RFL is an effective treatment for TN. Major complication rates are low. The most likely complicat... more RFL is an effective treatment for TN. Major complication rates are low. The most likely complications are related to the extent and density of lesion created and has been mitigated by the treatment strategy of minimizing the amount of hypoesthesia created during thermoablation.
Pain practice : the official journal of World Institute of Pain, 2005
Chronic pain has only recently been recognized as an important health care issue. There is no wid... more Chronic pain has only recently been recognized as an important health care issue. There is no widely shared agreement as to the best ways to diagnose and treat chronic pain patients. Pain management is a chaotic component of contemporary medicine. I argue that we need to think of chronic pain as a disease in its own right and develop our specialty of pain management on the basis of evidence for treatment outcomes. The current chaotic state confuses patients, health care providers, and payers. It is possible that pain management may disappear from health care if we do not improve our understanding of chronic pain and how to best treat those who suffer.
Chronic back pain (CBP) is a common symptom throughout the world, and those undergoing it often e... more Chronic back pain (CBP) is a common symptom throughout the world, and those undergoing it often experience a profound degradation of life. Despite extensive research, it remains an elusive symptom. In most cases, CBP is “non-specific,” since bio-mechanisms examined in the clinic do not account for it; another way of saying this is that it is “of obscure origins.” This paper re-directs attention towards origins that are distal and usually out of sight from the vantage point of the clinic. CBP as considered here is non-specific, persists ≥ 3 months, and, additionally, interferes with activities of daily life, such as family interaction or work. A theory proposed in the paper draws upon Durkheim’s Suicide to explain why exposures in the distal social contexts of family and workplace are fundamentally implicated in CBP. The theory is formed out of previously published studies on family and workplace social contexts of CBP and, in effect, provides a theoretical framework with which to review them. After treatment of CBP in the clinic, patients return to family and workplace contexts. Unless exposures in these contexts are addressed, they serve as continually renewing sources of CBP that remain unabated regardless of mechanism-based treatment in the clinic.
A minority of industrial-back-sprain claimants account for most of the cost of industrial back sp... more A minority of industrial-back-sprain claimants account for most of the cost of industrial back sprain: those whose disability persists into “chronicity,” which is defined as 90 days or more off work. The data in this study demonstrate the effects of socioeconomic factors on chronicity. This analysis is based on State of Washington industrial insurance claims for back sprain. For both men and women, three socioeconomic factors significantly affect the risk of chronicity: age, wage, and the family status of being either widowed or divorced with no children. In addition, the Nam-Powers Socioeconomic Index is significant for men. Wage compensation ratio cannot be shown to be a factor in chronicity.
The hospital separation records for 1987 in the health planning regions of South Australia were r... more The hospital separation records for 1987 in the health planning regions of South Australia were reviewed using a selection algorithm to identify all hospitalizations involving a lumbar spine surgery (LSS) for low back or leg pain. Among 16 health planning regions (two additional regions were excluded from the analysis because of the low number of observations) the LSS rate varied almost four-fold, from 25 to 92/100,000, with a mean of 55/100,000. The effect of 24 socioeconomic and health care supply characteristic variables upon observed differences in rates were tested. The unemployment rate was the only significant variable in the analysis, explaining 11% of the variation in the surgery rates for the 16 regions. This finding is in agreement with studies from other countries that suggest that characteristics of small areas do not substantially predict the rates of elective surgical procedures. The decision-making processes of surgeons and their patients remain poorly defined; the contributions to the rate of lumbar spine surgery by the health care delivery system, physician behaviours or patient expectations are not yet identified.
Chronic back pain (CBP) is a common symptom throughout the world, and those undergoing it often e... more Chronic back pain (CBP) is a common symptom throughout the world, and those undergoing it often experience a profound degradation of life. Despite extensive research, it remains an elusive symptom. In most cases, CBP is “non-specific,” since bio-mechanisms examined in the clinic do not account for it; another way of saying this is that it is “of obscure origins.” This paper re-directs attention towards origins that are distal and usually out of sight from the vantage point of the clinic. CBP as considered here is non-specific, persists ≥ 3 months, and, additionally, interferes with activities of daily life, such as family interaction or work. A theory proposed in the paper draws upon Durkheim’s Suicide to explain why exposures in the distal social contexts of family and workplace are fundamentally implicated in CBP. The theory is formed out of previously published studies on family and workplace social contexts of CBP and, in effect, provides a theoretical framework with which to review them. After treatment of CBP in the clinic, patients return to family and workplace contexts. Unless exposures in these contexts are addressed, they serve as continually renewing sources of CBP that remain unabated regardless of mechanism-based treatment in the clinic.
