What is included in preprocedural evaluation of patients receiving therapeutic injections for pain management?

Updated: Jun 19, 2018
  • Author: Anthony H Wheeler, MD; Chief Editor: Meda Raghavendra (Raghu), MD  more...
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Prior to performing or even scheduling injection procedures, the practitioner is obliged to assess the patient thoroughly, including the history of the present illness, past medical history, medications, and drug allergies, and the extent to which operant and psychological factors are salient with regard to the illness at hand. Of course, all such information should be documented thoroughly.

Prior to any medical treatment, especially neural blockade or therapeutic injection, the practitioner should inform the patient fully regarding technique, indications for the procedure, operative complications, typical time for convalescence, and cost.

The patient's pretreatment status should be documented carefully. A flow sheet and medical chart to record the procedure and document any complications or side effects from pretreatment to posttreatment is standard. On-call practitioner advice and care should also be available. Any and all adverse effects, whether related to the injection or not; objective observations such as changes in temperature, color, and/or edema affecting an extremity or other pertinent body region; and assessment of therapeutic efficacy should be documented.

Digital video or still photographic documentation of the physiological appearance of the involved extremity or anatomical region and, in some cases, the procedure, provide the practitioner with a visual record of the injection locale, including any preoperative cosmetic problems such as skin lesions, scars, or deformities. Postoperative photographic recording also can be obtained for comparison.

Further objective and meaningful information can be obtained using preoperative and postoperative visual analogue scales (VAS), pain and disability scales, quality-of-life measures, and injection-specific questionnaires. The purpose and medical necessity for therapeutic injection also should be well documented. Appropriate subspecialty consultation may be necessary in some cases to support the preoperative diagnosis and the medical necessity for application of specific procedures.

Furthermore, the use of adjunctive guidance such as electromyography (EMG), ultrasound, and radiologic studies is recommended in some cases. Injections are rarely the only suggested treatment; therefore, expectations regarding the extent to which the procedure may provide pain or symptom relief should be explained to the patient preoperatively. Most therapeutic injections are not curative; therefore, any assumption that a procedure is a panacea should be dismissed.

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