Dr John MacVicar
Medical Director, Southern Rehab, Christchurch, NZ
Dr. MacVicar was born and raised in the Scottish Highlands and he graduated in medicine from the University of Glasgow. He has been vocationally registered with the Medical Council of New Zealand in Musculoskeletal Medicine since 2002, and he has a Masters degree in Pain Medicine. He is the medical director of Southern Rehab, based in Christchurch. His main clinical interest is the evidence-based use of interventional procedures for the investigation and treatment of spine pain. He has been a member of the (International) Spine Intervention Society since 2004 and is the immediate Past President of the Society.
The Role of Procedures for Chronic Lower Back Pain, An Evidence-Based Approach &
The Rational Use of Imaging for Lower Back Pain
Guided injections are commonly performed to investigate and treat lower back pain. Some diagnostic procedures lack validity and some therapeutic procedures lack evidence of effectiveness, yet they are performed. The discipline of interventional pain medicine is threatened by overuse and abuse of procedures. The focus of this section of the workshop will be the few procedures that do have evidence to support their use. In order to understand why procedures are used to investigate the source of back pain, the limitations of imaging will be discussed and the presentation will begin with a talk on the rational use of imaging in lower back pain. The diagnostic procedures that will be discussed are lumbar medial branch blocks and intra-articular local anaesthetic blocks of the sacroiliac joint. The therapeutic procedures that will be discussed are lumbar medial branch radiofrequency neurotomy and transforaminal injections of steroid. These procedures are performed under fluoroscopic guidance. For each procedure the technique will be described and the evidence presented, and there will also be an explanation about how they are abused. In the context of a workshop for General Practitioners, there will be a discussion about when and how to access these interventions for patients.