Chad Stephens is the President and Managing Partner of Noble Pain Management & Sports Medicine in Texas, USA. As a musculoskeletal expert, his unique training with fellowships in sports medicine and interventional pain leads him to seek out the most innovative and cutting-edge treatments to help his patients. He works as a consultant for multiple sports and spine companies and enjoys teaching and mentoring other doctors.
OPN: How has the cancellation of elective surgeries impacted the pain management landscape?
CS: COVID-19 has had far-reaching effects in all aspects of the healthcare system. A significant number of elective surgeries have been delayed or even cancelled. Furthermore, it remains unclear how hospital systems are going to deal with the backlog of elective surgeries once they do start happening again.
With pain management, and knee pain in particular, we have seen many patients that were scheduled for surgery only to have their surgeries indefinitely delayed. Unfortunately, their pain is not delayed. In some instances, they are in even more pain. Often, those indicated for surgery are at the end of their treatment journey – minimally invasive procedures have lost their efficacy and surgery is their terminal treatment. It can be disheartening, and many patients are feeling like they don’t have many options.
With my practice, I aim to help restore function, which in turn will increase mobility and decrease pain. When the treatments within my practice aren’t able to help this, I will send patients to an orthopedic surgeon.
OPN: What complications does COVID-19 present to pain patients?
CS: In addition to the cancellation of elective surgeries, COVID-19 has impacted how patients feel about entering hospitals. Many patients are hesitant to go into a hospital for fears of exposure to the virus. Even though elective surgeries have resumed, we have a number of patients who aren’t comfortable undergoing invasive procedures. These patients will still need effective procedures to help manage their pain.
Additionally, we have seen a lot of concerns regarding loss of health insurance. Because of the economic toll of COVID-19, patients are fearful they will not have insurance by the time their surgery will take place. These patients are hoping for something in the near term that can manage their pain while they still have coverage.
COVID-19 has also had lifestyle impacts for the pain patient that might not be immediately evident. Because of sheltering-in-place, many patients are finding themselves much more sedentary. This can be detrimental to patients, and movement is key to helping manage pain.
OPN: What options have pain patients turned to in the interim?
CS: The typical treatments for knee pain remain, but COVID has impacted a lot of these as well. Over the counter analgesics can be helpful for people early in their disease progression, but often times doesn’t provide adequate pain relief. Physical therapy can be effective, but patients are still expressing hesitation of returning to healthcare settings. Healthcare practices can offer the standard injections (steroid and hyaluronic acid), but these effects wear off after a few months.
Additionally, we’ve seen many patients resort to self-medication (e.g. alcohol and illicit drugs), which can lead to substance abuse problems. It’s important these patients come back into a healthcare setting to manage their pain.
OPN: What innovative solutions are proving to be safe and effective for patients?
CS: In my practice, I frequently use cooled radiofrequency ablation (CRFA) which can provide pain relief beyond that of injections. CRFA is a minimally invasive and quick procedure. Patients tend to be more comfortable with this procedure than a total joint replacement. While CRFA improves a patient’s pain scores, what I am most excited about is how functionality increases following this procedure. This allows for patients to return to the things they love. I am a firm believer that increases in functionality will lead to decreases in pain.
The longer we can extend pain relief via improved functionality, the more time we can buy while our healthcare system adapts to the new normal. When I see a patient who has had their surgery cancelled, I tell them cooled radiofrequency ablation can serve as a bridge until their joint surgery. I believe this is a great technology that can help serve patients who have had their elective surgeries cancelled.
OPN: How have you adapted operations and treatment plans amid COVID?
CS: Like many, we transitioned to telemedicine overnight. I am pleasantly surprised with how engaging and impactful these virtual interactions have been. Telemedicine allows us to have more personal interactions with our patients and we are speaking to more of our patients’ family and caregivers. This insight has facilitated deeper levels of patient-family-doctor interaction, thus more personal treatment plans and strategies
It has been especially helpful for consultations. Patients from other states and countries are seeking us out and we’re able to help them decide whether our solution is geared for them before making the trip. Being able to have these discussions with patients prior to in-person visits can help us mitigate patient apprehension around visits to healthcare facilities, while still bringing them into the treatment paradigm.
Although the in-person patient-doctor interaction will always have value, I believe telemedicine is here to stay.
OPN: Do you think COVID will have a long-term impact on the interventional pain field and care delivery?
CS: Major open surgery will probably continue to be affected by the ramifications of COVID-19 and general shifts in consumer demand. People want relief with less risk, less time off work, and without burning a bridge for procedures down the line. Those who are contemplating surgery are interested in solutions that could offer less post-op pain. Cooled radiofrequency ablation is an excellent option for all these considerations, and our practice has seen an increase in this procedure. I would expect this treatment to continue to grow while we navigate the impact of COVID-19.
For more information of Dr Chad Stephens and his work, please visit: https://www.noblepainandsports.com/