Pain Management: Acute vs. Chronic Pain and Interventional Therapies

Pain is a complex experience that can be acute or chronic, requiring different treatment approaches. Acute pain alerts us to potential injury, while chronic pain lasts longer and affects quality of life. Management options range from medical and psychological treatments to advanced interventions and surgical procedures. Implantable pain therapies like neurostimulation and targeted drug delivery offer hope for those with severe, persistent pain conditions.

• Pain management
• Acute pain
• Chronic pain
• Interventional therapies
• Neurostimulation

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1. Pain, Pain and Pain Scott A. Burlison, M.D. Interventional Pain Management Azalea Orthopedics

2. My Pathway Born in Shreveport, Louisiana Elementary through medical school in Louisiana Residency UTMB, Anesthesiology Private practice anesthesiology Tyler Fellowship- UTMB, Anesthesiology, Pain Management Private Practice Azalea Orthopedics

3. Pain An unpleasant sensory and emotional experience associated with actual or potential tissue damage, or described in terms of such damage No one likes it Can manifest in a lot of ways

4. Acute Pain vs Chronic Pain Acute pain- normal sensation that alerts us to possible injury Chronic pain any pain lasting more than 12 weeks (3 months)

5. Acute Pain Office setting Emergency setting Surgical setting Preoperative Intraoperative Postoperative

6. Chronic Pain Myriad of treatments Medical management Psychological management Physical/Occupational therapy Massage Interventional management Advanced interventional management Surgical management

7. Implantable Pain Therapies Neurostimulation Targeted Drug Delivery Delivery of low-voltage electrical stimulation to the spinal cord to inhibit or mask the sensation of pain Delivers precise doses of prescribed medication directly into the cerebrospinal fluid(CSF) to modulate the transmission of pain signals

8. Implantable Therapy Realistic expectations Sufficient pain relief ADL s improve Increased ROM Overall improvement in quality of life

9. Neurostimulation Indications Failed Back Surgery Syndrome (FBSS) Radicular pain syndrome Post laminectomy pain Multiple back surgeries Degenerative Disk Disease/herniated disc refractory to conservative and surgical intervention CRPS Epidural Fibrosis/ Arachnoiditis Ischemic leg pain Angina

10. Neurostimulation Psychological evaluation Trial period 3-7 days Successful trial defined as: >50 % relief in pain/symptoms ADL s improved Able to take less medications? Life was better

12. Percutaneous vs Paddle

14. Neurostimulator Lead Placement

15. Lead Placement

16. Spinal Cord Stimulators Medtronic Nevro

17. Spinal Cord Stimulators

18. Intrathecal Drug Delivery Psychological evaluation Single shot vs catheter trial Duramorph Baclofen Ziconotide >50% pain/symptom relief

19. Targeted Drug Delivery Indications Failed Back Surgery Syndrome Degenerative Disc Disease Spinal Stenosis Radicular Leg pain CRPS Compression Fractures Cancer Pain Spasticity

20. Intrathecal Drug Therapy

21. Logistics Refill schedule -1 month, 3 month, 6 months Internal Support Problem(s)

22. Intrathecal Therapy Refill Programming

23. Usually lower quadrant placement Occasional back

24. Medtronic Synchromed II Very common

26. Coders Absolutely essential the entire way