Interventional Pain Management Training

Integrative Pain Management Certification Training for lumbar pathologies, osteoarthritis, joint, and soft tissue injections for Primary Care Physicians and Other Specialties

This is a comprehensive course for physicians to learn and receive their Pain Management Certification onhow to properly test, diagnose, and treat a variety of pain related presentations by your patient. Emphasis is placed on anatomy, pain pathologies, and treatment options available to your patient. Over the 3-Day event, extensive training will be provided on a multitude of interventional pain management techniques with a focus on treating lumbar spinal disorders using the various injection modalities. All protocols for the spinal injections are given including medicines needed for the chemical neurolysis (facet joints), epidurals, and steroid joint injections. Physicians will be trained on and perform the various spinal injections, including facet joint, epidural (lateral foraminal, central, caudal), sympathetic nerve blocks, sacroiliac as well as other joint and specialty injections on human cadavers and other training models throughout the course study.

The use of medical devices for many of the spinal injections are taught for the various large joints and tendon/sheaths including the Platelet Rich Plasma (PRP) injections. Specialty injections using Botulinum Toxin for muscle spasticity and hyaluronic acid for visco-supplementation for shoulders and knees are part of the course study. Chronic pain management is also included within the program study for the management of chronic pain and safe administration of prescriptions within your practice. In addition, physical therapy options are discussed for those patients that need orthopedic rehabilitation after receiving pain management procedures.

Procedures and Topics Covered

We know that with the alarmingly high numbers of patients suffering with Sexual Dysfunction is an equally high demand for treatment and return to a pleasurable, intimate lifestyle. It is also important, however, to treat ED promptly to prevent further deterioration and disuse atrophy, which is the typical progression of this disease when treatment is not provided early on.

Why Integrate Sexual Dysfunction Treatment into my Practice?

1. One-on-One Fluoroscopy Equipment Training
2. Spinal Procedures/ Injections – Sacroiliac Joint Injections, Diagnostic/Destructive Paravertebral Facet Joint Injections (Cervical, Thoracic, Lumbar)- chemical neurolysis, ablation, Sympathetic Nerve Blocks, and Epidural Injections (lateral foraminal, central, caudal).
3. Large Joint Injections – Shoulder, Hip, Knee, SI Joint.
4. Prolotherapy & Platelet Rich Plasma Injections for soft tissue and joints.
5. Viscosupplementation HA Therapies (Shoulder and Knee)
6. Botox Injections for the treatment of Cervical Dystonia, Migraine Headaches, Non-specific headaches, TMJ; Jaw Tension and pain, Chronic Pain, and Back Pain associated with muscle spasticity.
7. Small Joint Injections
8. Trigger Point Injections – tendons and sheath muscles
9. Other Specialty Injections – Intercostal Injections, Injections for Medial and Lateral Epicondylitis, (Golfers, Tennis Elbow), and Carpal Tunnel Syndrome.
10. Safe Administration of Pharmaceuticals for Chronic Pain including drug contracts and detailed listing of safe, less addicting medications by group.
11. Diagnostic Imaging and Interpretation

Learn more about the Pain Management Training

After completion of the course you will be able to develop a correct diagnosis of your patient’s pain symptoms and develop a personalized treatment plan for the management of pain. Attendees will learn how to perform various cervical and lumbar examinations using established “standard of care” testing methods that meet the highest standards. After performing a comprehensive history and physical exam, you will be able to create your diagnosis and treatment plan thus using either technologies or by additional testing such as the following:

• Spurling Test : nerve root compression primarily at the cervical level
• Naffziger Test: for nerve root compression to evaluate an increase or aggravation of pain or sensory disturbance over the nerve root
• Hoover’s Test: To determine the patient’s back pain as non-organic; negative sitting LSR with positive supine SLR. Jerky or quick release on motor testing…
  • Compression Test
  • Cervical Test
  • Transforaminal
  • Bilateral Trochanteric (CT)
  • Pelvic Test
• Sensory, Motor and DTR Tests: Most common tests to isolate pain and other findings.
• Gaenslens Maneuver/Test: This test flexes the hip joint on one side and extends the other hip to test for sciatica, spondyloarthritis, or other presentations of rheumatism.
• Shobar Test: is a test used to assess the amount of lumbar flexion in presentations of rheumatism while measuring the ability of a patient to flex his/her lower back.
• Slump Test: Helps to assess whether neural tension, disc herniation, or altered neurology are contributing to the patient’s pain symptoms
• Milgram’s Test: Thoracic and Lumbar Spine test designed to help diagnose nerve root irritation or inflammation.
• Bowstring Test: Lower back stress examination test commonly used to diagnose sciatic nerve injury.
• Le Segue’s Test: Passive dorsiflexion of the foot to help diagnose nerve root compression or impingement
• Braggards “Stretch” Test: Straight leg raise test that may be indicative of sciatic nerve involvement
• Waddell Test: Set of (5) tests to determine the patient’s back pain as non-organic
• CrossFit Fortis Test: Test takes into account your calf muscle, hamstring muscle and back flexibility
• Kernigs Test: Knee extension beyond 135 degrees indicative of nerve root impingement

