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Picture As Pdf Download Letters Before impeaching facet joint consistently superior to the 2 Rados I, Sakic K, Fingler M, Kapural L. Efficacy of interlaminar vs transforaminal epidural steroid injections and medial branch blocks, interlaminar route for radiculopathy. injection for the treatment of chronic unilateral and thereby medial branch Further, we note that when the radicular pain: prospective, randomized study. neurotomies, as well as lumbar evidence for transforaminal injections Pain Med 2011; 12: 1316-1321. these 3 Abdi S, Datta S, Trescot AM, et al. Epidural transforaminal epidural steroid is isolated to placebo-controlled trials, steroids in the management of chronic spinal injections, Harris and Buchbinder the evidence is based on very few “procedures pain: a systematic review. Pain Physician 2007; should consider: studies. The largest of these showed help people 10: 185-212. 4 Pinto RZ, Maher CG, Ferreira ML, et al. Epidural • interprofessional patient-centred marginal short-term (2-week) struggling to corticosteroid injections in the management of improvement in the steroid and local sciatica: a systematic review and meta-analysis. approaches are key; continue in • pharmacological management is anaesthetic group over the saline Ann Intern Med 2012; 157: 865-877. social roles 5 Karppinen J, Malmivaara A, Kurunlahti M, et al. often ineffective; group for the primary outcome (leg Periradicular infiltration for sciatica: a • their view does not reflect the pain), an effect that was not sustained and maintain randomized controlled trial. Spine 2001; 26: current practice of Australian pain by 4 weeks.5 Short-term relief is a quality of life 1059-1067. 6 Boswell MV, Colson JD, Sehgal N, et al. A medicine physicians; common finding in studies that use systematic review of therapeutic facet joint • these procedures help people local anaesthetic in the active group. interventions in chronic spinal pain. Pain struggling to continue in social roles We consider the evidence for the Davies et al Physician 2007; 10: 229-253. ❏ and maintain quality of life, so they effectiveness of transforaminal ” help to reduce the economic impact steroids over placebo to be neither of spinal pain on Australian society. strong nor consistent (within or Students as teachers We support education to improve between studies). We suggest that the evidence-based practice of gem in the bathwater be subject to TO THE EDITOR: Silbert and interventional procedures. more scrutiny and weighed against colleagues highlight the benefits of peer-assisted learning (PAL).1 They Stephanie J Davies Head of Pain Medicine Unit,1 the risks and costs. and Adjunct Associate Professor2 We thank Davies and colleagues for allude to the number of overseas Malcolm N Hogg Head of Pain Services,3 and their comments about medial branch medical schools that provide tutor 4 President blocks and transforaminal epidural training programs, and to the Eric J Visser Pain Medicine Physician and possibility that Australian medical 1 steroid injections. We have addressed steroid Anaesthesiologist students are missing out on this the latter in our response above. Our “injections in 1 Fremantle Hospital and Health Service, Perth, WA. article does not extend beyond the opportunity. We agree that PAL is 2 School of Physiotherapy, Curtin University, Perth, WA. the spine have use of steroids to procedures such useful, but not all Australian medical 3 Royal Melbourne Hospital, Melbourne, VIC. as neurotomy, so we have not no specific students have been deprived. Since 4 Australian Pain Society, Sydney, NSW. therapeutic 2008, Monash University has been [email protected] commented on this procedure here. Regarding medial branch blocks, effect beyond running VESPA (Vertical Study Acknowledgements: We acknowledge Andrew Briggs, Program), an optional PAL program.2 John Quintner, Nicholas Cooke and Helen Slater for their we note that in a systematic review natural history, assistance with this letter. Initiated by a group of medical mentioned by Davies and colleagues, the effect of any Competing interests: All authors work in public pain each of the randomised trials showed undergraduate students, it continues medicine units and perform interventional pain proce- concomitant to be largely student-driven, with dures. Stephanie Davies has a private fee-for-service prac- no significant difference in the tice; Stephanie Davies and Malcolm Hogg are board response between groups treated with treatment faculty support. Further, our program members of the Australian Pain Society, which has a has had international impact.3 position statement on interventional pain management steroid and those treated with local or any placebo procedures published in March 2010. anaesthetic alone.6 This reinforces our effect VESPA is open to all students in the doi: 10.5694/mja13.11206 point that steroid injections in the 5-year undergraduate and 4-year 1 Harris IA, Buchbinder R. Time to reconsider spine have no specific therapeutic graduate-entry streams. Students meet steroid injections in the spine? Med J Aust 2013; after hours to discuss a case, which is 199: 237. effect beyond natural history, the Harris et al authored by students and reviewed by 2 Sehgal N, Dunbar EE, Shah RV, et al. Systematic effect of any concomitant treatment review of diagnostic utility of facet ” a medical graduate. The objectives of or any placebo effect. (zygapophysial) joint injections in chronic spinal our program are to provide an effective pain: an update. Pain Physician 2007; 10: 213-228. 