Course Outline

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.

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

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

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.

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