interventional spine?

[amyl]

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with pmr programs adding fellowships in interventional spine do you think this will eventually take some of the procedures away from anes/pmr pain fellowship trained doctors?

 

[drusso]

with pmr programs adding fellowships in interventional spine do you think this will eventually take some of the procedures away from anes/pmr pain fellowship trained doctors?

Probably not. What is "interventional spine" anyway? What is the difference between an "spinal interventionalist" and a comprehensive pain physician?

There is *NO* scientific evidence that pain of spinal origin is physiologically different from other kinds of pain.

If you perform a lumbar sympathetic block for a patient with CRPS of the lower extremity are you practicing Interventional Spine Medicine? How about if you place a thoracic epidural catheter for treatment refractory post herpetic neuralgia? Do spinal interventionalists implant pumps for malignant pain? What would they do for a patient with severe whole body neuropathic pain from calciphylaxis secondary to renal osteodystrophy? How about a paravertebral block for flail chest following a motor vehicle collision in a patient who is having difficulty weaning from a ventilator because of splinting? Any or all of these conditions may require a "spinal intervention" but are not necessarily primary pain of spinal origin.

I think that "interventional spine" is what some physiatrists call what they do when they perform basic spinal procedures for back pain (which is very common). There is nothing wrong with this, but they are not practicing a separate specialty. They are not relying on a separate "evidence base" than pain physicians use every day.

I consider myself a pain physician or a pain physiatrist in so far as that I diagnose, treat, and rehabilitate people with painful conditions regardless of etiology using all available modalities at my disposal. I don't know how a spinal interventionalist define what they do...

 

[Taus]

Am I wrong in thinking that most of the people who are differentiating IV Spine vs. Pain are referring to more of a purely neuromusculoskeletal/sports medicine practice in the former, rather then "pain of any etiology" practice?

 

[Ligament]

I agree with a lot of Dave's sentiments above, and in fact Dave and I are in the same boat regarding our medical training to this point, although I can't say all the time we've spent placing brachial plexus marcaine catheters or doing trigeminal blocks for example makes us better at treating a spine pain patient than a physician that was not trained in these techniques but instead spent his/her fellowship seeing primarily spine pain...I suppose we all have our strenghts...

 

[drusso]

Am I wrong in thinking that most of the people who are differentiating IV Spine vs. Pain are referring to more of a purely neuromusculoskeletal/sports medicine practice in the former, rather then "pain of any etiology" practice?

That sounds to me like a MSK physiatrist. Certainly the spine falls in the purview of the musculoskeletal system. "Interventional Spine" does not so much define a discrete knowledge base as it does a practice model.

 

[Taus]

that makes sense

 

[Disciple]

I consider myself a pain physician or a pain physiatrist in so far as that I diagnose, treat, and rehabilitate people with painful conditions regardless of etiology using all available modalities at my disposal. I don't know how a spinal interventionalist define what they do...

Spinal interventionists typically can't clearly define what they do, but like to imply "Orthopaedic" with a strong spine focus. In other words, claiming a superior or more in depth knowledge of anatomy, biomechanics and kinematics, possibly pathophysiology and conservative care.

That's all fine to claim that, just better be able to back it up.

 

[paz5559]

Probably not. What is "interventional spine" anyway? What is the difference between an "spinal interventionalist" and a comprehensive pain physician?

I think that "interventional spine" is what some physiatrists call what they do when they perform basic spinal procedures for back pain (which is very common). There is nothing wrong with this, but they are not practicing a separate specialty. They are not relying on a separate "evidence base" than pain physicians use every day.

I consider myself a pain physician or a pain physiatrist in so far as that I diagnose, treat, and rehabilitate people with painful conditions regardless of etiology using all available modalities at my disposal. I don't know how a spinal interventionalist define what they do...

This is very much an academic vs private practice distinction - anytime you use the word "pain" to describe your practice, you invite PCPs and self-referring patients to descend on your doorstep for medication management alone.

Given that you only have a certain number of patients you can see in a day, I would think you would prefer to attract those patients you might most be able to help with interventions. Using the term Spinal Interventionist may not be academically pure, but if it is good enough for ISIS (International Spine Intervention Society), that seems good enough for me.

