Well, there you go

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Yuck. Note to self, don't go to Gastroenterology Associates of Western Colorado for anything...
 
I'm a little confused exactly what the job is for. It says it's not chronic pain, and rarely regional, but acute pain. Why would you need to do acute pain at an endoscopy center? What does that look like? Do CRNAs have prescribing privileges in Colorado, are they just hiring a fall guy to prescribe a bunch of narcs? So confused...
 
They probably just checked the wrong box there. My guess is that this is a split between doing sedation for endoscopies and doing chronic pain stuff such as trigger points and epidural steroids plus or minus narcs. The sort of stuff somebody who has done couple of would figure they could just do all day long without any need for any sort of actual chronic pain training. Or maybe a weekend seminar or two. Take that you fellowship trained suckers.
 
yep, looks like they want a CRNA to do the endoscopy sedation but they probably don't have enough work for them full time so they encourage them to do some pain procedures like epidural steroids that the endoscopy center can bill for as well.
 
Mman said:
yep, looks like they want a CRNA to do the endoscopy sedation but they probably don't have enough work for them full time so they encourage them to do some pain procedures like epidural steroids that the endoscopy center can bill for as well.
Click to expand...
Exactly. If you guys only knew how common this is, you'd be mortified. Or maybe not.
 
Consigliere said:
Are you mortified?
Click to expand...

Mortified by CRNAs administering sedation for endoscopy? Hardly. That's been going on for a long time. Not the best idea and as a patient you should understand what you are getting, but hard for me to be mortified by. The GI doc bears legal responsibility for supervising them in non opt out states.

Mortified by an epidural steroid injection by a CRNA? Sort of. They are not appropriate to be evaluating and managing chronic pain. Then again, I'm also mortified when PM&R docs are doing cervical injections.
 
Epidurals are monkey procedures. Frankly, a lot of epidurals and similar injections administered by pain docs are probably fake (we'll call it placebo to be politically correct). Oh yeah, you really nailed that facet block 🙄. The gastroenterologist sees a business opportunity and is taking advantage of a broken system. I'm sure there are plenty of anesthesia groups doing the same. There are worse things in medicine that mortify me.
 
Arch Guillotti said:
Why?
Click to expand...

potential complications and the ability to manage them acutely from a specialty that doesn't do hundreds of epidurals in residency. But that's just me. You are free to go to them for your injection.
 
Mman said:
potential complications and the ability to manage them acutely from a specialty that doesn't do hundreds of epidurals in residency. But that's just me. You are free to go to them for your injection.
Click to expand...
How does a pain management doctor with residency training in anesthesia manage an acute problem differently from one trained in pmr?
 
Arch Guillotti said:
How does a pain management doctor with residency training in anesthesia manage an acute problem differently from one trained in pmr?
Click to expand...

I would hope you would know. My pain colleagues still work in the OR periodically and are quite skill in resuscitation.
 
Arch Guillotti said:
They must not be very good pain docs if they are having to resuscitate everyone that they do a block on.
Click to expand...

Why so snippy? They are skilled because of what they do in the OR, not because they have to do it in the pain clinic.
 
GravelRider said:
Epidurals are monkey procedures. Frankly, a lot of epidurals and similar injections administered by pain docs are probably fake (we'll call it placebo to be politically correct). Oh yeah, you really nailed that facet block 🙄. The gastroenterologist sees a business opportunity and is taking advantage of a broken system. I'm sure there are plenty of anesthesia groups doing the same. There are worse things in medicine that mortify me.
Click to expand...

A CESI is not straight-forward. Can you intelligently discuss:

R/B of IL vs TF approach?
ASRA and other societies anti-coag guidelines for chronic pain procedures
R/B of DSA vs live flouro vs spot shots with contrast injection
Different iodine based contrast agents labeling for intrathecal vs non intrathecal as well as different degrees of radiopaqueness and appropriate agent selection
R/B of gadolinium based agents in people with iodine allergies
EBM prophylactic regimens for moderate contrast reactions with iodinated contrast agents
Anatomy of cervical segmental medullary arteries, vertebral arteries, and contrast patterns with venous versus arterial injection
Safe minimum amount of epidural space present on MRI and how to assess a given spinal level for safety
Amount of injectate to be used for maximum safety/efficacy
R/B of local/steroid versus steroid only
R/B of seated versus prone approach
CLO versus straight lateral to assess depth
Manipulation of fluoroscope to obtain true AP/true lateral images in altered spinal anatomy
Optimal degree of CLO for accurate needle placement
After which spine surgeries CESIs are safe versus unsafe at any given level
Difference between SNRB and TFESI?
Clinical utility of SNRB diagnostically and in guiding surgical approach
R/B of catheter versus through needle
R/B of midline approach versus paramedian in terms of discontinuous ligament in the midline
R/B of injection at levels superior to C7/T1 in terms of discontinuous ligament at superior levels
R/B Particulate versus non-particulate steroid
R/B of perservative free steroid formulations
Various types of systemic versus local chronic and/or acute infections ranging from HIV to various dental procedures and if CESI is safe in these senarios if on/not on antimicrobials
Indications for spine surgery referral based on history/physical/imaging rather than just doing the injection
Safe amount of CESIs to do in a given time period based on pt and risk factors present
Assessment of cervical instability, myelopathy, syrinx, cancer, hardware failure, shoulder pathology, myofascial pain, facetogenic pain, etc etc that needs to be excluded in assessing cervical radicular pain...including comprehensive physical examination, knowledge of indications for and sensitivity/specificity of EMG/NCV, MRI w/ contrast, MRI w/o contrast, CT, CT myelogram.

And so on.

No? Neither can any of the CRNAs doing CESIs. And neither can 99.999% of referring surgeons speak intelligently to all these issues. Seems to me this would be, off the top of my head, the minimum type of knowledge one would need to safely perform these injections.

And note that his all only has to do with actually doing a CESI. Not managing someone with radicular pain. That is a much larger base of knowledge. Including a comprehensive knowledge of evidence for various types of PT, traction, TENs, neck braces, CESI versus SCS versus various surgical approaches to radicular pain, various pain medications topical and oral NNT, side effects, use in CKD/Liver disease, etc.

Etc, etc.

You get the point I hope. Because your post was pretty ignorant.

There is a reason pain fellowship is a year.

CRNAs should NOOOOOOOOOOOOOOOOTTTTTTTTTTTTTT be doing CESIs man.

How are we gonna win the "battle against CRNAs" with this type of commentary floating around from our own...

Get a clue.
 
Last edited:
Timeoutofmind said:
A CESI is not straight-forward. Can you intelligently discuss:

R/B of IL vs TF approach?
ASRA and other societies anti-coag guidelines for chronic pain procedures
R/B of DSA vs live flouro vs spot shots with contrast injection
Different iodine based contrast agents labeling for intrathecal vs non intrathecal as well as different degrees of radiopaqueness and appropriate agent selection
R/B of gadolinium based agents in people with iodine allergies
EBM prophylactic regimens for moderate contrast reactions with iodinated contrast agents
Anatomy of cervical segmental medullary arteries, vertebral arteries, and contrast patterns with venous versus arterial injection
Safe minimum amount of epidural space present on MRI and how to assess a given spinal level for safety
Amount of injectate to be used for maximum safety/efficacy
R/B of local/steroid versus steroid only
R/B of seated versus prone approach
CLO versus straight lateral to assess depth
Manipulation of fluoroscope to obtain true AP/true lateral images in altered spinal anatomy
Optimal degree of CLO for accurate needle placement
After which spine surgeries CESIs are safe versus unsafe at any given level
Difference between SNRB and TFESI?
Clinical utility of SNRB diagnostically and in guiding surgical approach
R/B of catheter versus through needle
R/B of midline approach versus paramedian in terms of discontinuous ligament in the midline
R/B of injection at levels superior to C7/T1 in terms of discontinuous ligament at superior levels
R/B Particulate versus non-particulate steroid
R/B of perservative free steroid formulations
Various types of systemic versus local chronic and/or acute infections ranging from HIV to various dental procedures and if CESI is safe in these senarios if on/not on antimicrobials
Indications for spine surgery referral based on history/physical/imaging rather than just doing the injection
Safe amount of CESIs to do in a given time period based on pt and risk factors present
Assessment of cervical instability, myelopathy, syrinx, cancer, hardware failure, shoulder pathology, myofascial pain, facetogenic pain, etc etc that needs to be excluded in assessing cervical radicular pain...including comprehensive physical examination, knowledge of indications for and sensitivity/specificity of EMG/NCV, MRI w/ contrast, MRI w/o contrast, CT, CT myelogram.

