Evidence-based Interventional Pain Practice: According to Clinical Diagnoses PDF
Preview Evidence-based Interventional Pain Practice: According to Clinical Diagnoses
Evidence-Based Interventional Pain Medicine According to Clinical Diagnoses Evidence-Based Interventional Pain Medicine According to Clinical Diagnoses EDITED BY JAN VAN ZUNDERT MD, PhD, FIPP Anesthesiologist Department of Anesthesiology and Multidisciplinary Pain Centre Ziekenhuis Oost-Limburg Genk, Belgium JACOB PATIJN MD, PhD Neurologist Department of Anesthesiology and Pain Management Maastricht University Pain Centre Maastricht, the Netherlands CRAIG T. HARTRICK MD, DABPM, FIPP Anesthesiologist Departments of Anesthesiology, Biomedical Sciences, and Health Sciences Oakland University William Beaumont School of Medicine Rochester, MI, USA ARNO LATASTER, MSc Anatomist Department of Anatomy and Embryology Maastricht University Maastricht, the Netherlands FRANK J.P.M. HUYGEN MD, PhD, FIPP Anesthesiologist Department of Anesthesiology and Pain Management Erasmus Medical Centre Rotterdam, the Netherlands NAGY MEKHAIL MD, PhD, FIPP Carl E. Wasmthus professor and chair Department of Pain Management Cleveland Clinic Cleveland, OH, USA MAARTEN VAN KLEEF MD, PhD, FIPP Anesthesiologist Department of Anesthesiology and Pain Management Maastricht University Medical Centre Maastricht, the Netherlands EDITORIAL COMMISSIONERS ROGIER TROMPERT, Medical Illustrator NICOLE VAN DEN HECKE, Coordinator A John Wiley & Sons, Ltd., Publication This edition fi rst published 2012, © 2012 by John Wiley & Sons, Ltd Wiley-Blackwell is an imprint of John Wiley & Sons, formed by the merger of Wiley’s global Scientifi c, Technical and Medical business with Blackwell Publishing. Registered offi ce: John Wiley & Sons, Ltd, The Atrium, Southern Gate, Chichester, West Sussex, PO19 8SQ, UK Editorial offi ces: 9600 Garsington Road, Oxford, OX4 2DQ, UK The Atrium, Southern Gate, Chichester, West Sussex, PO19 8SQ, UK 111 River Street, Hoboken, NJ 07030-5774, USA For details of our global editorial offi ces, for customer services and for information about how to apply for permission to reuse the copyright material in this book please see our website at www.wiley.com/wiley-blackwell The right of the author to be identifi ed as the author of this work has been asserted in accordance with the UK Copyright, Designs and Patents Act 1988. All rights reserved. No part of this publication may be reproduced, stored in a retrieval system, or transmitted, in any form or by any means, electronic, mechanical, photocopying, recording or otherwise, except as permitted by the UK Copyright, Designs and Patents Act 1988, without the prior permission of the publisher. Designations used by companies to distinguish their products are often claimed as trademarks. All brand names and product names used in this book are trade names, service marks, trademarks or registered trademarks of their respective owners. The publisher is not associated with any product or vendor mentioned in this book. This publication is designed to provide accurate and authoritative information in regard to the subject matter covered. It is sold on the understanding that the publisher is not engaged in rendering professional services. If professional advice or other expert assistance is required, the services of a competent professional should be sought. The contents of this work are intended to further general scientifi c research, understanding, and discussion only and are not intended and should not be relied upon as recommending or promoting a specifi c method, diagnosis, or treatment by physicians for any particular patient. The publisher and the author make no representations or warranties with respect to the accuracy or completeness of the contents of this work and specifi cally disclaim all warranties, including without limitation any implied warranties of fi tness for a particular purpose. In view of ongoing research, equipment modifi cations, changes in governmental regulations, and the constant fl ow of information relating to the use of medicines, equipment, and devices, the reader is urged to review and evaluate the information provided in the package insert or instructions for each medicine, equipment, or device for, among other things, any changes in the instructions or indication of usage and for