bluuebunny/crossref_metadata_2025 huggingface dataset:
Pengaruh Need for Achievement Terhadap Job Performance dengan Budgetary Participation sebagai Variabel Intervening
Authors: Sagara Yusar , Permatasari Indah , Soemantri Roebiandini
Published: March 2021

ABSTRACT

      Employee performance is very important to determine success and failure in achieving organizational goals. But the high performance of employees depends on motivation and a supportive work environment. So that in this study aims to examine the relationship between need for achievement which is a motivation for employees to participate in the budget so that it indirectly affects the performance improvement at the Planning and Finance Bureau of the Secretariat General of the Ministry of Finance. The sample selection technique used in this study was purposive sampling. 72 respondents were obtained as samples. Data analysis and hypothesis testing methods are used using the Structural Equation Model (SEM) with the help of Lisrel 8.80. Normality test is carried out before using Structural Equation Model (SEM) analysis. The results of this study indicate that directly or indirectly the need for achievement has a positive and significant effect on job performance through budget participation. This study has implications for the design of an effective budgeting process by involving the concept of motivation which creates a responsibility in achieving the goals that have been designed.

ABSTRAK

      Kinerja pegawai sangat penting untuk menentukan keberhasilan dan kegagalan dalam pencapaian tujuan organisasi. Namun tingginya kinerja pegawai tergantung dari motivasi dan lingkungan kerja yang mendukung. Sehingga dalam penelitian ini bertujuan mengkaji keterkaitan antara need for achievement yang menjadi suatu motivasi pegawai dalam melakukan partisipasi anggaran sehingga secara tidak langsung  berdampak pada peningkatan kinerja pada Biro Perencanaan dan Keuangan Sekretariat Jenderal Kementrian Keuangan.  Teknik pemilihan sampel yang digunakan dalam penelitian ini adalah purposive sampling. Sebesar 72 responden diperoleh sebagai sampel. Metode analisis data dan pengujian hipotesis yang digunakan menggunakan Structural Equation Model (SEM) dengan bantuan Lisrel 8.80. Uji normalitas dilakukan sebelum menggunakan analisis Structural Equation Model (SEM). Hasil penelitian ini menunjukkan bahwa secara langsung maupun tidak langsung  need for achievement berpengaruh positif dan signifikan terhadap job performance melalui  budgetay participation. Studi ini memiliki implikasi untuk desain proses penganggaran yang efektif dengan melibatkan konsep motivasi yang meciptakan sebuah tanggung jawab dalam mencapai tujuan yang telah dirancang.

JEL Classification: J24, L21
Administrasi Pajak Pertambahan Nilai Pada Industri Teknologi Keuangan Dompet Elektronik Di Indonesia
Authors: Hambali Mohamad Luhur , Setyowati Milla S.
Published: March 2021

ABSTRACT

       Industrial development continues to develop from time to time. One of the growing industries in Indonesia is the Digital Wallet Financial Technology Industry. This study aims to analyze the administration of Value Added Tax in the electronic wallet financial technology industry in Indonesia. By using qualitative research methods and in-depth interview data collection techniques and literature studies, it is hoped that this research can analyze the appropriate Value Added Tax administration policies for the electronic wallet financial technology industry in Indonesia.

 

ABSTRAK

        Perkembangan Industri terus berkembang dari waktu ke waktu. Salah satu industri yang sedang berkembang di Indonesia adalah Industri Teknologi Keuangan Dompet Digital. Penelitian ini bertujuan untuk menganalisis administrasi Pajak Pertambahan Nilai pada industri teknologi keuangan dompet elektronik di Indonesia. Dengan menggunakan metode penelitian kualitatif dan Teknik pengumpulan data wawancara mendalam dan studi literatur, diharapkan peneliltian ini dapat menganalisis kebijakan administrasi Pajak Pertambahan Nilai yang tepat bagi industri teknologi keuangan dompet elektronik di Indonesia. 

JEL Classification : H25, M41
Pengelolaan Pajak Daerah dan Retribusi Daerah Kota Tasikmalaya Tahun 2016-2019
Authors: Betanika Nila Nirbita  , Sartika Sri Hardianti
Published: March 2021

ABSTRACT

       Original Local Government Revenue is the income used by regional autonomy to fund the implementation of regional autonomy in accordance with each region's potential. Local taxes and retribution are part of local revenue. This study aims to determine the effectiveness and contribution of local taxes and retribution to the Local Government Revenue of Tasikmalaya. This research is a descriptive study using Time Series-type secondary data source. Secondary data comes from the 2016-2019 Budget Realization and Target report of OLGR of Tasikmalaya Region. The results of this study indicate that the highest level of regional tax effectiveness in Tasikmalaya by 2019 was 106.18% and the lowest value is in 2016 at 101.6%, while the highest level of effec-tiveness of regional retribution was in 2016, at 105.33%, and the lowest was 2019 at 90.92%. The contribution of local taxes to Tasikmalaya local revenue reached the high-est in 2016 with 88.59% while the lowest was in 2019, at 49.37%. In the other hand, the highest contribution to regional retribution was in 2016 at 11.4% and the lowest in 2019, at 3, 83%..

