Q: Education

• Ph.D. Nursing Education • Studied Biobehavioral Aspects of Pain (Hypnotherapy) • Post-Graduate Certificate in Pain Management • MHS Nurse Anesthesiology for Army Nurse Corps Officers • Bachelor of Science in Nursing • Diplomat American Academy of Pain Management • 2015 Ira P. Gunn Award winner for professional advocacy • 2015 Exceptional Leadership, Service, and Dedication Award, IANA

Q: Education

• Ph.D. Nursing Education • Studied Biobehavioral Aspects of Pain (Hypnotherapy) • Post-Graduate Certificate in Pain Management • MHS Nurse Anesthesiology for Army Nurse Corps Officers • Bachelor of Science in Nursing • Diplomat American Academy of Pain Management • 2015 Ira P. Gunn Award winner for professional advocacy • 2015 Exceptional Leadership, Service, and Dedication Award, IANA

Question 1

Course Objectives

Accepted Answer

The student will be expected to meet the following objectives:
 
1. Relate anatomical, pathological and physiological theory to identify normal and abnormal findings.
2. Perform a comprehensive pain assessment that includes systematically obtaining a history, ordering and interpreting diagnostic tests, and identifying normal and abnormal physical examination findings.
3. Make a clinical diagnostic impression that includes the Emory Pain Estimate Model categorization, defines the type of pain syndrome and symptoms, and prescribes the appropriate treatment.
4. Differentiate between  the various types of pain pathology: neuropathic pain, bone pain, myofascial pain, psychogenic pain, sympathetic maintained pain, visceral pain and cancer related pain syndromes.
5. Participate in a synthetic cadaver lab and practice various injections and associated       spinal interventions based on an anticipated pathological disorder.
6. Apply knowledge of pharmacology, pharmacokinetics and pharmacodynamics in the management of pain syndromes using allopathic, osteopathic, naturopathic and herbal modalities.
7. Understand the underlying biomechanics of the human body as it relates to pain disorders and apply basic manual therapy interventions to correct abnormal posture related disorders.
8. Explain thoroughly the role of the different members of the interdisciplinary and multidisciplinary team.
 
By the completion of this program, the student will be expected to have acquired the following clinical skills to:
1. Perform and document a thorough pain assessment and evaluation, including requesting consultations and diagnostic studies
2. Order, provide and modify pain relief therapy through the use of drugs, natural medicines, infusion therapy, manual therapy, electrical therapy, prolotherapy and neural therapy techniques
3. Demonstrate on a synthetic cadaver or actual patient the performance of some common spinal interventional techniques that includes: spinal injections, epidural injections, peripheral nerve blocks, regional nerve blocks, ligamentous and myofascial injections, facet medial branch nerve blocks and other regional anesthesia related nerve blocks
4. Practice in conformity with established Code of Ethics identified by the American Association of Nurse Anesthesiology
5. Meet the criteria for credentialing by NBCRNA in Non-Surgical Pain Management.

Question 2

Lessons

Accepted Answer

1.    Epidural Injections and Considerations
       A.  Anatomy of the epidural space
       B.  Techniques for the various epidural injections
       C.  Use of radiopaque contrast dye
       D.  Pathology responsive to epiduralinjections
       E.  Complications related to epidural injections
 
2.    Facet Injections and Considerations
       A.  Zygapophyseal joint anatomy
       B.  Spine range of motion
       C.  Intraarticular and medial branch nerve blocks     
       D.  Spinal vasculature considerations
 
3.    Perspectives in Pain Management
       A.  Definitions
       B.  The personal pain experience
       C.  Pain epidemiology
       D.  Consequences of untreated pain
       E. Culture and pain
 
4.    Pathophysiology of Pain
        A.  Pain and pain pathways
        B.  Gate control theory
        C.  Central and peripheral sensitization
        D.  Pain and neurotransmitters
        E.  Spine and brain opiate receptors
        F.  Role of ketamine
 
5.    The Assessment of Pain
       A.  Objective components of pain
       B.  Pain intensity measurement
       C.  Pain complaint and data collection
       D.  Pain history
       E.  Physical examination
       F.  Dictating the findings
 
6.    Painful Polyneuropathies
        A.  Diabetic peripheral neuropathy
        B.  Diagnostic testing
        C.  Treatment of neuropathies
        D.  Nerve anatomy
        E.  Examination of the foot
 
7.    Painful Joints and Injections
       A. Anatomy of the sacroiliac joint
       B.  Treatment of the SI joint
       C.  Trochanteric bursitis
       D.  Iliotibial band syndromes
       E.  Piriformis muscle syndromes
       F.  Joint and bursa injections
       G. Genicular nerve blocks
 
8.    Diagnostic Testing and Interpretation
       A.  Anatomical planes of view
       B.  MRI interpretation
       C.  Radiographic interpretation
       D.  Disc pathology
       E.  EMG and nerve conduction testing
 
9.    Neuropathic Pain
       A.  Neuropathic pain disorders
       B.  Pharmacological considerations in neuropathic pain
       C.  CRPS-I and CRPS- II
       D.  Acute herpes zoster and post-herpetic neuralgia
       E.  Trigeminal neuralgia
 
