Evidence-based pain medicine: The good, the bad, and the ugly

Neuraxial and sympathetic blocks in herpes zoster and postherpetic neuralgia: An appraisal of current evidence

“…However, the specific role of individual techniques in the management of various pain syndromes is still evolving. 11,12 EBM offers an excellent vehicle to assess these questions and provide a logical approach to pain management.…”

Suprascapular nerve block at the spinoglenoid notch

“…2 Patients are typically affected in their second or third trimester. 3 Progressive uterine enlargement may place traction on the iliohypogastric nerve; this nerve may become entrapped as it traverses the anterolateral abdominal musculature. 2 Iliohypogastric neuralgia typically presents as severe pain in the ipsilateral lower abdominal quadrant, flank, inguinal region, and superolateral hip area.…”

“…If this nerve block is diagnostic, pain relief occurs within a few minutes and can last several hours. 3 Subsequently, cryoneurolysis may be used for long-term pain relief. 2,3 Cryoneurolysis induces a reversible lesion, which minimizes the risk of neuritis, neuroma formation, and deafferentation pain.…”

“…2,3 Cryoneurolysis induces a reversible lesion, which minimizes the risk of neuritis, neuroma formation, and deafferentation pain. 3 Six cases of iliohypogastric neuralgia in pregnancy, which were successfully treated with neural blockade or cryoneurolysis, have been reported. 2,3 There were no complications from these procedures.…”

When Bad Evidence Happens to Good Treatments

“…It was already clear that powerful stakeholders in the healthcare enterprise were looking to evidencebased medicine (EBM) for answers about effectiveness, cost effectiveness, appropriateness, and even efficacy beyond what EBM could reasonably provide. 9 Since then, over-and mis-application of EBM to support health policies such as "pay for performance" and to restrict payment has created a crisis. 10 This ongoing crisis threatens the survival of important forms of pain therapy, restricting health care offered by many members of ASRAPM and the clinical infrastructure needed to sustain it.…”