It's an exciting time for pain management, which is a relatively young specialty compared to others. Here are five areas of opportunities and ways for pain management physicians to grow and ensure success in 2011.
1. Read up on high-quality research. Pain management, as a field of medical practice and research, has exploded since it first came onto the stage only a couple decades ago. Even though the pain management field is a young one compared to most other specialties, pain management-related research continues to spur the emergence of higher-quality procedures.
"Especially in the past few years, the research has really been able to validate the efficacy of many commonly performed procedures," says Jonathann Kuo, MD, a board-certified anesthesiologist and pain management specialist. "In the past, there was a lack of good quality data, but there is now more recent studies and meta-analysis published by both academics and physicians in private practice that validate what we do."
One example of recently published significant research in pain management is data on vertebroplasty, which is now recommended against by the American Academy of Orthopaedic Surgeons because of endorsement of evidence-based medical studies. "The data has led the field to shift away from vertebroplasty and lean more toward balloon kyphoplasty or other minimally invasive nerve blocks to ease the pain of spinal fractures. In balloon kyphoplasty, the physician is able to create a cavity with a balloon that allows for a safer, more controlled filling of cement and better fracture reduction than vertebroplasty," Dr. Kuo says.
Although more high-quality research benefiting pain management continues to come out, Dr. Kuo says pain management physicians should keep watch for more randomized control studies to validate the efficacy of procedures, which ultimately helps during payor negotiations. "The goal is to prove to payors that interventional pain management is often a cost-effective and proven alternative to more invasive surgery with demonstrable results," he says.
2. Understand expanded use of neurostimulation. Dr. Kuo says the field of neurostimulation has increased dramatically over the past several years. Originally, neurostimulation was developed for radicular symptoms and failed back syndromes, but the indications for usage have expanded. Pain management physicians can now use neurostimulation for other chronic pain conditions, such as complex regional pain syndromes, pelvic pain, angina, pancreatitis, phantom limb pain, occipital, chest wall or inguinal neuralgia and other painful neuropathies.
"The whole point is that pain physicians can utilize neurostimulation not only in the spinal cord but also on the peripheral nerves. There is an expanded use of peripheral nerve or peripheral field stimulation and now physicians can place the electrodes anywhere in the body," Dr. Kuo says. "It's no longer only limited to the spinal cord."
3. Watch for more minimally invasive procedures. Pain management is a specialty that has made a large shift from inpatient to outpatient settings, such as office-based procedure suites and ambulatory surgery centers. The shift has implications for pain management physicians who can now better control healthcare costs and reduce in-patient therapy and recovery times for pain management procedures. Minimally invasive pain procedures also mean fewer complications and require little anesthesia. One such minimally invasive pain management procedure that is making its way into the outpatient setting is minimally invasive lumbar decompression, which does not involve traditional open incisions with a scalpel.
"Traditionally, pain management procedures took place in the hospital setting and involved significant administrative work and lack of efficiency. The trend now is that many procedures, including minimally invasive lumbar decompression, percutaneous discectomies and spinal cord stimulator implants can be done in an outpatient setting without a hospital stay," Dr. Kuo says. "It's been a trend in this field, and more of these procedures are being funneled from the hospital into ASCs and office spaces."
4. Stay connected on pain management issues. There is no doubt pain management physicians will benefit greatly from staying connected, which will help the physicians stay up-to-date on relevant news and trends. Dr. Kuo says a great practice to adopt is regularly reading pain management-related journals, attend educational conferences and staying in touch with colleagues This is crucial not only because the pain management field still young but also because the introduction of new role players into the picture is forcing the field to rapidly evolve at an accelerated rate.
"Traditionally, pain management was made up of mostly physicians with anesthesiology backgrounds, but more specialists, such as physiatrists and neurologists, are coming into the field as well," he says. "It's still a field where there is a lot of discordance among practicing physicians on how to treat patients. There is no more uniform algorithm for pain management at this point in time because physicians come from different backgrounds and training programs. There should be a push to further unify the field with standardized and accredited fellowships in the future."
5. Know the device market. Another driving force behind the explosion of pain management is the medical device market. Medical technology is a main reason many of the pain management procedures have been able to shift from the inpatient to outpatient setting. Increased attention toward delivering high quality patient care in a cost-efficient manner has driven IT innovators to come out with new tools and equipment to help physicians reach that same goal. Dr. Kuo says now is an exciting time for pain management physicians, but extra care must be taken when choosing new technology.
"There has to be a word of caution for pain management physicians, and really it's that they should not jump to adopt the newest technology before there is some data to validate its efficacy. There has been a long string of failures in the history of pain management, an example being IDET and other intradiscal procedures," he says.
