Pain and Rheum

[AnybodyWantAPeanut?]

Hey guys,
PGY1 here, just finished a rheumatology rotation and noticed a lot of patient with chronic pain that would benefit from interventioinal pain or pharm treatment such as fibro, or inflammatory arthritis that could benefit from geniculat blocks, or chronic neck and back pain. I am interested in pain, do not know all available interventions but noticed the patients were not well controlled at times. How feasible would a rheum/interventional pain clinic be or would it even make sense?

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[244913]

Hey guys,
PGY1 here, just finished a rheumatology rotation and noticed a lot of patient with chronic pain that would benefit from interventioinal pain or pharm treatment such as fibro, or inflammatory arthritis that could benefit from geniculat blocks, or chronic neck and back pain. I am interested in pain, do not know all available interventions but noticed the patients were not well controlled at times. How feasible would a rheum/interventional pain clinic be or would it even make sense?

My general rule is not to perform procedures in any patient who has a central pain d/o like Fibro. I treat them like artifacts, rare works of art. They are to be viewed from a distance and admired, but not touched or photographed.

Rheum needs to start having the "difficult conversations" with these slugs and stop punting them for "pain management" when they know better than anyone the answer isn't opioids or procedures.

- ex 61N

 

[lobelsteve]

See other thread. RA and FMS co exist. RA and OA and spine pathology are comingled. Treatment for RA including prednisone for years has been a boon for kyphoplasty. RFA in neck and back is needed in most of the RA patients I see.

But...pure FMS. Nope, i dont offer trigger points. Let the rheum np or pa have at it.

 

[painfree23]

See other thread. RA and FMS co exist. RA and OA and spine pathology are comingled. Treatment for RA including prednisone for years has been a boon for kyphoplasty. RFA in neck and back is needed in most of the RA patients I see.

But...pure FMS. Nope, i dont offer trigger points. Let the rheum np or pa have at it.

Why not tpis? Ive had decent success with them in rheum pts

 

[lobelsteve]

Why not tpis? Ive had decent success with them in rheum pts

No down side. Just hrs to 2 days of partial relief. Happy to give it up to other providers. Will do if patient requests and im not too far behind.

 

[Ducttape]

I have done rare tpis for fibromyalgia but... are we “feeding” in to their pre-conceived notion that there is something structurally wrong that can be repaired?

 

[101N]

I have done rare tpis for fibromyalgia but... are we “feeding” in to their pre-conceived notion that there is something structurally wrong that can be repaired?

Absolutely we are, and we are incentivized - by our wRVU's - to do so. The argument that fibro is somehow unrelated to the pt's other
CNP diagnoses is intended to ligitimize a procedural approach to these patient 'other' unique, unrelated, legitimate pain diagnoses. People
who do this create iatrogenic harm and they should be called out.

 

[lobelsteve]

Only travell and simmomds got rich doing tpi. Wrvu for 20552 isnt always credited if performed at time of ov.

And the literature appears mixed, but supportive of tpi for fms. The literature is weak and not believable. Articles appear biased by author background.

 

[BobBarker]

No one is doing trigger points for the wrvu.

.66 decreased 50% because you billed for office visit yields $20

 

[AnybodyWantAPeanut?]

I dont know if everyone commenting on this thread is private or academic but I would like to open a private prac. Did you learn as you went in terms of billing,etc. or have someone train you? Ive been trying to read as much as I could and one of my attendings was teaching my how to code between the different levels, which doesnt seem that hard once you know the criteria.

I dont start pain rotations till PGY3 year and will pick my attendings brains a bunch on this as well as learning everything I can.