We found a high no-show rate, which was associated with predictable and unpredictable (eg, snow) factors. Steps to reduce the no-show rate are discussed. To maximize access to care, operation managers should consider a regression model that accounts for patient-level risk of predictable no-shows. Knowing the patient level, no-show rate can potentially help to optimize the schedule programming by staggering low- versus high-probability no-shows.

There are many obstacles for the development of effective medications to treat chronic pain, including the inherent challenges in identifying pathophysiological mechanisms, the overlap and multiplicity of pain pathways, and off-target adverse effects stemming from the ubiquity of drug target receptor sites and the lack of highly selective receptor ligands. Despite these barriers, the number and diversity of potential therapies have continued to grow, to include disease-modifying and individualized drug treatments.

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In the United States, there are 143.3 million people who own a smartphone mobile technology as of July 2013, accounting for 60% of the mobile phone market [1]. Concurrently, approximately 100 million people in the United States are suffering from chronic pain [2]. While the intersection of these two populations is unknown, the portion of the people who do have access to a mobile technology and suffer from chronic pain is likely significant to warrant exploration of the benefits of mobile technology applications on the management of chronic pain.In light of the changes in health care with the Affordable Care Act, physicians are asked to adapt and provide a high level of care more efficiently thus driving the growth of mobile technology usage. Modern-day patients now have the opportunity to quickly access health information on the Internet via ubiquitous smartphones or tablets. Within seconds, they can research treatment options, study disease prognosis, and view videos of surgical procedures online. Although physicians remain the most trusted source of medical information, studies have shown that patients also seek this information online. In 2005, a Health Information National Trends survey reported 63.7% of the 6,369 patients studied searched health-related information prior to visiting their physician.The rise in both mobile technology use and the growing number of available pain management mobile applications has led clinicians to questions what applications are available to their patients. In 2012, Dr. L. Wallace conducted a systematic review of 222 unique pain-related mobile applications to determine their commercial information, including the cost, primary purpose, and involvement by any medical professional in developing the app [3]. The researcher found that most pain-related mobile applications were providing the patient with interactive pain diaries, exercises, and pain-coping strategies to help manage stress, moderate emotional reactions, and maintain an overall balanced lifestyle [4]. However, nearly twothirds of these mobile applications were not designed or edited by licensed health care providers [5]. In fact, according to Dr. Wallace's study, only 27% of the mobile applications had confirmed some participation in design by a physician (MD or DO) and 8% by a nonphysician health care provider.Even if clinician participation in the design of most mobile applications is limited or even absent, the next question becomes: how effective are these applications at helping patients manage their chronic pain? Rosser et al. described several core characteristics that a panel of clinicians and chronic pain patients believed would be important to incorporate into the design of a successful pain management application [6]. These identified characteristics were: supporting awareness of behavioral patterns, encouraging personal goals, and providing access to a real-time therapist.Kristjansdottir et al. examined this topic further in a randomized controlled trial aimed at assessing the efficacy of a mobile technolo...

IntroductionLow back pain is the leading cause of disability worldwide, with sacroiliac joint pain comprising up to 30% of cases of axial lower back pain. Conservative therapies provide only modest relief. Although placebo-controlled trials show efficacy for sacral lateral branch cooled radiofrequency ablation, there are no comparative effectiveness studies.MethodsIn this randomized, multicenter comparative effectiveness study, 210 patients with clinically suspected sacroiliac joint pain who obtained short-term benefit from diagnostic sacroiliac joint injections and prognostic lateral branch blocks were randomly assigned to receive cooled radiofrequency ablation of the L5 dorsal ramus and S1–S3 lateral branches or standard medical management consisting of pharmacotherapy, injections and integrative therapies. The primary outcome measure was mean reduction in low back pain score on a 0–10 Numeric Rating Scale at 3 months. Secondary outcomes included measures of quality of life and function.Results3 months post-treatment, the mean Numeric Rating Scale pain score for the cooled radiofrequency ablation group was 3.8±2.4 (mean reduction 2.5±2.5) compared with 5.9±1.7 (mean reduction 0.4±1.7) in the standard medical management group (p<0.0001). 52.3% of subjects in the cooled radiofrequency ablation group experienced>2 points or 30% pain relief and were deemed responders versus 4.3% of standard medical management patients (p<0.0001). Comparable improvements favoring cooled radiofrequency ablation were noted in Oswestry Disability Index score (mean 29.7±15.2 vs 41.5+13.6; p<0.0001) and quality of life (mean EuroQoL-5 score 0.68±0.22 vs 0.47±0.29; p<0.0001).ConclusionsIn patients with sacroiliac joint pain, cooled radiofrequency ablation provided statistically superior improvements across the spectrum of patient outcomes compared with standard medical management.Trial registration numberNCT03601949.

Objectives: Intrathecal drug delivery systems (IDDSs) are used for the treatment of pain and spasticity. A wide range of educational criteria exist for these devices. The North American Neuromodulation Society (NANS) Education Committee developed a comprehensive IDDS curriculum to function as a standard for physician graduate education and assessment through training and into practice.Material and Methods: A multidisciplinary and diverse task force gathered by the NANS Education Committee met in person and virtually over several sessions and developed an IDDS curriculum modeling their previous work on spinal cord stimulation and following the Accreditation Council for Graduate Medical Education (ACGME) Milestones. There were iterative revisions and adaptations to the curriculum, and the final version was approved by the NANS Board of Directors. Results:The curriculum was developed with distinction between implanting physicians and managing physician and physicians who perform both tasks. There is a lateral temporal progression from early learner to practitioner, with advanced learner in the middle. In addition, there is a modular vertical organization that divides the curriculum into the six educational competencies outlined by the ACGME.

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Chronic bleeding disorders, allergy to implants, and chronic infections are all complicating factors when considering neuromodulation therapies. The American Society of Pain and Neuroscience (ASPN) determined a need for clinical guidance in these special patient populations that have increased risk of complications, in order to ensure patient safety and optimal outcomes with device implantation. The purpose of this publication was to review the published literature and explore the unique clinical challenges encountered among several special patient populations with relation to spinal cord stimulation. The executive board of the ASPN appointed a diverse group of well-established physicians to develop best practice guidelines regarding spinal cord stimulation implantation in these special populations. The physicians used the United States Preventive Services Task Force (USPSTF) structured guidelines for grading and level of certainty to make evidence-based recommendations about clinical practice. Where sufficient evidence was lacking to justify a USPSTF ranking, the physicians queried experts in neuromodulation and achieved consensus. These best practices and interventional guideline found the evidence for the use of neuromodulation in specialized patient populations to be relatively modest.