ABSTRAK

        Pendapatan Asli Daerah (PAD) merupakan pendapatan yang digunakan oleh otonomi daerah untuk mendanai pelaksanaan otonomi daerah sesuai dengan potensi daerah masing-masing. Pajak daerah dan retribusi daerah merupakan bagian dari Pendapatan Asli Daerah. Penelitian ini bertujuan untuk mengetahui efektivitas dan kontribusi pajak daerah dan retribusi daerah terhadap Pendapatan Asli Daerah Kota Tasikmalaya. Penelitian ini merupakan penelitian diskriptif dengan menggunakan sumber data sekunder tipe Time Series. Data sekunder berasal dari laporan Anggaran Realisasi dan Target PAD Kota Tasikmalaya tahun 2016-2019. Hasil penelitian ini menunjukkan bahwa tingkat efektivitas tertinggi pajak daerah Kota Tasikmalaya pada tahun 2019 yaitu 106,18% dan yang paling rendah tahun 2016 yaitu 101,6%, sedangkan tingkat efektivitas retribusi daerah tertinggi pada tahun 2016 yaitu 105,33% dan paling rendah tahun 2019 yaitu 90,92%. Kontribusi pajak daerah terhadap pendapatan asli daerah Kota Tasikmalaya tertinggi pada tahun 2016 yaitu 88,59 dan paling rendah pada tahun 2019 yaitu 49,37%, sedangkan kontribusi retribusi daerah tertinggi pada tahun 2016 yaitu 11,4% dan paling rendah tahun 2019 yaitu 3,83%.

JEL Classification : H27, H30
Model Prediksi Financial Distress Grup Perusahaan Keluarga Di Indonesia Dengan Model Beneish Ratio Index
Authors: Tyas Nurina Prawinin , Ahmar Nurmala , Syam M. Ardiansyah
Published: March 2021

ABSTRACT

       This study aims to test and prove the empirical evidence of the Financial Distress Prediction Model of Family Companies in Indonesia with the Beneish Ratio Index. The sample used in this study is a group of family companies in Indonesia which are listed on the Indonesia Stock Exchange with an observation period of 31 December 2014 to 2018. The research method used is a quantitative method with a survey approach for secondary data. The Days Sales in Receivable Index (DSRI), Sales Growth Index (SGI), Sales General and Administrative Index (SGAI), and Leverage Index (LVGI) variables do not differ in the treatment of the Beneish Model components based on the Financial Distress status of the Family Group Company. Variable Gross Margin Index (GMI), Asset Quality Index (AQI), Depreciation Index (DEPI), and Total Accruals to Total Assets Index (TATA) differ in the treatment of the Beneish Model component based on the Financial Distress status of the Family Company Group. This research contributes to the parties concerned with the prediction of financial distress, such as auditors and the government in assessing the potential for financial distress in the company.

ABSTRAK

        Studi ini bertujuan untuk menguji dan membuktikan bukti empiris Model Prediksi Financial Distress Grup Perusahaan Keluarga Di Indonesia Dengan Beneish Ratio Index. Sampel yang digunakan dalam penelitian ini adalah Grup perusahaan keluarga di Indonesia yang terdaftar di Bursa Efek Indonesia dengan periode pengamatan 31 Desember 2014 hingga 2018. Metode penelitian yang digunakan adalah metode kuantitatif dengan pendekatan survey untuk data sekunder. Variabel Days Sales in Receivable Index (DSRI), Sales Growth Index (SGI), Sales General and Administrative Index (SGAI), dan Leverage Index (LVGI) tidak ada perbedaan perlakuan komponen Beneish Model berdasarkan status Financial Distress pada Grup Perusahaan Keluarga. Variabel Gross Margin Index (GMI), Asset Quality Index (AQI), Depreciation Index (DEPI), dan Total Accruals to Total Assets Index (TATA) ada perbedaan perlakuan komponen Beneish Model berdasarkan status financial distress pada Grup Perusahaan Keluarga. Riset ini memberikan panduan kepada pihak-pihak yang berkepentingan terhadap memprediksi financial distress yang akan terjadi dalam perusahaan ataupun industri, pihak yang berkepentingan seperti Auditor dan Pemerintahan.

JEL Classification : G32, M41
Kompetensi Pengelola Anggaran, Pemanfaatan Teknologi Informasi, Sistem Pengendalian Internal Dan Akuntabilitas Laporan Keuangan Di Kementerian Pertahanan Indonesia
Authors: Sundari Dewi , Mulyadi J.M.V
Published: March 2021

ABSTRACT

This research is conducted to see the influence of several variables that determine the accountability of financial statement in Directorate General of Defence Potential, Ministry of Defence of The Republic of Indonesia. The variables studied were the influence of the competence of budget personnel, the utilization of information technology, and the application of government internal control system. The data collection techniques of this research is used a questionnaire survey with primary data sources and the statistical methods used to test the hypotheses is multiple linear regression analysis. The result of this research are the competence of budget personnel and the application of government internal control system do not influence accountability of financial statement but utilization of information technology have influence positive and significantly to accountability of financial statement in Directorate General of Defence Potential, Ministry of Defence of The Republic of Indonesia.

ABSTRAK

Penelitian ini dilaksanakan untuk melihat pengaruh dari beberapa variabel yang menentukan akuntabilitas laporan keuangan pada Direktorat Jenderal Potensi Pertahanan Kementerian Pertahanan Republik Indonesia. Variabel yang diteliti antara lain pengaruh kompetensi pengelola anggaran, pemanfaatan teknologi nformasi, dan penerapan sistem pengendalian internal pemerintah. Teknik pengumpulan data penelitian ini menggunakan teknik survei kuesioner dengan metode statistik yang digunakan untuk menguji hipotesis adalah melalui metode analisis regresi linear berganda. Hasil dari Penelitian ini antara lain variabel kompetensi pengelola anggaran dan penerapan sistem pengendalian internal pemerintah tidak berpengaruh terhadap akuntabilitas laporan keuangan sedangkan variabel pemanfaatan teknologi informasi terbukti berpengaruh positif dan signifikan terhadap akuntabilitas laporan keuangan Direktorat Jenderal Potensi Pertahanan Kementerian Pertahanan Republik Indonesia.