added warnings and precautions. Readers should consult with a specialist where appropriate. The fact that an organization or Website is referred to in this work as a citation and/or a potential source of further information does not mean that the author or the publisher endorses the information the organization or Website may provide or recommendations it may make. Further, readers should be aware that Internet Websites listed in this work may have changed or disappeared between when this work was written and when it is read. No warranty may be created or extended by any promotional statements for this work. Neither the publisher nor the author shall be liable for any damages arising herefrom. A catalogue record for this book is available from the British Library. This book is published in the following electronic formats: ePDF 9781119968344; Wiley Online Library 9781119968375; ePub 9781119968351; mobi 9781119968368 Set in 9.25/12pt Minion by Toppan Best-set Premedia Limited, Hong Kong 1 2012 Contents Contributor List, vii 10 Thoracic Pain, 62 Maarten van Kleef, Robert Jan Stolker, Arno Foreword by Menno E. Sluijter, x Lataster, José W. Geurts, Honorio T. Benzon Foreword by P. Prithvi Raj, xi and Nagy Mekhail Intoduction, xiii 11 Lumbosacral Radicular Pain, 71 Koen Van Boxem, Jianguo Cheng, Jacob Patijn, 1 Trigeminal Neuralgia, 1 Maarten van Kleef, Arno Lataster, Nagy Maarten van Kleef, Wilco E. van Genderen, Mekhail and Jan Van Zundert Samer Narouze, Turo J. Nurmikko, Jan Van Zundert, José W. Geurts and Nagy Mekhail 12 Pain Originating from the Lumbar Facet Joints, 87 Maarten van Kleef, Pascal Vanelderen, 2 Cluster Headache, 8 Steven P. Cohen, Arno Lataster, Jan Van Maarten van Kleef, Arno Lataster, Samer Narouze, Zundert and Nagy Mekhail Nagy Mekhail, José W. Geurts and Jan Van Zundert 13 Sacroiliac Joint Pain, 96 3 Persistent Idiopathic Facial Pain, 14 Pascal Vanelderen, Karolina Szadek, Steven P. Cohen, Paul Cornelissen, Maarten van Kleef, Nagy Jan De Witte, Arno Lataster, Jacob Patijn, Nagy Mekhail, Mekhail, Miles Day and Jan Van Zundert Maarten van Kleef and Jan Van Zundert 4 Cervical Radicular Pain, 18 Jan Van Zundert, Marc Huntoon, Jacob Patijn, 14 Coccygodynia, 103 Arno Lataster, Nagy Mekhail and Maarten van Kleef Jacob Patijn, Markus Janssen, Salim Hayek, Nagy Mekhail, Jan Van Zundert and Maarten 5 Cervical Facet Pain, 31 van Kleef Maarten van Eerd, Jacob Patijn, Arno Lataster, Richard W. Rosenquist, Maarten van Kleef, 15 Discogenic Low Back Pain, 107 Nagy Mekhail and Jan Van Zundert Jan Willem Kallewaard, Michel A. M. B. Terheggen, Gerbrand J. Groen, Menno E. Sluijter, Richard Derby, 6 Cervicogenic Headache, 40 Leonardo Kapural, Nagy Mekhail and Hans van Suijlekom, Jan Van Zundert, Samer Maarten van Kleef Narouze, Maarten van Kleef and Nagy Mekhail 16 Complex Regional Pain Syndrome, 123 7 Whiplash-Associated Disorders, 45 Frank van Eijs, Michael Stanton-Hicks, Jan Van Hans van Suijlekom, Nagy Mekhail, Nileshkumar Zundert, Catharina G. Faber, Timothy R. Patel, Jan Van Zundert, Maarten van Kleef Lubenow, Nagy Mekhail, Maarten van Kleef and Jacob Patijn and Frank Huygen 8 Occipital Neuralgia, 49 Pascal Vanelderen, Arno Lataster, Robert Levy, 17 Herpes Zoster and Post-Herpetic Neuralgia, 137 Nagy Mekhail, Maarten van Kleef Albert J. M. van Wijck, Mark Wallace, Nagy Mekhail and Jan Van Zundert and Maarten van Kleef 9 Painful Shoulder Complaints, 55 18 Painful Diabetic Polyneuropathy, 145 Frank Huygen, Jacob Patijn, Olav Rohof, Wouter Pluijms, Frank Huygen, Jianguo Cheng, Arno Lataster, Nagy Mekhail, Maarten van Nagy Mekhail, Maarten van Kleef, Jan Van Zundert Kleef and Jan Van Zundert and Robert van Dongen v Contents 19 Carpal Tunnel Syndrome, 151 24 Chronic Refractory Angina Pectoris, 191 Jacob Patijn, Ricardo Vallejo, Markus Janssen, Maarten van Kleef, Peter Staats, Nagy Mekhail Frank Huygen, Arno Lataster, Maarten van and Frank Huygen Kleef and Nagy Mekhail 25 Ischemic Pain in the Extremities and Raynaud’s 20 Meralgia Paresthetica, 155 Phenomenon, 196 Jacob Patijn, Nagy Mekhail, Salim Hayek, Arno Jacques Devulder, Hans van Suijlekom, Robert Van Lataster, Maarten van Kleef and Jan Van Zundert Dongen, Sudhir Diwan, Nagy Mekhail, Maarten van Kleef and Frank Huygen 21 Phantom Pain, 160 Andre Wolff, Eric Vanduynhoven, Maarten van Kleef, 26 Pain in Chronic Pancreatitis, 202 Frank