Pain Management Therapy Training with Med Ed Labs
With the current opioid epidemic, the medical industry has been working very diligently to find better methods to treat chronic back pain. One current therapy that has seen excellent results in evidence-based studies, is non-pharmacologic neuromodulation. This cutting edge, innovative therapy is used for the treatment of chronic pain using spinal cord stimulation (SCS).
Clinical data has shown that this modern treatment method helps reduce chronic lower back pain without using opioid-based medications to treat patients.
MED-ED LABS offers many physician training labs for non-pharmacologic neuromodulation for the treatment of chronic pain using spinal cord stimulation.
Spinal cord stimulation (SCS)
This the most-established member of the family of therapies known as neuromodulation. Neuromodulation is defined by the International Neuromodulation Society as therapeutic interaction with the central, peripheral or autonomic nervous system for therapeutic effect by means of targeted electrical stimulation or pharmacological delivery from implanted devices. The uses for SCS continue to evolve and grow.
Why Is Pain Important?
Pain is integral to life; it is a critical component of the body’s natural defense system, signaling threats to the body and provoking self-preservation behaviors to further survival. Pain often signals an urgent need to act (e.g., to flee, strike back, or otherwise respond aggressively to a threat), significant pain is typically associated with strong feelings (e.g., combinations of fear, anxiety, anger, or rage).
Pain can also occur in the absence of any discernible threat or identifiable tissue damage, due to alterations in the body’s normal neural processing. It is not uncommon to encounter distressed patients complaining about pain for which there is no clear origin.
What is considered to be chronic pain?
Chronic pain is defined as pain that lasts more than 12 weeks.
The Problem with Pain and Opioid Use
Pain can become complicated when it occurs with an addictive disorder, particularly in a patient using opioids for pain control. The initial evaluation and treatment plan for a patient using opioids may present a complex clinical challenge for care providers and cause considerable frustration and prolonged suffering for the patient. As in all instances, these complaints of pain must be taken seriously and carefully evaluated. Pain alone can impair health, function, and quality of life.
Addiction professionals are able to contribute valuable perspective and skills to the care of addicted patients, especially if they possess a working understanding of pain’s mechanisms, evaluation and management, and interrelationships with substance use.
What is involved in pain management therapy?
Pain management is a branch of medicine that applies science to the reduction of pain. As you would assume, it covers a wide range of conditions with the common denominator being ongoing, chronic pain. This is a rapidly growing medical specialty.
Doctors who specialize in pain management approach the problem from a variety of directions and treatment approaches. There aren’t many established standards, as the nature of chronic pain is complex.
To qualify as a pain management specialist, according to the American Board of Medical Specialties, a healthcare provider should be an MD with board certification in at least one of these specialties:
- Physical rehabilitation
- Psychiatry and neurology
Pain management therapy looks at pain as a disease, not a symptom of another condition. This allows pain management providers to apply scientific advances to treating the pain, rather than trying to link it to other health conditions. The field is moving away from helping patients learn to cope with ongoing pain through the involvement of a psychiatrist or therapist and to use many different modalities to actively minimize patients’ pain.
Pain management therapy now involves these modalities:
- Interventional pain management techniques (nerve blocks, spinal cord stimulation, and others)
- Physical therapy
- Alternative medicine
The goal of pain management is to minimize patient pain, rather than seeking to fully eliminate it, as this is quite often not possible. Other goals are to improve function and increase patient quality of life.
The benefits of pain management therapy training
Chronic pain impacts every part of a patient’s life. Beyond the actual pain, this condition causes everyday activities to become difficult. It also makes the patient eliminate many activities from his or her life that formerly were important to them or were enjoyed. This can lead to a downward spiral of depression and other psychological impacts.
By removing a good deal of a patient’s chronic pain, pain management therapy allows the patient to, in effect, get his or her life back. Advances in pain management therapy look beyond pharmacological solutions to far broader treatment approaches, many of them that involve the patient through self-management skills. These engage the patient and help them to feel as if they can, in part, take charge of their own pain management.