JEL Classification: M40, J24
Hubungan Book Tax Difference Terhadap Tax Avoidance dengan Manajemen Laba sebagai Variabel Moderasi
Authors: Dimas Prihandana Jati  , Murwaningsari Etty
Published: March 2021

ABSTRACT

       This research was conducted with the aim to examine the relationship between book tax with the tax avoidance. This study seeks to examine the items in the financial statements which are a proxy of the book tax difference that is closely related to the existence of indications of tax avoidance by the company. This study also uses moderation variables in the form of earnings management and control variables namely company size, leverage, profitability and operational cash flow. The sample selection is done by purposive sampling method with a total sample of 49 companies listed on the Indonesia Stock Exchange (BEI) in the time span between 2016 - 2018. Test results from this study indicate that fixed assets and intangible assets didn’t have an effect towards tax avoidance. Sales growth have a positive effect on tax avoidance. Meanwhile deferred tax expense are known to have a negative effect on tax avoidance. The results of moderation of earnings management variables on 4 (four) independent variables in this study indicate that there is no significant probability value for the moderation of the four independent variables.

ABSTRAK

        Penelitian ini dilakukan dengan tujuan untuk menguji hubungan antara book tax dengan tax avoidance. Penelitian ini berupaya untuk menguji item-item dalam laporan keuangan yang merupakan proksi dari book tax difference yang berkaitan erat dengan adanya indikasi penghindaran pajak oleh perusahaan. Penelitian ini juga menggunakan variabel moderasi berupa variabel manajemen laba dan kontrol yaitu ukuran perusahaan, leverage, profitabilitas dan arus kas operasional. Pemilihan sampel dilakukan dengan metode purposive sampling dengan jumlah sampel 49 perusahaan yang terdaftar di Bursa Efek Indonesia (BEI) dalam rentang waktu antara tahun 2016 - 2018. Hasil penelitian ini menunjukkan bahwa aset tetap dan aset tidak berwujud tidak berpengaruh terhadap penghindaran pajak. Pertumbuhan penjualan berpengaruh positif terhadap penghindaran pajak. Sedangkan beban pajak tangguhan diketahui berpengaruh negatif terhadap penghindaran pajak. Hasil moderasi variabel manajemen laba pada 4 (empat) variabel independen dalam penelitian ini menunjukkan bahwa tidak adanya nilai probabilitas variabel yang signifikan untuk moderasi keempat variabel independen tersebut.

JEL Classification : H26, M41
Pengembangan Model Efektifitas Kebijakan Ekonomi Berbasis Tax Amnesty untuk Meningkatkan Kepatuhan Wajib Pajak di Indonesia
Authors: Suratno Suratno , Ahmar Nurmala , Tampubolon Monang Nixon Haposan , Sumarsyah Riki
Published: March 2021

ABSTRACT

        The purpose of this study is to analyze and investigate the implementation of tax amnesty, and to develop a tax amnesty effectiveness model to improve corporate taxpayer compliance. The sample is 639 companies listed on the Indonesia Stock Exchange and divided into 9 industrial groups. The type of data used is secondary data. Tax amnesty data is obtained from information on the implementation of PSAK 70 in the notes to the financial statements and the presentation of tax payable due to tax amnesty in the statement of financial position. This shows that there is still a gap in the participation status of the tax amnesty program based on the industrial sector and sub-sector. This is supported by the observation of participation status, where the overall level of participation in the tax amnesty program only shows 35.1% and those who have not participated are 64.9%. These findings indicate that there is a potential tax revenue of 64.9% from the tax amnesty policy. Based on the research results, the tax amnesty policy is still needed based on the research results that the tax potential for the policy is more than 50%.

ABSTRAK

        Tujuan penelitian ini adalah melakukan analisis dan menginvestigasi implementasi tax amnesty, dan mengembangkan model efektifitas tax amnesty untuk meningkatkan kepatuhan wajib pajak badan. Sampel adalah 639 perusahaan yang terdaftar di Bursa Efek Indonesia dan terbagi dalam 9 kelompok industri Jenis data yang digunakan adalah data sekunder. Data tax amnesty diperoleh dari informasi implementasi PSAK 70 pada catatan atas laporan keuangan dan penyajian utang pajak akibat tax amnesty di laporan posisi keuangan. Hal ini menunjukkan bahwa masih ada kesenjangan/perbedaan status partisipasi program tax amnesty berdasarkan sektor maupun subsektor industri.  Hal ini terdukung observasi status partisipasi dimana secara keseluruhan tingkat partisipasi  pprogram tax amnesty baru menunjukkan 35,1% dan yang belum berpartisipasi sebanyak 64,9%. Temuan ini menunjukkan bahwa terdapat potensi penerimaan pajak sebesar 64,9% dari kebijakan tax amnesty. Berdasarkan hasil penelitian, kebijakan tax amnesty masih diperlukan didasarkan pada hasil penelitian bahwa potensi pajak untuk kebijkan tersebut lebih dari 50%.