1 Ian A Harris Professor of Orthopaedic Surgery forum for revision in the setting of 3 Lord SM, Barnsley L, Wallis BJ, et al. Percutaneous radio-frequency neurotomy for chronic cervical Rachelle Buchbinder Rheumatologist and vertically integrated assessment, to Director,2 and Professor3 zygapophyseal-joint pain. N Engl J Med 1996; 335: develop a culture of collaboration 1721-1726. 1 South Western Sydney Clinical School, University of New and peer support, and to foster the 4 van Kleef M, Barendse GA, Kessels A, et al. South Wales, Sydney, NSW. Randomized trial of radiofrequency lumbar facet 2 Monash Department of Clinical Epidemiology, Cabrini development of teaching and facilitation denervation for chronic low back pain. Spine Health, Melbourne, VIC. skills of pre-intern participants.4 1999; 24: 1937-1942. 3 Department of Epidemiology and Preventive Medicine, Our model emphasises facilitation 5 Vad VB, Bhat AL, Lutz GE, et al. Transforaminal School of Public Health, Monash University, Melbourne, epidural steroid injections in lumbosacral VIC. rather than didactic teaching; we radiculopathy: a prospective randomized study. [email protected] provide optional, small-group Spine 2002; 27: 11-15. ❏ Competing interests: No relevant disclosures. facilitation training for senior doi: 10.5694/mja13.11159 students. This is far less IN REPLY: We thank Bogduk for his 1 Gharibo CG, Varlotta GP, Rhame EE, et al. comprehensive than the Teaching comments, but, based on previous Interlaminar versus transforaminal epidural on the Run model,1 yet we hope this reviews and some comparative steroids for the treatment of subacute lumbar “taster” encourages students to seek 1-4 radicular pain: a randomized, blinded, studies, do not consider the prospective outcome study. Pain Physician 2011; and practise their teaching skills in transforaminal route to be clearly and 14: 499-511. other settings. 754 MJA 199 (11) · 16 December 2013 Letters PAL is a valuable learning strategy, The knowledge and skills and skilled surgical educators remains which should be more widely used competency of students must also be substantial. Development of a to optimise medical graduates’ ascertained before placing a teaching comprehensive array of educational education and communication skills. burden on them. Where a person is programs is the current focus of the Future doctors who are eager and able on his or her personal learning curve RACS Academy of Surgical to teach may alleviate the forecasted will influence that person’s ability to Educators.4 The Academy provides medical educator shortage.5 teach.3 As a result, it is essential that curriculum delivery with oversight, as medical students and junior doctors well as the exchange of educational Joanna H-M Tai VESPA Co-Chair 2013, and PhD Candidate, HealthPEER are deemed competent in performing ideas through a combination of a task before the responsibility of workshops, face-to-face activities Sumudu P Cooray VESPA Co-Chair 2013 teaching is thrust on them. and digital delivery. Jonathan K Kam Past VESPA Co-Chair (2008–2011) To ensure safety and high-quality However, as Silbert et al highlight, health care provision, the role of a the skills for being an educator HealthPEER, Faculty of Medicine, Nursing and Health Sciences, Monash University, Melbourne, VIC. trainer must be given to a select group need to be developed early. There [email protected] with the right attributes, competence is increasing focus on the early Acknowledgements: Thanks to Rob Mitchell, Sheila levels and passion for teaching. It is this the skills postgraduate years and the Australian Vance and Elaine Halley for being instrumental in group that needs to be trained, allocated “for being an Curriculum Framework for Junior developing the VESPA case night, and to the Faculty 4 of Medicine, Nursing and Health Sciences, Monash time, resourced and rewarded. The educator need Doctors provides clear expectations University, for its ongoing support. responsibility to teach should be an for self-directed learning, teaching, to be developed Competing interests: No relevant disclosures. honour bestowed on a few rather than supervision and career development. doi: 10.5694/mja13.11058 a rite or obligation for all. early However, like many other key skills, the time to start this development is 1 Silbert BI, Lam SJP, Henderson RD, Lake FR. Michael Pearson Master of Health Services Students as teachers. Med J Aust 2013; 199: Management Student in undergraduate medical courses. It Tobin et a l 164-165. Monash University, Melbourne, VIC. is here that programs such as those 2 Kam J, Mitchell R, Tai J, et al.
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