RFL is an effective treatment for TN. Major complication rates are low. The most likely complicat... more RFL is an effective treatment for TN. Major complication rates are low. The most likely complications are related to the extent and density of lesion created and has been mitigated by the treatment strategy of minimizing the amount of hypoesthesia created during thermoablation.
Pain practice : the official journal of World Institute of Pain, 2005
Chronic pain has only recently been recognized as an important health care issue. There is no wid... more Chronic pain has only recently been recognized as an important health care issue. There is no widely shared agreement as to the best ways to diagnose and treat chronic pain patients. Pain management is a chaotic component of contemporary medicine. I argue that we need to think of chronic pain as a disease in its own right and develop our specialty of pain management on the basis of evidence for treatment outcomes. The current chaotic state confuses patients, health care providers, and payers. It is possible that pain management may disappear from health care if we do not improve our understanding of chronic pain and how to best treat those who suffer.
Chronic back pain (CBP) is a common symptom throughout the world, and those undergoing it often e... more Chronic back pain (CBP) is a common symptom throughout the world, and those undergoing it often experience a profound degradation of life. Despite extensive research, it remains an elusive symptom. In most cases, CBP is “non-specific,” since bio-mechanisms examined in the clinic do not account for it; another way of saying this is that it is “of obscure origins.” This paper re-directs attention towards origins that are distal and usually out of sight from the vantage point of the clinic. CBP as considered here is non-specific, persists ≥ 3 months, and, additionally, interferes with activities of daily life, such as family interaction or work. A theory proposed in the paper draws upon Durkheim’s Suicide to explain why exposures in the distal social contexts of family and workplace are fundamentally implicated in CBP. The theory is formed out of previously published studies on family and workplace social contexts of CBP and, in effect, provides a theoretical framework with which to review them. After treatment of CBP in the clinic, patients return to family and workplace contexts. Unless exposures in these contexts are addressed, they serve as continually renewing sources of CBP that remain unabated regardless of mechanism-based treatment in the clinic.
A minority of industrial-back-sprain claimants account for most of the cost of industrial back sp... more A minority of industrial-back-sprain claimants account for most of the cost of industrial back sprain: those whose disability persists into “chronicity,” which is defined as 90 days or more off work. The data in this study demonstrate the effects of socioeconomic factors on chronicity. This analysis is based on State of Washington industrial insurance claims for back sprain. For both men and women, three socioeconomic factors significantly affect the risk of chronicity: age, wage, and the family status of being either widowed or divorced with no children. In addition, the Nam-Powers Socioeconomic Index is significant for men. Wage compensation ratio cannot be shown to be a factor in chronicity.
The hospital separation records for 1987 in the health planning regions of South Australia were r... more The hospital separation records for 1987 in the health planning regions of South Australia were reviewed using a selection algorithm to identify all hospitalizations involving a lumbar spine surgery (LSS) for low back or leg pain. Among 16 health planning regions (two additional regions were excluded from the analysis because of the low number of observations) the LSS rate varied almost four-fold, from 25 to 92/100,000, with a mean of 55/100,000. The effect of 24 socioeconomic and health care supply characteristic variables upon observed differences in rates were tested. The unemployment rate was the only significant variable in the analysis, explaining 11% of the variation in the surgery rates for the 16 regions. This finding is in agreement with studies from other countries that suggest that characteristics of small areas do not substantially predict the rates of elective surgical procedures. The decision-making processes of surgeons and their patients remain poorly defined; the contributions to the rate of lumbar spine surgery by the health care delivery system, physician behaviours or patient expectations are not yet identified.
Chronic back pain (CBP) is a common symptom throughout the world, and those undergoing it often e... more Chronic back pain (CBP) is a common symptom throughout the world, and those undergoing it often experience a profound degradation of life. Despite extensive research, it remains an elusive symptom. In most cases, CBP is “non-specific,” since bio-mechanisms examined in the clinic do not account for it; another way of saying this is that it is “of obscure origins.” This paper re-directs attention towards origins that are distal and usually out of sight from the vantage point of the clinic. CBP as considered here is non-specific, persists ≥ 3 months, and, additionally, interferes with activities of daily life, such as family interaction or work. A theory proposed in the paper draws upon Durkheim’s Suicide to explain why exposures in the distal social contexts of family and workplace are fundamentally implicated in CBP. The theory is formed out of previously published studies on family and workplace social contexts of CBP and, in effect, provides a theoretical framework with which to review them. After treatment of CBP in the clinic, patients return to family and workplace contexts. Unless exposures in these contexts are addressed, they serve as continually renewing sources of CBP that remain unabated regardless of mechanism-based treatment in the clinic.
Uploads
Papers by John D Loeser