10.  Weight Loss Considerations in Pain Management 
       A.  Nutrition and pain management
       B.  Anti-inflammatory diet
 
11.  Cancer Pain Considerations
       A.  Pain in the patient with cancer
       B.  Neurosurgical interventions
       C.  Role of neurolytic techniques
       D.  Cancer pain control guidelines
       E.  Sympathetic blockade
 
12.  Psychological Considerations in Pain Management 
       A. Psychosocial issues
       B.  Psychological assessment and testing
       C.  Neurolinguistic programing 
       D.  Treatment strategies
 
13.  Pharmacological considerations in Pain Management 
       A.  Pharmacology of pain management
       B.  Steroids
       C.  NSAIDs
       D.  Antiepiletic drugs
       E.  Antispasmodics
       F.  Tricyclic antidepressants
       G.  Compounded agents and transdermal application
       H.  Prescribing protocols
 
14.  Geriatric and Special Population Pain Management 
       A.  Assessment of persistent pain
       B.  Pharmacological considerations
       C. Non-pharmacological considerations
       D.  Palliative care and hospice
 
15.  Pain in Infants and Children
       A.   Analgesic therapy
       B.  Conscious sedation considerations
       C.  Palliative care and hospice
 
16.  Integrative Medicine and Pain Management
       A.  Complementary and alternative medicine
       B.  Meditation and hypnosis
       C.  Exercise and life pacing
       D.  Neural therapy
       E.  Prolotherapy and regenerative therapy principles
       F.  Other interventions
 
17.  Complications in Pain Management  
       A.  Anticoagulants and spinal interventions
       B.  Spinal interventional incidents
       C.  Renal failure and contrast dye
       D.  Particulate steroids
 
18.  Pain Clinic Organization and Set Up
       A.  Pain clinic types
       B.  Role of pain clinic staff
       C.  Organization and set up
 
19.  Ethics of Pain Management 
       A.  Code of ethics
       B.  Patient's Bill of Rights
       C.  Legal considerations
 
20.  Monitoring Quality of Pain Services
       A.  Accreditation
       B.  Standard of care
       C.  Research issues
 
Assessments
Lesson 1-20 will each have a self-assessment to measure your knowledge

Question 3

Correspondence Course Outline

Accepted Answer

I.          Perspectives in Pain and Pain Management
            A.        Historical Perspectives of Pain Management
            B.        Patient Descriptions of Pain
            C.        IASP and Other Descriptions of Pain
            D.        Consequences of Untreated Pain
            E.        Culture and Pain
            F.         Family and Pain
            G.        Sex, Gender and Pain
            H.        Racial and Ethnic Issues in Pain
             I.         Myths and Pain Therapy
 
II.        Pathophysiology of Pain
 
           A.        The Neuroscience of Pain and Analgesia
           B.        The Pharmacodynamics of Pain and Transmission
III.       Multidisciplinary Approaches to Pain Management
 
            A.        Components of a Multidisciplinary Pain Clinic
            B.        Starting a Pain Clinic
            C.        Quality Assurance in Pain Management
            D.        The Role of Nursing in Pain Management
            E.         The Role of the Physician in Pain Management
            F.         The Role of the Podiatrist in Pain Management
            G.        The role of the Physical Therapist
            H.        The Role of the Occupational Therapist
            I.          Vocational Rehabilitation
            J.          The Role of the Dentist and Oral Surgeon in Pain Management
 
IV.       The Assessment of Pain
 
            A.        Measuring Pain Intensity
            B.        Medical History and Clinical Interview
            C.        Neuromuscular Examination
V.        Common Pain Syndromes
 
            A.        Types of Pain:  Classifications and Concepts
                        1.  Somatic Pain
                        2.  Neuropathic Pain
                        3.  Cancer Pain
                        4.  Psychogenic Pain
                        5.  Bone Pain
                        6.  Sympathetic Pain
                        7.  Visceral Pain
            B.        Fibromyalgia
            C.        Primary Headache Disorders
            D.        Post-Traumatic Head Injuries
            E.         TMJ Disorders
            F.         Abdominal Pain
            G.        Low Back Pain
            H.        Pelvic Pain
            I.          Urologic Pain
            J.         Rheumatologic Related Pain
            K.        Orthopedic Pain
            L.         Myofascial Pain Syndromes
            M.       CRPS Type I and II
            N.        Post-herpetic Neural
            O.        Painful Polyneuropathies
 
VI.       Diagnostic Interpretations
 
            A.        Lab Testing for Pain Disorders
            B.        Functional Capacity Evaluations
            C.        Plain Films
            D.        CT Scans
            E.         MRI
            F.         Thermography
            G.        PET Scans
            H.        EMG and NCV
            I.          Ultrasound
            J.          Bone Scans
            K.         Discography
            L.         Myelogram
 
VII.      Bio-Behavorial Assessment and Interventions
 
            A.        Chronic Pain and Addictions
            B.        The Role of the Psychologist in Pain Management
            C.        The Role of the Social Worker in Pain Management
            D.        Addressing Anxiety and Depression
            E.         Psychogenic Pain and it’s Implications
            F.         Psychological Assessment Tools
            G.        The Bio-Psycho-Social Model of Pain Management
            H.        Psychotherapeutic Interventions
            I.          Hypnotherapy and Pain Management
            J.          Neurolinguistic Programming
            K.         Biofeedback and Relaxation Interventions in Pain Management
            L.         Guided Imagery
 