And so on.

No? Neither can any of the CRNAs doing CESIs. And neither can 99.999% of referring surgeons speak intelligently to all these issues. Seems to me this would be, off the top of my head, the minimum type of knowledge one would need to safely perform these injections.

And note that his all only has to do with actually doing a CESI. Not managing someone with radicular pain. That is a much larger base of knowledge. Including a comprehensive knowledge of evidence for various types of PT, traction, TENs, neck braces, CESI versus SCS versus various surgical approaches to radicular pain, various pain medications topical and oral NNT, side effects, use in CKD/Liver disease, etc.

Etc, etc.

You get the point I hope. Because your post was pretty ignorant.

There is a reason pain fellowship is a year.

CRNAs should NOOOOOOOOOOOOOOOOTTTTTTTTTTTTTT be doing CESIs man.

How are we gonna win the "battle against CRNAs" with this type of commentary floating around from our own...

Get a clue.
Click to expand...

No way in hell I would let a nurse do one on me or anyone I love.
 
Timeoutofmind said:
A CESI is not straight-forward. Can you intelligently discuss:

R/B of IL vs TF approach?
ASRA and other societies anti-coag guidelines for chronic pain procedures
R/B of DSA vs live flouro vs spot shots with contrast injection
Different iodine based contrast agents labeling for intrathecal vs non intrathecal as well as different degrees of radiopaqueness and appropriate agent selection
R/B of gadolinium based agents in people with iodine allergies
EBM prophylactic regimens for moderate contrast reactions with iodinated contrast agents
Anatomy of cervical segmental medullary arteries, vertebral arteries, and contrast patterns with venous versus arterial injection
Safe minimum amount of epidural space present on MRI and how to assess a given spinal level for safety
Amount of injectate to be used for maximum safety/efficacy
R/B of local/steroid versus steroid only
R/B of seated versus prone approach
CLO versus straight lateral to assess depth
Manipulation of fluoroscope to obtain true AP/true lateral images in altered spinal anatomy
Optimal degree of CLO for accurate needle placement
After which spine surgeries CESIs are safe versus unsafe at any given level
Difference between SNRB and TFESI?
Clinical utility of SNRB diagnostically and in guiding surgical approach
R/B of catheter versus through needle
R/B of midline approach versus paramedian in terms of discontinuous ligament in the midline
R/B of injection at levels superior to C7/T1 in terms of discontinuous ligament at superior levels
R/B Particulate versus non-particulate steroid
R/B of perservative free steroid formulations
Various types of systemic versus local chronic and/or acute infections ranging from HIV to various dental procedures and if CESI is safe in these senarios if on/not on antimicrobials
Indications for spine surgery referral based on history/physical/imaging rather than just doing the injection
Safe amount of CESIs to do in a given time period based on pt and risk factors present
Assessment of cervical instability, myelopathy, syrinx, cancer, hardware failure, shoulder pathology, myofascial pain, facetogenic pain, etc etc that needs to be excluded in assessing cervical radicular pain...including comprehensive physical examination, knowledge of indications for and sensitivity/specificity of EMG/NCV, MRI w/ contrast, MRI w/o contrast, CT, CT myelogram.

And so on.

No? Neither can any of the CRNAs doing CESIs. And neither can 99.999% of referring surgeons speak intelligently to all these issues. Seems to me this would be, off the top of my head, the minimum type of knowledge one would need to safely perform these injections.

And note that his all only has to do with actually doing a CESI. Not managing someone with radicular pain. That is a much larger base of knowledge. Including a comprehensive knowledge of evidence for various types of PT, traction, TENs, neck braces, CESI versus SCS versus various surgical approaches to radicular pain, various pain medications topical and oral NNT, side effects, use in CKD/Liver disease, etc.

Etc, etc.

You get the point I hope. Because your post was pretty ignorant.

There is a reason pain fellowship is a year.

CRNAs should NOOOOOOOOOOOOOOOOTTTTTTTTTTTTTT be doing CESIs man.

How are we gonna win the "battle against CRNAs" with this type of commentary floating around from our own...

Get a clue.
Click to expand...

Well clearly you are doing a terrific job communicating that to the people who matter. Do you think the gastroenterologist would hire a few PAs to do some arthroscopic procedures in his procedure center?
 
