Potentially Interesting Thought...

[TUGM]

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Anyone heard of any NIR guys doing interventional pain management on the side? Most NIRs I've talked to or rotated with so far end up doing vertebroplasty/kyphoplasty procedures every once in a while. Just wondering if it is feasible to set up a practice with other pain procedures, especially if you have access to equipment?

Lol... I can only imagine how much the lifestyle would suck though.

 

[typhoonegator]

At least one of the interventionalists at my establishments does kyphoplasty procedures during the day, so it is possible.

 

[bustbones26]

Anyone heard of any NIR guys doing interventional pain management on the side? Most NIRs I've talked to or rotated with so far end up doing vertebroplasty/kyphoplasty procedures every once in a while. Just wondering if it is feasible to set up a practice with other pain procedures, especially if you have access to equipment?

Lol... I can only imagine how much the lifestyle would suck though.

Lifestyle suck???

Let's see, I have to file paperwork and wait weeks to approve a chronic migraine patient for botox.

A pain doctor can do a sacroiliac joint injection, oh, but wait, it has to be done under floro (add more money) and oh wait, patient required conscious sedation (attending is anesthesia and again, adds more money), and lastly, let's do it at an ambulatory surgery center that is owned by the doctor so that while the reimbursement for the procedure is less, the overall cost and greater and the doctor skims off more cash. That will be about $2000+ for 15 minutes of work. Oh, and whenever the patient comes back to complain that the procedure did not work and start drug seeking, they can sit in a room and while at a PA-C or something while the doctor is in the ambulatory surgery center raking in more dough.

 

[TUGM]

Sounds like pain medicine is a PAIN for you, friend. Sorry couldn't resist the bad joke... I assumed lifestyle would suck as in having to work all the time, deal w/ chronic pain patients in general... Lol reimbursement for something like these would be pretty sweet I'm assuming... $$$$

I suppose I was just wondering if NIRs can do pain management on top of doing their aneurysms/ embolizations/acute stroke treatments/stents. Since they become fairly adept at doing image-guided needle/catheter work, it seems like they have the potential to overlap?

 

[Taus]

Lifestyle suck???

Let's see, I have to file paperwork and wait weeks to approve a chronic migraine patient for botox.

A pain doctor can do a sacroiliac joint injection, oh, but wait, it has to be done under floro (add more money) and oh wait, patient required conscious sedation (attending is anesthesia and again, adds more money), and lastly, let's do it at an ambulatory surgery center that is owned by the doctor so that while the reimbursement for the procedure is less, the overall cost and greater and the doctor skims off more cash. That will be about $2000+ for 15 minutes of work. Oh, and whenever the patient comes back to complain that the procedure did not work and start drug seeking, they can sit in a room and while at a PA-C or something while the doctor is in the ambulatory surgery center raking in more dough.

SI injections absolutely need image guidance. It is foolish to think you can reliably get intra-articular without fluoro (or ultrasound) guidance. Otherwise you are essentially just doing a trigger point injection. Very different from a knee or subacromial shoulder.

The rest of what you said is pure bs and its a real shame that the pain docs in your area practice this way. Also, to paint with such a broad brush as you repeatedly have in many posts and assume that all pain docs practice that way is also pure bs.

 

[bustbones26]

SI injections absolutely need image guidance. It is foolish to think you can reliably get intra-articular without fluoro (or ultrasound) guidance. Otherwise you are essentially just doing a trigger point injection. Very different from a knee or subacromial shoulder.

The rest of what you said is pure bs and its a real shame that the pain docs in your area practice this way. Also, to paint with such a broad brush as you repeatedly have in many posts and assume that all pain docs practice that way is also pure bs.

You have missed the broad brush that I am trying to paint with and it isn't about bashing pain doctors.


We sit back and watch our own specialty get picked apart by the vultures. Back in my early days, neurologists and physiatrists used to brag that they made more money from doing an EMG than the surgeon did for the carpal tunnel release. Is that still the case? I do continuously bring up the problems with botox. If you would like, I can share with you all the latest rants from the Southern Headache Society listserve about botox reimbursement/approvals (by the way, a good number of those doctors are pain doctors too).

My point is simply that pain doctors seem to NOT have to jump through these hoops? Again, I ask, why is it that patient can show up at a pain clinic complaining of back pain with a normal EMG and an MRI that might show only a bulging disc, yet the doc can do some sort of injeciton with minimal barriers? What if tomorrow Medicare tinkered with the idea of cutting the reimbursement rates for epidural injections by 50 to 60%? What if they also not only cut the rates but demanded that pain doctors bundle their procedures (e.g. one CPT code for 1 to 3 levels)? If that happened, how long do you think it would take for a number of anesthesiologists to show up in Washington DC creating an uproar?

So where are the neurologists at whenever these types of things happen to us? Sending out numerous emails to help us "prepare for it". Am I the first one to point this out or complain about it on this board?

Now, back to the OPs question. If you feel that you have been adquately trained to perform interventional injections, then you are more than welcome to take that risk. Who knows? Perhaps during an NIR fellowship, some institutions do these? It is my understanding that radiologists are trained for these in some musculoskeletal radiology fellowhsips? If that is the case, then why not? You just cannot go out there and advertise to the public that you are a board certified pain doctor (at least in my state that is the rule).

 

[bustbones26]

Sounds like pain medicine is a PAIN for you, friend. Sorry couldn't resist the bad joke... I assumed lifestyle would suck as in having to work all the time, deal w/ chronic pain patients in general... Lol reimbursement for something like these would be pretty sweet I'm assuming... $$$$

I suppose I was just wondering if NIRs can do pain management on top of doing their aneurysms/ embolizations/acute stroke treatments/stents. Since they become fairly adept at doing image-guided needle/catheter work, it seems like they have the potential to overlap?

Okay, back to another point. Yes, pain docs have to deal with chronic pain patients acting stupid, how do they do it? The same way we deal with problematic patients, you grin and bear it. Also, make reasonable barriers.

I suppose you have to decide what it is you want to do. Again, I have heard of radiologists doing musculoskeletal fellowship and being exposed to interventional spine, etc I just have not heard of NIR fellowships doing this?