VIII.    Pharmacotherapy Considerations
 
           A.        The Role of the Pharmacist in Pain Management
           B.        Opioid Therapy for Non-Cancer  Related Pain
           C.        NSAIDs
           D.        The Role of Cannabis and Cannabinoids in Pain Management
           E.         Anti-Convulsants and other Adjuvants
           F.         Anti-Depressants
          G.         Muscle Relaxants
          H.         Role of Vitamins and Minerals in Pain Management
           I.          Natural Supplements
           J.          Chemical Neurolytics: Alcohol, Phenol and Glycerine
          K.          Corticosteroids
           L.         Topical and Compounded Drugs
 
IX.       Interventional Pain Management
 
            A.        Epidural Steroid Injections
            B.        Sympathetic Neural Blockade
            C.        Facet Injections
            D.        Radiofrequency neurolysis
            E.         Muscular Injections
            F.          Joint Injections
            G.        Spinal Cord Stimulation
            H.        Intrathecal Pumps
X.        Integrative Medicine Approaches
 
            A.        Osteopathic and Chiropractic Manual Medicine Techniques
            B.        Prolotherapy
            C.        Neural Therapy
            D.        Acupuncture and Traditional Chinese Medicine
            E.         Aromatherapy
            F.         Homeopathy
            G.        Massage Therapy
            H.        Naturopathy
            I.          Art Therapy
            J.          Music Therapy
 
XI.       Legal and Ethical Considerations
            A.         Code of Ethics in Pain Management
            B.         Practitioner Specific Code of Ethics
            C.         American Academy of Pain Management Credentialing
            D.         Legal consideration in Pain Management
            E.         Controlled Substance Issues in Chronic Pain Management
 
XII.      Electrical and Related Therapy
 
            A.        Alpha Stimulation
            B.        Micro vs. Macro-current and Stimulation
            C.        Auricular Therapy
            D.        Percutaneous Neuromodulation Therapy
XIII.    Special Populations and Their Considerations
 
            A.        Pain in Infants and Children
            B.        Pain in the Elderly
            C.        Pain in the Cognitively Impaired
            D.        Occupational Medicine
            E.         Hospice and Palliative Care
            F.         HIV and AIDS Related Pain
            G.        Cancer Pain
            H.        Weight Loss Program
 
XIV.    Spiritual Aspects
 
            A.        The Role of Prayer in Pain Management
            B.        Spiritual Assessment
 
XV.      Additional Issues in Pain Management
 
            A.       CRNA Billing Issues
            B.       Organization and Set-up of a Multidisciplinary Pain Clinic
 
XVI.    Case Presentations in Pain Management
 
            A.        Low Back Pain
            B.        Neck Pain
            C.        Post-thoracic Pain
            D.        Opioid Addiction
            E.        Radicular Pain
 
XVII.   Lesson Plans
           A.  Available for each lesson
​
XVIII.  Examinations
           A.  Each assignment has specific course questions
           B.  Each course will have a self-assessment test
 
XIX.  Writing Assignments
            A.       One Ethics Paper

Question 4

Clinical Sites and Rotations

Accepted Answer

Iowa
 • Story County Medical Center: Nevada
 • Hansen Family Hospital: Iowa Falls
 • Grundy County Memorial Hospital: Grundy Center
 • Greene County Medical Center: Jefferson
 • Decatur County Hospital, Leon, Iowa
 • Cass County Hospital, Atlantic , Iowa

Clinical Rotations are available for non-pain externs/CRNAs/ARNPs at a $1,500/day fee.

Question 5

Clinical Rotation Questions

Accepted Answer

1. What is the difference between a consult and a referral?
2. What are the CPT codes for a consult level I-V and what are the criteria to determine each level?
3. What are the CPT codes for an inpatient and outpatient follow up level I-IV?
4. What is the CPT code for using fluoroscopy or CT scan for an injection?
5. Define the following diagnosis and list their diagnostic codes: see recommended list.
6. What is the ICD-10 code for the following conditions:
 • Low back pain         
 • Facet arthropathy (cervical, thoracic and lumbar)
 • Cervicalgia
 • Radiculopathy (cervical, thoracic and lumber)
 • Neuropathy
 • Degenerative disc disease
 • Spondylolysis
 • Spondylolythesis
 • Fibromyalgia
 • Myofascial pain syndrome
 • Complex regional pain syndrome I & II
 • Vertebral fracture
 • Sacrolitis
 • Neuralgia
 • Trochanteric bursitis
 • Postherpetic neuralgia
7.  Define the following terms:
a) Visceral pain
b) Neuropathic pain
c)  Bone pain
d) Sympathetic maintained pain
e) Cancer pain
f)  Psychogenic pain
g) Somatic pain
 