The seven claims for spinal cord injury resulting from cervical epidural steroid injections all had MRI evidence of trauma to the cord at or near the level of the attempted epidurals. Imaging descriptions included cord edema, abnormal signals consistent with blood, fluid or contrast material within the cord, cord syrinx, or scarring. Most of these patients had preprocedure MRIs or CT scans, proving that the findings were new.

Medical records showed that the patients complained immediately or in recovery of varying degrees of pain, weakness, or numbness in one or both arms and hands and, in two cases, one arm and the ipsilateral leg. Most patients were treated with steroids. None had surgical interventions. The symptoms tended to improve with time, but all patients alleged some permanent residual disability.

Four of the patients received intravenous sedation before the block—usually a combination of midazolam and fentanyl, with propofol added in two of the claims. Oversedation was an allegation in some of these claims during litigation. The issue of conscious sedation during epidural steroid blocks remains controversial. While many anesthesiologists use sedation to increase patient comfort and relieve anxiety, it has been suggested by some authors that sedation might leave some patients unable to complain about pain or paresthesias, which are early warning signs of nerve irritation, before more serious damage is done.3, 8

http://www.thedoctors.com/Knowledge...tions-of-Cervical-Epidural-Steroid-Injections
 
Additional article information

Abstract
Background:
Multiple type of spinal injections, whether epidural/translaminar or transforaminal, facet injections, are offered to patients with/without surgical spinal lesions by pain management specialists (radiologists, physiatrists, and anesthesiologists). Although not approved by the Food and Drug Administration (FDA), injections are being performed with an increased frequency (160%), are typically short-acting and ineffective over the longer-term, while exposing patients to major risks/complications.

Methods:
For many patients with spinal pain alone and no surgical lesions, the “success” of epidural injections may simply reflect the self-limited course of the disease. Alternatively, although those with surgical pathology may experience transient or no pain relief, undergoing these injections (typically administered in a series of three) unnecessarily exposes them to the inherent risks, while also delaying surgery and potentially exposing them to more severe/permanent neurological deficits.

Results:
Multiple recent reports cite contaminated epidural steroid injections resulting in meningitis, stroke, paralysis, and death. The Center for Disease Control (CDC) specifically identified 25 deaths (many due to Aspergillosis), 337 patients sickened, and 14,000 exposed to contaminated steroids. Nevertheless, many other patients develop other complications that go unreported/underreported: Other life-threatening infections, spinal fluid leaks (0.4-6%), positional headaches (28%), adhesive arachnoiditis (6-16%), hydrocephalus, air embolism, urinary retention, allergic reactions, intravascular injections (7.9-11.6%), stroke, blindness, neurological deficits/paralysis, hematomas, seizures, and death.

Conclusions:
Although the benefits for epidural steroid injections may include transient pain relief for those with/without surgical disease, the multitude of risks attributed to these injections outweighs the benefits.


https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3642757/
 
Timeoutofmind said:
A CESI is not straight-forward. Can you intelligently discuss:

R/B of IL vs TF approach?
ASRA and other societies anti-coag guidelines for chronic pain procedures
R/B of DSA vs live flouro vs spot shots with contrast injection
Different iodine based contrast agents labeling for intrathecal vs non intrathecal as well as different degrees of radiopaqueness and appropriate agent selection
R/B of gadolinium based agents in people with iodine allergies
EBM prophylactic regimens for moderate contrast reactions with iodinated contrast agents
Anatomy of cervical segmental medullary arteries, vertebral arteries, and contrast patterns with venous versus arterial injection
Safe minimum amount of epidural space present on MRI and how to assess a given spinal level for safety
Amount of injectate to be used for maximum safety/efficacy
R/B of local/steroid versus steroid only
R/B of seated versus prone approach
CLO versus straight lateral to assess depth
Manipulation of fluoroscope to obtain true AP/true lateral images in altered spinal anatomy
Optimal degree of CLO for accurate needle placement
After which spine surgeries CESIs are safe versus unsafe at any given level
Difference between SNRB and TFESI?
Clinical utility of SNRB diagnostically and in guiding surgical approach
R/B of catheter versus through needle
R/B of midline approach versus paramedian in terms of discontinuous ligament in the midline
R/B of injection at levels superior to C7/T1 in terms of discontinuous ligament at superior levels
R/B Particulate versus non-particulate steroid
R/B of perservative free steroid formulations
Various types of systemic versus local chronic and/or acute infections ranging from HIV to various dental procedures and if CESI is safe in these senarios if on/not on antimicrobials
Indications for spine surgery referral based on history/physical/imaging rather than just doing the injection
Safe amount of CESIs to do in a given time period based on pt and risk factors present
Assessment of cervical instability, myelopathy, syrinx, cancer, hardware failure, shoulder pathology, myofascial pain, facetogenic pain, etc etc that needs to be excluded in assessing cervical radicular pain...including comprehensive physical examination, knowledge of indications for and sensitivity/specificity of EMG/NCV, MRI w/ contrast, MRI w/o contrast, CT, CT myelogram.

