Portable Medical Tech that Revolutionizes and Democratizes Pain Medicine
Before ultrasound became a revolutionizing staple in the field of pain medicine, some brilliant, forward-thinking doctors used X-Ray (fluoroscopy) to add vision to their pain injections. But with these tools came drawbacks. Firstly, while fluoroscopy is excellent for viewing bones and spread of contrast, they do not let us see the intricate detail of muscles, tendons and ligaments. Secondly, they emit radiation, which means that they should only be used on an ‘as necessary’ basis. In our effort to provided safe, accurate and effective injections, about 10-15 years ago our field began using ultrasound to make major improvements. Not only is it 100% safe, ultrasound immediately transformed pain medicine patient outcomes.
With ultrasound-guided injections we are no longer aiming at a moving and sometimes invisible target: we are now able to locate a patient’s pain and place a relieving injection directly into its bull’s eye. We are finally able to get close to a guarantee that the medication is delivered to the correct location, which not only creates far better pain relief, it also mitigates pernicious side effects and risks relating to medication travelling to the wrong places. Beyond the mere fact that ultrasound immediately revolutionized pain medicine, patients enjoy being able to see on a big screen their treatment being done right in front of them – the treatment they signed up for in action. If seeing is believing, there are immeasurable benefits for a patient enduring the deeply subjective experience of pain to witness with their own eyes that – while we cannot feel it or fully understand the pain they are suffering – we are able to locate it and deliver into its source targeted pain relief.
While many pain medicine doctors regularly take advantage of the brilliant benefits bestowed on us by ultrasound, the blind anatomic guided approach is still used pervasively. There are experienced pain doctors who have been providing effective treatments for their whole careers without the assistance of ultrasound. There are also plenty of physicians who – for any number of reasons – were not able to receive the correct training to perform ultrasound-guided injections, who are compelled to rely on the old-fashion blind anatomic method. However, for the contemporary generation of pain doctors at least rudimentary ultrasound knowledge is ingrained in them during their studies and training and as they join our workforce, use of visually guided injections will only improve.
In my own career I have been inspired to fully leverage the potential of ultrasound in pain medicine because I refuse to allow other factors – namely billing cost – to influence how I treat my patients. I will use whatever tech is the best for the patient with best possible outcomes. Ultrasound-guided injections have been at the forefront of my treatment arsenal, but I have also extended ultrasound’s application to other pain treatments like cryoablation (through which we can now actually see the nerves we are freezing), peripheral nerve stimulation, cutting edge stem-cell regenerative medicine and far more. I have had the privilege to go way beyond ultrasound-guided injections because, well… I spent years and thousands of hours practicing. Beyond hours spent practicing on myself, cadavers and finally utilizing the craft with patients, I wrote a book on ultrasound’s application in pain medicine: Atlas of Ultrasound Guided Musculoskeletal Injections. I wrote the book because I’m passionate about ultrasound and wanted to do my part to convert the world’s pain docs to its revolutionizing potential; I also wrote it to bury myself even deeper into this topic to further augment my own expertise.
It is my hope that pain doctors do as I have done and commit themselves to mastering ultrasound to add it as among their top tools in their pain fighting kits. I should reiterate that despite this technology being genuinely revolutionizing, practicing it is not very glamorous. It is a bit like how one gets really good at free throws: shooting hundreds a day in workman-like fashion. There are great books on the topic and some brilliant courses (I particularly recommend those provided by WAMPU) that do special training specifically for ultrasound. Anyone can learn, it is just a matter of spending time on patients and in one’s office on oneself. After a few hundred hours of practice pain doctors will be able to competently perform basic diagnostic and common interventions; after a few thousand hours training, more advance applications will be possible.
In recent years ultrasound has provided yet another vital, game-changing layer to pain medicine and, indeed, medicine in general: portability. According to Teresa Lopez, Clinical Product Specialist at Butterfly Network, new portable ultrasound devices are opening up elite healthcare opportunities to the world. In her words: ‘Butterfly Network’s mission is to democratize healthcare by making medical imaging, especially ultrasound, accessible to everyone around the world.’ I have seen devices like Lopez’s Butterfly iQ and others in a race to miniaturize ultrasound to make something that has historically been large, immobile and cumbersome (not to mention and very expensive) into a dynamic tool that is affordable that can simply be placed in a physicians pocket or travelling bag. According to Lopez, ‘Butterfly’s ultrasound-on-chip technology replaces the traditional transducer and system with a single silicon chip all for less than $2,000.’ Because of ultrasound’s new portability and cost-effectiveness, it means that we can bring world-class level of care to the global masses, regardless of how remote or impoverished. What is more, as Lopez highlighted, many of these portable ultrasounds have cloud-based software so images can be sent to other specialists and hospitals around the world at the press of a button.
According to Lopez, new ultrasound technology has become so user-friendly that any healthcare professional, not just specialists, can incorporate it into their tool kit. With Artificial Intelligence (AI) recognition software, she says, using ultrasound has never been more straightforward for non-experts. ‘Any doctor can do it and they can do it at point of care instead of having to wait for weeks for results.’ She continued, ‘Everyday doctors can have a portable ultrasound device with them at all times, so can EMTs and physician assistants who will really benefit from the AI recognition software.’ I see EMTs and nurses using portable ultrasound all the time, for procedures like vascular access to looking at a patient’s bladder to see if they are voiding. In my view, the ways in which technology is making ultrasound all the more accessible to non-experts is absolutely amazing; however, I should caution against laziness and complacency as for a pain doctor there is no substitute for the expertise acquired through several thousand hours of training.
Ultrasound has become a tremendous asset for pain medicine as it has given us the vision to be able to look inside our patients’ bodies, witness the nature and form of their pain and leverage a range of targeted treatments that deliver dramatic and lasting relief. What is more, in a world in which the cost of medicine has skyrocketed, it is innovations like incorporating ultrasound into pain medicine that will improve the efficacy of treatments, result in fewer hospital visits and decrease pain medication requirements. We may well be standing on a threshold of a brilliant new era of pain medicine in which technology and the next generation of pain doctors will innovate even more to further improve patient outcomes. Very encouragingly, with portable and affordable ultrasound tech we are also able to enfranchise a portion of the medical community that has been cut off from this game-changing tool. Not only will these pain doctors’ input add to our mission’s critical mass, they will now also be able to offer their patients the revolutionary targeted and image-guided pain relief only made possible through ultrasound. This is not just democratizing ultrasound – it is democratizing pain relief.