Sunday, September 11, 2016

Empower Yourself for Pain Management

 / by Dr Margaret Aranda /

 Pain Management is a huge area of extreme expertise. We have Subspecialties in several medical specialties, with physicians electing to do 1 extra year of Fellowship Training in order to be updated with the best bedside manner, compassion and use of today's technology to treat pain.

In less than 45 minutes from time of posting this article, Stanford Pain Medicine is holding a LIVE Stream broadcast for 6 hours, here:   / Dr Sean Mackey is Redlich Professor and Professor, by Courtesy, of Neurology at the Stanford University Medical Center. I know Dr Sean Mackey as we were both in Stanford's Anesthesiology residency. And I'm pleased and so grateful that my life circles around to bring Women and the Invisible Illness community into the fold of Excellence in Medicine.

SO I didn't get to keep my high heels on, ladies! And I've been bed-ridden for 10 years now. I lived on a PICC line for almost 4 years and you know what? I thought my life was over - and that wasn't just a fleeting thought as those of us with a chronic illness know. The devastation of being disabled is something that cannot be ignored. And you know what? I'm glad that my life has Purpose because nothing is going to stop me from being the best that I can be. I'll find a way. I'll do it.

Stanford also has the quintessential Stanford Medicine X program that 'approves' of patient self-awareness and self-advocacy. Music!

Image. Dr Sean Mackey at Stanford. #BackPainDay2016 hosting LIVE Stream in 1 hr: 10 am - 4 pm, PST.

Watch the LIVE Stream Here: 

Pain Management Specialties:
The American Board of Pain Medicine has this to say on its website:

 "Recognition of the American Board of Pain Medicine In Federal and State Policies
The following chart shows the recognition of ABPM in federal and state policies. If you do not see your state or federal agency listed, please contact us at to find out what you can do to help gain recognition.

U.S. Veterans Health Administration
2009 Pain Management Directive 2009-053
In 2009, the U.S. Veterans Health Administration (VHA) adopted "Standards of Pain Management" to improve the organization and delivery of integrated pain care throughout the VHA.  The Directive emphasizes the importance of “stepped, consultative care,” that includes ensuring primary care providers have access to specialists to help effectively evaluate and manage complex cases.  Under the heading “Clinician Competence and Expertise in Pain Management,” the Directive recommends that Pain Medicine specialists obtain and maintain one or more of the following certifications:  Pain Medicine specialty board certification by the American Board of Pain Medicine (ABPM) or subspecialty board certification in Pain Medicine or Hospice and Palliative Care Medicine by one of several American Board of Medical Specialty (ABMS) Boards.
Act 2013-257; Article 11, Chapter 24, Title 34-24-1007
Alabama’s “Pain Management Act” was enacted to empower the Alabama Board of Medical Examiners with broad authority to regulate physicians who provide pain management services in the state.  Among the provisions, the Act requires physicians providing pain management services to register with the BME and access the Alabama Prescription Drug Monitoring Program (PDMP).  The Act also requires that pain management services be provided in a “practice location” that meets the Act’s standards relating to ownership and operation.  Every practice location must certify that it is under the direction of a medical director who meets the Act’s training requirements, which include specialty certification in pain medicine by the ABMS, AOA and Board certification by the ABPM.
CA Business and Professions Code, §651(h)(5)(A) & (B)
California’s Business and Professions code prohibits physicians from advertising that they are board-certified unless they are certified by an ABMS member specialty board, a specialty board with an ACGME accredited postgraduate training program or “a specialty board with “equivalent” requirements approved by the Medical Board of California’s Licensing Program.”  The Medical Board has approved the following four specialty boards:
  • American Board of Facial Plastic and Reconstructive Surgery (1995)
  • American Board of Pain Medicine (1996)
  • American Board of Sleep Medicine (1998)
  • American Board of Spine Surgery (2002)
Florida Board of Medicine Rule 64B8-11.001 – Advertising
Florida’s Board of Medicine formally recognizes ABPM as a specialty board, and authorizes ABPM Pain Medicine Diplomates to advertise as specialists in Florida.
FL Statutes 456.44  – Controlled substance prescribing law
Pursuant to this law, “Board-certified pain management physician” means a physician who possesses board certification in pain medicine by the American Board of Pain Medicine, board certification by the American Board of Interventional Pain Physicians, or board certification or sub-certification in pain management by a specialty board recognized by the American Association of Physician Specialists or an osteopathic physician who holds a certificate in Pain Management by the American Osteopathic Association.”
Georgia Rule 360-3-.06 – Pain Management Protocol
The Georgia pain management protocol states: the Georgia Composite Medical Board “recognizes certifications in pain medicine or palliative medicine by the American Board of Medical Specialties or the American Osteopathic Association, the American Board of Pain Medicine and the American Board of Interventional Pain Physicians.”
201 KAR 9:250E - Registration and Oversight of Pain Management Facilities
The regulation details Kentucky’s requirements for owning pain management facilities.  The regulation imposes strict requirements for physician-owners or physician owner-designees who will actively practice medicine in the facility, to include an attestation that demonstrates current ABMS or AOA subspecialty certification in either pain management or hospice and palliative medicine or through certification by the American Board of Pain Medicine or American Board of Interventional Pain Physicians.
OAC 4731-29-01 - Standards and procedures for the operation of a pain management clinic
Ohio code includes requirements regarding ownership and operation of pain management clinics.  Physician owners must demonstrate certification in pain management or hospice and palliative medicine by the ABMS, AOA BOS, American Board of Pain Medicine or American Board of Interventional Pain Physicians.  There are significant additional requirements for physician owners who cannot demonstrate one of these Board certifications.
Rhode IslandRules and Regulations for Pain Management, Opioid Use and the Registration of Distributors of Controlled Substances in Rhode Island [R21-28-CSD]

