Spine surgeons and spine pain management physicians want to reduce their patients' pain, but do their methods of reaching this goal separate or integrate?
Collaborate or collapse
Patients deserve the full spectrum of options when dealing with back pain, according to North American Spine Society President Heidi Prather, DO, of Washington University Orthopedics.
Specializing in physical medicine and rehabilitation, Dr. Prather admits she doesn't know much about the specifics of spine surgery. And most spine surgeons don't know much about the specifics of non-operative care.
"We train to provide expertise for different areas of diagnosis and treatment of spine disorders. Our areas of expertise should be considered additive to the core of knowledge, not exclusive," says Dr. Prather. That's why she is in communication with orthopedic surgeons and neurosurgeons quite often.
"People need you whether you're a surgeon or non-surgeon," says Dr. Prather. Supportive of collaboration between the two groups, Dr. Prather loops in surgeons with her patients' care. Then, if patients decide to go the surgery route, they already met with surgeons along the way.
"Focus on what the patient tells you," says Dr. Prather.
Working in a common office space with surgeons, Dr. Prather believes this integrated environment increases quality of care. The patient benefits from the input of various fields of expertise.
"The population of patients with spine disorders needs a variety of things — specialists that perform injections, specialists that prescribe exercise and medication and specialists that perform high-level procedures," says Dr. Prather.
And the future will demand collaboration, as physicians must find ways to provide a continuity of care for patients.
"I think the future is bright for our non-operative care people, and bright on the surgical side, if we improve our collaborative care," says Dr. Prather.
Pain management doesn't take two
As an interventional pain management physician, Scott Glaser, MD, president, Pain Specialists of Greater Chicago, says it is always preferable to follow an array of interventional treatment protocols to reduce patients' pain, instead of jumping to surgery. This is based on both the substantial efficacy of interventions, when given in an algorithmic fashion, and the minimal risk associated with interventional treatment compared to surgery.
By reducing inflammation and pain signals in spinal joints and spinal nerves with injections, nerve blocks and radiofrequency procedures, pain relief and increased functionality can be accomplished. Based on the number of failed back surgeries in the United States, Dr. Glaser thinks it's obvious that patients should only consider surgery when all other options are exhausted.
"The fact is that if you have back or neck pain, that pain itself is not an indication for surgery," says Dr. Glaser. "Surgery for pain is always elective."
Given the array of treatment options available, Dr. Glaser views surgery as the last solution to pain, and sees collaboration with spine surgeons as unnecessary for any patients with spinal pain.
"The more integrated a pain management doctor and pain program is with a surgeon, the less independent he is from that surgeon, and it's more likely the patient might end up with surgery," says Dr. Glaser.
Dr. Glaser suggests pain physicians become board certified and focus on caring for patients immediately after the onset of symptoms. Early involvement with patients allows physicians to design treatment plans that patients understand. That way, patients understand their full scope of treatment options before turning to surgery. Education about the pain, the spine and the MRI findings prove essential to accomplishing these goals.
"If pain management physicians don't have proper training, and access to a full compendium of treatment protocols, patients will not achieve the desired outcome of being pain free, or at least substantially mitigated, and having improved function,” says Dr. Glaser, who wants to hold this specialty to a higher standard of care.
Dr. Glaser says the current paradigm of treatment leads patients to surgery long before they should consider it. If pain management physicians take ownership of their medical responsibilities by learning treatment pathways, more patients will steer clear of surgery.
"We are the cardiologists of spine," says Dr. Glaser. "We have vowed to do no harm; a more conservative approach that avoids surgery, whenever possible, in my opinion is optimal care and fulfills this vow."
Pictured: Dr. Heidi Prather and Dr. Scott Glaser
