Scope of Practice

This discussion is rather interesting. I do not practice pain management. But I have been reading all of the arguments and looking up each of the links. I would like to hear from those CRNAs that do pain management and their thoughts as well as what their education/internships were before getting involved in pain. Are they practicing within a group that includes pain MDAs? Independent? I'm just trying to get all of the facts. It is interesting, the previous post, what is actually included in a fellowship at UCSF. Kind of telling, isnt it? How long does this quoted fellowship/resident elective last? How many hands-on subjects does it require? Cadaver or live? One on one instruction or read the book, watch the film and go do it over there. (a lot of MD classes). Just curious. Just the facts, please. We all know everyone's opinions.

Did anyone answer the previous questions concerning whether the Navy/AirForce CRNAs perform pain management? I know the Navy/Balboa CRNAs are masters in regional blocks (fem, brachial etc).

CRNAs or MDs without extensive pain training are not qualified to perform lumbar, thoracic, cervical discography, radiofrequency neurolysis of the DRG or medial branches, cryoneurolysis of the DRG or intercostal nerves, sphenopalatine ganglion blocks and RF, trigeminal blocks and RF, transforaminal epidural steroid injections fluoroscopically guided, fluoroscopically guided sacroiliac injections, intraarticular and medial branch blocks with contrast and fluoro guidance, T2 sympathetic blocks, celiac plexus blocks (should never ever be performed blind), laser discectomy, hydrocision, disc dekompressor, endoscopic disc decompression, IDET, biaculoplasty, SINERGY, acutherm, plasma disc decompression, laser or mechanical foraminoplasty, TON blocks, SCS trials or implantation, intrathecal pump trials or permanent implants, peripheral nerve stimulator lead trials or implants, etc etc etc....the list is expansive and includes techniques that are definitely not included in FP programs or in any CRNA school.

The straw man argument by CRNAs that MDs should do their research for them is an insult to the profession of nurse anesthesia.

CRNAs or MDs without extensive pain training are not qualified to perform lumbar, thoracic, cervical discography, radiofrequency neurolysis of the DRG or medial branches, cryoneurolysis of the DRG or intercostal nerves, sphenopalatine ganglion blocks and RF, trigeminal blocks and RF, transforaminal epidural steroid injections fluoroscopically guided, fluoroscopically guided sacroiliac injections, intraarticular and medial branch blocks with contrast and fluoro guidance, T2 sympathetic blocks, celiac plexus blocks (should never ever be performed blind), laser discectomy, hydrocision, disc dekompressor, endoscopic disc decompression, IDET, biaculoplasty, SINERGY, acutherm, plasma disc decompression, laser or mechanical foraminoplasty, TON blocks, SCS trials or implantation, intrathecal pump trials or permanent implants, peripheral nerve stimulator lead trials or implants, etc etc etc....the list is expansive and includes techniques that are definitely not included in FP programs or in any CRNA school.

The straw man argument by CRNAs that MDs should do their research for them is an insult to the profession of nurse anesthesia.

I honestly can't figure out who would want to do the above listed procedures- CRNA or anesthesiologist. I worked in a pain clinic with an anesthesiologist (not a very good one either) for a while as a nurse before I went to CRNA school. Many of the patients in these practices are manipulative, lawsuit happy, drug seekers. Good luck with that, I'll stick with the bread and butter, easy money, private practice cases.

FALSE.

I say again: please GET YOUR FACTS STRAIGHT.

This is the same case. Not two cases. NOT TWO SEPARATE CASES.

The LA Supreme Ct last year REFUSED to review a preliminary injunction regarding the case. They REFUSED to review it. Without comment, they REFUSED.

They have NEVER found that, as you say they did, Pain = Medicine.

!

Here's a copy of the judgment.

Is someone here in denial about the verdict?

I want an appeal this decision. I want to see this go all the way to the Louisiana Supreme Court.

Here's a copy of the judgment.

........

Just as I said -- District Court. One Judge.

Not, as you said, LA Supreme Court.

....And your qualifications again?

They have NEVER found that, as you say they did, Pain = Medicine.

Oops - I guess they did.

Oops - I guess they did.

If you read the post, in context 'they' refers to the LA Supreme Court.

You're just all catty because LA has a LAW forbidding AAs.

Just as I said -- District Court. One Judge.

Not, as you said, LA Supreme Court.

....And your qualifications again?

Dude, are you denying that there was even a LA Supreme Court case that ruled that it was improper for the LA BON to simply change the CRNA scope without going through the proper process?

This is a separate case. So far, one court has ruled that pain is medicine and not nursing. Are you denying that this ruling has any consequence?

Why do you think that the president of the LA CRNA has advised all CRNA's in Louisiana that they can't do pain? Every court case has to start somewhere. If the CRNA's keep fighting this, it will go to the LA Supreme Court.

A more important question that CRNA's everywhere need to ask is this. Can they convince a court in any state of this country that pain is within the scope of CRNA's? Look back at paindoc's post and his descriptions of what pain entails. Did your training cover all those areas for you to be able to competently and safely provide this service or did you pick them up on some weekend? If your answer is the latter, then there is a good chance that the results of this case will be repeated throughout the country.

Well I guess all those FP docs who set themselves up in pain medicine will be pushed out? I doubt ti Look just because pain doc lists a procedure it does not mean that the provider has to perform them, Hell implanting a pain pump is part of pain but very few pain docs do that, most let someone else do it as most pain docs are not competent surgeons, no slams there it just depends on your training.

Family physicians without fellowship training in pain medicine have no business performing interventional pain procedures. They are far better at medication management for chronic pain than CRNAs will ever be due to vast experience in residency and beyond. Nonetheless, FPs doing interventional procedures is no different than a geneticist suddenly deciding to start a chronic pain practice with fluoroscopically guided injections....it is beneath the standard of care, demonstrates a callous arrogance regarding their own abilities, and unnecessarily places patient lives at risk due to the lack of education.

Yet I do not hear any hue and cry over these providers, the big concern seems to be over "nurses" providing care. It seems to me that this is not an oversight but just an acknowledgment that no medical organization will censure or police itself they will only attempt to police other organizations and attempt to mandate the scope of practice for others. I am sure that the AMA, ASA, or any other body of physicians would not appreciate their scope of practice to be determined by any nursing organization. In the end these organizations are attempting to regulate nursing practice not by education or training but by legislation the exact same thing they accuse CRNA's of doing.

I disagree. The lack of education of CRNAs providing interventional or comprehensive pain management is exactly the issue. While there are similarities between anesthesiology and nurse administered anesthesia, there are profound differences between the two above specialties and interventional pain medicine. The tacit assumption that CRNAs may treat pain, any pain, providing they have a weekend course in anything, is based on an outdated view of pain medicine that existed in 1994. If the few CRNAs practicing interventional pain medicine do not recognize these differences, they will end up fighting a war with the 1,000,000 physicians in this country. The overwhelmining political and numerical advantage will result in an extreme setback to CRNAs as a whole, not only to those that are playing in a field of medicine in which they have no background, no CRNA school education, no substantial post CRNA training other than a weekend course in order to learn an entire medical specialty with very few similarities to CRNA practice or training, and perform no research. If it is really all about patient safety, I cannot think of a more poignant example of substandard care than to have untrained uneducated individuals from CRNAs to FPs performing interventional pain procedures.