Huygen, Jason E. Pope and Nagy Mekhail Martine Puylaert, Leonardo Kapural, Jan Van Zundert, Dirk Peek, Arno Lataster, Nagy Mekhail, Maarten 22 Traumatic Plexus Lesion, 168 van Kleef and Yolande C. A. Keulemans Robert van Dongen, Steven P. Cohen, Maarten van Kleef, Nagy Mekhail and Frank Huygen Index, 212 23 Pain in Patients with Cancer, 173 Kris C. P. Vissers, Kees Besse, Michel Wagemans, Wouter Zuurmond, Maurice J.M.M. Giezeman, Arno Lataster, Nagy Mekhail, Allen W. Burton, Maarten van Kleef and Frank Huygen vi Contributor List Honorio T. Benzon MD, FIPP Richard Derby, MD, FIPP Jos é W. Geurts, MSc Department of Anesthesiology Medical Director Department of Anesthesiology and Pain Northwestern University Feinberg School of Spinal Diagnostics and Treatment Center Management Medicine Daly City, CA, USA Maastricht University Medical Centre Chicago, IL, USA Maastricht, the Netherlands Jacques Devulder MD, PhD Kees Besse MD, FIPP Department of Anesthesiology and Maurice J.M.M. Giezeman MD, PhD Department of Anesthesiology Pain and Palliative Multidisciplinary Pain Centre Department of Anesthesiology and Pain Medicine University Hospital Ghent Management Radboud University Ghent, Belgium Diakonessenhuis, Utrecht Nijmegen Medical Centre the Netherlands Nijmegen, the Netherlands Sudhir Diwan, MD, DABIPP, FIPP Executive Director Gerbrand J. Groen MD, PhD Allen W. Burton MD, FIPP The Spine & Pain Institute of New York Department of Anesthesiology & Pain Treatment, Department of Pain Medicine Staten Island University Hospital University Medical Centre Groningen UT MD Anderson Cancer Center New York University of Groningen, Groningen, the Houston, TX, USA Netherlands R obert van Dongen MD, PhD, FIPP Jianguo Cheng MD, PhD Department of Anesthesiology, Pain Craig T. Hartrick, MD, FIPP Department of Pain Management and Palliative Medicine Department of Anesthesiology, Biomedical Cleveland Clinic, Cleveland Radboud University Nijmegen Medical Centre Sciences, and Health Sciences OH, USA Nijmegen, the Netherlands Oakland University William Beaumont School of Medicine S teven P. Cohen MD Maarten van Eerd MD, FIPP Rochester, MI, USA Department of Anesthesiology & Critical Care Department of Anesthesiology and Pain Medicine Management S alim Hayek MD, PhD, FIPP John Hopkins School of Medicine, Baltimore Amphia Ziekenhuis, Breda Division of Pain Medicine Walter Reed Army Medical Center The Netherlands University Hospitals Washington, DC, USA Cleveland, OH, USA Frank van Eijs MD Paul Cornelissen MD Department of Anesthesiology and Pain M arc Huntoon MD Department of Anesthesiology and Pain Management Division of Pain Medicine Management St. Elisabeth Hospital Chief Jeroen Bosch Ziekenhuis ’ s Hertogenbosch Tilburg, the Netherlands Professor of Anesthesiology the Netherlands Vanderbilt University, Catharina G. Faber MD, PhD Nashville TN, USA Miles Day MD, DABA FIPP, DABIPP Department of Neurology Professor Maastricht University Medical Centre F rank Huygen MD, PhD, FIPP Medical Director the Netherlands Department of Anesthesiology and Pain International Pain Centre Texas Tech Management University HSC Wilco E. van Genderen, MD Erasmus University Medical Centre Lubbock, Texas, USA Department of Anesthesiology and Pain Rotterdam Management J an De Witte MD Medical Centre Jan van Goyen Department of Anesthesiology Amsterdam, the Netherlands Intensive Care Medicine, and Pain Management OLV - Ziekenhuis, Aalst, Belgium vii Contributor List Markus Janssen MD, FIPP N ileshkumar Patel MD, MBA M ichael Stanton- Hicks MB; BS, Department of Anesthesiology and Pain Clinical Professor, Anesthesiology Dr med, FIPP Management Advanced Pain Management Department of Pain Management Maastricht University Medical Centre, Maastricht Green Bay, WI, USA Cleveland Clinic, Cleveland The Netherlands OH, USA Jacob Patijn, MD, PhD J an Willem Kallewaard MD, FIPP Department of Anesthesiology and Pain R obert Jan Stolker MD, PhD Department of Anesthesiology and Pain Management Department of Anesthesiology and Pain Management Maastricht University Pain Centre Management Rijnstate Hospital Maastricht, the Netherlands Erasmus University Medical Centre Arnhem, the Netherlands Rotterdam the Netherlands D irk Peek MD L eonardo Kapural MD, PhD, FIPP Department of Anesthesiology and Pain Medicine Hans van Suijlekom MD, PhD Department of Pain