Erin Freeman: Welcome to Sweet Tea and Strategy, a podcast produced by Ackerman Marketing and PR, featuring leaders throughout Tennessee talking about issues and trends of importance in our state and beyond. I’m ErinFreeman, and on behalf of Ackerman, today I’m bringing you a special podcast with our guest, Dr. Stephanie Vanterpool. Dr. Vanterpool is the Director of Comprehensive Pain Services for the University of Tennessee Medical Center, Assistant Professor of Anesthesiology at the UT Graduate School of Medicine, and the Medical Director for the University Center for Pain Management in Knoxville. In addition to her clinical duties, she is the President of the Tennessee Pain Society, Director-at-Large for the North American Neuromodulation Society, and outreach co-chair of the NANS Diversity and Outreach Committee. She also serves as Treasurer for the NANS Women in Neuromodulation Committee. She has established a reputation as a national leader in Targeted Pain Treatment, a protocol she created, which she’ll explain in a moment. She’s frequently asked to speak at national conferences and uses her platform to educate other healthcare providers through continuing medical education curriculum she developed. As Dr. Vanterpool is a trailblazer in her field, and I could spend the entire length of our podcast speaking to her expertise and accolades in the healthcare industry, I want you all to hear from her directly. So, Dr. Vanterpool, welcome to the podcast.
Dr. Stephanie Vanterpool: Thank you, Erin. Thank you for having me.
Erin Freeman: We really appreciate the opportunity to talk with you today. So with that said, let’s start at the beginning. So it goes without saying that we all know someone who experiences pain, or we may experience it ourselves. Give us some background on the need for Targeted Pain Treatment and its impact, and also talk to us about how this accurate diagnosis and targeted treatment of pain has made positive change in the practice of pain management and in patients’ lives.
Dr. Stephanie Vanterpool: Well, thank you for that question, Aaron. And yes, you highlighted some of the components of Targeted Pain Treatment that really make it unique in terms of how we assess and treat pain. So Targeted Pain Treatment is the process of accurately diagnosing the cause of pain and then targeting the treatment to the cause. The goal is to identify all of the underlying components that may be contributing to a patient’s pain and thereby their limited function—they’re not able to do what they want to do because they’re hurting. And once you’ve identified those different causes of pain, we can then target the treatments to those specific causes. The way that this works in terms of improving patients’ quality of life is that we are addressing independently each of the things that are contributing to their limited function or their pain or their decreased quality of life and making sure that we’re treating the source of pain and not just a pain score.
Erin Freeman: And I know that you’ve already made a tremendous impact in a lot of patients’ lives, and needless to say, a pandemic has not put a stop to people experiencing pain. So talk to us about practicing pain management before and during the pandemic.
Dr. Stephanie Vanterpool: You are absolutely correct in saying that pain does not stop just because there’s a global pandemic. Patients experience pain every day, and pain limits their function every single day. So prior to the pandemic, our practice was very typical. We would evaluate patients that were referred to us; we would take our time at the initial visit, figuring out what was potentially causing their pain, looking at their story, their history, how they came to where they are right now in terms of what circumstances might have precipitated the onset of their pain. And then we figure out based on their physical exam findings and any relevant imaging or tests what are the underlying causes of pain. Is it a physiologic cause of pain? Is it an anatomic cause of pain, such as a bone or joint or disc? Is it a functional cause of pain—something they’re doing, a way that they’re sitting at work in terms of ergonomics? Or even a psychosocial component that’s contributing to their pain. Once we did that, we would then describe or prescribe particular treatments to treat those individual causes of pain. Medications would treat the physiologic cause of pain; interventions would treat the anatomic cause of pain—interventions being things like injections or procedures that people may think about when they think about pain management procedures. And physical therapy for the functional component, and then psychosocial treatment for the psychological component of pain. That is the premise under which we practiced, and it was very easy to do because you had a hands-on approach. You were able to see the patient face-to-face, you were able to examine them, and then obviously get them in for treatment very quickly without necessarily some of the limitations that the pandemic brought. Right around March and April of 2020, that was when the pandemic was hitting its peak of affecting elective procedures here in Tennessee. And that was at the point when the University of Tennessee and many other healthcare systems around the state and the country decided to stop doing elective procedures. And that was when we needed to make the switch, and we did make the rapid switch to telemedicine to at least allow us to continue to engage with our patients via telemedicine to make sure that we were at least continuing to assess and monitor those patients that were already existing in our panel. And also, we were able to help new patients via telemedicine consults, which is something we probably hadn't thought we would need to test out until the pandemic made it relevant. So it’s interesting to see how to do a physical exam with a cellphone or an iPad with somebody holding it behind the patient’s back and they’re pointing to where they hurt. But you’d be surprised how accurate we can be if we ask the right questions and look at the right things when we’re examining this patient over video. Because very many of those patients that we saw in that initial period of exclusive telemedicine, when we brought them in for physical exam and actual follow-up, it was very consistent with what we'd found on telemedicine. So that was a good learning experience.
