chronic pain as an underdiagnosed consequence of TBI and to review the interaction between chronic pain and severity of TBI as well as the characteristics of pain after TBI among civilians and combatants. Evidence acquisition: The Ovid/MEDLINE database was searched for articles published between 1951 and February 2008 using any combination of the terms brain injury, pain, headache, blast injury, and combat (combat disorders, war, military medicine, wounds and injuries, military personnel, veterans). The PubMed and MD Consult databases were searched in a similar fashion. The Cochrane Collaboration, National Institutes of Health Clinical Trials Database, Meta-Register of Current Controlled Trials, and CRISP databases were searched using the keyword brain injury. All articles in peer-reviewed journals reporting original data on pain syndromes in adult patients with TBI with regard to pain prevalence, pain category, risk factors, pathogenesis, and clinical course were selected, and manual searches were performed of their reference lists. The data were pooled and prevalence rates calculated. Evidence synthesis: Twenty-three studies (15 cross-sectional, 5 prospective, and 3 retrospective) including 4206 patients were identified. Twelve studies assessed headache pain in 1670 patients. Of these, 966 complained of chronic headache, yielding a prevalence of 57.8% (95% confidence interval [CI], 55.5%-60.2%). Among civilians, the prevalence of chronic pain was greater in patients with mild TBI (75.3% [95% CI, 72.7%-77.9%]) compared with moderate or severe TBI (32.1% [95% CI, 29.3%-34.9%]). Twenty studies including 3289 civilian patients with TBI yielded a chronic pain prevalence of 51.5% (95% CI, 49.8%-53.2%). Three studies assessed TBI among 917 veterans and yielded a pain prevalence of 43.1% (95% CI, 39.9%-46.3%). PTSD may mediate chronic pain, but brain injury appears to have an independent correlation with chronic pain. Conclusions: Chronic pain is a common complication of TBI. It is independent of psychologic disorders such as PTSD and depression and is common even among patients with apparently minor injuries to the brain.
MeSH term(s)	Brain Injuries/complications ; Chronic Disease ; Combat Disorders/epidemiology ; Comorbidity ; Complex Regional Pain Syndromes/epidemiology ; Complex Regional Pain Syndromes/etiology ; Headache Disorders/epidemiology ; Headache Disorders/etiology ; Humans ; Military Personnel/statistics & numerical data ; Mood Disorders/epidemiology ; Pain/epidemiology ; Pain/etiology ; Prevalence ; Severity of Illness Index ; Stress Disorders, Post-Traumatic/epidemiology ; Substance-Related Disorders/epidemiology ; Veterans/statistics & numerical data ; Warfare
Language	English
Publishing date	2008-08-13
Publishing country	United States
Document type	Journal Article ; Review
ZDB-ID	2958-0
ISSN	1538-3598 ; 0254-9077 ; 0002-9955 ; 0098-7484
ISSN (online)	1538-3598
ISSN	0254-9077 ; 0002-9955 ; 0098-7484
DOI	10.1001/jama.300.6.711
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Article ; Online: Chronic Headache after Pediatric Brain Injury

Devi E. Nampiaparampil

Journal of Behavioral and Brain Science, Vol 01, Iss 03, Pp 81-

A Systematic Review

2011 Volume 86

Abstract: Introduction: Chronic pain is an under-diagnosed consequence of traumatic brain injury (TBI) in subjects aged ≤16. The objective of this study was to determine its prevalence. Methods: The Ovid/Medline database was searched for articles published between ...