 

[Spine Specialist]

Using the term Spinal Interventionist may not be academically pure, but if it is good enough for ISIS (International Spine Intervention Society), that seems good enough for me.

me too.😉

 

[Disciple]

This is very much an academic vs private practice distinction - anytime you use the word "pain" to describe your practice, you invite PCPs and self-referring patients to descend on your doorstep for medication management alone.

Given that you only have a certain number of patients you can see in a day, I would think you would prefer to attract those patients you might most be able to help with interventions. Using the term Spinal Interventionist may not be academically pure, but if it is good enough for ISIS (International Spine Intervention Society), that seems good enough for me.

I think if you call yourself a "Spine doc" or "Spine Interventionist" you should have a clear and in-depth knowledge of complex spinal disorders, functional anatomy, biomechanics, rehab/functional exercise and conservative care. You should also probably be able to read your own MRI, CT scans and plain films.

Otherwise (and here is where many Physiatrists frequently get into trouble), you start to look like one of those pain docs (whom other pain docs complain about) that "cherry-pick" the best patients or simply a pain doc with a limited knowledge base and skill set.

 

[Spine Specialist]

I think if you call yourself a "Spine doc" or "Spine Interventionist" you should have a clear and in-depth knowledge of complex spinal disorders, functional anatomy, biomechanics, rehab/functional exercise and conservative care. You should also probably be able to read your own MRI, CT scans and plain films.

Absolutely. and also to use your most powerful diagnostic tools ( two ears and one mouth piece) as Joel Press, MD said in his prez speech at NASS meeting to listen and speak with your patients which gives you the diagnostic clues than any modern machines.

 

[Mister Mxyzptlk]

I don't know how a spinal interventionalist define what they do...

They are easily spotted by the conspicuous absence of any prescription pads. I saw a patient chart today whose single visit to the pain doctor was summarized as follows:

"The patient states that the best medication for her pain is oxycodone. However, since I don't see a procedure that I can offer her I will not prescribe the medication. She can get it from her family doctor."

 

[Tenesma]

disagree...

1) if patient is satisfied with her current pain regimen of oxycodone - then why should a consultant have to change anything... go back to the prescribing physician --- otherwise it is only a referral dump

2) if the consultant doesn't feel oxycodone is appropriate - then why should he have to prescribe it...

3) the concept that pain physicians can only be "GOOD" pain doctors by also prescribing narcotics is a flawed concept... There is no "GOOD" evidence to suggest narcotics improve outcomes in chronic pain...

then again there is no "GOOD" evidence that anything we do improves outcomes... look at what happened to the recent spine surgery studies...

I don't routinely write narcotics - either because the patient is functional and well controlled on their current regimen or because the patient isn't functional and not improving on their current regimen.... I do prescribe for terminal cancer and terminal pain (ie: panc. ca. w/ 3 months to go, or 96yo w/ a spine that looks like swiss cheese wrapped cookie crumbs)

 

[drusso]

This is very much an academic vs private practice distinction - anytime you use the word "pain" to describe your practice, you invite PCPs and self-referring patients to descend on your doorstep for medication management alone.

Given that you only have a certain number of patients you can see in a day, I would think you would prefer to attract those patients you might most be able to help with interventions. Using the term Spinal Interventionist may not be academically pure, but if it is good enough for ISIS (International Spine Intervention Society), that seems good enough for me.

But, most chronic pain of spinal origin is indeed a *medical* management problem anyway though not necessarily an opioid deficiency problem.

Unless it is specifically for a diagnostic block, only infrequently has a surgeon or PCP referred a patient with a thoughtful plan for conservative care. It's seems tautological to say that by calling yourself a "spinal interventionalist" that you're going to attract those patients who would most benefit from an intervention when the majority of your referring providers seem to have no idea about the breadth or scope of conservative care, whether the pain is of primary spinal origin, myofascial, discogenic; what the appropriate indications are for neuraxial procedures, etc.

Most commonly, its goes...

Pt: "Dr. So-and-so said he won't operate on my back (yet) so he sent me here."

Pain Doc: "Sent you here for what?"

Pt: "I don't know..."

Thus, it makes more sense to me to call yourself a "pain doctor" since practically everyone agrees that the patient does indeed have back pain of some flavor.

I value and respect what ISIS is and does but again I don't think even they believe that their scope is like NASS or the International Society for the Study of the Lumbar Spine.

