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Back Pain: HELP
Articles by Juan G. Ripoll
Based on 2 articles published since 2010
(Why 2 articles?)

Between 2010 and 2020, Juan G. Ripoll wrote the following 2 articles about Back Pain.
+ Citations + Abstracts
1 Review Pain in the Elderly. 2016

Jones, Mark R / Ehrhardt, Ken P / Ripoll, Juan G / Sharma, Bharat / Padnos, Ira W / Kaye, Rachel J / Kaye, Alan D. ·Medical Student, Tulane University School of Medicine, New Orleans, LA, USA. · Medical Student, Louisiana State University Health Science Center, New Orleans, LA, USA. · Department of Anesthesiology, LSU School of Medicine, New Orleans, LA, USA. · Department of Biochemistry, Bowdoin College, Brunswick, ME, USA. · Department of Anesthesiology, LSU School of Medicine, New Orleans, LA, USA. alankaye44@hotmail.com. ·Curr Pain Headache Rep · Pubmed #26896947.

ABSTRACT: Pain management in the elderly has increasingly become problematic in the USA as the aged population grows. The proportion of the population over 65 continues to climb and may eclipse 20 % in the next decade. In order to effectively diagnosis and treat these patients, a proper history and physical exam remain essential; pain assessment scales such as the Verbal Descriptor Scales (VDS), the Numerical Rating Scales (NRS), and the Visual Analogue Scales (VAS) often but not always prove beneficial. The conditions most frequently afflicting this population include osteoarthritis, diabetic neuropathy, post-herpetic neuralgia, and lower back pain which include spondylosis and radiculopathies. While the normal aging process does not necessarily guarantee symptoms of chronic pain, elderly individuals are far more likely to develop these painful conditions than their younger counterparts. There are many effective treatment modalities available as potential therapeutic interventions for elderly patients, including but not limited to analgesics such as NSAIDs and opioids, as well as multiple interventional pain techniques. This review will discuss chronic pain in the elderly population, including epidemiology, diagnostic tools, the multitude of co-morbidities, and common treatment modalities currently available to physicians.

2 Article Value of Examination Under Fluoroscopy for the Assessment of Sacroiliac Joint Dysfunction. 2015

Eskander, Jonathan P / Ripoll, Juan G / Calixto, Frank / Beakley, Burton D / Baker, Jeffrey T / Healy, Patrick J / Gunduz, O H / Shi, Lizheng / Clodfelter, Jamie A / Liu, Jinan / Kaye, Alan D / Sharma, Sanjay. ·Department of Anesthesiology, Tulane School of Medicine, New Orleans, LA. · Department of Anesthesiology, Southeast Louisiana Veterans Health Care System, New Orleans, LA; · PM&R, Southeast Louisiana Veterans Health Care System, New Orleans, LA. · Research(WOC), Southeast Louisiana Veterans Health Care System, New Orleans, LA. · PM&R, Southeast Louisiana Veterans Health Care System, New Orleans, LA; · Department of Anesthesiology, Southeast Louisiana Veterans Health Care System, New Orleans, LA. ·Pain Physician · Pubmed #26431131.

ABSTRACT: BACKGROUND: Pain emanating from the sacroiliac (SI) joint can have variable radiation patterns. Single physical examination tests for SI joint pain are inconsistent with multiple tests increasing both sensitivity and specificity. OBJECTIVE: To evaluate the use of fluoroscopy in the diagnosis of SI joint pain. STUDY DESIGN: Prospective double blind comparison study. SETTING: Pain clinic and radiology setting in urban Veterans Administration (VA) in New Orleans, Louisiana. METHODS: Twenty-two adult men, patients at a southeastern United States VA interventional pain clinic, presented with unilateral low back pain of more than 2 months' duration. Patients with previous back surgery were excluded from the study. Each patient was given a Gapping test, Patrick (FABERE) test, and Gaenslen test. A second blinded physician placed each patient prone under fluoroscopic guidance, asking each patient to point to the most painful area. Pain was provoked by applying pressure with the heel of the palm in that area to determine the point of maximum tenderness. The area was marked with a radio-opaque object and was placed on the mark with a fluoroscopic imgage. A site within 1 cm of the SI joint was considered as a positive test. This was followed by a diagnostic injection under fluoroscopy with 1 mL 2% lidocaine. A positive result was considered as more than 2 hours of greater than 75% reduction in pain. Then, in 2-3 days this was followed by a therapeutic injection under fluoroscopy with 1 mL 0.5% bupivacaine and 40 mg methylprednisolone. RESULTS: Each patient was reassessed after 6 weeks. The sensitivity and specificity in addition to the positive and negative predictive values were determined for both the conventional examinations, as well as the examination under fluoroscopy. Finally, a receiver operating characteristic (ROC) curve was constructed to evaluate test performance. The sensitivity and specificity of the fluoroscopic examination were 0.82 and 0.80 respectively; Positive predictive value and negative predictive value were 0.93 and 0.57 respectively. The area under ROC curve was 0.812 which is considered a "good" test; however the area under ROC for the conventional examination were between 0.52-0.58 which is considered "poor to fail". LIMITATIONS: Variation in anatomy of the SI joint, small sample size. CONCLUSIONS: Multiple structures of the SI joint complex can result in clinical symptoms of pain. These include intra-articular structures (degenerative arthritis, and inflammatory conditions) as well as extra-articular structures (ligaments, muscles, etc.).