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15 Articles in Volume 21, Issue #4
Advanced Practice Matters: Needs Assessment in Pain Management Training
Analgesics of the Future: Novel Capsaicin Formulation CNTX-4975
Ask the PharmD: How to Improve Medication Adherence in Chronic Pain Management
Behavioral Medicine: Applying Mindfulness-Based Stress Reduction for Comorbid Pain and PTSD
Case Report: Multimodal Management of Osteoarthritis
Commentary: The PCP's Role in Preventing Chronic Back Pain
Guest Editorial: Structural Racism in Pain Practice and How to Combat the “Hidden Curriculum”
Hypermobile Ehlers-Danlos Syndrome: An Update on Therapeutic Approaches for Pain Management
Male Clinicians as Allies in Women’s Leadership: What Your Female Peers Want You to Know
Meet the Women Changing Pain Medicine
Perspective: It’s Time to Advocate for Early Interventional Pain Management
Research Insights: Is Spinal Fusion Surgery Being Overused in Back Pain Care?
Tips from the Field: Treating Pain in an Under-Resourced State
Utilizing Music Therapy to Manage Chronic Pain
Woman to Woman: Leaders Share Advice for the Next Generation of Pain Medicine Clinicians

Perspective: It’s Time to Advocate for Early Interventional Pain Management

The author proposes confronting the convergence of 3 crises – opioids, COVID-19, and a lack of awareness about non-pharmacological treatment options for chronic pain – with early and increased use of interventional medicine.

Nearly 20 million Americans suffer from high-impact chronic pain that limits their ability to live their lives as they wish.1 Sadly, many of these patients are led to believe that medication is the only treatment path.

When I was practicing pain medicine at the Cleveland Clinic, as well as in my own practice, I helped hundreds of patients successfully transition off opioids with interventional pain management. This approach uses both diagnostic and therapeutic procedures to precisely define the source of pain before offering drug-free therapies such as radiofrequency ablation, spinal spacer treatment, or spinal neuromodulation.

One patient who comes to mind was unaware of non-opioid alternatives until a single radiofrequency procedure nearly eliminated her symptoms. While every patient is unique, had she known about this interventional option, I believe she could have been spared 20 years of needless suffering. It’s stories like hers that illustrate the potential impact drug-free pathways can have in managing chronic pain if we can increase awareness and expand access.

The author argues that clinicians must continue to educate primary care providers – and patients – about how different pain management strategies benefit different presentations of pain and how early interventions can affect treatment outcomes. (Image: iStock)

More than Pain: Clinicians Facing 3 Crises

However, as we know, this is no ordinary time. There are three distinct crises affecting people living with chronic pain conditions: the opioid crisis, the COVID-19 pandemic, and what I call a “lack of awareness” crisis. A recent survey found that nearly half of those living with chronic pain have reported that their pain has worsened during the pandemic. And while 94% of these individuals said they would try an FDA-approved, drug-free alternative, 58% were unaware of interventional pain procedures.2

So, after 20 years of practice in pain medicine, I chose to take a new path, transitioning out of day-to-day patient care to an environment where I now have a unique ability to influence how non-opioid pain treatments – specifically, neuromodulation – are developed. Keeping my decades of prior patient interactions top of mind, I’ve had the opportunity to work closely with R&D teams to build tangible therapeutics and support for patients, physicians, and practices to modernize and personalize pain management. Already, we have tools in our arsenal (eg, spinal cord stimulation) that herald a new era of personalized treatment that address the unmet needs for many thousands of patients whose pain is better managed with a multidisciplinary approach.

A key barrier to the growth of interventional pain management is the lack of clinical knowledge about different treatment options as well as conflicting guidelines as to their use.3 Yet, the CDC, along with its opioid prescribing guidelines, has provided modules to help physicians educate and advise patients about non-opioid treatments “as the preferred therapies for chronic pain outside of active cancer, palliative, or end-of-life care.”4,5

We must continue to educate providers –  and patients – about how different pain management strategies benefit different presentations of pain, and I believe this should begin in primary care.

Advocating for Patients Amid Overlapping Crises

A typical holistic multimodal approach to chronic pain management may include a combination of therapies, such as prescription medications (including monitored opioid use), restorative therapies (eg, exercise, physical therapy, or massage), and psychological interventions (eg, behavioral therapies, mindfulness training, and stress management).6

However, clinicians know that one size does not fit all nor do patients require each of the therapies listed above, hence the need for personalized care which I believe can be provided through interventional pain medicine. I recommend the following.

Primary Care Providers Need to Make Early Referrals for Comprehensive Pain Care

Early referrals of every patient presenting with chronic pain, ideally before they are started on opioids, serves multiple purposes:

  1. Early referrals aid in making an adequate diagnosis. Primary care providers may not realize that interventional pain management incorporates diagnostics that can assist them in defining the source of an individual’s pain.
  2. Early referrals allow the patient to receive, or at the very least, understand their drug-free pain management options and how certain interventions can be added to their treatment regimens for better outcomes.6,8
  3. On the macro level, early referrals provide a step toward stemming the ongoing opioid crisis.9,10

Utilize Digital Health and Telehealth

Physicians can also advocate for their patients locally and one-on-one to help them better access a variety of pain management therapeutics. Digital health solutions, for instance, are helping clinicians connect withpatients remotely – and are likely to remain after the pandemic is under control. One study showed that individuals living with chronic pain were receptive to telehealth, with 92% of respondents indicating they were satisfied with their telemedicine visit.11-13

In the long term, primary care and pain specialty practices that invest in telehealth may not only be able to better serve their patients, but providers also may gain important insights from a patient presenting themselves from inside their home environment and learning how their daily activities play a role in their pain management.

Creating Lasting Change in Pain Management

Looking ahead, interventional pain specialists need to commit to identifying patients who may benefit from interventional techniques and collaborating with their non-specialist colleagues – the primary care providers – who are a key source of referrals. Such partnerships require an investment in education and digital tools to connect practices.

Unfortunately, we cannot ignore that healthcare is an industry often controlled by stakeholders who are not physicians and patients. One barrier to providing comprehensive pain management is the many-layered payer protocols that may delay or make recommended treatments unaffordable to the patient.14,15

However, how clinicians choose to fight these crises will determine whether the narrative of chronic pain management can be changed. With drug-free therapeutic approaches, increased access to patients through telemedicine, and a personalized pain management approach, pain specialists may be able to help end the opioid crisis and give their patients safe, long-term solutions.


Disclosure: The author serves as vice president of medical affairs, neuromodulation, at Boston Scientific.




Last updated on: July 7, 2021
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