The course study begins with didactic material that will cover the technical principles of a diverse range of procedures and diagnosis of the various pathologies associated with pain. Pathologies that will be discussed in depth suggest the most common types of pain management that you will encounter within your practice and include the following:

• Osteoarthritis
• Herniated Nucleus Pulposus (HNP)
  • Herniation
  • Disc Bulge
• Spinal Stenosis
• Segmental Instability
  • Spondylolisthesis
  • Spondylolysis
  • Spondyloloptosis
• Degenerative Disc Disorders
  • Facet Arthritis
  • Osteophytes
  • Discogenic Pain
• Muscle / Joint Pain
• Chronic Pain

Chronic pain is present in many patients where even though they suffer from any of a variety of pathologies it can only be managed by prescription drugs. As part of the program we will instruct you in a safe manner how to manage pain by the use of pharmaceutical drugs. Indications for the use of these NSAIDS as well as the contraindications for their use are discussed as well as treating testosterone deficiency which can be caused by extended NSAID use or andropause.

Pain Management Training Objectives

Upon Completion of this program, the physician should be able to:

• Expand current practice to include pain management services. Be able to perform all the injection procedures detailed in a proper and efficient manner in adherence with the latest “standard of care” protocols.
• Learn proper needle placement and techniques using injection models and/or human cadavers (tissue) under image guidance. Trigger point injection training and other joint injections are discussed or demonstrated using the palpatory method and/or image guidance.
• Diagnose and evaluate patients with chronic lumbosacral pain and develop an approved treatment plan using accepted injection techniques.
• Test, Diagnose and treat the patient suffering from joint pain using various “evidenced based” injection therapies.
• Receive training on specialty injections with Botulinum Toxin-A; Botox® for a variety of pain related conditions (i.e. migraines, bruxism, tmj) associated with muscle spasticity.
• Evaluate and diagnosis the patient for testosterone deficiency and be able to administer testosterone for patients with low testosterone secondary to chronic narcotic usage or andropause.
• Fully understand specific supplies, protocols, and appropriate solutions needed including billing and coding requirements.
• Learn how to perform these injections using the Palpatory Method, as well as learn to perform the various injections using the image guidance for proper needle placement. This may includes working on advanced injection models or human cadavers depending upon location.
• Properly document each patient chart and procedure performed adhering to strict medical necessity and selection criteria.
• Utilize specific methods for compliance to help ensure correct procedure and standard of care thus preventing over-utilization of these procedures.
• Be able to attract new and existing patients using proven business and internet or conventional marketing methods.

The American Academy of Procedural Medicine offer these pain management courses to help you become confident and have a full understanding in performing and integrating these new procedures after leaving the event. Besides the confidence you will gain from your pain management course and certification; you will also receive practical business training to become financially successful with these new services.

Physicians who successfully complete the Pain Management Certification program and demonstrate proficiency with the newly learned injection procedures will receive a Certificate of Achievement as well as allow physicians to advance towards getting their AAOPM Board Certification in Pain Management.

DAY 1 - 8:30am–9:00am

Registration

9:00am–10:45am

Speaker Introduction, Lumbosacral Osteology including Scotty Dog, lumbar vertebra, articular, spinous, and traverse processes, landmarks used in Pain Management. Sacrum anatomy, Os Coxa, Sacroiliac Joint, and lumbrosacral region. Injection approaches and correct needle placement for diagnostic and therapeutic pain pathologies.

10:45am-11:00am

Break.

11:00am–12:00pm

Chemical Agents used in Pain Management Injections including facet injections, epidurals, diagnostic injections, anesthesia options, and chemical neurolysis. Review supplies and medications, contraindications, safety profiles, as well as contrasting agents used for imaging including suggested dosing and protocols.

