Chronic, persistent pain affects nearly 75 million Americans, according to the American Pain Foundation and the National Center for Health Statistics. Veterans of all ages are at higher risk for developing chronic pain ailments. The West Palm Beach VA Medical Center’s Chronic Pain Management Program has evolved into the type of program tailored to meet the needs of the population it serves. It is a rather unique program that offers a very wide array of comprehensive and coordinated evaluation and management options. This has been facilitated in part by its organizational structure and leadership.
The program is under the auspices of the Physical Medicine & Rehabilitation (PM&R) Service in contrast to stand-alone or anesthesia-based programs. This organizational structure has promoted a truly interdisciplinary model, bringing together the expertise of Anesthesiology and PM&R (Physiatry). Under this model, physicians with expertise in the field of interventional and conservative pain management have cross-trained and work hand-in-hand with multiple other professionals. Physicians, psychologists, pharmacists, acupuncturists, therapists, and nurses provide the wide variety of coordinated therapeutic modalities that rival pain management programs in the VA system, the private sector or major academic centers. Therapies available include physical therapy (guided exercise programs and a multitude of physical modalities), alternative medicine (i.e. acupuncture and electroacupuncture), psychological evaluation and management, expert comprehensive medication management and monitoring and state-of-the-art invasive procedures (spinal injections and nerve blocks, botulinum toxin injections, joint injections, radiofrequency ablation procedures, kyphoplasty, and implanted stimulators, among others). This unique collaborative arrangement has also facilitated the evaluation and coordinated management of our youngest veterans returning home after serving in Iraq and Afghanistan as part of Operation Iraqi Freedom/Operation Enduring Freedom (OIF/OEF). The complexity of treating these injured servicemen and women is a challenge. Many of them have suffered multiple traumatic injuries, sometimes repeatedly while in the combat theater, and many have concomitant brain trauma (Traumatic Brain Injury or TBI) and severe psychological stress. These veterans represent a particularly vulnerable and complex group, with physical, psychological, and vocational needs where expertise in comprehensive interdisciplinary management is of key importance.
Over the last year, our main focus has been the enhancement of the interventional component of the program in an effort to prevent the excessive use of opioids commonly seen in this population. We have expanded our procedural capabilities, both in number and complexity. We have recently added functional discograms for more accurate diagnosis of lumbar discogenic pain, have increased the use of pulsed radiofrequency ablation procedures, and a new minimally invasive treatment for spinal stenosis (X-stop system) will soon be offered. Also, the number and indications for the use of implantable stimulators for intractable pain has drastically increased. At present an average of 35-45 special spinal procedures are performed every week and demand is expected to rise as the need for effective chronic pain management increases in the veteran population.
A process of tracking outcomes has been developed and deployed. Data collection started over a year ago and the initial results have been quite impressive, with patients showing improvements in pain relief scores as well as functional abilities and satisfaction. The program is expected to continue expanding with the addition of additional physiatrists over the next few months.
Post Views: 1,241