Abstract	Introduction: Chronic pain is an under-diagnosed consequence of traumatic brain injury (TBI) in subjects aged ≤16. The objective of this study was to determine its prevalence. Methods: The Ovid/Medline database was searched for articles published between 1951 and February 2008 using any combination of the terms brain injury, pain, headache, blast injury, and combat. The PubMed, MD Consult, Cochrane Collaboration, National Institutes of Health Clinical Trials Database, Meta-Register of Current Controlled Trials, and CRISP databases were searched using the keyword brain injury. 1110 articles were identified for evaluation. 258 articles were reviewed and 26 met the inclusion criteria for calculating the prevalence of chronic pain after TBI. Three cross-sectional studies met the inclusion criteria for calculating this prevalence in the population aged ≤16. Results: Twenty-six studies (18 cross-sectional, 5 prospective, and 3 retrospective) including 4468 patients with TBIs were identified. Fifteen studies assessed headache (HA) pain in 1932 patients. Of these, 1081 complained of chronic HA, yielding a prevalence of 56.0% (95%CI, 53.9% - 58.2%). Three studies furnished data on 262 patients with TBI and age ≤16. One-hundred-fifteen of these subjects experienced chronic HA suggesting prevalence of 43.9% (95%CI, 37.9% - 49.9%) in this population. We found evidence to suggest that there is an association between TBI and the development of chronic HA pain. Conclusions: Chronic pain from headache is a common complication of TBI and is common even among children with apparently minor injuries to the brain. The evidence suggests that this condition is independent of psychiatric disorders such as post-traumatic stress disorder and depression.
Keywords	Traumatic Brain Injury ; Pediatrics ; Pain ; Headache ; Neurology. Diseases of the nervous system ; RC346-429 ; Neurosciences. Biological psychiatry. Neuropsychiatry ; RC321-571 ; Internal medicine ; RC31-1245 ; Medicine ; R ; DOAJ:Neurology ; DOAJ:Medicine (General) ; DOAJ:Health Sciences
Subject code	610
Language	English
Publishing date	2011-08-01T00:00:00Z
Publisher	Scientific Research Publishing
Document type	Article ; Online
Database	BASE - Bielefeld Academic Search Engine (life sciences selection)

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Article: What is the Role of Epidural Injections in the Treatment of Lumbar Discogenic Pain: A Systematic Review of Comparative Analysis with Fusion.

Manchikanti, Laxmaiah / Staats, Peter S / Nampiaparampil, Devi E / Hirsch, Joshua A

The Korean journal of pain

2015 Volume 28, Issue 2, Page(s) 75–87

Abstract: Background: Lumbar discogenic pain without pain mediated by a disc herniation, facet joints, or the sacroiliac joints, is common and often results in chronic, persistent pain and disability. After conservative treatment failure, injection therapy, such ... ...

Abstract	Background: Lumbar discogenic pain without pain mediated by a disc herniation, facet joints, or the sacroiliac joints, is common and often results in chronic, persistent pain and disability. After conservative treatment failure, injection therapy, such as an epidural injection, is frequently the next step considered in managing discogenic pain. The objective of this systematic review is to determine the efficacy of lumbar epidural injections in managing discogenic pain without radiculopathy, and compare this approach to lumbar fusion or disc arthroplasty surgery. Methods: A systematic review of randomized trials published from 1966 through October 2014 of all types of epidural injections and lumbar fusion or disc arthroplasty in managing lumbar discogenic pain was performed with methodological quality assessment and grading of evidence. The level of evidence was based on the grading of evidence criteria which, was conducted using 5 levels of evidence ranging from levels I to V. Results: Based on a qualitative assessment of the evidence for both approaches, there is Level II evidence for epidural injections, either caudal or lumbar interlaminar. Conclusions: The available evidence suggests fluoroscopically directed epidural injections provide long-term improvement in back and lower extremity pain for patients with lumbar discogenic pain. There is also limited evidence showing the potential effectiveness of surgical interventions compared to nonsurgical treatments.
Language	English
Publishing date	2015-04-01
Publishing country	Korea (South)
Document type	Journal Article ; Review
ZDB-ID	2558899-0
ISSN	2093-0569 ; 2005-9159
ISSN (online)	2093-0569
ISSN	2005-9159
DOI	10.3344/kjp.2015.28.2.75
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Article: The provocative lumbar facet joint.

Binder, David S / Nampiaparampil, Devi E

Current reviews in musculoskeletal medicine

2009 Volume 2, Issue 1, Page(s) 15–24

Abstract: Low back pain is the most common pain symptom experienced by American adults and is the second most common reason for primary care physician visits. There are many structures in the lumbar spine that can serve as pain generators and often the etiology of ...