And so on.

No? Neither can any of the CRNAs doing CESIs. And neither can 99.999% of referring surgeons speak intelligently to all these issues. Seems to me this would be, off the top of my head, the minimum type of knowledge one would need to safely perform these injections.

And note that his all only has to do with actually doing a CESI. Not managing someone with radicular pain. That is a much larger base of knowledge. Including a comprehensive knowledge of evidence for various types of PT, traction, TENs, neck braces, CESI versus SCS versus various surgical approaches to radicular pain, various pain medications topical and oral NNT, side effects, use in CKD/Liver disease, etc.

Etc, etc.

You get the point I hope. Because your post was pretty ignorant.

There is a reason pain fellowship is a year.

CRNAs should NOOOOOOOOOOOOOOOOTTTTTTTTTTTTTT be doing CESIs man.

How are we gonna win the "battle against CRNAs" with this type of commentary floating around from our own...

Get a clue.
Click to expand...

While part of me agrees with you, part of me agrees with Gravelrider. All of the above is a laundry list of the specific things you have to regurgitate to become BC in Pain. Its all the highlights of the fellowship material and exam. Its advanced stuff and its interesting stuff. It makes you feel like your an expert. But how often are those things really making a difference for patients? A lot or practices are like this: "I have neck pain and I was referred to you for a CESI. " "I was sent to you by Dr. Ortho when I ran out of percocet" Its great if your thinking deeply about it, but a lot of it is automatic.. failed LESI? how about MBBs?

Agree that I would certainly NOT have a CESI by a CRNA, or LESI, or almost anything..

But I do think the pain "expertise" is a little overblown and mostly driven by these items on the above list that are mainly board topics, which are just a result of having a written exam and needing some kind of structured material to test. The real world value of this stuff is certainly questionable IMO..
 
Man o War said:
Me too, I feel sorry for patients who have nurses performing procedures on them and they don't know any better.
Click to expand...

I dont think its unethical if you know and trust that the CRNA is experienced and skilled.
 
BLADEMDA said:
Sorry, but not a CESI. I encourage one to really look up the risks/benefits of this procedure. A CESI is a not a CRNA type procedure.
Click to expand...

Man, CESIs were the thing that freaked me out the most in residency. More than happy to let the attendings do those. A couple weeks of (maybe) improved pain vs the risk of cervical spine injury? No thanks.
 
Hoya11 said:
While part of me agrees with you, part of me agrees with Gravelrider. All of the above is a laundry list of the specific things you have to regurgitate to become BC in Pain. Its all the highlights of the fellowship material and exam. Its advanced stuff and its interesting stuff. It makes you feel like your an expert. But how often are those things really making a difference for patients? A lot or practices are like this: "I have neck pain and I was referred to you for a CESI. " "I was sent to you by Dr. Ortho when I ran out of percocet" Its great if your thinking deeply about it, but a lot of it is automatic.. failed LESI? how about MBBs?

Agree that I would certainly NOT have a CESI by a CRNA, or LESI, or almost anything..

But I do think the pain "expertise" is a little overblown and mostly driven by these items on the above list that are mainly board topics, which are just a result of having a written exam and needing some kind of structured material to test. The real world value of this stuff is certainly questionable IMO..
Click to expand...
Hoya11 said:
While part of me agrees with you, part of me agrees with Gravelrider. All of the above is a laundry list of the specific things you have to regurgitate to become BC in Pain. Its all the highlights of the fellowship material and exam. Its advanced stuff and its interesting stuff. It makes you feel like your an expert. But how often are those things really making a difference for patients? A lot or practices are like this: "I have neck pain and I was referred to you for a CESI. " "I was sent to you by Dr. Ortho when I ran out of percocet" Its great if your thinking deeply about it, but a lot of it is automatic.. failed LESI? how about MBBs?