In February 2015, the Rhode Island Board of Medicine officially adopted a new opioid prescribing protocol, which includes ABPM Diplomates in the definition of "pain medicine physician." 
1200-34-01-.09)(d) Training Requirements for Medical Directors of Pain Clinics
Tennessee’s Department of Health adopted regulations to improve the care provided in “Pain Management Clinics.”  The regulation outlines the requirements for physicians who serve as medical directors of a clinic, including board certification by the American Board of Pain Medicine.
TennesseeTennessee Clinical Practice Guidelines for Management of Chronic Pain 
Within the Tennessee Clinical Practice Guidelines for Management of Chronic Pain, ABPM Diplomates are recognized as Pain Medicine specialists.
TexasAdvertisement of Board Certification 
The Texas Board of Medicine carefully reviewed all aspects of ABPM’s rigorous certification process and found them to be “substantially equivalent” to those required of ABMS member boards.  As reflected on the Texas Board of Medicine’s website, Texas Diplomates can now convey this well-earned certification to patients and for the purpose of advertising this well-earned credential.
Washington Annotated Code 246-919-863
As of March 2014, the State of Washington officially recognizes ABPM as an approved credentialing board under the state-endorsed definition of “pain medicine specialist.” The Washington State Medical Quality Assurance Commission took this action after reviewing the ABPM’s rigorous credentialing process, including qualifications for Applicants and the administration of ABPM’s certification examination.
West VirginiaWest Virginia Code - Article 5H - Chronic Pain Licensing Act 
West Virginia’s Chronic Pain Clinic Licensing Act established requirements for operating a pain management clinic. The regulation imposes strict requirements which mandates each pain management clinic shall designate a physician owner who shall practice at the clinic and be responsible for the operation of the clinic. The designated physician must meet one of the following training requirements: 1) complete a pain medicine fellowship that is accredited by the Accreditation Council for Graduate Medical Education or such other similar program as may be approved by the secretary; or 2) hold current board certification by the American Board of Pain Medicine or current board certification by the American Board of Anesthesiology or such other board certification as may be approved by the secretary."

