Archive June 2017 XVIII, No. 6

The Changing Face of Chronic Pain Management

The opioid epidemic is forcing pain physicians to put down their prescription pad and embrace interventional pain treatments.

Diane Stopyra

Diane Stopyra


chronic pain procedures SEE YOU IN 8 WEEKS Chronic pain procedures offer what other surgical specialties can't: repeat business.

The crackdown on opioids has changed the way many pain physicians practice. Instead of reaching for their prescription pads, they're relying more heavily on interventional pain treatments: steroid injections, joint injections, fluid injections, nerve blocks, implantable pain devices and radio-frequency ablation.

"A decade ago, doctors misread their responsibility to treat chronic pain," says Robert Saenz, president of VIP Medical, a San Antonio, Texas-based consulting firm that advises pain management practices nationwide. "They believed they needed to prescribe painkillers, or risk being reported to their medical board. But what I teach people is that this is not the only way. More and more, physicians are open to embracing alternatives."

Pain medicine continues to gain in popularity, especially among patients who want to remain active, mobile and pain-free as they age. OR managers have recognized that adding pain procedures to their surgical services can be quite profitable, supplying a high-volume, low-cost source of revenue that offers what other specialties can't: repeat business. Most surgeries are single events at your facility, whereas most pain management patients require ongoing visits to your facility.

As a service line, pain management is a natural extension to specialties that frequently deal in chronic pain: the cervical and lower back pain of orthopedics and neurosurgery, the foot and leg pain of podiatry, even the pelvic and prosthetic pain of urology and gynecology. Surgeons practicing these specialties at your facility have a captive audience for pain management referrals.

The overhead is low, as the amount of equipment required is minimal. Capital equipment is limited to a C-arm or other intraoperative imaging system and a fluoroscopy table. In terms of OR personnel, you'll need someone to run the C-arm and a nurse to assist the surgeon. Basic pain management cases like lumbar epidurals, facet joint injections and lumbar facets — the patient's pain is diagnosed and located, an injection is administered — take about 15 minutes apiece. Here's a look at how our understanding of pain, and our strategies for managing it, have evolved.

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