Are You Suffering From Chronic Pain?
Pain Management Today discusses the growth of the specialty of managing pain. In Pain Management Today® eNewsletter series, they focus on opinions and experiences of experts on the management of medication utilized in this sensitive area:
The Use Of Opioids
In one article of pain management: one primary care physician discussed the use of opioid therapy as a part of the pain treatment.
Chronic pain, often defined as pain lasting longer than 3 months, is becoming increasingly common, mainly because of the identification and persistence of the medical field, tracking, treating and documenting the experiences of so many patients dealing with this difficult condition. Of course, the effect on the quality of life is profound. The patients are seeking a path, a plan to relief.
And, Opioids are considered the most potent analgesics. Chronic use of this therapy is increasingly prescribed for chronic pain. This therapy can have dramatic life impacts, opioids are associated with high abuse potential, in fact, many of the medical board administrative actions, which result in the State Medical Licensing Bodies taking action and initiating inquiries begin with the over prescription of addictive pain medication.
Primary care physicians, often are the front line dealing with the patients before and after their referral to pain management physicians.
The burden of managing the persistent, desperate requests for refills, for more and heavier doses falls to the primary care physician or the pain management center’s allied staff.
Because of relationship with patients, primary care physicians are in a position to make informed prescribing and management decisions. The decisions around the prescriptions that these physicians make can help to decrease pain and more importantly, manage the pain without causing harm from the use of the drugs.
The American Pain Society (APS) recently partnered with the American Academy of Pain Medicine (AAPM) to publish evidence-based recommendations on the use of opioid therapy. This newsletter summarizes the APS/AAPM recommendations related to patient selection and initiation of opioids, and provides suggestions on how to implement the guidelines in clinical practice.
The Doctors’ Company Invests In The Development Of Successful Patient Safety In Pain Management
Part of Patient Safety in pain management is smart Patient Selection. Whether it is a knee surgery, plastic reconstructive, aesthetic or other elective surgical procedure, patient selection can avoid or contribute to medical malpractice claims.
All clinicians prescribing opioids should be knowledgeable about risk factors for abuse; there are risk assessment methods available to minimize the adverse outcome.
The assessment of a pain management patient should include: A comprehensive history and physical examination, including assessment of psychosocial factors.
The treatment protocol should be considered only in patients with at least moderately severe pain that is unresponsive to nonopioid therapies. This article in the Pain Management Newsletter indicates that both neuropathic and nonneuropathic pain can respond to chronic opioid therapy, although there is little evidence that opioids are effective when there is a strong psychological component to the pain.
Potential Risk Factors
For abuse, misuse, addiction, and other aberrant drug-related behaviors in patients started on opioids are real and well documented. Clinicians should also consider the likelihood and seriousness for the individual patient of other opioid-related adverse effects, such as constipation, nausea, pulmonary disease, sedation, and cognitive impairment.
Since this specialty is growing, and high demand, the criteria and curriculum is becoming more specialized.
Doctors who are providing pain management care are required to be residency trained physicians. In fact, most of them have completed additional training by doing a fellowship. Physicians seeking to become pain management doctors complete their residency in anesthesiology and then typically complete a one year fellowship in pain management.
Over the past years, there has been a large increase in doctors looking for coverage for clinics in the state of California. Doctors that are interested in working in a clinic need a partner to insure and help them stay educated in the legal system as well as keep them apprised of the innovative methods of managing the risk of a medical malpractice claim in this field.
Medical Malpractice Insurance companies classify pain management in the same class of risk as anesthesiology. Therefore, many anesthesiologists and trained physicians practice both specialties in their practices. One of the basic ‘affirmative duties’ of the insure is to inform their medical malpractice insurance company that they are performing both specialties. Most underwriting departments will ask what percentage of each specialty they practice and if they are practicing any interventional pain management. Doctors will not need two policies to cover both specialties, as long as the physician malpractice insurance company is aware of the totality of the physicians practice.
And as long as the Anesthesiology Group for which they are providing Anesthesia Services benefits in some way from the work.
Services Provided At A Pain Management Clinic include:
- Evaluation of complex pain problems
- Regional anesthesia (nerve block)
- Transcutaneous electrical nerve stimulation (TENS)
- Spinal Cord stimulator evaluation and placemant
- Physical therapy
- Home exercise and activity guidance
- Medication tailoring
- Short term individual and couples psychotherapy and psychoeducation
- Stress management
Pain management clinics prescribe medications for various medical drug needs; however the most common is chronic pain.
As mentioned above, the tendency to abuse the availability of pain management treatment drugs is one of the constant challenges; States, Medical Boards and Med Mal Carriers struggle to contain the random case which slips through, in which an addict passes as a main stream patient, abusing the staff and the availability of the medications to their harm.
Medical Malpractice Claims Review By The Doctors' Company
The Doctors Company has noted an alarming incidence of major claims relating to cervical epidural steroid blocks in the field of pain management. The number of claims for these blocks consistently exceeds the combined total of claims for steroid blocks performed at all other levels.
Epidural steroid injections are widely used in the United States to treat chronic and acute pain. These blocks are routinely performed by the specialties managing pain: Anesthesiologists, Physical Medicine and Rehabilitation Physicians, Neurologists, and Radiologists.
Discussions in anesthesia literature regarding complications of epidural steroid injections include an article in the Anesthesia Patient Safety Foundation (APSF) newsletter, a closed claim study reported that 114 out of the 276 claims for invasive pain procedures concerned epidural steroid blocks. Both articles, however, included epidurals performed at all levels (cervical, thoracic, lumbar, and caudal) in their discussions and conclusions….discussions with The Doctors’ Company insureds indicate that cervical blocks may not be performed at a substantially higher rate than blocks at other levels and, therefore, may have a true higher incidence of significant complications. The narrowing of the epidural space in the cervical area and its increased proximity to the spinal cord are factors that might lead to higher injury rates when the dural space is unintentionally entered.
It is this kind of Data, the studies of claims and the availability of peer review groups, webinars, CME sessions on the specific procedures which are likely to give rise to claims, that benefit our insured physicians the most. It is a bit more expensive to practice pain management due to the incidence of medical malpractice.
Our agency will work hard with you and with underwriting to make sure your practice is accurately represented and that you are taking advantage of all available discounts.
Our goal is to help pain management physicians obtain medical malpractice insurance coverage as easily as possible.
For more information regarding Medical Malpractice Insurance for Pain Management, please contact us or fill out the form. We look forward to setting up your Pain Management Medical Malpractice Insurance coverage.