JEL Classification : H26, H32
Preferential Purchase of E-commerce Model in China
Authors: Du Ming
Published: March 2021

The popularization of the Internet has promoted the leap-forward development of e-commerce. In recent years, the increasing number of e-commerce platforms and merchants has led to a sharp increase in customer acquisition costs. Low-cost access to customers has become the main goal pursued by e-commerce merchants. The e-commerce Preferential Purchase model relies on the mainstream e-commerce platform to serve as a shopping guide for merchants of various e-commerce platforms. It provides multi-channel promotion and promotion of e-commerce products to increase customer traffic by saving money, rebates and making money. However, the credibility of the Preferential Purchase platform, the poor quality of products brought by low prices, the preferential procedures and the illegal behavior of the hierarchical agents have also become the bottleneck for the development of the Preferential Purchase model.
Research on the Effects and Influencing Factors of Social Work Profes_x0002_sional Policy in China
Authors: Tu Bin , Bai Xue
Published: March 2021

Social work professional are an indispensable force for building a harmonious society and strengthening and innovating so- cial governance. In order to promote the development of social work professional, some policies about social work professional have been issued in China. This article attempts to explore the effect and influencing factors of social work professional policy. Finding as followings: social workers' education degree, professional titles and the number of female social workers shows a growing trend. There is still a gap in the total number of social workers and professional compared with developed countries. The proportion of social work- ers below 46yrs. in national social workers has dropped year by year. The rationality of the regional structure of social work profession- al needs to be improved. The main causes are: There are lower professional awareness and social recognition to social worker in the so- ciety. The social worker professional' salary system is not perfect, and the organization management capabilities need to be improved. The suggestions are: Expand the communication platform of social work professional' team construction by informatization. Strengthen publicity and enhance social awareness of social work professional. Implement salary incentive measures and strengthen system guar- antees.
Retrospective Review of Physician Opioid
Prescribing Practices in Patients with Aberrant
Behaviors
Authors: Gupta Anita
Published: March 2021

In the past few decades, opioid use for the treatment of chronic noncancer pain has
slowly gained acceptance. With this increase in prescription opioid use, there has
also been an increase in prescription opioid abuse. To help detect aberrant drug
related behaviors, clinicians have utilized urine drug screens to determine patient
noncompliance in outpatient pain clinics. The primary objective is to determine
how the use of urine drug testing (UDT) affects health care outcomes. The
secondary outcome is to evaluate these findings as it relates to pharmacoeconomics
and aberrant behaviors in an outpatient clinical setting. In this study we will
determine if UDT influences prescribing practices among physicians. Patients at an
academic center’s chronic pain outpatient clinic were categorized as having urine
screens that were “normal” (expected findings based on their prescribed drugs) or
abnormal. Abnormal findings were those with either 1) the absence of a prescribed
opioid, 2) the presence of an additional nonprescribed controlled substance, 3)
detection of an illicit substance, or 4) an adulterated urine sample. We examined
the incidence of such aberrant behaviors as well as concomitant pain diagnoses,
psychiatric comorbidities, and the ultimate effect upon the prescribing patterns of
the physicians in this clinic. Results of the study showed that the patients exhibiting
aberrant drug behaviors have similar pain and psychiatric diagnoses as other chronic
pain patients. The most common aberrancy detected was an abnormal urine drug
screen, often with the presence of illegal substances. However, in the great majority
of aberrancies detected, providers chose to continue prescribing opioids. We
speculate on the reasons for this, and discuss the role of the urine drug screen in
influencing prescriber behaviors.
Key words: Chronic pain, noncancer pain, opioid, aberrant behavior, urine drug
test, prescriber pattern, preference
Intramuscular Botulinum Toxin in Complex
Regional Pain Syndrome: Case Series and
Literature Review
Authors: Schwartzman Robert
Published: March 2021

Background: Pain associated with Complex Regional Pain Syndrome (CRPS) is frequently
excruciating and intractable. The use of botulinum toxin for relief of CRPS-associated pain
has not been well described.
Objectives: To assess whether intramuscular botulinum toxin injections cause relief of
pain caused by CRPS, and to assess the risks of this treatment.
Study Design: Retrospective chart review.
Setting: Outpatient clinic.
Methods: Thirty-seven patients with spasm/dystonia in the neck and/or upper limb girdle
muscles.
Intervention: EMG-guided injection of Botulinum toxin - A (BtxA), 10-20 units per
muscle. Total dose used was 100 units in each patient. Local pain score was measured on
an 11-point Likert scale, 4 weeks after BtxA injections.
Results: Mean pain score decreased by 43% (8.2 ± 0.8 to 4.5 ± 1.1, P < 0.001). 97% of
patients had significant pain relief. One patient had transient neck drop after the injections.
Limitations: This is a retrospective study. It lacks a control group and so the placebo
effect cannot be eliminated. This study does not provide information on the efficacy of this
treatment after 4 weeks.
Conclusions: Intramuscular injection of botulinum toxin in the upper limb girdle muscles
was beneficial for short term relief of pain caused by CRPS. The incidence of complications
was low (2.7%)
Institutional Review: This study was approved by the Institutional Review Board of the
Drexel College of Medicine.
Key words: Complex regional pain syndrome, botulinum toxin, spasm, dystonia
Spinal Cord Stimulation for Treatment of
Pain in a Patient with Post Thoracotomy Pain
Syndrome
Authors: Graybill Jordan
Published: March 2021