8.  List the components of the Emory Pain Estimate Model.
 
9.  Describe the P-3 and BHI-2 psychometric tests and include the components of each.
 
10. Describe the role of the following specialties in pain management:
 • Anesthesiologist
 • CRNA
 • Registered Nurse
 • Advanced Practice Nurse/Physician Assistant
 • Physiatrist
 • Psychologist/Psychiatrist
 • Chiropractor
 • Orthopedic surgeon
 • Neuologist
 • Neurosurgeon
 • ENT specialist
 • Oral surgeon/dentist
 • Physical therapist
 • Occupational therapist
 • Massage therapist
 • Social worker
 • Family physician
 • Podiatrist
 • Brace specialist
 • Radiologist
11. List the components of a pain consultation/assessment:
 
12. Describe the components of a professional dictation:
 
13. Describe the following techniques:
 • Trigger point injection
 • Joint injection
 • Bursa injection
 • Sympathetic injection
 • Epidural injection
 • Facet joint/MBN injection
 • Radiofrequency Lesioning
 • Cryoablation
 • Neuroablation
14. What is a home exercise program (HEP)?
 
15. What is the treatment criteria for a worker’s compensation injury?
 
16. What procedures are CRNAs allowed and disallowed to perform on medicare insured patients?
 
17. What are the components of an opiate and treatment compliance contract?
 
18. What restrictions do private insurance carriers put on CRNAs?
 
19. What are the minimum requirements for a pain chart or medical record?
 
20. Describe the significance of the following diagnostic tests:
 • Plain films
 • CT scan
 • MRI
 • Bone scan
 • EMG/NCV

Question 6

Program Objectives

Accepted Answer

The student will be expected to meet the following objectives:
1. Relate anatomical, pathological and physiological theory to identify normal and abnormal findings.
2. Perform a comprehensive pain assessment that includes systematically obtaining a history, ordering and interpreting diagnostic tests, and identifying normal and abnormal physical examination findings.
3. Make a clinical diagnostic impression that includes the Emory Pain Estimate Model categorization, defines the type of pain syndrome and symptoms, and prescribes the appropriate treatment.
4. Differentiate between the various types of pain pathology: neuropathic pain, bone pain, myofascial pain, psychogenic pain, sympathetic maintained pain, visceral pain and cancer related pain syndromes.
5. Participate in a synthetic cadaver lab and practice various injections and associated spinal interventions based on an anticipated pathological disorder.
6. Apply knowledge of pharmacology, pharmacokinetics and pharmacodynamics in the management of pain syndromes using allopathic, osteopathic, naturopathic and herbal modalities.
7. Understand the underlying biomechanics of the human body as it relates to pain disorders and apply basic manual therapy interventions to correct abnormal posture related disorders.
8. Explain thoroughly the role of the different members of the interdisciplinary and multidisciplinary team.
 
By the completion of this program, the student will be expected to have acquired the following clinical skills to:
1. Perform and document a thorough pain assessment and evaluation, including requesting consultations and diagnostic studies.
2. Order, provide and modify pain relief therapy through the use of drugs, natural medicines, infusion therapy, manual therapy, electrical therapy, prolotherapy and neural therapy techniques.
3. Demonstrate on a synthetic cadaver or actual patient the performance of some common spinal interventional techniques that includes: spinal injections, epidural injections, peripheral nerve blocks, regional nerve blocks, ligamentous and myofascial injections, facet medial branch nerve blocks and other regional anesthesia related nerve blocks.
4. Practice in conformity with established Code of Ethics identified by the American Association of Nurse Anesthesiologists (AANA).
5. Meet the criteria for credentialing by NBCRNA in Non-Surgical Pain Management.

