Five New Trends In Pain Management

The World Institute of Pain,  an organization whose aim is to better educate pain



physicians for the 21st century will hold its Sixth World Congress from Feb 4-6, 2012 at Miami Beach, Florida in USA.

In conjunction with this event, its founder and chairman of the advisory board, Dr Ira Fox, shares his insights on five trends in pain management.

1.   The importance of Opioids in pain management and how to use it in a responsible manner.

According to Dr Fox, the crackdown on “pill mills” has increased following reports from CDC relating to the prescription of drug abuse. Recently there have been news generated in Florida relating to the closing down of pill mills and these require attention.  He felt that the negative effect is just a perception and the reputation of interventional pain management remain untarnished.

He says, “People don’t understand that what we do as pain specialists entails not only the use of medication but also interventional techniques,”  He reiterated that  there’s a role for medication management, but it has to be done in a responsible manner.
It is important for pain specialists to implement certain standards, such as random drug testing and narcotic contracts, into medication management to ensure patients are taking the prescribed medication and that it’s not being diverted.  Doctors prescribing opioids for pain management must do it correctly and where it makes a difference and improves the quality of life of the patients.

2.   The application of spinal cord stimulation is becoming more extensive.

Spinal cord stimulation is not a new technology but it has been applied in new ways.

Conventionally, it involved placing leads into the spine to impede pain impulses to the other parts of the body.  Now the leads are placed under the skin in different parts of the body, preventing the pain from coming from these areas.

Hybrid stimulation is another method which is becoming more common and this involves leads being positioned into the spine and also other parts of the body

“A typical example of that is placing a spinal cord stimulator lead into the spine blocking impulses that may radiate down into somebody’s leg,” he says. “You would also place stimulation leads under the skin in the lower back area as well in order to augment relief of back pain.”

3.   Minimally invasive spine surgery is becoming popular with pain physicians.

According to Dr Fox, minimally invasive spine procedures are increasingly being used by pain specialists for conditions such as lumbar decompressions, intradiscal procedures and disectomies. In the case of intradiscal procedures, pain physicians go in to remove part of the disc.  For radiofrequency procedures, they completely remove the pain pathways. This is bit different from the conventional epidural steroid injections and other pain management procedures.

 4.   Evidence based medicine and guidelines.

Most sessions of the congress will touch on evidence based medicine in pain management, but Dr Fox says this has its pitfalls as the outcomes are dependent on individual physician’s skill.  “From a personal level, I think evidence based medicine is not quite that simple because there’s definitely a benefit from someone whose technique is a little bit more proficient,” he says.  There is also the need to develop more guidelines for interventional pain management, in addition to evidence based medicine.

On the down side, insurance companies used these guidelines in a way to deny care to the patients. These guidelines should instead be used to expedite the process and approve rather than deny care. However if the patients don’t meet the criteria they should be assessed on an individual basis.

5.   Board certification will allow for separation.

 The World Institute of Pain conducts certification exam at the congress by using cadavers so that examiners can watch closely how the pain physicians perform certain procedures.
Although certification is not mandatory for physicians to practice, it represents the enduring spirit of pain physicians.


The World Institute of Pain was founded in 1993 as an organization to better educate pain physicians for the 21st century. The theme of the World Congress is: Better education, better relief. One of its main objectives is to improve the management of pain centres to a level of excellence.

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