What kinds of patients require pain management therapy?
Anyone with chronic pain, which is defined as any pain that lasts more than 12 weeks, would require pain management. This contrasts with acute pain, which is the way our body alerts us to an injury or illness. Chronic pain persists for months or longer.
Chronic pain is widespread, estimated to affect up to 80 percent of American adults at some point. This type of pain can be caused by musculoskeletal injury, nervous system dysfunction, chronic disease, and autoimmune disorders.
These are the four most common causes of chronic pain:
- Back pain — Disc herniation, spinal stenosis, scoliosis, nerve compression, etc.
- Headaches — Chronic headaches occur for at least 15 days per month for at least three consecutive months.
- Joint pain — Rheumatoid arthritis, osteoarthritis, bursitis, tendinitis, etc.
- Nerve pain — Sciatica, diabetic neuropathy, carpal tunnel syndrome, etc.
What is non-pharmacological neuromodulation?
This is pain therapy without the use of prescription pain medication. Therapeutic neuromodulation is the alteration of nerve activity through the targeted delivery of a stimulus. At Med Ed Labs, we focus our training on the stimulus of spinal cord stimulation.
In this form of neuromodulation, mild electric currents are applied to the spinal cord through small medical devices. This electrical stimulation can modulate the body’s pain signals, replacing them with a mild tingling sensation known as paresthesia. If the patient responds to spinal cord stimulation initially through a device worn outside the body, an implanted system is then placed through minimally invasive surgery.
Can pain management doctors prescribe medication?
Yes, prescription medication is one of the main treatment approaches. However, there is a movement to make less use of prescription narcotic pain medications due to the increasing problem with addiction.
What does pain management therapy training entail?
- Learn how spinal cord stimulation is used.
- Learn how pain signals respond to treatments, from drugs to spinal cord stimulation.
- Learn the two-stage process of implementing neuromodulation with spinal cord stimulation.
- Learn how to enter the epidural space above the spinal canal with an x-ray guided needle.
- Learn how to thread the electrical leads into the epidural space.
- Learn how to test the electrode position to deliver the tingling sensation through patient feedback.
- Learn the ins and outs of the external pulse generator, which is usually worn for seven days on the patient’s belt.
- Learn how to judge the effectiveness of the spinal cord stimulation for managing the patient’s pain.
- Learn about the implantable spinal cord stimulation device.
- Learn how to implant the power source of this device under the skin.
- Learn how to monitor function once the device is implanted.
Who are candidates for spinal cord therapy training?
Neurosurgeons and doctors who specialize in pain management are prime candidates for adding this form of pain management therapy to their skill set. Seeing as how spinal cord stimulation is a relatively new option for treating chronic pain, many doctors and surgeons never received training in this form of pain management.
How is spinal cord stimulation performed?
Spinal cord stimulation begins with a trial run. This involves placing one or two wires into space outside the spinal cord. These are placed through a needle using fluoroscopy to ensure proper placement. These wires are connected to a unit that is outside the patient’s body. This is kept in place usually for about one week, and the patient tries the system to see how well stimulation helps to relieve their pain. The actual electrical impulses are very mild, and the patient cannot feel them. These electrical pulses mask the pain signal and can be adjusted over the course of the trial to get the greatest pain relief. If the stimulation reduces the patient’s pain by at least half, it is considered a success.
A successful trial is then followed by surgery to place a permanent stimulator. A small incision is made in the back and another near the waist. A small, flat electrode is placed through the incision on the back into space behind the spinal cord. The wire is then tunneled under the skin to the incision near the waist where it is connected to a small battery-powered generator. The generator is implanted under the skin at the waist incision. The system is tested and if everything is working the incisions are closed and the procedure is finished.
The patient then controls the spinal cord stimulation with a small hand-held remote.