Question 7

Program Lessons

Accepted Answer

1. Epidural Injections and Considerations
A. Anatomy of the epidural space
B. Techniques for the various epidural injections
C. Use of radiopaque contrast dye
D. Pathology responsive to epiduralinjections
E. Complications related to epidural injections
2. Facet Injections and Considerations
A. Zygapophyseal joint anatomy
B. Spine range of motion
C. Intraarticular and medial branch nerve blocks 
D. Spinal vasculature considerations
3. Perspectives in Pain Management
A. Definitions
B. The personal pain experience
C. Pain epidemiology
D. Consequences of untreated pain
E. Culture and pain
4. Pathophysiology of Pain
A. Pain and pain pathways
B. Gate control theory
C. Central and peripheral sensitization
D. Pain and neurotransmitters
E. Spine and brain opiate receptors
F. Role of ketamine
5. The Assessment of Pain
A. Objective components of pain
B. Pain intensity measurement
C. Pain complaint and data collection
D. Pain history
E. Physical examination
F. Dictating the findings
6. Painful Polyneuropathies
A. Diabetic peripheral neuropathy
B. Diagnostic testing
C. Treatment of neuropathies
D. Nerve anatomy
E. Examination of the foot
7. Painful Joints and Injections
A. Anatomy of the sacroiliac joint
B. Treatment of the SI joint
C. Trochanteric bursitis
D. Iliotibial band syndromes
E. Piriformis muscle syndromes
F. Joint and bursa injections
G. Genicular nerve blocks
8. Diagnostic Testing and Interpretation
A. Anatomical planes of view
B. MRI interpretation
C. Radiographic interpretation
D. Disc pathology
E. EMG and nerve conduction testing
9. Neuropathic Pain
A. Neuropathic pain disorders
B. Pharmacological considerations in neuropathic pain
C. CRPS-I and CRPS- II
D. Acute herpes zoster and post-herpetic neuralgia
E. Trigeminal neuralgia
10. Weight Loss Considerations in Pain Management 
A. Nutrition and pain management
B. Anti-inflammatory diet
11. Cancer Pain Considerations
A. Pain in the patient with cancer
B. Neurosurgical interventions
C. Role of neurolytic techniques
D. Cancer pain control guidelines
E. Sympathetic blockade
12. Psychological Considerations in Pain Management 
A. Psychosocial issues
B. Psychological assessment and testing
C. Neurolinguistic programing 
D. Treatment strategies
13. Pharmacological considerations in Pain Management 
A. Pharmacology of pain management
B. Steroids
C. NSAIDs
D. Antiepiletic drugs
E. Antispasmodics
F. Tricyclic antidepressants
G. Compounded agents and transdermal application
H. Prescribing protocols
14. Geriatric and Special Population Pain Management 
A. Assessment of persistent pain
B. Pharmacological considerations
C. Non-pharmacological considerations
D. Palliative care and hospice
15. Pain in Infants and Children
A. Analgesic therapy
B. Conscious sedation considerations
C. Palliative care and hospice
16. Integrative Medicine and Pain Management
A. Complementary and alternative medicine
B. Meditation and hypnosis
C. Exercise and life pacing
D. Neural therapy
E. Prolotherapy and regenerative therapy principles
F. Other interventions
17. Complications in Pain Management 
A. Anticoagulants and spinal interventions
B. Spinal interventional incidents
C. Renal failure and contrast dye
D. Particulate steroids
18. Pain Clinic Organization and Set Up
A. Pain clinic types
B. Role of pain clinic staff
C. Organization and set up
19. Ethics of Pain Management 
A. Code of ethics
B. Patient's Bill of Rights
C. Legal considerations
20. Monitoring Quality of Pain Services
A. Accreditation
B. Standard of care
C. Research issues
21-26 Nonsurgical Pain Management Prep Courses
Assessments
Lesson 1-26 will each have a self-assessment to measure your knowledge

Question 8

Correspondence Program Outline

Accepted Answer

I. Perspectives in Pain and Pain Management
	A. Historical Perspectives of Pain Management
	B. Patient Descriptions of Pain
	C. IASP and Other Descriptions of Pain
	D. Consequences of Untreated Pain
	E. Culture and Pain
	F. Family and Pain
	G. Sex, Gender and Pain
	H. Racial and Ethnic Issues in Pain
	I. Myths and Pain Therapy
II. Pathophysiology of Pain
	A. The Neuroscience of Pain and Analgesia
	B. The Pharmacodynamics of Pain and Transmission
III. Multidisciplinary Approaches to Pain Management
	A. Components of a Multidisciplinary Pain Clinic
	B. Starting a Pain Clinic
	C. Quality Assurance in Pain Management
	D. The Role of Nursing in Pain Management
	E. The Role of the Physician in Pain Management
	F. The Role of the Podiatrist in Pain Management
	G. The role of the Physical Therapist
	H. The Role of the Occupational Therapist
	I. Vocational Rehabilitation
	J. The Role of the Dentist and Oral Surgeon in Pain Management
IV. The Assessment of Pain
	A. Measuring Pain Intensity
		1. Types of Pain: Classifications and Concepts
			a. Somatic Pain
			b. Neuropathic Pain
			c. Cancer Pain
			d. Psychogenic Pain
			e. Bone Pain
			f. Sympathetic Pain
			g. Visceral Pain
	B. Fibromyalgia
	C. Primary Headache Disorders
	D. Post-Traumatic Head Injuries
	E. TMJ Disorders
	F. Abdominal Pain
	G. Low Back Pain
	H. Pelvic Pain
	I. Urologic Pain
	J. Rheumatologic Related Pain
	K. Orthopedic Pain
	L. Myofascial Pain Syndromes
	M. CRPS Type I and II
	N. Post-herpetic Neural
	O. Painful Polyneuropathies
	B. Medical History and Clinical Interview
	C. Neuromuscular Examination
V. Common Pain Syndromes
VI. Diagnostic Interpretations
	A. Lab Testing for Pain Disorders
	B. Functional Capacity Evaluations
	C. Plain Films
	D. CT Scans
	E. MRI
	F. Thermography
	G. PET Scans
	H. EMG and NCV
	I. Ultrasound
	J. Bone Scans
	K. Discography
	L. Myelogram
VII. Bio-Behavorial Assessment and Interventions
	A. Chronic Pain and Addictions
	B. The Role of the Psychologist in Pain Management
	C. The Role of the Social Worker in Pain Management
	D. Addressing Anxiety and Depression
	E. Psychogenic Pain and it’s Implications
	F. Psychological Assessment Tools
	G. The Bio-Psycho-Social Model of Pain Management
	H. Psychotherapeutic Interventions
	I. Hypnotherapy and Pain Management
	J. Neurolinguistic Programming
	K. Biofeedback and Relaxation Interventions in Pain Management
	L. Guided Imagery
VIII. Pharmacotherapy Considerations
	A. The Role of the Pharmacist in Pain Management
	B. Opioid Therapy for Non-Cancer Related Pain
	C. NSAIDs
	D. The Role of Cannabis and Cannabinoids in Pain Management
	E. Anti-Convulsants and other Adjuvants
	F. Anti-Depressants
	G. Muscle Relaxants
	H. Role of Vitamins and Minerals in Pain Management
	I. Natural Supplements
	J. Chemical Neurolytics: Alcohol, Phenol and Glycerine
	K. Corticosteroids
	L. Topical and Compounded Drugs
IX. Interventional Pain Management
	A. Epidural Steroid Injections
	B. Sympathetic Neural Blockade
	C. Facet Injections
	D. Radiofrequency neurolysis
	E. Muscular Injections
	F. Joint Injections
	G. Spinal Cord Stimulation
	H. Intrathecal Pumps
X. Integrative Medicine Approaches
	A. Osteopathic and Chiropractic Manual Medicine Techniques
	B. Prolotherapy
	C. Neural Therapy
	D. Acupuncture and Traditional Chinese Medicine
	E. Aromatherapy
	F. Homeopathy
	G. Massage Therapy
	H. Naturopathy
	I. Art Therapy
	J. Music Therapy
XI. Legal and Ethical Considerations
	A. Code of Ethics in Pain Management
	B. Practitioner Specific Code of Ethics
	C. American Academy of Pain Management Credentialing
	D. Legal consideration in Pain Management
	E. Controlled Substance Issues in Chronic Pain Management
XII. Electrical and Related Therapy
	A. Alpha Stimulation
	B. Micro vs. Macro-current and Stimulation
	C. Auricular Therapy
	D. Percutaneous Neuromodulation Therapy
XIII. Special Populations and Their Considerations
	A. Pain in Infants and Children
	B. Pain in the Elderly
	C. Pain in the Cognitively Impaired
	D. Occupational Medicine
	E. Hospice and Palliative Care
	F. HIV and AIDS Related Pain
	G. Cancer Pain
	H. Weight Loss Program
XIV. Spiritual Aspects
	A. The Role of Prayer in Pain Management
	B. Spiritual Assessment
XV. Additional Issues in Pain Management
	A. CRNA Billing Issues
	B. Organization and Set-up of a Multidisciplinary Pain Clinic
XVI. Case Presentations in Pain Management
	A. Low Back Pain
	B. Neck Pain
	C. Post-thoracic Pain
	D. Opioid Addiction
	E. Radicular Pain
XVII. Lesson Plans
	A. Available for each lesson
XVIII. Examinations
	A. Each assignment has specific course questions
	B. Each course will have a self-assessment test
XIX. Writing Assignments
	A. One Ethics Paper