Post Thoracotomy Pain Syndrome (PTPS) is defined as pain that occurs or persists in the area
of the thoracotomy incision for at least 2 months following the initial procedure. The true
incidence of PTPS is hard to define as literature reports a wide range of occurrence from 5%
to 90%. Thoracotomy is associated with a high risk of severe chronic postoperative pain.
Presenting symptoms include both neuropathic pain in the area of the incision, as well as
myofascial pain commonly in the ipsilateral scapula and shoulder.
Pain management can be challenging in these patients. Multiple treatments have been
described including conservative treatments with oral nonsteroidal anti-inflammatory drugs
(NSAIDs); topically applied, peripherally acting drugs; neuromodulating agents; physical
therapy; transcutaneous electrical nerve stimulation as well as more invasive treatments
including intercostal nerve blocks, trigger point steroid injections, epidural steroid injections,
radiofrequency nerve ablation, cryoablation, and one case report of spinal cord stimulation.
Unfortunately, a portion of these patients will have persistent pain in spite of multiple treatment
modalities, and in some cases will experience worsening of pain.
This case report describes the novel utility and complete resolution of symptoms with spinal
cord stimulation (SCS) in treatment of a patient with persistent PTPS.
In the operating room, a percutaneous octet electrode lead was placed using sterile technique
under fluoroscopic guidance and loss-of-resistance technique. The octet electrode lead was
subsequently advanced with the aid of fluoroscopy to the level of the T3 superior endplate
just right of midline. The patient’s pain distribution was captured optimally with stimulation
at this level. With the assistance of a neurosurgeon, the lead was anchored, tunneled, and
connected to a generator, which was implanted over the right iliac crest. The patient tolerated
the procedure well with no complications.
We report the successful use of SCS as well as complete resolution of symptoms at 4 months
follow-up, in a patient with persistent PTPS, which was resistant to other modalities.
In conclusion, studies designed to evaluate the effectiveness of SCS for PTPS may be warranted.
Key words: post thoracotomy pain syndrome, PTPS, chronic pain, spinal cord stimulation,
thoracic pain, neuropathic pain, transcranial magnetic stimulation
Monitoring Opioid Adherence in Chronic Pain
Patients: Assessment of Risk of Substance
Misuse
Authors: Solanki Daneshvari R.
Published: March 2021

Background: Use of opioids for chronic non-cancer pain (CNCP) has increased in recent
years because this pain had been undertreated. There was also a simultaneous increase
in misuse and abuse of opioids. Deaths due to such abuse and misuse also have risen
as seen in the many reports published every day in local papers as well as in the medical
literature. So, it is imperative that patients who are prescribed these medications be
monitored for adherence so misuse and abuse can be curtailed and opioids are available
to those who genuinely need them for chronic pain control. There are various screening
tools available to monitor such adherence, and there is an abundance of literature about
it in addiction and psychiatric medicine. There is, though, a paucity of such literature as
applied to pain medicine.
Objectives: Our objectives for this review were twofold. We wanted to identify which
screening tools are available to monitor opioid adherence and we wanted to see if there
were prospective comparative studies of these tools to identify a single best tool that can
be applied to all chronic non-cancer pain patients managed with opioids.
Study Design: We did a review of the current literature about monitoring of opioid
adherence. We also looked at their use, validity, and comparative studies.
Methods: We performed a literature search using PubMed, EMBASE, and the Cochrane
library. The search was conducted using the terms opioids, non-cancer pain, monitoring,
and adherence. The databases from 1996 to November 2010 were reviewed. The
search included prospective and retrospective studies, review articles, and FDA records.
Bibliographies and cross references were reviewed when deemed appropriate.
Conclusion: We found 52 publications, of which 22 met the criteria to be included
in this manuscript. We found only one study that was prospective, and compared the
various screening tools that are available to monitor opioid adherence. In the majority of
the studies the number treated was small. There was not a single screening tool that can
be applied universally to all patients who are on opioid therapy for chronic non-cancer
pain.
Key words: Opioids, chronic pain, chronic non-cancer pain, opioid adherence,
monitoring of opioid adherence, controlled substances, prescription monitoring
programs, screening tools
Treatment Considerations in Painful
HIV-Related Neuropathy
Authors: Smith Howard
Published: March 2021

