Interventional Pain management incorporates interventional treatment options for patients to reduce or eliminate the need for chronic conventional opioids medication management. Interventional treatment options include: spinal cord stimulation, peripheral nerve stimulation, vertebral augmentation, radiofrequency nerve ablation, etc. Since Interventional Very often, training of cutting edge specific interventional tecgniques may not be available during fellowships and residencies. Training in the proper patient selection and utilization of these therapies is limited. Interventionalists need to attend and participate in training programs to receive education and skill based training in options available for patients. Additionally, new guidelines promoting best practices are emerging. For example, in 2015 the Neuromodulation Appropriateness Committee drafted the first guideline outlining where and when neuromodulation techniques are recommended. The physicians require training on new options in interventional techniques and options so that they can identify appropriate patients for interventions earlier in the treatment paradigm.
Emerging science and treatment options for patient care are growing rapidly. In the lrecent years, novel Spinal Cord Stimulation systems have been approved by the FDA, and a few systems have been approved for peripheral nerve stimulation. In the last 3 years, a new intrathecal pain pump was approved. Additionally, in the last 12 months, 5 new opiate products with “Abuse Deterrent Technologies” have been approved by the FDA to counteract the opioid crisis. It is of paramount importance that the Interventional Pain Management clinicians understand and evaluate available options to be able to continue to provide the best treatment and quality of care for patients. The field of medicine is subject to higher than normal scrutiny, liability and litigiousness stemming from alleged over and under treatment. It is criticall and vitally important for clinicians to understand best practices and practice guidelines to ensure that they are offering the best care, remaining in compliance, managing exposure and liability while still insuring access to care and the best treatment outcomes for patients.
In the current financial environment for practices, clinicians are presented with new techniques and therapies emerge every year. The Regenerative Medicine, DNA testing and Botox for headache, and new guided techniques using disposable in-office needle-arthroscopy are emerging for treating chronic pain patients.
Clinicians need to critically review the data on these therapies to determine whether or not it makes sense to add this to their treatment offerings and/or refer patients out of practice for these therapies when appropriate. P
Providers must have the ability to legally and ethically bill for these treatment options, legally and in an ethical manner.
The role of Bioethics and Business ethics has been topics of great interest for decades. The role of Managed Care and adequate reimbursements for approrpiate treatment modalities is a continuing struggle for payers and providers. The treating physician’s inability to offer therapies to to their patients that could improve their condition, but is non-coverage by insurance, is a complex issue. Bioethical considerations of treatments available in Interventional Pain Management such as Regenerative Medicine gene therapy and DNA testing, need to have meaningful conversations amongst the experts and peer groups and understood by providers to make informed decisions and provide the best care anywhere.
- As a result of participation in this activity, learners will be better able to:
Utilize best practices in the assessment, diagnosis, treatment and management of patients with pain
- Recognize and evaluate presentation of pain, description of pain, and pain markers
- Properly incorporate the best available such as ASIPP guidelines and CDC Guidelines, for Prescribing Opiate Medication for Chronic Pain, safely and effectively
- Differentiate between abuse deterrent technologies to counteract oipoid crisis, and protect community lat large, protect patients and protect individual practice
- Understand the minimally invasive cutting sdge therapy options to reduce the need for extenstive sacroiliac fusion surgery
- Evaluate and offer appropriate in-office treatment oftions for vertebral fractures
- Ability to assess cutting edge advances in neuromodulation therapies, and select the best for their patients, that is safe and highly effective
- Update billing practices where ICD-10 coding has changed with respect to interventional pain management
- Evaluate and assess the MIST guidelines and treatment algorithm to decide the best minimally invasive options for lumbar spinal stenosis
- Prepare or make necessary changes in preparation for MIPS and MACRA, as they relate to potential impacts for my practice and ability to effectively treat chronic pain patients
- Evaluate advanced cellualr and acellular regenerative medicine modalities and techniques
- Incorporate appropriate regenerative medicine modalities and/or techniques for the treatment of chronic pain