Agree that I would certainly NOT have a CESI by a CRNA, or LESI, or almost anything..

But I do think the pain "expertise" is a little overblown and mostly driven by these items on the above list that are mainly board topics, which are just a result of having a written exam and needing some kind of structured material to test. The real world value of this stuff is certainly questionable IMO..
Click to expand...

If I wanted to make a laundry list of things that are necessary to regurgitate for the exam, I would have discussed landmark blocks, differential nerve block and other 1980s medicine, as well as minutiae regarding microglia, peripheral versus central sensitization, etc.

On the contrary, the above list were things that actually do matter when performing CESIs.

I have to deal with people with "contrast allergies" and actual contrast allergies all the time.
I got a referral for a TF CESI yesterday, and talked pt into a IL CESI.
I added CLO to lateral to assess depth recently.
I do CESIs on people s/p cervical spine surgery all the time.
Etc, I dont want to type a long post but literally everything else on that list is something I put quite a bit of thought into when formulating my approach to these injections, after fellowship and before starting as an attending, was it not for you?

I appreciate that you have posted your story on here, and that you joined a pill mill/injection mill/Workers comp scam fest after fellowship and it put a bad taste in your mouth, but again my pain practice is the polar opposite. No narcs, no disability, etc.

Yesterday I did a high volume glenohumeral intra-articular + suprascapular nerve block and coordinated aggressive ROM same day PT post procedure for a lady with frozen shoulder that her PCP had not addressed. She felt amazing afterwards
Doing the same next week for some lady with frozen shoulder that a douche ortho did a blind subacromial on in the office for
I did a genicular RF for a lady with pain after TKA yesterday
Did BL image guided knee injections that were done blindly by a PCP last week with no relief by the PCP and tons of relief after mine
Did an image guided hip intra-articular injection last week for a lady that failed one blind, and she got great relief
Saw a lady today with raging painful peripheral neuropathy, consult from neurologist, and totally changed her regimen around based on her comorbidites and what meds she had failed etc
Upcoming BL pulsed RF of pudendal nerve for a lady with horrendous perineal pain after multiple gyn and abdonimal procedures as she had good relief with image guided pudendal blocks
Orthos refer to me in system for US guided diagnostic nerve blocks to help them diagnosis and treat
I onboarded high frequency spinal cord stimulation in my hospital system, which is epically effective at times and a life changing event for many patients
Etc
Etc

Orthos and PCPs suck at treating chronic pain.

These modalities are gamechangers for the pts.

I said it before and I will say it again, you should try working in a healthy pain practice, before jumping ship totally to OR as you have

In a healthy practice, pain is such a great field

It seems for whatever reason you just cannot accept the facts as such, although I really wish you could for your own sake, so I am not going to have an extended convo with you or post anymore on this thread but this is just for the residents out there to help them appreciate pain is a great and sophisticated field, and also to inform whoever might be reading this that CESIs and other such procedures are NEVER OK for a CRNA to do. Again, patients lives are at stake and your posts are irresponsible, regardless of your negative post-fellowship experiences.

Peace out.
 
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WholeLottaGame7 said:
Man, CESIs were the thing that freaked me out the most in residency. More than happy to let the attendings do those. A couple weeks of (maybe) improved pain vs the risk of cervical spine injury? No thanks.
Click to expand...
I still remember the first one I did in residency. It was that nerve racking.
I never got to the point of doing them as comfortably as lumbars of thoracics. But I got comfortable enough. I probably did greater than 1000 in my first few years of PP.
I can tell you, this is no procedure for a nurse.

But I found that these CESI's were some of the most rewarding blocks to do because pts did really well with them.
 
WholeLottaGame7 said:
Man, CESIs were the thing that freaked me out the most in residency. More than happy to let the attendings do those. A couple weeks of (maybe) improved pain vs the risk of cervical spine injury? No thanks.
Click to expand...

Agree I meant Labor epis, def not any pain procedures especially the dreaded CESI
 
Timeoutofmind said:
A CESI is not straight-forward. Can you intelligently discuss:

R/B of IL vs TF approach?
ASRA and other societies anti-coag guidelines for chronic pain procedures
R/B of DSA vs live flouro vs spot shots with contrast injection
Different iodine based contrast agents labeling for intrathecal vs non intrathecal as well as different degrees of radiopaqueness and appropriate agent selection
R/B of gadolinium based agents in people with iodine allergies

blah
blah
blah
.
Click to expand...

wow, you actually took the time to type all that out. why??
 