Background: Human immunodeficiency virus (HIV)-related distal sensory polyneuropathy (DSP)
is the most common HIV-associated sensory neuropathy. The envelope glycoprotein of HIV-1, gp
120, appears to contribute to this painful neuropathy. Two standard treatments for HIV infection/
HIV-related painful DSP (e.g., antiviral therapy [e.g., nucleoside reverse transcriptase inhibitors
(NRTI)] opioids) should each be carefully evaluated prior to being utilized to ameliorate the pain of
DSP, since they may actually promote nociception.
Nucleoside reverse transcriptase inhibitors require activation in the cell via the addition of 3
phosphate groups (by cellular kinases) to their deoxyribose moiety, to form NRTI triphosphates.
Subsequently, these deoxynucleotide analogs compete with natural deoxynucleotides for
incorporation into the growing viral DNA chain. The incorporation of NRTIs into the viral DNA
chain leads to chain termination; since the nucleoside reverse transcriptase inhibitors lack a
3’-hydroxyl group on the deoxyribose moiety (unlike natural deoxynucleotides), so that the next
incoming deoxynucleotide cannot form the next 5’-3’ phosphodiester bond needed to extend the
DNA chain.
Unfortunately, many conventional agents utilized as pharmacologic therapy for neuropathic
pain are not effective for providing satisfactory analgesia in painful HIV-related distal sensory
polyneuropathy. Although there is no robust data, there does seem to be information which would
support the notion of opioids having increased risk of being particularly pronociceptive when being
used to treat painful HIV-related neuropathy. It thus appears conceivable that the use of at least
certain opioids in efforts to achieve analgesia in patients with painful HIV-related neuropathy may
be less than ideal since at least certain opioid analgesics themselves may potentially contribute to
“fueling the fire” of HIV enhanced pain hypersensitivity; at least in part via upregulation of specific
chemokine receptors (e.g., CXCR4) which seem to be vitally important in promoting HIV-related
pain facilitation. The risk benefit ratio of treatment with agents such as NRTIs as well as opioids
should be reviewed for specific individual patients, prior to clinicians initiating these agents.
Objectives: To raise awareness of the theoretical potential downside that opioids may possess if
they are used for the treatment of painful HIV-related neuropathy.
Methods: A narrative review of selected literature.
Limitations: Hypothetical in nature.
Conclusions: Clinicians should consider all aspects of various therapeutic options, carefully
weighing the risk/benefit ratios of each potential treatment before initiating opioids for painful
HIV-related neuropathy.
Key words: Human immunodeficiency virus, acquired immune deficiency syndrome, distal
sensory polyneuropathy, pain, glia, neuropathy, opioids, nucleoside reverse transcriptase inhibitors
Methylene Blue in the Treatment of Discogenic
Low Back Pain
Authors: Gupta Gaurav
Published: March 2021

Background: The personal and societal impact of chronic low back pain is considerable.
The intervertebral disc is considered the etiologic source in up to 40% of patients, with
considerable previous efforts directed at developing reliable and efficacious treatments.
Recent publications, including a double-blind, randomized, placebo-controlled trial, using
a one-time treatment of methylene blue, showed statistically significant, clinically relevant
improvements in pain and function in the treatment groups. The postulated mechanism
of action of methylene blue is denervation of small nociceptive fibers that grow into the
annulus fibrosis, which are implicated in discogenic pain.
Study Design: Retrospective case series.
Setting: Academic pain management center.
Objectives: To examine the outcomes for a cohort of patients treated with methylene blue
for discogenic pain, discuss potential differences in selection and administration protocols and
briefly review other proposed treatments for discogenic pain (e.g. intradiscal electrothermy
therapy, intradiscal steroids, intradiscal biaccuplasty, rami communicans radiofrequency
thermocoagulation, and chymopapain ).
Methods: This case series examines the pain and functional outcomes in 8 patients treated
with a one-time administration of methylene blue for discogenic back pain. Follow-up
information was available between 2 months and over one year, depending on the patient.
Results: Application of this treatment for these 8 patients for discogenic pain diagnosed
by provocation discography showed only one clinical success at our center. Four patients
had a time-limited clinical response in pain and/or function between 2 weeks and 5 months.
Patient specific data are outlined in detail herein.
Conclusions: Low back pain ascribed to a discogenic source continues to be an elusive
clinical entity to treat. We have reserved further treatment of methylene blue for discogenic
pain until other controlled trials have been published.
Limitations: A case series.
Key Words: Low back pain, discogenic pain, provocation discography, methylene blue,
spinal injections, intervertebral disc therapy, intradiscal therapy.
Results of 2-Year Follow-Up of a Randomized,
Double-Blind, Controlled Trial of Fluoroscopic
Caudal Epidural Injections In Central Spinal
Stenosis
Authors: Manchikanti Laxmaiah
Published: March 2021

Background: Lumbar spinal stenosis is one of the most common causes of low back pain among older
adults and can cause significant disability. Despite its prevalence, there is a paucity of literature concerning
the treatment of spinal stenosis symptoms. Multiple interventions, including surgery and interventional
techniques such as epidural injections and adhesiolysis, are commonly utilized in managing pain related
to central spinal stenosis. However, there is a paucity of literature from randomized, controlled trials about
the effectiveness of epidural injections for lumbar central spinal stenosis.
Objective: This study sought to assess the effectiveness of caudal epidural injections with or
without steroids in providing effective and long-lasting pain relief for the management of chronic
low back pain related to lumbar central stenosis.
Study Design: A randomized, double-blind, active-controlled trial.
Methods: One hundred patients were randomly assigned to one of 2 groups, with Group I
patients receiving caudal epidural injections of local anesthetic (lidocaine 0.5%), whereas Group II
patients received caudal epidural injections with 0.5% lidocaine 9 mL mixed with 1 mL of steroid,
6 mg (non-particulate betamethasone).
Outcomes Assessment: Multiple outcome measures, including the Numeric Pain Rating Scale
(NRS), the Oswestry Disability Index 2.0 (ODI), employment status, and opioid intake were utilized.
Assessments were carried out at 3, 6, 12, 18, and 24 months posttreatment.
The primary outcome was defined as pain relief and improvement in disability scores of 50%
or more. Successful treatment was considered as at least 3 weeks of relief following the first 2
injections, categorizing these patients into a successful group, and others into a failed group.
Results: Significant pain relief and functional status improvement were seen in 51% in Group
I and 57% in Group II at the end of 2 years in the successful group when the participants were
separated into successful and failed groups. However, overall, significant pain relief and functional
status improvement (≥ 50%) was demonstrated in 38% in Group I and 44% in Group II at the end
of 2 years. The overall number of procedures for 2 years were 4 in both groups, with 5 procedures
on average in the successful groups, and approximately 60 weeks of relief in Group I and 54 weeks
of relief in Group II at 2 years in the successful group.
Conclusion: Caudal epidural injections of local anesthetic with or without steroids provide
relief in a modest proportion of patients undergoing the treatment and may be considered as an
effective treatment for a select group of patients who have chronic function-limiting low back and
lower extremity pain secondary to central spinal stenosis.
Key Words: Low back pain, lower extremity pain, spinal stenosis, epidural injections, steroids,
local anesthetics
Acute Cauda Equina Syndrome Secondary to a
Lumbar Synovial Cyst
Authors: Muir Jeffery J.
Published: March 2021

