Why physician led pain care is important for patients

Why physician led pain care is important for patients

A guest column by the American Society of Anesthesiologists, exclusive to KevinMD.com.

All of us know the unpleasant feeling of pain. Often we know what caused it: a burn, a sprain or a surgical procedure. Most pain stops when the cause is removed and healing takes place. That is acute pain. When pain arises and persists for three months or more without any apparent/obvious cause or reason, it becomes chronic pain.

Regardless of the type of pain, acute or chronic, patients seek relief. Anesthesiologists are committed to relieving pain for patients before, during and after surgery. In addition, anesthesiologists treat chronic pain unrelated to surgery. These physicians have the additional education and training to accurately evaluate, diagnose and treat patients with chronic pain through a comprehensive medical approach.

The diagnosis of the source of chronic pain determines the proper treatment. The treatment of chronic pain is complex and differs from the treatment of acute pain. Due to the strength of pain medication and the delicate structure of the spine and nerves upon which pain procedures are performed, it is important only qualified physicians appropriately and safely diagnose and treat patients suffering from chronic pain.

As my colleagues, Drs. Buvanendran and Sibert have previously voiced on KevinMD.com, the recent decision by the Centers for Medicare & Medicaid Services (CMS) to adopt a new and untested national policy allowing Medicare funds to be used to pay untrained providers to diagnose and treat chronic pain is dangerous and jeopardizes patient safety.

Untrained acute pain providers, such as nurse anesthetists, simply do not have education and training required to diagnose and treat chronic pain patients. Restrictions on nurse anesthetists providing chronic pain services are reasonable and necessary due to the risks of procedures including allergic reactions, infections, bleeding, nerve damage, spinal cord injuries (e.g., paralysis) and brain stem tissue damage.

CMS itself acknowledged that it is unable to assess whether nurse anesthetists are competent and qualified to deliver pain care:

We are unable, at this time, to assess the appropriateness of the CRNA training relating to specific procedures. We are also unaware of any data regarding the safety of chronic pain management services when furnished by different types of professionals.

In addition, allowing untrained acute pain providers to administer chronic pain treatments increases the risk for prescription drug abuse. While other government agencies including the Centers for Disease Control & Prevention (CDC) and the White House Office of National Drug Control Policy (ONDCP) have called for more education and training on pain medication, CMS has shown a great disconnect.

Patients have a right to receive the highest quality of pain care from physicians. If you or someone you know suffers from pain, it is your right to ask your provider about his or her credentials and qualifications.

For more information on chronic pain, please visit Lifeline to Modern Medicine.

Stanley W. Stead is the Section Chair of Professional Practice and a member of the American Society of Anesthesiologists’ Committees on Economics, Electronic Media and Information Technology, Future Models of Anesthesia Practice, Practice Management and Professional Education Oversight. 

Image credit: Shutterstock.com

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  • MacKinnon


    So how does the ASA, in their infinite wisdom, respond to many of their own members and many MANY physicians doing pain with a weekend class and NO fellowship? If the ASA was so concerned about patients and education as opposed to money then wouldnt they be the first ones to require a fellowship for pain practice? Yet they do not. If the ASA was so concerned and believed that patients were at risk by not having such specialty training wouldnt they be spending time first fighting for the REQUIREMENT in their own house (medicine) for pain fellowships? Yet they do not. Hypocritical straw man much?

    CRNAs have successfully been doing pain for decades. The proof is in the pudding and this new attack by the ASA is just another example of them doing what they do best, protect their wallets.

  • cynholt

    As I’ve been saying since the dawn of healthcare reform, serious
    problems will emerge from narcotics being over prescribed to patients
    with so-called “chronic pain.” I can’t begin to tell you how many times
    patients, whom I’ve cared for in the hospital, who were rushed to the
    emergency room from home and put on a ventilator for being over sedated
    on narcotics. And after they are weaned off the ventilator in the
    intensive care and transferred to a step-down unit, many times they will
    call out for stronger narcotics and more frequent doses of them. And
    because hospitals are reimbursed by how well they meet the needs of
    their patients, chief among them being their pain needs, doctors and
    nurses have hardly any other choice but to load them back up on

    It seems rather idiotic, to say the least, to load patients up on
    narcotics when that’s what put them in the hospital in the first place!
    But unfortunately, this is one of the major pitfalls of having a
    healthcare system like ours that reimburses hospitals according to
    patient satisfaction scores.

    So until we wake up to the fact that we are frequently doing more
    harm than good by treating hospital patients as though they were
    hard-to-please customers at a five-star hotel and restaurant, our
    idiotic healthcare system should shoulder the lion’s share of the blame
    for turning America into a nation full of deadbeat drug addicts!

  • http://www.facebook.com/jeffrey.balfus Jeffrey Balfus

    Chronic pain is one of the most difficult clinical problems to treat. I am now retired from 25 + years of active practice as an anesthesiologist and pain management specialist. Looking back on years of treating this problem I can see some important lessons.

    First it’s important to get a proper diagnosis. Often if the underlying cause can be found then a proper plan of treatment can be proscribed. Over half of the case referred to me had no diagnosis. Pain, lumbago and sciatica are not a diagnosis!

    Second do not rely on opioids! If they worked we would not need pain specialists! I have seen the explosion in high dose powerful opioid drugs that not relevant to this population. A chronic condition doesn’t not need short term rapidly acting drugs. Methadone makes way sense then Fentanyl. It’s cheap , long lasting doesn’t give a high and has a low potential for abuse.

    Third the patient needs to be incorporated back in the family and community. The usually chronic pain patient is no longer working, becomes isolated and very depressed. There is real sense of loss of control and hopelessness.

    Fourth increase actitivies and exercise. Forget the pain scales and focusing on the pain, this increases secondary gain. Instead look to increases daily activities and improved mental outlook.

    Finally, realize that this is a perceptual condition.

    I don’t mean to leave them with “learn to with it” idea. Instead look at how athletes cope with pain. It’s part of their daily life, they push to endure more pain. It’s perceived as a “good” pain, a sign of progress.

    They need to understand the pain is perception, it’s not going to kill them. They need a combination medications to help control the base pain and a plan for break through pain. Restore hope and control!

    I don’t feel most physician are properly trained to deal with complex illness. I don’t want to argue who should be able to treat this problem. I would be happy if “witch doctor” could dance the illness away. Simple algorithms and lots “pain killers” will not work.

    It is complex issue and will demand all the clinical knowledge and skill we can provide.

    So much for my 2 cents!

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