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CarefulPrescribingPractices
During Dr. Berezovski’s time in the pain management specialty, one of the major changes has been digital technology’s impact in making devices smaller and more effective. Equipment used to treat chronic pain, such as spinal cord and peripheral nerve stimulators and ultrasound, “has become better and better and cheaper, so more and more practices can afford to have those devices and do different types of procedures. “For example, when I started, spinal cord stimulators were about the size of a hockey puck; now, they are barely bigger than a silver dollar – which is much better for the patient, because they require a smaller incision, meaning less chance of an infection. ”Using modern technology, device manufacturers have been able to increase the number of lead wires used to map pain patterns from four to 16, he notes, which allows treating larger areas of pain. Longer battery life has also made a difference. In the earlier days of implantable devices “we had to replace batteries in implantable devices every three to ve years; now we can recharge them, using radio waves. And, the devices can last 10 to 12 years.” transmission mechanisms, to determine “why some people have more and some less pain,” with similar injuries. Functional MRI devices enable physicians to analyze what areas of the brain “ are up” when a patient feel pain, or takes medication. “It’s all given us a better understanding of how to treat pain,” Dr. Berezovski says. Better diagnostic equipment has enabled physicians to develop a better understanding of pain
The physicians at PMTC are appropriately conservative in prescribing painkillers. “There are a lot of other things available to control pain – physical therapy, home exercise programs, non-narcotic medications, injections...We’re always looking at other options to treat the problem, instead of just masking the pain with painkillers,” he says.
Much of the over-prescribing of pain medications by primary physicians can be remedied by providing better training on their use, he believes, “or at least by referring patients to pain specialists like us.” Legislation can also help, like Wisconsin’s relatively new law requiring the doctors prescribing monitored prescription drugs to a patient for more than 90 days in a 12-month period to obtain the pain medicine certi cation.
In spite of the challenges, Dr. Berezovski has found pain treatment to be a rewarding specialty.
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