Question 9

Clinical Sites and Rotations

Accepted Answer

Clinical Sites
Decatur County Hospital, Leon, Iowa
Hansen Family Hospital, Iowa Falls, Iowa
Grundy Center Memorial Hospital, Grundy Center, Iowa
Greene County Hospital, Jefferson, Iowa
​
Clinical Rotations are available for non-pain externs/CRNAs/ARNPs at a $1,500/day fee.

Question 10

Clinical Rotation Questions

Accepted Answer

1. What is the difference between a consult and a referral?
2. What are the CPT codes for a consult level I-V and what are the criteria to determine each level?
3. What are the CPT codes for an inpatient and outpatient follow up level I-IV?
4. What is the CPT code for using fluoroscopy or CT scan for an injection?
5. Define the following diagnosis and list their diagnostic codes: see recommended list.
6. What is the ICD-10 code for the following conditions:
 • Low back pain 
 • Facet arthropathy (cervical, thoracic and lumbar)
 • Cervicalgia
 • Radiculopathy (cervical, thoracic and lumber)
 • Neuropathy
 • Degenerative disc disease
 • Spondylolysis
 • Spondylolythesis
 • Fibromyalgia
 • Myofascial pain syndrome
 • Complex regional pain syndrome I & II
 • Vertebral fracture
 • Sacrolitis
 • Neuralgia
 • Trochanteric bursitis
 • Postherpetic neuralgia
7. Define the following terms:
a) Visceral pain
b) Neuropathic pain
c) Bone pain
d) Sympathetic maintained pain
e) Cancer pain
f) Psychogenic pain
g) Somatic pain
8. List the components of the Emory Pain Estimate Model.
9. Describe the P-3 and BHI-2 psychometric tests and include the components of each.
10. Describe the role of the following specialties in pain management:
 • Anesthesiologist
 • CRNA
 • Registered Nurse
 • Advanced Practice Nurse/Physician Assistant
 • Physiatrist
 • Psychologist/Psychiatrist
 • Chiropractor
 • Orthopedic surgeon
 • Neuologist
 • Neurosurgeon
 • ENT specialist
 • Oral surgeon/dentist
 • Physical therapist
 • Occupational therapist
 • Massage therapist
 • Social worker
 • Family physician
 • Podiatrist
 • Brace specialist
 • Radiologist
11. List the components of a pain consultation/assessment:
12. Describe the components of a professional dictation:
13. Describe the following techniques:
 • Trigger point injection
 • Joint injection
 • Bursa injection
 • Sympathetic injection
 • Epidural injection
 • Facet joint/MBN injection
 • Radiofrequency Lesioning
 • Cryoablation
 • Neuroablation
14. What is a home exercise program (HEP)?
15. What is the treatment criteria for a worker’s compensation injury?
16. What procedures are CRNAs allowed and disallowed to perform on medicare insured patients?
17. What are the components of an opiate and treatment compliance contract?
18. What restrictions do private insurance carriers put on CRNAs?
19. What are the minimum requirements for a pain chart or medical record?
20. Describe the significance of the following diagnostic tests:
 • Plain films
 • CT scan
 • MRI
 • Bone scan
 • EMG/NCV

