My Rotation Through a VA Pain Medicine Clinic
SOURCE: ACA News ~ January 29, 2018
By Stephanie Halloran, DC
Part of a series on the chiropractic residency program in the VA health care system
Some of the most valuable knowledge you gain in the Veterans Affairs (VA) chiropractic residency program comes from rotating in other specialties. Within the VA Connecticut Healthcare System, I rotate at both the West Haven and Newington locations. Thus far, I have spent time in rheumatology, physiatry, women’s clinic (primary care), neurology, pain medicine and the interventional pain clinic. Although each rotation has contributed greatly to my clinical acumen, this post will primarily focus on pain medicine.
Pain medicine is a medical subspecialty generally comprised of anesthesiologists, physiatrists or neurologists who have completed an additional one-year post-residency fellowship. As the name implies, these specialists manage overall pain with a goal of improving quality of life for patients. In the private sector, this is done through a combination of medication and interventional procedures, while in the VA the focus is primarily on the latter. This is due to the VA system allocating the majority of medication management to primary care physicians. That’s not to say a VA pain physician will not provide suggestions for medication management when indicated, but they will not prescribe or manage this medication.
Within the VA system, pain management generally manages spinal conditions such as stenosis, non-surgical disc herniation, musculoskeletal trigger points, symptomatic spondylosis and unspecified radicular pain with absence of progressive neurological deficits. Sound familiar? Essentially, this department treats very similar conditions as chiropractors treat but with interventional procedures.
If you are like me at the beginning of my residency, you are currently asking, or have already Googled, what interventional procedures are. Interventional procedures include medial branch block, radiofrequency ablation, epidural steroid injection, sacroiliac (SI) joint corticosteroid injection and musculoskeletal trigger point corticosteroid injection. Intervention selection is determined by identifying the most likely pain generator and presence or absence of radicular symptoms. Below I have broken down each procedure into axial and radicular categories and provided a brief explanation of the goal.
Axial pain: symptomatic spondylosis, SI joint arthritis/dysfunction