Management, St. Jans Gasthuis, Weert Department of Anesthesiology and Pain Cleveland Clinic The Netherlands Management Cleveland, OH, USA Catharina Ziekenhuis, Eindhoven Wouter Pluijms MD The Netherlands Yolande Keulemans, MD, PhD Department of Anesthesiology and Pain Department of Gastroenterology Management K arolina Szadek MD Maastricht University Medical Centre Maastricht University Medical Department of Anesthesiology and Pain Maastricht, the Netherlands Centre, Maastricht Management Vrije Universiteit Amsterdam Maarten van Kleef, MD, PhD, FIPP Jason E. Pope, MD Amsterdam, the Netherlands Department of Anesthesiology and Pain Director of the Headache Center Management Napa Pain Institute Michel A. M. B. Terheggen MD Maastricht University Pain Centre Napa, CA Department of Anesthesiology and Pain Maastricht, the Netherlands Assistant Professor of Anesthesiology Management Vanderbilt University Medical Center Rijnstate Hospital Arno Lataster MSc Nashville, TN Arnhem, the Netherlands Department of Anatomy and Embryology Maastricht University M artine Puylaert MD, FIPP R icardo Vallejo MD, PhD, FIPP Maastricht, the Netherlands Department of Anesthesiology and Millennium Pain Center Multidisciplinary Pain Centre Bloomington, IL, USA Robert Levy MD, PhD Ziekenhuis Oost - Limburg Professor and Chairman Genk, Belgium Koen Van Boxem MD, FIPP Department of Neurological Surgery and Department of Anesthesiology and Pain Co-Director, P rithvi Raj, MD, FIPP Management Shands Jacksonville Neuroscience Institute Department of Anesthesiology and Pain Medicine Sint - Jozefkliniek, Bornem and Willebroek University of Florida College of Medicine Texas Tech University Bornem, Belgium Jacksonville, Fl, USA Texas, TX, USA E ric Vanduynhoven MD T imothy R. Lubenow MD, FIPP Olav Rohof MD, PhD, FIPP Department of Anesthesiology and Pain Department of Anesthesiology Orbis Medisch Centrum, Management Rush University Medical Center Pijnkliniek GZA, Campus Sint Chicago, IL, USA Sittard Geleen Augustinus, Antwerp the Netherlands Belgium Nagy Mekhail, MD, PhD, FIPP Department of Pain Management Richard W. Rosenquist MD Pascal Vanelderen MD, FIPP Cleveland Clinic Chairman of the Pain Management Department Department of Anesthesiology and Cleveland, OH, USA Cleveland Clinic Multidisciplinary Pain Centre Cleveland, OH, USA Ziekenhuis Oost - Limburg, Genk, Belgium Samer Narouze MD, MSc, FIPP Centre For Pain Medicine Menno E. Sluijter MD, PhD, FIPP Jan Van Zundert, MD, PhD, FIPP Summa Western Reserve Hospital Pain Unit, Swiss Paraplegic Centre Department of Anesthesiology and Cuyahoga Falls, Oh, USA Nottwil, Switzerland Muitidisciplinary Pain Centre Ziekenhuis Oost - Limburg, Genk, Belgium T uro J. Nurmikko MD, PhD P eter Staats MD, FIPP Pain Research Institute and Department of Anesthesiology and Critical Care Faculty of Health and Life Sciences Medicine University of Liverpool John Hopkins University Liverpool, UK Baltimore, MA, USA viii Contributor List K ris C. P. Vissers MD, PhD, FIPP Mark Wallace MD A ndre Wolff MD, PhD Department of Anesthesiology Pain and Palliative Center for Pain Medicine Department of Anesthesiology Pain Medicine University of California and Palliative Medicine Radboud University San Diego Medical Center Radboud University Nijmegen Medical Centre Nijmegen Medical Centre San Diego, CA, USA Nijmegen, the Netherlands Nijmegen, the Netherlands A lbert J. M. van Wijck MD, PhD Wouter Zuurmond MD, PhD M ichel Wagemans MD, PhD Department of Anesthesiology and Pain Department of Anesthesiology, Pain Therapy and Department of Anesthesiology and Pain Management Palliative Care Management University Medical Centre, Utrecht VU Medical Centre, Amsterdam Renier de Graaf Groep the Netherlands The Netherlands Delft, The Netherlands ix Foreword by Menno E. Sluijter MD, PhD, FIPP Seeing this book makes me proud of my university city Maas- If this is placebo, so be it. It makes pain treatment different from tricht, where I have left so many footsteps and where I still have putting a stent into a coronary artery or from removing a tumor many friends. It is a great honor for me to have been invited to under general anesthesia. write this foreword. Maturity is a sign of growth and it has to be encouraged. Besides accurately describing the various techniques in detail, Evidence - based medicine will be an indispensible and