Image 1. American Board of Pain Medicine Specialty Licensure. The Pain Management Doctor is rigorously trained and has to pass National Board Examinations to practice medicine as a Pain Management Doctor. 

Women who are aging in today's society need to know that there are many governmental issues overseeing pain management. Surely you've heard that drug use of opioid narcotics is something that's been looked at closely. There's no need to panic ~ but still ~ be informed. With Pain Management, your entire Quality of Life is affected:

Quality of Life (QoL) Issues with Pain Management:
  • Sleep - loss of circadian rhythm leads to insomina, mental health issues. You have to sleep
  • Diet - a poor nutrition diet will leave you without defenses against many illnesses
  • Exercise - I think that women can in pain develop an attitude of self-consciousness when their bodies can't work out to be as fit as they normally are. It was depressing for example, when I could no longer swim laps in a pool - I was 'reduced' to riding a reclining bike at home. Loss of outside sun, socializing with others, and just having that contact with the water left me depressed: that's normal
  • Emotions - exaggerated emotions frequently accompany a woman in pain. Of course. 
  • Socialization - it doesn't have to be complete 'isolation' that ruins a woman's psyche momentarily: even the loss of being able to take one's children to play at the park is very depressing to a woman who takes great pride in being the best mother that she can be
  • Business - the Power Woman can have changes in cognition when making huge and far-reaching conclusions and then making a grave decision that affects the lives of many employees 
  • Motherhood - so many women just 'miss out' on what they perceive to be weeks, months or years of staunch survival...that falls short of everyone else's expectations
  • Empathy - when others don't believe that a woman's pain is real, this can have devastating consequences on a woman's perception of how she views the world we live in - don't lose hope
  • Activities of Daily Living - if a woman can't make family breakfast or even dress herself in the morning, she still needs to feel valuable as a mother and a contributing member of the family
  • Caregiving - mothers are used to caregiving and not used to being on 'the receiving end' - this can make a woman feel particularly like a 'failure' when in reality, she is showing so much strength and dignity that others are inspired and motivated by her actions and demeanor
  • Much too much more to add. This list is incomplete, of course. 
  • What other issues would you like to have me discuss?

Solutions for Pain and More Pain Problems

  • Visit your Primary Health Care Provider - many patients are seeing not only a doctor, but other allied professionals that aren't discussed a lot include the Nurse Practitioner and the Physician Assistant
  • Keep going to doctor after doctor for any complaint that bothers you. Don't give up.
  • I had to go to literally 20 doctors before getting my diagnosis of the Invisible Illness, dysautonomia (dysfunction of the Autonomic Nervous System, ANS, that 'automatically' controls blood pressure and heart rate when standing up) and I fainted when I stood up
  • Specialists - If you doctor or Nurse Practitioner can't 'fix' your problem or seems to clearly have run out of Solutions, then Ask For A Referral to a Pain Management Specialist.

I also tell people to go ahead and go online - to Facebook Groups - discuss your symptoms with other members and see if you aren't able to get a 'working diagnosis' that puts you in a new direction. 

Millions of other women have successfully received the correct diagnosis after going to discussion groups on social media.

This is the basis of Stanford Medicine X: Patient Empowerment for Excellence in HealthCare Delivery. 

"Keep informed. Stay educated. That's your SuperPower..." ~Dr Margaret Aranda

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Dr Margaret Aranda is a Stanford alumni of anesthesiology and critical care. She and her beautiful daughter were in a tragic 2006 car accident that left Dr Aranda with dysautonomia, vertebral artery dissection, and traumatic brain injury. 🎀Her daughter is just fine. Dr Margaret Aranda is a Public Figure in Patient Advocacy for Invisible Illnesses, Teens and Ethics.

These are her Books - Genre

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