At the 10th Annual Orthopedic, Spine and Pain Management-Driven ASC Conference in Chicago on June 14, Scott Glaser, MD, DABIPP, of Pain Specialists of Greater Chicago, gave a presentation titled "Interventional Pain Management — New Concepts to Reduce ER Visits, Hospitalizations and Re-Admissions." Dr. Glaser touched on several key trends in interventional pain management and where the specialty is headed in the future.
1. Opioid administration and management. Many patients with back pain are being prescribed opioids from a variety of practitioners. "Patients are getting opioids in the ER and when you take that first narcotic pill you may be heading to a life of tragedy," said Dr. Glaser. "There is a risk right there, especially with accidental poisoning. There is confusion regarding appropriate and effective treatment for pain management. Conservative care is directed by orthopedic surgeons or neurosurgeons, and these doctors aren't focused on conservative care or minimally invasive interventional treatment. There isn't coordinated care."
Care coordination is an opportunity for pain management physicians. "There is a lack of standard and coordinated care in medical care," said Dr. Glaser. "The longer you have the late treatment and diagnosis, the higher risk of a misdiagnosis and increased risk for medication or medication abuse."
2. Lack of appropriate follow up. Dr. Glaser stressed the importance of following up with chronic pain patients and knowing when to intervene, exercising caution with opioids. "In short, opioids are a high risk treatment option, it's the same as telling someone to have surgery, and we need the utmost care and appropriate training," said Dr. Glaser. "Another consequence of the situation is a dramatic increase in the performance of minimally invasive procedures for spine care."
In some cases, certified register nurses assistants and physician's assistants perform interventional procedures for back pain. "The confluence of inadequately trained physicians and non-physicians performing interventional procedures has led to overutilization, fraud and abuse," said Dr. Glaser. "The consequence is a backlash. Like opioids, procedures are not without substantial risk."
3. Need for appropriate guidelines and pathways for patient treatment. Creating pathways and guidelines for care are difficult in pain management because the variation in patient population means variation in appropriate care. "You are going to treat a young laborer differently than an old worker with a desk job," said Dr. Glaser. "There are well defined, published interventional treatment pathways for patients."
Patients often go through life adjustments, behavioral modification, medication management, interventional procedures and minimally invasive procedures. "Chronic pain is bothersome, but in many cases patients aren't injuring themselves by going back to work," said Dr. Glaser. "For interventional pain management, we use opioids and narcotics judiciously. We know when patients have gone as far as they can and when an intervention is going to be appropriate."
Care coordination is an opportunity for pain management physicians. "There is a lack of standard and coordinated care in medical care," said Dr. Glaser. "The longer you have the late treatment and diagnosis, the higher risk of a misdiagnosis and increased risk for medication or medication abuse."
2. Lack of appropriate follow up. Dr. Glaser stressed the importance of following up with chronic pain patients and knowing when to intervene, exercising caution with opioids. "In short, opioids are a high risk treatment option, it's the same as telling someone to have surgery, and we need the utmost care and appropriate training," said Dr. Glaser. "Another consequence of the situation is a dramatic increase in the performance of minimally invasive procedures for spine care."
In some cases, certified register nurses assistants and physician's assistants perform interventional procedures for back pain. "The confluence of inadequately trained physicians and non-physicians performing interventional procedures has led to overutilization, fraud and abuse," said Dr. Glaser. "The consequence is a backlash. Like opioids, procedures are not without substantial risk."
3. Need for appropriate guidelines and pathways for patient treatment. Creating pathways and guidelines for care are difficult in pain management because the variation in patient population means variation in appropriate care. "You are going to treat a young laborer differently than an old worker with a desk job," said Dr. Glaser. "There are well defined, published interventional treatment pathways for patients."
Patients often go through life adjustments, behavioral modification, medication management, interventional procedures and minimally invasive procedures. "Chronic pain is bothersome, but in many cases patients aren't injuring themselves by going back to work," said Dr. Glaser. "For interventional pain management, we use opioids and narcotics judiciously. We know when patients have gone as far as they can and when an intervention is going to be appropriate."
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