CRNA's practicing pain management is very common in Colorado and every state where CRNA's can practice independently. They are board certified (by the national board of nurse anesthetists), fellowship trained, have doctorates, and get reimbursed the same as physicians. What's not to like?

http://www.metamorphosispain.com/ "Dr. Lisa Pearson - Nurse Anesthetist Board Certified in Pain Management and Anesthesia"
http://inwapainmanagement.com/inland-northwest-anesthesia-and-pain/about-us.html "a neurosurgeon asked if he would provide pain management for some of his patients. He soon realized he enjoyed working with patients in a non-operative environment."

"In 2012, the Centers for Medicare & Medicaid Services (CMS) abruptly stopped reimbursement for CRNAs who submitted requests for payment using CPT codes related to nonsurgical pain management. The AANA, COA, and NBCRNA successfully appealed this decision and the CMS reinstated reimbursement to CRNAs who provide nonsurgical pain management services. The NBCRNA made a commitment to developing a certification process associated with pain management." https://www.nbcrna.com/NSPM/Pages/About_NSPM.aspx

http://www.aana.com/ceandeducation/...ronic-Pain-Management-Fellowship-Program.aspx
http://www.aana.com/newsandjournal/...nced-Pain-Management-Fellowship-to-CRNAs.aspx
 
mmag said:
CRNA's practicing pain management is very common in Colorado and every state where CRNA's can practice independently. They are board certified (by the national board of nurse anesthetists), fellowship trained, have doctorates, and get reimbursed the same as physicians. What's not to like?

http://www.metamorphosispain.com/ "Dr. Lisa Pearson - Nurse Anesthetist Board Certified in Pain Management and Anesthesia"
http://inwapainmanagement.com/inland-northwest-anesthesia-and-pain/about-us.html "a neurosurgeon asked if he would provide pain management for some of his patients. He soon realized he enjoyed working with patients in a non-operative environment."

"In 2012, the Centers for Medicare & Medicaid Services (CMS) abruptly stopped reimbursement for CRNAs who submitted requests for payment using CPT codes related to nonsurgical pain management. The AANA, COA, and NBCRNA successfully appealed this decision and the CMS reinstated reimbursement to CRNAs who provide nonsurgical pain management services. The NBCRNA made a commitment to developing a certification process associated with pain management." https://www.nbcrna.com/NSPM/Pages/About_NSPM.aspx

http://www.aana.com/ceandeducation/...ronic-Pain-Management-Fellowship-Program.aspx
http://www.aana.com/newsandjournal/...nced-Pain-Management-Fellowship-to-CRNAs.aspx
Click to expand...


"The Pain Management Fellowship is a 12 month program. It is comprised of 9 online courses and 3 clinical practicums for a total of 22 credit hours."
Taught by CRNAs with inadequate training.....

Hahahaha is this a joke? I feel so sorry for patients duped by their "fellowship trained" and "board certified" bogus credentials.
 
Man o War said:
"The Pain Management Fellowship is a 12 month program. It is comprised of 9 online courses and 3 clinical practicums for a total of 22 credit hours."
Taught by CRNAs with inadequate training.....

Hahahaha is this a joke? I feel so sorry for patients duped by their "fellowship trained" and "board certified" bogus credentials.
Click to expand...

What is with CRNAs and online courses?? Some of our CRNAs are getting their online DNPs as well, which usually gets a nice laugh out of our attendings when they talk about it - I can feel their blood boil when this happens.

But seriously, these patients would be way better served by seeing a legitimate pain physician, or at least a chiropractor or acupuncturist. All 3 have extensive (more than 3 practicums worth!) training in procedures they commonly perform, and more importantly get trained in what to do when they fail.
 
Man o War said:
"The Pain Management Fellowship is a 12 month program. It is comprised of 9 online courses and 3 clinical practicums for a total of 22 credit hours."
Taught by CRNAs with inadequate training.....

Hahahaha is this a joke? I feel so sorry for patients duped by their "fellowship trained" and "board certified" bogus credentials.
Click to expand...