 

[Mister Mxyzptlk]

disagree...

1) if patient is satisfied with her current pain regimen of oxycodone - then why should a consultant have to change anything... go back to the prescribing physician --- otherwise it is only a referral dump

2) if the consultant doesn't feel oxycodone is appropriate - then why should he have to prescribe it...

3) the concept that pain physicians can only be "GOOD" pain doctors by also prescribing narcotics is a flawed concept... There is no "GOOD" evidence to suggest narcotics improve outcomes in chronic pain...

then again there is no "GOOD" evidence that anything we do improves outcomes... look at what happened to the recent spine surgery studies...

I don't routinely write narcotics - either because the patient is functional and well controlled on their current regimen or because the patient isn't functional and not improving on their current regimen.... I do prescribe for terminal cancer and terminal pain (ie: panc. ca. w/ 3 months to go, or 96yo w/ a spine that looks like swiss cheese wrapped cookie crumbs)

"quod erat demonstrandum"

 

[Aether2000]

ISIS has its own philosophy of teaching that for which there is scientific evidence of efficacy and indication, and ISIS serves as a source for scientifically based guidelines and research. They recognize the scope of pain medicine far exceeds that which they espouse, but understand there are many other organizations that can effectively teach other aspects of pain medicine such as opiates. ISIS does not take a formal position on the prescribing of opiates for chronic pain since that is not their venue.

 

[mid|ine]

Sorry to bump this old thread, but looking for an English major to clarify. Is someone that practices interventional spine work a:

spine interventionist

spine interventionalist

spinal interventionist

spinal interventionalist

 

[lobelsteve]

Sorry to bump this old thread, but looking for an English major to clarify. Is someone that practices interventional spine work a:

spine interventionist

spine interventionalist

spinal interventionist

spinal interventionalist

Needle monkey. 😀

Appropriate term is Interventional Pain Physician.

You down with IPP?

 

[mid|ine]

To most of the world, including referring docs, "pain" = narcotics. That's not me. I am not the candy store, don't want those referrals. I practice interventional spine. The difference between a needle jockey/monkey and an interventionalist? I evaluate and examine every patient, do appropriate procedure, explain to the patients what and why I am doing things.

 

[hyperalgesia]

I would use "spine interventionalist". Not sure if that's correct...

 

[Jcm800]

To most of the world, including referring docs, "pain" = narcotics. That's not me. I am not the candy store, don't want those referrals. I practice interventional spine. The difference between a needle jockey/monkey and an interventionalist? I evaluate and examine every patient, do appropriate procedure, explain to the patients what and why I am doing things.

but will you refill their oxycontin?!!?

 

[101N]

To most of the world, including referring docs, "pain" = narcotics. That's not me. I am not the candy store, don't want those referrals. I practice interventional spine. The difference between a needle jockey/monkey and an interventionalist? I evaluate and examine every patient, do appropriate procedure, explain to the patients what and why I am doing things.

There is a lot of this 'rebranding' going on where I live. I think a lot of it has to
do with the climate of prescription drug abuse and patient expectations where a
a subset of liberal prescribers work.

 

[mid|ine]

I also lean to "spine interventionalist", but many interventional cardiologists, say the are interventionist (no -al). A google search seems to turn up more spinal then spine.

I don't like that the re-branding doesn't fully encompass what I can and am willing to do. I have no problem counseling patients on appropriate use of narcotics, or being the "bad cop" for a PCP that is having trouble getting a pt off narcotics or making reasonable suggestions regarding appropriate dosing and intervals for PCP.

But I don't want the pt that was recently discharged from another "pain" doc on crazy doses of narcs to write the refills. Its a waste of my time and the patients. I won't do it for them.

 

[Mister Mxyzptlk]

There's a group here that uses the term "spinal diagnosticians", which translates to "we just give shots".

 

[lobelsteve]

Unimodal care exists to benefit the doctor.
Multimodal care exists to benefit the neighborhood (I mean patient).

 

[ml2001]

There's a group here that uses the term "spinal diagnosticians", which translates to "we just give shots".

Can you please elaborate on your comment above. Are you talking about 'spinal diagnosticians' in realm of PM&R docs OR in the realm of Pain docs?

-ML