Abstract	Low back pain is the most common pain symptom experienced by American adults and is the second most common reason for primary care physician visits. There are many structures in the lumbar spine that can serve as pain generators and often the etiology of low back pain is multifactorial. However, the facet joint has been increasingly recognized as an important cause of low back pain. Facet joint pain can be diagnosed with local anesthetic blocks of the medial branches or of the facet joints themselves. Subsequent radiofrequency lesioning of the medial branches can provide more long-term pain relief. Despite some of the pitfalls associated with facet joint blocks, they have been shown to be valid, safe, and reliable as a diagnostic tool. Medial branch denervation has shown some promise for the sustained control of lumbar facet joint-mediated pain, but at this time, there is insufficient evidence that it is a wholly efficacious treatment option. Developing a universal algorithm for evaluating facet joint-mediated pain and standard procedural techniques may facilitate the performance of larger outcome studies. This review article provides an overview of the anatomy, pathophysiology, diagnosis, and treatment of facet joint-mediated pain.
Language	English
Publishing date	2009-03-31
Publishing country	United States
Document type	Journal Article
ZDB-ID	2407827-X
ISSN	1935-9748 ; 1935-973X
ISSN (online)	1935-9748
ISSN	1935-973X
DOI	10.1007/s12178-008-9039-y
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Article ; Online: Pain and prejudice.

Nampiaparampil, Devi E / Nampiaparampil, Joseph X / Harden, R Norman

Pain medicine (Malden, Mass.)

2009 Volume 10, Issue 4, Page(s) 716–721

Abstract: Background: The primary objective of this pilot study is to understand the relationship between physicians' characteristics and physicians' management decisions about pain. The secondary aim is to understand how patient characteristics, including race/ ... ...

Abstract	Background: The primary objective of this pilot study is to understand the relationship between physicians' characteristics and physicians' management decisions about pain. The secondary aim is to understand how patient characteristics, including race/ethnicity and socioeconomic status (SES) may affect these treatment decisions in chronic low back pain. Methods: We conducted a double-blinded randomized controlled study using a survey instrument. Ninety physicians were randomly allocated one of two scenarios of a patient with chronic low back and lower extremity pain. In one version, the patient is a Caucasian male with Blue Cross health insurance. In the other version, the patient is an African American male with Medicaid. All other aspects of the survey scenarios are identical. The physicians were subsequently presented with questionnaires about their treatment plans. We analyzed the physician demographic variables in addition to patient ethnicity and SES to differentiate which variables affected treatment preferences. Results: Based on bivariate analysis, physician specialty, gender, ethnicity, and professional status significantly affected treatment plans, including analgesic prescription and referrals for invasive therapy. Patient ethnicity/SES trended toward significance for the prescription of opioids. Conclusion: Our study is the first randomized controlled study assessing patient and treatment variables in the management of chronic pain. It suggests that physicians' demographic variables and perhaps patient demographic variables influence pain management decisions.
MeSH term(s)	Attitude of Health Personnel ; Continental Population Groups ; Data Collection ; Decision Making ; Double-Blind Method ; Health Services Accessibility/statistics & numerical data ; Health Status ; Health Status Disparities ; Humans ; Insurance, Health/ethics ; Pain/epidemiology ; Pain/psychology ; Pain Management ; Patient Satisfaction ; Physician-Patient Relations/ethics ; Pilot Projects ; Practice Patterns, Physicians'/statistics & numerical data ; Prejudice ; Prescriptions/statistics & numerical data ; Quality of Health Care/ethics ; Quality of Health Care/statistics & numerical data ; Referral and Consultation/statistics & numerical data ; Social Class ; Surveys and Questionnaires
Language	English
Publishing date	2009-05
Publishing country	England
Document type	Journal Article ; Randomized Controlled Trial
ZDB-ID	2015903-1
ISSN	1526-4637 ; 1526-2375
ISSN (online)	1526-4637
ISSN	1526-2375
DOI	10.1111/j.1526-4637.2009.00612.x
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Article ; Online: Use of medial branch blocks before radiofrequency ablation for lumbar facet joints.