Learn more about Dr. Jonathann Kuo.
1. Read up on high-quality research. Pain management, as a field of medical practice and research, has exploded since it first came onto the stage only a couple decades ago. Even though the pain management field is a young one compared to most other specialties, pain management-related research continues to spur the emergence of higher-quality procedures.
"Especially in the past few years, the research has really been able to validate the efficacy of many commonly performed procedures," says Jonathann Kuo, MD, a board-certified anesthesiologist and pain management specialist. "In the past, there was a lack of good quality data, but there is now more recent studies and meta-analysis published by both academics and physicians in private practice that validate what we do."
One example of recently published significant research in pain management is data on vertebroplasty, which is now recommended against by the American Academy of Orthopaedic Surgeons because of endorsement of evidence-based medical studies. "The data has led the field to shift away from vertebroplasty and lean more toward balloon kyphoplasty or other minimally invasive nerve blocks to ease the pain of spinal fractures. In balloon kyphoplasty, the physician is able to create a cavity with a balloon that allows for a safer, more controlled filling of cement and better fracture reduction than vertebroplasty," Dr. Kuo says.
Although more high-quality research benefiting pain management continues to come out, Dr. Kuo says pain management physicians should keep watch for more randomized control studies to validate the efficacy of procedures, which ultimately helps during payor negotiations. "The goal is to prove to payors that interventional pain management is often a cost-effective and proven alternative to more invasive surgery with demonstrable results," he says.
2. Understand expanded use of neurostimulation. Dr. Kuo says the field of neurostimulation has increased dramatically over the past several years. Originally, neurostimulation was developed for radicular symptoms and failed back syndromes, but the indications for usage have expanded. Pain management physicians can now use neurostimulation for other chronic pain conditions, such as complex regional pain syndromes, pelvic pain, angina, pancreatitis, phantom limb pain, occipital, chest wall or inguinal neuralgia and other painful neuropathies.
"The whole point is that pain physicians can utilize neurostimulation not only in the spinal cord but also on the peripheral nerves. There is an expanded use of peripheral nerve or peripheral field stimulation and now physicians can place the electrodes anywhere in the body," Dr. Kuo says. "It's no longer only limited to the spinal cord."
3. Watch for more minimally invasive procedures. Pain management is a specialty that has made a large shift from inpatient to outpatient settings, such as office-based procedure suites and ambulatory surgery centers. The shift has implications for pain management physicians who can now better control healthcare costs and reduce in-patient therapy and recovery times for pain management procedures. Minimally invasive pain procedures also mean fewer complications and require little anesthesia. One such minimally invasive pain management procedure that is making its way into the outpatient setting is minimally invasive lumbar decompression, which does not involve traditional open incisions with a scalpel.
"Traditionally, pain management procedures took place in the hospital setting and involved significant administrative work and lack of efficiency. The trend now is that many procedures, including minimally invasive lumbar decompression, percutaneous discectomies and spinal cord stimulator implants can be done in an outpatient setting without a hospital stay," Dr. Kuo says. "It's been a trend in this field, and more of these procedures are being funneled from the hospital into ASCs and office spaces."
4. Stay connected on pain management issues. There is no doubt pain management physicians will benefit greatly from staying connected, which will help the physicians stay up-to-date on relevant news and trends. Dr. Kuo says a great practice to adopt is regularly reading pain management-related journals, attend educational conferences and staying in touch with colleagues This is crucial not only because the pain management field still young but also because the introduction of new role players into the picture is forcing the field to rapidly evolve at an accelerated rate.
"Traditionally, pain management was made up of mostly physicians with anesthesiology backgrounds, but more specialists, such as physiatrists and neurologists, are coming into the field as well," he says. "It's still a field where there is a lot of discordance among practicing physicians on how to treat patients. There is no more uniform algorithm for pain management at this point in time because physicians come from different backgrounds and training programs. There should be a push to further unify the field with standardized and accredited fellowships in the future."
5. Know the device market. Another driving force behind the explosion of pain management is the medical device market. Medical technology is a main reason many of the pain management procedures have been able to shift from the inpatient to outpatient setting. Increased attention toward delivering high quality patient care in a cost-efficient manner has driven IT innovators to come out with new tools and equipment to help physicians reach that same goal. Dr. Kuo says now is an exciting time for pain management physicians, but extra care must be taken when choosing new technology.
"There has to be a word of caution for pain management physicians, and really it's that they should not jump to adopt the newest technology before there is some data to validate its efficacy. There has been a long string of failures in the history of pain management, an example being IDET and other intradiscal procedures," he says.
Learn more about Dr. Jonathann Kuo.