12:00pm–1:00pm

Lunch (on your own)

1:00pm–3:00pm

Fluoroscopy Basics: safety, function, setup, exposure patterns, and general guidelines for image guidance. Ultrasound Basics including advantages, disadvantages, and limitations, transducer selection, advanced technologies, and scanning approaches. Introduction and protocols for Radio Frequency Ablation, new technologies and RF Ablation techniques for lumbar spine, medial branch, and pain indications used for. Introduction to Facet Syndrome including diagnosing various pathologies (indications), treatment protocols, and injection techniques.

3:00pm–3:15pm

Break

3:15pm–5:30pm

Diagnostic Lumbar Facet Joint Injections, pain referrals, medial branch technique, intra-articular technique, patient selection, and irregularities. Destructive Lumbar Facet Joint Injections and epidural training utilizing palpatory method and with image guidance utilizing fluoroscopy with contrast and ultrasound technologies for facet injections.

DAY 2 - 7:30am–8:00am

Registration.

8:00am–10:30am

Review of pain pathologies, indications and treatments options, identification, symptoms, and testing options available for; HNP (herniated nucleus pulposus), spinal stenosis, instability, Spondylolysis, discogenic pain, osteophytes, facet arthritis and other degenerative disk disorders. Proper ICD-10 and CPT Coding, RVU, J-Codes, Global Periods, Patient Charting for various pain procedures as well as valuation of cash basis (non-insurance) pain management services.

10:30am-10:45am

Break

10:45am–12:30pm

Large and small bursa injection training, sacroiliac joint, shoulder injections, AC joint, knee injections and approaches, hip injections, elbow and small bursa. Viscosupplementation therapies for osteoarthritis of the knee and shoulder. Trigger Point Injections, referred pain indications for soft tissues and tendinopathies, Prolotherapy and the use of biologics (i.e. botulinum toxin, platelet rich plasma, exosomes, and umbilical cord blood) for interventional pain procedures.

12:30pm–1:30pm

Lunch (on your own)

1:30pm–3:30pm

Group “A”: Supervised hands-on training using fluoroscopy on anatomical models or cadavers for the following pain management injections; medial branch block, SI joint, Epidural Training and lower lumbar facets (all levels). All protocols, fluoroscopy orientation, safety, and positioning as well as the guidelines for procedures.

1:30pm–3:30pm

Group “B”: Supervised hands-on training utilizing anatomical models for large a medium bursa injections. Review of MSK ultrasound for injections, scanning of “live” patient for various anatomical locations. All protocols, safety considerations, visual approaches for injections, and guidelines for procedure.

3:30pm–3:45pm

Break

3:45pm–5:45pm

Group “B”: Supervised hands-on training using fluoroscopy on anatomical models or cadavers for the following pain management injections; medial branch block, SI joint, Epidural Training and lower lumbar facets (all levels). All protocols, fluoroscopy orientation, safety, and positioning as well as the guidelines for procedures.

3:45pm–5:45pm

Group “A”: Supervised hands-on training utilizing anatomical models for large a medium bursa injections. Review of MSK ultrasound for injections, scanning of “live” patient for various anatomical locations. All protocols, safety considerations, visual approaches for injections, and guidelines for procedure.

DAY 3 - 8:30am–9:00am

Registration.

9:00am–10:45am

Chronic Pain Management Administration, requirements, FDA oversight, compliance, and ethical standards. Review of various pain medications, mechanism of action, patient selection, follow-up, tapering, and side effects (i.e. testosterone). Patient evaluation, psychological review, chronic versus acute pain pathologies, legal concerns, and administrative record keeping. Patient drug contracts, testing, and re-evaluation.

10:45am-11:00am

Break

11:00am–12:30pm

Physical Therapy options for lower lumbar pain management, prescribing for physical therapy and requirements for physical therapy. Demonstration and review of the Cervical Spine, cervical epidurals and cervical facets including needle placement, injection techniques, contrast, pain pathologies, and alternative therapies.

12:30pm–1:30pm

Lunch (on your own)

1:30pm–2:30pm

Questions and Answers, Certification Pathways. Final Interventional Pain Management Certifications.

2:30pm–5:00pm

Supervised Open Lab Session: Supplemental Hands-On anatomical Model or Cadaver injection training under fluoroscopy for all image guided injections. All spinal injection training, trigger point injections, ultrasound guided injections, and specialty injections are demonstrated and available for additional practice by attendees (i.e. thoracic spine, cervical spine).

DISCLAIMER: The following is a summary of the course agenda. The full course agenda will be emailed to you a few days prior to the course. If you have any questions or need additional information, please contact our office.