Cauda equina syndrome is a well described state of neurologic compromise due to lumbosacral
root compression. In most cases, it is due to a herniated disc, tumor, infection, or hematoma. We
report a case of rapid lumbar synovial cyst expansion leading to acute cauda equina syndrome and
compare it to similar cases in the literature.
The patient is a 49-year-old woman with a history of chronic low back pain who developed cauda
equina syndrome. Serial lumbar magnetic resonance imaging studies demonstrated a significant
increase in the size of a lumbar synovial cyst over a 2 week interval. After an unsuccessful attempt
to relieve her acute symptoms with computed tomography-guided cyst aspiration, an L4-5
posterior spinal decompression with excision of the synovial cyst was performed.
Postoperatively the patient’s perineal numbness, bladder incontinence, and associated pain
complaints resolved. The only residual symptom at one month follow-up was continued numbness
in the right lower limb in an L5 distribution.
This report adds to 6 other well described similar cases found in the literature by illustrating several
important points. First, a lumbar synovial cyst is a rare but possible cause of acute cauda equina
syndrome. Second, magnetic resonance imaging is the test of choice to diagnose and characterize
lumbar synovial cysts; serial imaging can detect fluctuations in cyst size. Third, percutaneous
treatment of lumbar synovial cysts is variable in efficacy and proved to be unsuccessful in our patient.
Finally, surgical management has shown high success rates for symptomatic cysts. Specifically, in
the setting of acute cauda equina syndrome secondary to a lumbar synovial cyst, urgent surgical
decompression has led to resolution of neurologic symptoms in most reported cases.
A lumbar synovial cyst is an uncommon cause of acute cauda equina syndrome. Prompt diagnosis
and treatment may lead to reduced morbidity associated with this condition.
Key words: Acute pain, cauda equina syndrome, lumbar, polyradiculopathy, synovial cyst,
zygapophyseal joint
SynchroMed II Intrathecal Pump Memory Errors
Due to Repeated Magnetic Resonance Imaging
Authors: Gebhardt Rodolfo
Published: March 2021

Cancer patients with severe refractory pain are often managed with implantable drug
delivery systems (IDDS). The only drugs with US Food and Drug Administration approval
for intrathecal use are morphine, ziconotide, and baclofen. Other drugs used and
mixed include, hydromorphone, bupivacaine, sufentanil, and fentanyl. These patients
often undergo magnetic resonance imaging (MRI) for disease-related monitoring and
diagnoses. Although uncommon, IDDS can fail to resume normal functioning after MRI,
potentially causing complications. The magnetic field of an MRI will temporarily stop the
rotor of the pump motor and suspend drug delivery for the duration of the MRI exposure.
The pump should resume normal operation when removed from the MRI magnetic field,
but there is a potential for a delay in the return of proper drug infusion and a delay in
the logging of motor stall events after an MRI in the SynchroMed II pumps. A 57-yearold man who underwent multiple MRIs with an implanted IDDS experienced 2 separate
memory failures leading to multiple complications. After the first pump malfunction, the
patient developed withdrawal symptoms and was treated in the emergency department.
The first time, a memory reset resolved the problem. The second time, 29 months later,
the patient was admitted to the hospital to manage withdrawal symptoms and the
pump had to be exchanged with a new device. Post-MRI pump interrogation should be
performed on all patients with IDDS to ensure proper functioning of the pump. Special
attention should be paid to patients receiving baclofen, as acute withdrawal can be very
serious, even deadly.
Key words: Cancer pain, MRI, IDDS, SynchroMed II, baclofen, withdrawal, stall.
Prospective Clinical Study on Natural History of
Discogenic Low Back Pain at 4 Years of Follow-up
Authors: Peng Baogan
Published: March 2021

Background: To accurately assess the effect of any therapy for treating discogenic low
back pain, the natural history of such pain should be known beforehand. However, until
now, no pathological characteristic could be used to predict the disease course of low
back pain.
Objective: To better instruct the clinical treatment of discogenic low back pain, a
prospective clinical study was performed to observe the natural history of the disease.
Study Design: A prospective clinical study during a 4-year follow-up period.
Setting: The study was performed at a spinal center in China.
Methods: A total of 279 patients with chronic low back pain were included from June
2006 through October 2007. Using discography, 156 patients (56%) were diagnosed to
have discogenic back pain. A 101-point numerical rating scale (NRS) was used to assess
the back pain symptoms and the Oswestry Disability Index (ODI) was used to assess lumbar
function.
Results: Of the 156 patients, 131 (84%) completed the study at 4-year follow-up. At the
end of follow-up, 17 patients (13.0%) had their low back pain symptoms alleviated and
lumbar function improved; 10 patients (7.6%) were slightly improved; 16 patients (12.2%)
had their symptoms aggravated; and 88 patients (67.2%) experienced the same pain and
disability as before. Although the average NRS and ODI scores obtained during the 4-year
follow-up study gradually decreased, statistical significances were found in such changes
(P < 0.05,and P < 0.05, respectively); however, the improvement rates of both pain (7.6%)
and disability (5.2%) were very low.
Limitations: The shortcoming of this study is its relatively small sample size.
Conclusion: The present study indicated that the natural history of discogenic low back
pain was chronic but persistent, and that the pain and disability in most patients did not
improve over time.
Key words: Discogenic low back pain, chronic low back pain, lumbar discography, painful
disc, black disc, disc degeneration, internal disc disruption, natural history, prognosis.
An Update of the Appraisal of the Accuracy of
Thoracic Discography as a Diagnostic Test for
Chronic Spinal Pain
Authors: Singh Vijay
Published: March 2021

