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SpineSearch at NASS Breakout Sessions

Physician assistants, nurse practitioners and rehab professionals took in 22 hours of symposia and breakout sessions in the Annual Meeting's Allied Health Track.

The three days of learning kicked off with an Oct. 6 symposium on health care reform, health care IT, effective case management and career growth. On October 7 and 8, attendees immersed themselves in three-hour breakout sessions. The didactic instruction was coupled with hands-on demonstrations and open discussions.

The first day of the rehab breakout looked at the role of anatomy, imaging, medications, psychology, evaluation, outcomes and manual therapy. Hands-on workshops the next day demonstrated various forms of exercise to reduce and eliminate acute-to-chronic spine generated disorders.

"We had more attendees than we ever imagined we'd have," said moderator Michael Reed, DPT, OCS, Spine & Sport, Jupiter, Florida. "The audience included physical therapists, surgeons, physiatrists, physician assistants and pain management specialists."

Reed noted that rehab specialists should emphasize "exercise as medicine" when communicating with patients. "If you have an infection, you take an antibiotic," he said. "If you have a spine-related disorder, it has been shown that one of the most effective 'medications' is exercise."

Reed described how to identify patient subgroups and three evidence-based management approaches - direction preference, core stabilization training and cognitive behavior therapy.

He added that next year's rehab breakout would incorporate progress measurement within an equivocal setting.

In the two afternoons of the RN breakouts, presenters discussed clinical evaluations of patients with back pain, including those with cervical and lumbar spine disorders and spine trauma; issues of various care settings; and types of grafting materials available for surgical patients.

"I wanted attendees to be able to follow the care of the patient in the clinical area all the way through preop, intraop and postop, so they had a rounded feel for what nurses face, what they do and how we all work together to make the job of the surgeon easier and the whole process work," said moderator Donna Lahey, BSN, CNOR, RNFA, Spine Institute of Arizona, Scottsdale.

One of the breakout presenters, Nicola Hawkinson, DNP, RN, discussed clinical evaluation of the patient with back pain and sciatica. Hawkinson, SpineSearch, Carle Place, New York, highlighted symptoms, physical findings, imaging, nonoperative treatment approaches, and indications for surgery or referral to a surgeon.

"Low back pain is the second most common complaint to the primary care physician, with the common cold being the most common," she said. "Low back pain is the most common cause of missed work days by employees. What this means to us is that people who often have low back pain continue to have low back pain, and the majority turn out to be chronic low back pain sufferers. We need to know how to care for them more appropriately."

For Hawkinson, care begins with a thorough history and physical examination. "Most episodes of low back pain will resolve within two weeks, so we need to counsel the patient and be positive to let them know this isn't going to last forever," said Hawkinson, noting that some patients require referral to a spine surgeon.

The most successful strategy involves a team approach in which the patient is an equal participant, she added.

Presenters at the PA/NP breakouts offered guidance on how to read MRIs and myelograms, interpret and treat traumatic injuries, evaluate and treat postop complications, develop postop pain management techniques, and recognize technical postop complications.

Moderated by T. Lindley Pittman, MS, PA-C, Hinsdale (Illinois) Orthopedics, the breakout included a discussion of postop pain management with Megan Roberts, NP, West End Orthopedic Clinic, Richmond, Virginia.

"Pain affects more Americans than diabetes, heart disease and cancer combined," Roberts said. "It's something we should get better with dealing with."

Roberts looked at the dosage recommendations, contraindications, black box warnings and abuse rates of several pain medications, including narcotics such as fentanyl, propoxyphene and tramadol; acetaminophen; anti-inflammatory agents such as celecoxib, ibuprofen and ketorolac; anti-seizure medications; local anesthesia; and preop drugs.

She reminded attendees of complementary pain treatment options, such as pet therapy and acupuncture. "As Americans, we don't use as many as we should or could, but it's difficult to suggest these to patients. There's a safety factor because they are not regulated," she said.

Roberts added that it's important to encourage patients to return to activity. "We need to convince them that movement is not going to hurt them more, but rather it will hurt them less," she said.

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