welcome this book has an accent on evidence - based medicine. This comes element of invasive pain treatment in the time to come. It naturally for the Dutch since soberness and standing fi rmly on the will save patients from getting useless treatments and it will con- ground belong to their prominent features. It makes the book into vince insurers to follow up on reasonable demands. It will hope- a solid and reliable guide for many pain practitioners. fully discourage those who seek fi nancial gain from a vulnerable My fi rst footsteps in the world of invasive pain treatment date group of patients. It will also provide interventional pain treat- back to a very different period. My mentors and teachers were ment with the respected place in the medical community that it Jur Bouma in the Netherlands and legendary names, such as deserves. Sampson Lipton and Mark Mehta, who played such a pivotal But, on the other hand, maturity may also be taken as a sign of role in their time. Those were the days when solitary observa- immanent old age. When reading this book the reader should also tions easily sparked attention or even a trend. Epidural phenol at realize that all these procedures have once been done for the fi rst T12 has been recommended for anal pain for about a decade, one time. This refl ects a mixture of prudence and courage, but also author copying it from another because it was so bizarre. Ond- alertness to observations and the urge to make it a better world for ine ’ s syndrome, as a complication of a cordotomy, received undue patients who could not be helped before. This process of growth attention probably because of its romantic name. Evidence - based and renewal must not be lost. It should be seen as a complement medicine was still a far cry. of evidence - based medicine rather than as a contradiction. After This book therefore symbolizes for me how invasive pain treat- all, without ideas and innovation the need for evidence would ment has become mature within a relatively short period. This soon dry up, and what good is a new procedure without evidence? process of growth has taken place despite a head wind that is The book underscores the need for proper training. The preva- specifi c for the subject. Many of the procedures are intricate, and lence of chronic pain is such that, despite the laudable efforts of success or failure may depend on seemingly trivial details, causing World Institute of Pain, there is still a shortage of well trained differences in results between researchers. Also pain is a subjective doctors who can provide this type of treatment. This is a problem experience and this has various consequences. It makes it particu- because reading even this book is not enough and practical train- larly diffi cult to translate results into numbers that are suitable ing is costly in terms of material and manpower. It is to be hoped for meaningful statistical analysis. It may even infl uence results. that the increasing number of potential trainers will gradually I fi rmly believe that a procedure that is performed by a friendly, resolve the problem. interested doctor in a friendly environment has a greater chance I recommend this book as a standard manual in the library of of success than a procedure under less favorable circumstances. every interventionalist. Happy reading! x Foreword by P. Prithvi Raj MD, FIPP Jan Van Zundert, Jaap Patijn, Craig Hartrick, Arno Lataster, Frank where their pain will be relieved over the short - term rather than Huygen, Nagy Mekhail, and Maarten van Kleef, all internation- addressing the long - term goal of improving the patient ’ s function ally renowned pain physicians, have embarked on writing “ Evi- and quality of life. That is why one fi nds a prolifi c growth of Inter- dence - Based Interventional Pain Medicine According to Clinical ventional Pain Management Clinics and decrease in University - Diagnosis ” . They have devoted most of their lives to improving based Multidisciplinary Clinics. This is certainly the case in the the pain management of patients globally. At their request, I am USA and is also becoming common in other countries. honored to write a Foreword for their new book. Pain Physicians have not tackled at all the discrepancy in pain To emphasize the importance of this book, I need to reiterate practices between