Background: Even though the prevalence of thoracic pain has been reported to be
13% of the general population and up to 22% of the population in interventional
pain management settings, the role of thoracic discs as a cause of chronic thoracic and
extrathoracic pain has not been well studied. The intervertebral discs, zygapophysial or
facet joints, and other structures including the costovertebral and costotransverse joints
have been identified as a source of thoracic pain.
Study Design: A systematic review of provocation thoracic discography.
Objective: To systematically assess and update the quality of clinical studies evaluating
the diagnostic accuracy of provocation thoracic discography.
Methods: A systematic review of the literature was performed to assess the diagnostic
accuracy of thoracic discography with respect to chronic, function limiting, thoracic or
extrathoracic pain.
The available literature on thoracic discography was reviewed. A methodological quality
assessment of included studies was performed using Quality Appraisal of Reliability
Studies (QAREL).
The level of evidence was classified as good, fair, and limited (or poor) based on the
quality of evidence developed by the U.S. Preventive Services Task Force (USPSTF).
Data sources included relevant literature identified through searches of PubMed and
EMBASE from 1966 to June 2012, and manual searches of the bibliographies of known
primary and review articles.
Results: The evidence and clinical value of thoracic provocation discography is limited
(poor) with a paucity of evidence, with only 2 studies meeting inclusion criteria.
Limitations: The limitation of this study continues to be the paucity of literature.
Conclusion: Based on the available evidence for this systematic review, due to limited
evidence, thoracic provocation discography is rarely recommended for the diagnosis of
discogenic pain in the thoracic spine, if conservative management has failed and facet
joint pain has been excluded.
Key words: Thoracic pain, chest wall pain, intervertebral disc, thoracic intervertebral
disc, thoracic disc herniation, discogenic pain, thoracic provocation discography, falsepositive response, diagnostic accuracy
Survey of European Pain Medicine Practice
Authors: Gupta Manish
Published: March 2021

This survey was undertaken to explore the variation in the functional constitution of
pain clinics in Europe. In addition, we also explored the amount of training which
doctors practicing pain medicine typically receive. Approximate hospital charges for
common pain interventions and the source of funding were also surveyed. Members
of the British Pain Society (Interventional Pain Medicine-Special Interest Group) and
other pain physicians in Europe responded through the online questionnaire tool
“Survey Monkey.” About 215 requests were sent; 82 pain practitioners from 13
countries in Europe responded. This survey indicates that chronic pain interventions
are primarily funded either through government or insurance companies. The
primary chronic pain service members continue to be anesthesiologists, combined
with specialist nurses and physiotherapists. There appears to be some consistency,
both with regard to working in a multidisciplinary team, and the training required
to become a pain specialist. More than half of the respondents reported the cost
of common interventions like caudal epidural steroid injection (ESI) , transforaminal
ESI, 3 level medial branch blocks, and 6 level facet joint injections to fall under
the €500 range ($645). Two thirds of the respondents reported the cost of 4-joint
radiofrequency lumbar denervation to be less than €1,500 ($1,935). Good practice
should ensure an adequate duration of training, and development of a pain faculty
to ensure standards of assessments across the continent. A more detailed, large
scale survey is perhaps required to map the availability of chronic pain services and
understand the health economics in pain medicine across Europe.
Key words: Chronic pain, Europe, survey, charges for pain interventions, advanced
training, multidisciplinary pain team, pain specialists
Rethinking Satellite Data Merging: From Averaging to SNR Optimization
Authors: Kim Seokhyeon , Sharma Ashish , Liu Yi Y. , Young Sean I.
Published: March 2021

Merging of multiple satellite datasets is a simple yet effective way to reduce prediction error. However, most merging methods for satellite data today are based on weighted averaging first proposed in 1969 for economic forecasting, which does not provide optimal outcomes when applied to satellite data. If our aim is to produce a merged data product that minimizes the prediction errors against a prediction target, there is no reason to insist that the merged product be an average of the parent datasets. A more disciplined approach based on mathematical optimization would be to minimize prediction errors. However, formulating merging as an optimization problem is insufficient by itself as the statistics needed for optimization, e.g. signal-to-noise ratio (SNR) of parent products, are often unavailable in practice and must be estimated jointly. In this paper, we address both of these problems for data merging. We first formulate optimal merging of satellite data as a SNR optimization (SNR-opt), and propose an estimation method to jointly estimate the required SNRs. This SNR-based approach has a natural interpretation as a multi-input single-output Wiener filter. Through extensive experimental validation on three global- scale satellite-derived soil moisture and land surface temperature products, we demonstrate that our SNR optimization significantly improves merging results over weighted averaging schemes.