This is exactly why I can't take a nurse calling themselves "doctor" seriously. This is a joke and no self-respecting person should sell themselves as an expert.
 
Man o War said:
"The Pain Management Fellowship is a 12 month program. It is comprised of 9 online courses and 3 clinical practicums for a total of 22 credit hours."
Taught by CRNAs with inadequate training.....

Hahahaha is this a joke? I feel so sorry for patients duped by their "fellowship trained" and "board certified" bogus credentials.
Click to expand...

Taught by CRNAs with inadequate training? Look at how many letters this professor has behind his name!!

aynGAob.png
 
vector2 said:
Taught by CRNAs with inadequate training? Look at how many letters this professor has behind his name!!

aynGAob.png
Click to expand...

LMT- isn't that licensed massage therapist?
Now that I would pay to see him for.
 
mmag said:
CRNA's practicing pain management is very common in Colorado and every state where CRNA's can practice independently. They are board certified (by the national board of nurse anesthetists), fellowship trained, have doctorates, and get reimbursed the same as physicians. What's not to like?

http://www.metamorphosispain.com/ "Dr. Lisa Pearson - Nurse Anesthetist Board Certified in Pain Management and Anesthesia"
http://inwapainmanagement.com/inland-northwest-anesthesia-and-pain/about-us.html "a neurosurgeon asked if he would provide pain management for some of his patients. He soon realized he enjoyed working with patients in a non-operative environment."

"In 2012, the Centers for Medicare & Medicaid Services (CMS) abruptly stopped reimbursement for CRNAs who submitted requests for payment using CPT codes related to nonsurgical pain management. The AANA, COA, and NBCRNA successfully appealed this decision and the CMS reinstated reimbursement to CRNAs who provide nonsurgical pain management services. The NBCRNA made a commitment to developing a certification process associated with pain management." https://www.nbcrna.com/NSPM/Pages/About_NSPM.aspx

http://www.aana.com/ceandeducation/...ronic-Pain-Management-Fellowship-Program.aspx
http://www.aana.com/newsandjournal/...nced-Pain-Management-Fellowship-to-CRNAs.aspx
Click to expand...

I honestly don't understand how these practices get referrals from physicians. Most of the time referring docs want to hear about your academic credentials when you're marketing your practice (lunches, dinners, etc with docs). What doctor would hear about the CRNA training and say, "yeah, THIS is the person I want to send my patients to for procedures involving the spine."

Weird.
 
Man o War said:
LMT- isn't that licensed massage therapist?
Now that I would pay to see him for.
Click to expand...

He forgot the following initials he likely also earned...

LOLWTF, IDGAF, and BOHICA
 
EtherBunny said:
I honestly don't understand how these practices get referrals from physicians. Most of the time referring docs want to hear about your academic credentials when you're marketing your practice (lunches, dinners, etc with docs). What doctor would hear about the CRNA training and say, "yeah, THIS is the person I want to send my patients to for procedures involving the spine."

Weird.
Click to expand...

I've never seen a CRNA pain practice. My guess is these only exist when you have an unscrupulous doc who employs these nurses to do pain procedures and skims $ off the top or in BFE where there isn't a pain doc and people have decided they'd rather have subpar care than none at all.
No above board doctor with an option refers their patients to nurses for pain work up/procedures.
 
EtherBunny said:
I honestly don't understand how these practices get referrals from physicians. Most of the time referring docs want to hear about your academic credentials when you're marketing your practice (lunches, dinners, etc with docs). What doctor would hear about the CRNA training and say, "yeah, THIS is the person I want to send my patients to for procedures involving the spine."

Weird.
Click to expand...

Easy answer. Pain patients are the bane of existence for many primary care docs. They are needy, unappreciative, and come with a list of complaints that you simply cannot address in a 7 minute follow-up visit. In the end, all they want is a prescription for percocets. Anyone who sends out a flyer and says "send me your pain patients" is seen as a gift from a higher power...credentials be damned.
 
EtherBunny said:
I honestly don't understand how these practices get referrals from physicians. Most of the time referring docs want to hear about your academic credentials when you're marketing your practice (lunches, dinners, etc with docs). What doctor would hear about the CRNA training and say, "yeah, THIS is the person I want to send my patients to for procedures involving the spine."

Weird.
Click to expand...

You probably dont meet him at the lunch. You meet the docs who employ him, and then this guy is deep in the clinic doing scripts and injections
 
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