Sokolof, Jonas M / Nampiaparampil, Devi E / Chimes, Gary P

PM & R : the journal of injury, function, and rehabilitation

2012 Volume 4, Issue 7, Page(s) 521–526

MeSH term(s)	Aged ; Catheter Ablation ; Contraindications ; Humans ; Low Back Pain/surgery ; Lumbar Vertebrae/innervation ; Lumbar Vertebrae/surgery ; Male ; Median Nerve ; Nerve Block ; Platelet Aggregation Inhibitors/therapeutic use ; Risk Assessment ; Ticlopidine/analogs & derivatives ; Ticlopidine/therapeutic use ; Zygapophyseal Joint/innervation ; Zygapophyseal Joint/surgery
Chemical Substances	Platelet Aggregation Inhibitors ; clopidogrel (A74586SNO7) ; Ticlopidine (OM90ZUW7M1)
Language	English
Publishing date	2012-07
Publishing country	United States
Document type	Journal Article
ZDB-ID	2608988-9
ISSN	1934-1563 ; 1934-1482
ISSN (online)	1934-1563
ISSN	1934-1482
DOI	10.1016/j.pmrj.2012.06.011
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Article ; Online: Innovations in access to interventional pain management.

Nampiaparampil, Devi E / Lee, Bowlva M / Chen, Yan Y / Cheng, David S

Military medicine

2013 Volume 178, Issue 4, Page(s) 362–364

MeSH term(s)	Disability Evaluation ; Humans ; Military Medicine/methods ; Pain/rehabilitation ; Pain Management/methods
Language	English
Publishing date	2013-04
Publishing country	United States
Document type	Journal Article ; Review
ZDB-ID	391061-1
ISSN	1930-613X ; 0026-4075
ISSN (online)	1930-613X
ISSN	0026-4075
DOI	10.7205/MILMED-D-12-00398
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Article: Topiramate for the treatment of chronic corneal pain.

Nampiaparampil, Devi E / Nampiaparampil, Robert G / Prasad, Anita G

Cornea

2008 Volume 27, Issue 1, Page(s) 124–126

Abstract: Purpose: To explore the option of using anticonvulsant drugs to modulate pain from corneal erosions.: Methods: N.M. is a 28-year-old woman with posttraumatic recurrent corneal erosions treated with bandage contact lenses, Muro-128, topical ketorolac, ...

Abstract	Purpose: To explore the option of using anticonvulsant drugs to modulate pain from corneal erosions. Methods: N.M. is a 28-year-old woman with posttraumatic recurrent corneal erosions treated with bandage contact lenses, Muro-128, topical ketorolac, doxycycline, stromal micropuncture, and laser epithelial keratomileusis over the course of 4 years. Because of persistent episodes of corneal pain, she was prescribed topiramate. Results: Before starting topiramate therapy, N.M. had experienced 3-4 awakenings at night because of pain and 5-6 episodes of spontaneous tearing and pain during the day. She started topiramate at 25 mg orally 4 times a day without significant change in her symptoms. After 1 week, the dose was escalated to 50 mg orally 4 times a day, and within 1 day, she experienced 0-1 awakenings at night. She had approximately 2-3 episodes of pain and tearing during the day. The dose was escalated to 100 mg orally 4 times a day. At that dose, the patient continued to have pain relief but complained of nausea. The patient's topiramate was weaned off to determine whether her symptom relief was caused by the medication or improvement in her condition. Once off the topiramate, N.M.'s nausea resolved but her corneal symptoms returned at the same frequency as before the initiation of topiramate. Therefore, she was restarted on topiramate 50 mg orally 4 times a day with rapid onset of improvement in her symptoms. Conclusions: Anticonvulsants such as topiramate may be effective in the management of pain caused by recurrent corneal erosions.
MeSH term(s)	Adult ; Anticonvulsants/therapeutic use ; Chronic Disease ; Corneal Diseases/complications ; Corneal Diseases/drug therapy ; Female ; Fructose/analogs & derivatives ; Fructose/therapeutic use ; Humans ; Pain/drug therapy ; Pain/etiology
Chemical Substances	Anticonvulsants ; topiramate (0H73WJJ391) ; Fructose (30237-26-4)
Language	English
Publishing date	2008-01
Publishing country	United States
Document type	Case Reports ; Journal Article
ZDB-ID	604826-2
ISSN	1536-4798 ; 0277-3740
ISSN (online)	1536-4798
ISSN	0277-3740
DOI	10.1097/ICO.0b013e318158f6c8
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