Question 11

Components of the Advanced Pain Management Training Program

Accepted Answer

1. Didactic-online Litmos
Includes course content and supportive references
One time fee: $800

2. Clinical labs and mini-courses 
See below for labs and cost

3. Clinical observation only
Requires minimal credentialing-
Negotiable fee

4. Supervised hands-on clinical
Requires state license, malpractice, extensive credentialing, and completion of online training 
Fee is $9,000 for all the above components combined

5. Mentoring 
Available for the novice or experienced with each course

Question 12

Clinical Labs/Mini-Courses

Accepted Answer

Physical Assessment: The Focused Examination
  TBA
 
         Time:  0800-1200
          Location:  Grundy Center, Iowa
          Price: $250
 
Diagnostic Interpretation for the Nurse Pain Specialist
TBA
Time:  1300-1600
Location:  Grundy Center, Iowa
Price:  $250
 
Fluoroscopic-Guided Epidural Training
     TBA
 
         Time: 0800-1700
         Location:  Grundy Center, Iowa
         Price: $1,200
 
Fluoroscopic-Guided Selective Joint Injection Training
 TBA
 
         Time: 0800-1600
Location: Grundy Center, IA
Price: $1,200
 
Radiofrequency Ablation Training
TBA
 
         Time: 0800-1800
Location: Grundy Center, IA
Price: $1,500
 
Spinal Interventional Lab
    TBA
 
         Time: 0800-1800
Location: Grundy Center, IA
Price: $1,500

Question 13

Cost and Payment Information

Accepted Answer

The cost of the Pain Externship Program (PEP) is variable, based on type of training.
 
Learn more(javascript:void(0))

Question 14

Education

Accepted Answer

• Ph.D. Nursing Education
 • ﻿Studied Biobehavioral Aspects of Pain (Hypnotherapy)
 • Post-Graduate Certificate in Pain Management
 • MHS Nurse Anesthesiology for Army Nurse Corps Officers
 • Bachelor of Science in Nursing
 • Diplomat American Academy of Pain Management
 • 2015 Ira P. Gunn Award winner for professional advocacy
 • 2015 Exceptional Leadership, Service, and Dedication Award, IANA

Question 15

Education

Accepted Answer

• PhD Student and Pain and Associated Symptoms Research Fellow, University of Iowa
 • Graduate Certificate in Applied Biostatistics, University of Minnesota
 • Fellowship in Nonsurgical Pain Management, Texas Christian University
 • Externship in Pain Management, Premier Pain Management
 • Master of Science, Nurse Anesthesia, Saint Mary’s University of Minnesota
 • Bachelor of Science, Nursing Science, St. Cloud State University

Question 16

Education

Accepted Answer

• Ph.D. Nursing Education
 • ﻿Studied Biobehavioral Aspects of Pain (Hypnotherapy)
 • Post-Graduate Certificate in Pain Management
 • MHS Nurse Anesthesiology for Army Nurse Corps Officers
 • Bachelor of Science in Nursing
 • Diplomat American Academy of Pain Management
 • 2015 Ira P. Gunn Award winner for professional advocacy
 • 2015 Exceptional Leadership, Service, and Dedication Award, IANA

Question 17

Professional Experience

Accepted Answer

• Collaborative Faculty, University of South Florida Pain Management Fellowship
 • Clinical Instructor, Texas Christian University Pain Management Fellowship
 • President and Owner, Midwest Integrated Pain Care, P.C.
 • Pain Management Practitioner, Midwest Integrated Pain Care, P.C.

Question 18

Professional Experience

Accepted Answer

• Adjunct Assistant Professor, University of South Florida, Tampa, FL
 • ​Clinical coordinator and preceptor, CRNA accredited fellowship post-graduate program in Advanced Pain Management.​
 • Adjunct Clinical Instructor, Texas Christian University, Ft. Worth, TX
 • Clinical coordinator and preceptor, CRNA accredited fellowship post-graduate program in Advanced Pain Management.​
 • Adjunct Assistant Professor, University of Iowa, Iowa City, IA               
 • Curriculum Developer/Instructor, AANA Jack Neary Advanced Pain Management I and II Program
 • Curriculum Developer/Instructor, National Anesthesiology Pain Education Seminars
 • Former Assistant Professor, Bradley University School of Nursing, Peoria, IL
 • ​Clinical preceptor for nurse anesthetists and physicians in residency
 • Former Adjunct Professor, University of Illinois Medical College, Peoria, IL
 • ​​Clinical preceptor for nurse anesthetists and physicians in residency
 • ​Expert witness-consultant in medical/legal cases involving nurse anesthesia and pain management
 • Founding member of the Nurse Anesthesiology Pain Education Seminars (NAPES) corporation
 • President/Owner, Sleepers Anesthesia Service, P.C.
 • President/Owner, Premier Pain Management LLC​

