Scientific Information

Program Needs Assessment
Interventional Pain management incorporates interventional treatment options for patients to reduce or eliminate the need for chronic conventional medication management (and/or opiate therapy). Interventional treatment options include: spinal cord stimulation, peripheral nerve stimulation, vertebral augmentation, radiofrequency nerve ablation, etc. Since Interventional Pain Management is such a juvenile specialty, very few pain management physicians and anesthesiologists have gone through specific interventional 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 are emerging. For example, in 2015 the Neuromodulation Appropriateness Committee drafted the first guideline outlining where and when neuromodulation techniques are recommended. Non-pain management physicians require training on new options in interventional techniques and options so that they can refer proper patients for interventions earlier in the treatment paradigm.
Emerging science and treatment options for patient care are growing rapidly. In the last 2 years alone, four new Spinal Cord Stimulation systems have been approved by the FDA, and two 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. It is important for Interventional Pain Management clinicians to understand and evaluate available options to be able to continue to provide the best treatment and quality of care for patients. Additionally, this field of medicine is subject to higher than normal scrutiny, liability and litigiousness stemming from alleged over and under treatment. It is 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. For example, Regenerative Medicine, DNA testing and Botox for headache are emerging options for treating chronic pain and headache.
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. Additionally, 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 a hotly contested topic for the past three decades. The role of Managed Care and what is best for the population vs. what should be made available and is best for the individual, is a continuing struggle for payers. As the treating physicians, whether or not to offer therapies to an individual that could improve their condition, but is not covered by insurance, is a complex issue. Bioethical considerations of treatments available in Interventional Pain Management (such as Regenerative Medicine, DNA testing and Botox for headache) need to be discussed at length amongst peer groups and understood by providers so that they may make informed decisions and provide the best care to their patients.

Learning Objectives
As a result of participation in this activity, learners will be better able to:
i. Utilize best practices in the assessment, diagnosis, treatment and management of patients with pain.
ii. Recognize and evaluate: pain, description of pain, and pain markers
iii. Properly incorporate the March 2016 CDC Guidelines for Prescribing Opiate Medication for Chronic Pain
iv. Differentiate between abuse deterrent technologies in 5 new opiate medications.
v. Protect themselves and their practices to avoid an audit.
vi. Prepare for what to do in the event of an audit.
vii. Update billing practices where ICD-10 coding has changed with respect to interventional pain management
viii. Select an abuse-deterrent option vs. a traditional generic option, when more appropriate.
ix. 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
x. Evaluate regenerative medicine modalities and techniques
xi. Incorporate, as necessary, regenerative medicine modalities and/or techniques for the treatment of chronic pain