November - 20218THE EVOLVING TECHNOLOGY TO EASE PAINShorin Nemeth, DO FACOI, Medical Director Comprehensive Pain Service, Providence Health and ServicesByThe field of Pain Management has always suffered from an identity crisis. Toward the latter end of the last century, multidisciplinary pain centers seemed to be the standard of care. For clarification, a multidisciplinary center is a practice that involves specialists from different fields. For instance, there may be a pain physician, pain psychologist or social worker, pain physical therapist or occupational therapist, and Complementary and Alternative practitioner all working together. Then, with a push toward pharmaceuticals, particularly opioids, the reimbursement for multidisciplinary centers dwindled and the focus shifted to the interventional pain provider who treated pain with medications and interventions (epidural injections and similar). When the opioid crisis struck, pain providers found opioid prescribing challenging due to the numerous regulatory burdens imposed after the widespread overprescribing of opioids and resulting morbidity and mortality. Even before this, some pain centers had transitioned over to purely interventionally focused, only offering recommendations for prescribing, but not actually prescribing any medications. The development and refinement of intrathecal pumps, spinal cord stimulators, and radiofrequency ablation furthered the interventional model. This provided a large gap in care whereby a patient could receive interventional treatment or try and find a prescriber who would treat their pain pharmacologically. This binary model of either injections or medications left many patients without the relief for which they hoped. Physical therapists such as Professor Lorimer Mosely and others from the behavioral health realm seemed to show promise with their treatment models, seeming to bring the practice full circle back to a multidisciplinary practice, at least in theory. As the technology evolved, pain providers were able to take advantage of a wider variety of tools. For instance, with refinement in ultrasound technology, the prices of ultrasound machines came to a point where many office-based practices could not only afford them but rather considered them the standard of care for various procedures. With the increased use of ultrasound came improvements in imaging resolution, refinement in needle technology, and computer algorithms to allow better visualization of the needle tip, etc. Similarly, for radiofrequency, spinal cord stimulators, and other technologies, the advancement of the technology made the tools safer, arguably more effective, less cumbersome, less costly, and easier for the physician provider to use. Shorin NemethIn My Opinion
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