A guest column by the American Society of Anesthesiologists, exclusive to KevinMD.com.
As an anesthesiologist and pain physician, I understand the complexity of pain management procedures required for chronic pain disease. Chronic pain is a disease like others such as hypertension and cardiac disease. Several interventional pain procedures can be dangerous, even in the hands of the most specially trained interventional physicians, as they are performed near or around the spinal cord and surrounding nerves.
Potential complications from pain procedures include allergic reactions, infections, bleeding, nerve damage, spinal cord injuries (e.g., paralysis) and brain stem tissue damage. In addition, pain services include complex prescription medication regimens involving opioids. With the escalating use of prescription drug abuse in the U.S., it is critical for chronic pain physicians to determine the appropriate multimodal pharmacological therapies, taking into consideration the complex co-morbities that these patients have.
I recently treated a young woman for pain who had Tetralogy of Fallout at birth, a congenital heart defect, and had multiple cardiac surgeries and sternotomy incisions. With my medical background and training, I was able to recognize the patient needed CT scans of the chest to determine the cause of pain. Prior to seeing me, the patient was about to withdraw from graduate nursing school. However, following all the needed tests and using very precise needle placement in the nerves and joints around the sternotomy incisions, the pain was diminished and the patient was able to return to school and her normal activities.
Only physicians have the education, training and skill set to perform pain procedures, as well as prescribe pain medication. Currently, a variety of physicians have specialty training in chronic pain management, including anesthesiologists, physiatrists, radiologists, orthopedic surgeons and other medical specialists. These physicians deliver pain procedures across the country.
Unfortunately, last month the Centers for Medicare & Medicaid Services (CMS) issued a proposed rule establishing a national policy for nurse anesthetist pain management. The rule would allow nurses more freedom to practice pain medicine across the U.S. The proposed rule is unnecessary and unwise. It also will not improve access to care, as physicians deliver more than 99.8 percent of pain services, even in underserved areas.
Chronic pain management is the practice of medicine and only properly trained physicians should provide interventional pain services. All patients have the right to receive the safest and highest quality of care, particularly pain patients who receive complex and dangerous treatments.
Asokumar Buvanendran is a member of the American Society of Anesthesiologists’ Committee on Pain Medicine.