Pain Physicians: What is the Biggest Challenge Facing Pain Management as a Specialty Right Now?Written by Abby Callard | Tuesday, 21 February 2012 14:32
Five pain management physicians share their thoughts on the biggest issues facing pain management as a specialty right now.
Standiford Helm II, MD, Pacific Coast Pain Management Center (Laguna Hills, Calif.): Maintaining value and relevance to our patients, fellow physicians and providers. As a young specialty, we run the risk of not being perceived as a necessary service. With good diagnosis, a broad array of treatment options and tracking of outcomes, we can demonstrate our value.
Marc E. Lynch, DO, Casa Colina Surgery Center (Chino, Calif.): I believe maintaining reimbursement is one of many factors facing all physicians, not just pain management, though we have been targeted recently. We also face the challenge of convincing insurers that what we provide for our chronic pain patients has the potential for improving their lives. There are many services that we provide for our patients that have no reliable double blind studies to support their use. In most cases it is because it is either unethical or very difficult to set up such a study and for it to be reliable. So what we are now seeing from the insurance companies is a denial of care for a growing number of procedures that we have been performing for years, with very good results. This then becomes a challenge to provide for our chronic pain patients.
Ronald DeMeo, MD, MBA, Meridian Spine & Interventional Pain Medicine (Coral Gables, Fla.): I would say basically the perception of the practice. We've had some — especially in Florida — so-called pain clinics which are really opioid pain clinics. That's diluted the message and undermined the reputation of a lot of pain management physicians. There's been an effort from a lot of us — especially interventional pain management physicians — to create some separation. Down the road, we need to coalesce and create a unique name, something like interventionalist or interventional spine.
Sudhir Vaidya, MD, Burke Rehabilitation Hospital (White Plains, N.Y.): There are two big challenges. The first challenge is that we still do not understand clearly why some people suffer from chronic pain conditions and are dependent on opiates and other controlled substances to keep themselves barely functional, although still suffering. The particular patient population gets some relief with surgeries and other interventional procedures but can never get enough relief to get off the opiates and other controlled substances. Some other chronic pain patients with similar disease conditions get over the pain with specific surgical treatments. We need more research in this area. The second challenge for pain practices is the reimbursement structure. Surgeries and interventional procedures are reimbursed fairly. Medical management is reimbursed poorly. Medical management involves accurate clinical and functional assessment and sometimes medicines which are regarded by the DEA as banned substances. Physicians have privilege to prescribe them, and physicians have a duty to treat pain adequately. But physicians need to exercise due diligence in prescribing them. This requires assessment and documentation as to whether the medications are being abused or diverted, whether the medication is helping them to improve or maintain function and whether there are any other treatments which can be tried. This takes a lot of time and the reimbursement for this time is very limited. Physicians end up providing counseling and helping them to cope with pain as the psychologist as psychologist are not often easily available or not reimbursed by insurance. These are very time consuming but necessary processes that are paid the least by insurance companies. Pain medications are particularly restricted by insurance companies because of the perception that pain management is not lifesaving.
Meeru Sathi-Welsch, MD, Long Island Neuroscience Specialists (East Patchogue, N.Y.): The biggest challenge facing pain management right now is prescription opioid abuse. In some states, such as Washington, doctors are refusing to continue prescribing opioids to anyone now because of the misuse of a small percentage of patients. This is not the right answer. We just need to be more vigilant about who we prescribe narcotics to and do better monitoring of it. We have a social responsibility as pain management physicians to stop pain and prescription opioid abuse.
This is an ongoing series which will feature five pain management physicians' responses to questions about the specialty.
Next week's question is: What is your reaction to the recent report citing growing and serious side effects for epidural steroid injections?
Submit responses to firstname.lastname@example.org before Feb. 28.
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