developed, developing and under developed the statistics available to us on chronic pain today. Chronic pain countries. There is no factual account of the epidemiology of pain prevails globally, the total number of persons living with this spe- the world over; one cannot say for certain how many Pain Physi- cifi c disease or condition with feeling of pain, ranges from 54% cians are available per capita in any community. We certainly have in Sweden to 13% in Japan. These studies show that in the rest of made advances in understanding the new theories of pain, and the developed countries, such as United States, United Kingdom in some pain syndromes, the longitudinal natural course, but we and Australia, the incidence is somewhere in between. Studies also are far from having a reliable algorithm for any pain disorder. It show that pain imposes a huge economic burden on all countries; is still hit and miss. for example, in the United States it was calculated that in 1991, the The challenge today is to train Pain Physicians in such a way USA spent eighty - six billion dollars on chronic back pain man- that they have a standardized curriculum during their Residency agement. Today, because the elderly are living longer, the prev- and Pain Fellowship programs, followed by skilled practical train- alence of chronic pain is rising with age. Another problem one ing, either in Anesthesiology, Neurosurgery, Physical Medicine needs to recognize is that only one billion people in the developed and Rehabilitation or Psychiatry. Once trained, they need to be countries have the luxury of utilizing the most advanced pain examined and tested periodically for their competency. This will management techniques. The other fi ve billion people, who have raise the standard of pain practice, not only in the USA, but all medium to low standards of living, are unable to receive the ben- over the world. efi ts of these new techniques of pain management. Evidence - based medicine (EBM) or evidence - based practice The World Institute of Pain (WIP) and its members have been (EBP) aims to apply the best available evidence gained from aware of this problem and the disparities between countries in scientifi c methods to clinical decision making. It seeks to assess terms of standard of care and practices of pain management. the strength of evidence of the risks and benefi ts of treatments Since 1994, WIP ’ s mission has been to train pain physicians and (including lack of treatment) and diagnostic tests. Evidence certify their competency in interventional pain management. By quality can range from meta - analyses and systematic reviews of all accounts, this mission has become very successful globally. double - blind, placebo - controlled clinical trials at the top end, Pain practice today is fortunate to have many physicians taking down to conventional wisdom at the bottom. this practice as a professional part of their career. They come Let me explain the history of evidence - based medicine ’ s origin. from all specialties and the book now has to refl ect the advances Traces of evidence - based medicine ’ s origin can be found in in Pain Practice of all those specialties, not just those in Anesthe- ancient Greece. Although testing medical interventions for effi - siology. The debate is still raging whether a single pain specialist cacy has existed since the time of Avicenna ’ s The Canon of Medi- can deliver better pain management than a group of specialists cine in the 11th century, it was only in the 20th century that this together. The cost of managing such multidisciplinary clinics has effort evolved to impact almost all fi elds of health care and policy. been called into question especially by the reimbursement agen- Professor Archie Cochrane, a Scottish Epidemiologist, through cies. A program developed by a multidisciplinary clinic is nowa- his book Effectiveness and Effi ciency: Random Refl ections on days rejected outright by the reimbursement agencies, and even if Health Services (1972) and subsequent advocacy caused increas- it is approved, the effi cacy of such programs is questionable. More ing acceptance of the concepts behind evidence - based practice. and more the patients are referring themselves to the Pain Clinics Cochrane ’ s work was honored through the naming of centers xi
The list of books you might like
