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Dr. Constanza Bedoya highlights a synergistic approach to lumbar spinal stenosis (LSS) that integrates pain management and surgery for optimal outcomes. While conservative options like physical therapy, medication, and epidural steroid injections offer short-term relief, evidence shows minimal long-term benefit and potential complications with repeated injections. Surgical intervention—open, minimally invasive, or endoscopic—should not be delayed in severe cases to avoid poor outcomes from prolonged compression. A multidisciplinary model, combining perioperative pain management, pharmacologic strategies, and interdisciplinary planning, enhances recovery, reduces hospital stay, and improves functional scores. Ultimately, comprehensive care maximizes pain relief, mobility, and quality of life.
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Integrating Spine Surgery with Pain Management
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To Trial or not to Trial
This session explores the ongoing debate about trial vs. no trial before spinal cord stimulation (SCS) implantation. Historically mandated by NICE and NIH, trials aim to predict long-term outcomes, but recent evidence challenges their necessity. A 2022 RCT found no significant difference in pain, quality of life, or adverse events between trial and no-trial groups at 36 months, though limitations included high dropout rates and marginal statistics. Current guidelines still recommend trials—preferably percutaneous—for patient selection, reducing long-term failure and costs. Future strategies may involve AI prediction models and wireless technology to improve patient selection and streamline processes.
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DRG Stimulation for Low Back Pain
This presentation explores Dorsal Root Ganglion (DRG) stimulation for low back pain, an off-label but promising alternative to traditional spinal cord stimulation (SCS). DRG offers advantages such as better distal dermatomal coverage, low energy consumption, reduced habituation, and potential modulation of sympathetic and nociceptive pain pathways. Studies highlight successful outcomes at T12 and L2 levels, particularly for discogenic and failed back surgery pain, showing consistent improvements in pain scores, function (ODI), and quality of life. Evidence suggests DRG stimulation may outperform SCS in durability and efficacy, making it a compelling option for refractory cases and complex anatomies.
Hybrid Lead Placement For Chronic Neuropathic Pain
The presentation explores hybrid lead placement for chronic neuropathic pain, focusing on the combination of spinal cord stimulation (SCS) and dorsal root ganglion (DRG) stimulation. SCS has evolved with better technology, but challenges remain, including tolerance, positional changes, and inadequate coverage. DRG stimulation provides targeted therapy, especially for CRPS and neuropathic pain, with less positional variation and broader applicability. Evidence shows that combining DRG and SCS offers superior pain relief, dual modulation of nociceptive input, and improved functional outcomes. Recent studies and clinical experience confirm its benefit, particularly for patients with loss of efficacy on a single modality.
Watch Now
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Complex Regional Pain Syndrome CRPS
The lecture addresses Complex Regional Pain Syndrome (CRPS), a neuropathic pain disorder characterized by pain disproportionate to injury, sensory-motor changes, and autonomic dysfunction. Diagnosis relies on the Budapest Criteria, ensuring accurate identification. CRPS pathophysiology involves inflammation, immune changes, peripheral and central sensitization, and autonomic alterations, guiding treatment choices. Management starts with physical and occupational therapy to prevent atrophy, followed by pharmacologic options (anti-inflammatories, anticonvulsants, antidepressants, NMDA antagonists like ketamine, and bisphosphonates). Interventional options include sympathetic blocks, spinal cord stimulation (SCS), and dorsal root ganglion (DRG) stimulation, with DRG shown superior in trials. Early, aggressive, multimodal treatment prevents chronic disability.
Watch Now
Watch Now
Watch Now
Integrating Spine Surgery with Pain Management
Dr. Constanza Bedoya highlights a synergistic approach to lumbar spinal stenosis (LSS) that integrates pain management and surgery for optimal outcomes. While conservative options like physical therapy, medication, and epidural steroid injections offer short-term relief, evidence shows minimal long-term benefit and potential complications with repeated injections. Surgical intervention—open, minimally invasive, or endoscopic—should not be delayed in severe cases to avoid poor outcomes from prolonged compression. A multidisciplinary model, combining perioperative pain management, pharmacologic strategies, and interdisciplinary planning, enhances recovery, reduces hospital stay, and improves functional scores. Ultimately, comprehensive care maximizes pain relief, mobility, and quality of life.
Watch Now
This session explores the ongoing debate about trial vs. no trial before spinal cord stimulation (SCS) implantation. Historically mandated by NICE and NIH, trials aim to predict long-term outcomes, but recent evidence challenges their necessity. A 2022 RCT found no significant difference in pain, quality of life, or adverse events between trial and no-trial groups at 36 months, though limitations included high dropout rates and marginal statistics. Current guidelines still recommend trials—preferably percutaneous—for patient selection, reducing long-term failure and costs. Future strategies may involve AI prediction models and wireless technology to improve patient selection and streamline processes.
To Trial or not to Trial
Watch Now
This presentation explores Dorsal Root Ganglion (DRG) stimulation for low back pain, an off-label but promising alternative to traditional spinal cord stimulation (SCS). DRG offers advantages such as better distal dermatomal coverage, low energy consumption, reduced habituation, and potential modulation of sympathetic and nociceptive pain pathways. Studies highlight successful outcomes at T12 and L2 levels, particularly for discogenic and failed back surgery pain, showing consistent improvements in pain scores, function (ODI), and quality of life. Evidence suggests DRG stimulation may outperform SCS in durability and efficacy, making it a compelling option for refractory cases and complex anatomies.
DRG Stimulation for Low Back Pain
Watch Now
The presentation explores hybrid lead placement for chronic neuropathic pain, focusing on the combination of spinal cord stimulation (SCS) and dorsal root ganglion (DRG) stimulation. SCS has evolved with better technology, but challenges remain, including tolerance, positional changes, and inadequate coverage. DRG stimulation provides targeted therapy, especially for CRPS and neuropathic pain, with less positional variation and broader applicability. Evidence shows that combining DRG and SCS offers superior pain relief, dual modulation of nociceptive input, and improved functional outcomes. Recent studies and clinical experience confirm its benefit, particularly for patients with loss of efficacy on a single modality.
Hybrid Lead Placement For Chronic Neuropathic Pain
Watch Now
The lecture addresses Complex Regional Pain Syndrome (CRPS), a neuropathic pain disorder characterized by pain disproportionate to injury, sensory-motor changes, and autonomic dysfunction. Diagnosis relies on the Budapest Criteria, ensuring accurate identification. CRPS pathophysiology involves inflammation, immune changes, peripheral and central sensitization, and autonomic alterations, guiding treatment choices. Management starts with physical and occupational therapy to prevent atrophy, followed by pharmacologic options (anti-inflammatories, anticonvulsants, antidepressants, NMDA antagonists like ketamine, and bisphosphonates). Interventional options include sympathetic blocks, spinal cord stimulation (SCS), and dorsal root ganglion (DRG) stimulation, with DRG shown superior in trials. Early, aggressive, multimodal treatment prevents chronic disability.
Complex Regional Pain Syndrome CRPS
Published on October 22, 2019
Dr. Edit Racz discusses her passion for pain management and how this has compelled her to join the World Institute of Pain (WIP). She also explains how Pain School International...