Question 19

Professional Experience

Accepted Answer

• Adjunct Assistant Professor, University of South Florida, Tampa, FL
 • ​Clinical coordinator and preceptor, CRNA accredited fellowship post-graduate program in Advanced Pain Management.​
 • Adjunct Clinical Instructor, Texas Christian University, Ft. Worth, TX
 • Clinical coordinator and preceptor, CRNA accredited fellowship post-graduate program in Advanced Pain Management.​
 • Adjunct Assistant Professor, University of Iowa, Iowa City, IA               
 • Curriculum Developer/Instructor, AANA Jack Neary Advanced Pain Management I and II Program
 • Curriculum Developer/Instructor, National Anesthesiology Pain Education Seminars
 • Former Assistant Professor, Bradley University School of Nursing, Peoria, IL
 • ​Clinical preceptor for nurse anesthetists and physicians in residency
 • Former Adjunct Professor, University of Illinois Medical College, Peoria, IL
 • ​​Clinical preceptor for nurse anesthetists and physicians in residency
 • ​Expert witness-consultant in medical/legal cases involving nurse anesthesia and pain management
 • Founding member of the Nurse Anesthesiology Pain Education Seminars (NAPES) corporation
 • President/Owner, Sleepers Anesthesia Service, P.C.
 • President/Owner, Premier Pain Management LLC​

Question 20

Memberships

Accepted Answer

• American Association of Nurse Anesthetists
 • Iowa Association of Nurse Anesthetists
 • American Nurses Association and the Iowa Association of Nurses
 • International Association for the Study of Pain (IASP)

Question 21

Memberships

Accepted Answer

• International Association for the Study of Pain (IASP)
 • American Society of Ketamine Physicians, Psychotherapists & Practitioners (ASKP3)
 • American Society for Pain Management Nursing (ASPMN)
 • American Association of Nurse Anesthesiologists (AANA)
 • Iowa Association of Nurse Anesthetists and Iowa Nurses Association

Question 22

Memberships

Accepted Answer

• American Association of Nurse Anesthetists
 • Iowa Association of Nurse Anesthetists
 • American Nurses Association and the Iowa Association of Nurse Anesthesiologists (AANA)
 • International Association for the Study of Pain (IASP)

Question 23

Recent Work

Accepted Answer

• Active in the organization and set up of pain clinics and physician practices throughout the US. His professional interests are in interventional pain management, bio-behavioral approaches to pain management, and pain management education.
 • Presently, Dr. Barnhill works for  Heartland Pain Management a professional healthcare company in Des Moines, Iowa.
 • He manages pain clinics in four locations in Iowa. 
 • His significant projects include:
 • Collaboration with the American Association of Nurse Anesthetists for the Jack Neary Course
 • Collaboration in the Development of the Hamline University Post-Graduate Program in Advanced Pain Management.
 • Collaboration in the Development of the Texas Christian University Post-Graduate Program in Advanced Pain Management
 • Also acts an clinical instructor for the spinal interventional simulation lab at the USF facility.
 • Most recent publication, co-authored: "Answering the call to address chronic pain in military service members and veterans: Progress in improving pain care and restoring health," (September-October, 2016), Nursing Outlook. http://dx.doi.org/10.1016/j.outlook.2016.05.010

Question 24

Recent Work

Accepted Answer

Mr. Jacobs currently shares his time between his clinical pain practice and research interests. His clinical interests include interventional pain management, management of central pain disorders, and training/mentoring advanced practice nurses in comprehensive pain treatment. His research interests include exploring biomarkers and therapeutics for nociplastic pain syndromes, advanced neuroimaging techniques of the spine, and symptomatology of neurogenic inflammation.

Question 25

Recent Work

Accepted Answer

• Active in the organization and set up of pain clinics and physician practices throughout the US. His professional interests are in interventional pain management, bio-behavioral approaches to pain management, and pain management education.
 • Presently, Dr. Barnhill works for Heartland Pain Management, a professional healthcare company in Des Moines, Iowa.
 • He has pain clinics in four locations in Iowa. 
 • His significant projects include:
 • Collaboration with the American Association of Nurse Anesthetists for the Jack Neary Course
 • Collaboration in the Development of the Hamline University Post-Graduate Program in Advanced Pain Management.
 • Collaboration in the Development of the Texas Christian University Post-Graduate Program in Advanced Pain Management
 • Also acts an clinical instructor for the spinal interventional simulation lab at the USF facility.
 • Most recent publication, co-authored: "Answering the call to address chronic pain in military service members and veterans: Progress in improving pain care and restoring health," (September-October, 2016), Nursing Outlook. http://dx.doi.org/10.1016/j.outlook.2016.05.010

About Brian Jacobs