Erin Freeman: Well, and needless to say, there have been so many negatives that have come out of the pandemic, but perhaps a positive relative to the healthcare industry are the quick innovations that were able to have been made through telehealth and telemedicine. So it’s going to add a layer of convenience for patients and providers much more quickly than we ever expected.
Dr. Stephanie Vanterpool: Exactly. Now, the thing that we have to remember is that telemedicine, the technology continues to exist, but in order for us to continue to provide it for our patients, the physician offices need to be reimbursed for it so that we can continue to maintain our practices and pay our staff. Because it requires a lot of staff to manage telemedicine visits—between the scheduling, the calling the patient to prepare them for the physician or the provider that’s going to be talking to them, and then the follow-up afterwards. It requires as much staff as seeing a patient in office, sometimes more in terms of the amount of time and engagement. And so we have to be reimbursed for that in order for us to continue to provide it in an efficient and effective fashion so that the patients continue to have access to it. And honestly, as of December 31st of 2020, a lot of payers have stopped reimbursing telemedicine at the rates that they were reimbursing it during the pandemic, which makes it less accessible for those practices that are relying on the insurance payments to continue to run the practice and provide service to their patients.
Erin Freeman: Hopefully in 2021, we’ll have legislation and whatnot that will allow for those appropriate reimbursements to come to physicians so everyone can continue to have that convenience.
Dr. Stephanie Vanterpool: Yeah, because it’s critical to understand that we provide a service to our patients because of specialized training, specialized equipment, specialized resources. And we want to be able to continue to provide those services. But in order for us to do that to where patients are satisfied with the care that they’re receiving, we have to provide a certain level of patient service, not just patient care. As a physician, we have to provide a certain level of service. In order for us to do that, it really requires resources that should be reimbursed at a rate that allows us to maintain those resources.
Erin Freeman: An unfortunate negative aspect of the pandemic was that in Tennessee, we saw an increase in opioid overdose deaths in 2020. And some have attributed that to the various challenges caused by the pandemic. So with the uptick in opioid misuse, how do you believe this could impact a physician’s ability to appropriately treat pain?
Dr. Stephanie Vanterpool: Well, that’s a multifactorial question which requires a multifactorial answer. So the first thing to note is what was the reason for the increase in opioid overdose deaths? Were they all medically related? Were some of them substance abuse misuse related? I’m sure there was definitely a mix. It goes without saying that un- or under-treated pain, especially if we’re not treating the underlying cause of pain appropriately and we’re trying to cover it up with an opioid—which is what opioids essentially do; they don’t treat the cause of pain, but they basically treat the way the body processes pain signals. It’s kind of like if you were to try to cover up a bleeding wound with a bandage. If you don’t stop the source of the bleeding, you need a bigger and bigger bandage to cover up the bleeding wound because it’s going to keep bleeding through the smaller bandages to the next size, to the next size. And so the same can be said for using opioids to treat pain or opioids exclusively to treat pain. If you don’t address the underlying cause of pain, which is what Targeted Pain Treatment does, if you don’t identify and address that underlying cause of pain, then you try to cover it up with an opioid, the body develops tolerance to that opioid and then it requires more to get the same effect. And a higher and higher dose of opioid can eventually lead to tolerance, dependence, and addiction, all of which can precipitate some of these unfortunate overdose deaths that we have seen. That’s one component of increasing opioid overdoses, but I don’t think that was the exclusive component in 2020. We know that there was significant social, societal, economic strain that came upon a lot of members of our community, and it’s still going on, and people may or may not have been self-medicating with opioids or some other combination. So it’s important to understand what the causes of the opioid overdoses were to make sure that we’re not just attributing them all to un- or under-treated pain. That said, I do know that there was a large proportion of patients, I’m certain, that continued to experience pain during the epidemic and may not have had access to treatment because of the different shutdowns or different levels of limitation of elective procedures and so on. And in those cases, yes, the pandemic was harmful for them. They weren’t able to access the medical care that they needed and probably tried to figure out how to manage on their own, either by requesting for a well-meaning provider to continue to prescribe medication for them or to increase the prescribed medication, or by finding another way to self-medicate or a combination thereof.
Erin Freeman: Can you give us an example of a patient success story that has focused on function instead of a pain score?
Dr. Stephanie Vanterpool: Certainly. We have so many of those, thankfully, because of what we do with Targeted Pain Treatment to allow us to help so many patients. But one comes to mind very often when I think about this particular topic. And that is the case of an 87-year-old female who had severe scoliosis—that’s a twisting of the spine, the bones in the spine—and had severe pain. Was not able to stand or even walk without her walker from her bed to her bathroom without severe pain and really couldn’t do very much. And we treated her in the clinic for several months before deciding upon a device called a spinal cord stimulator. So a spinal cord stimulator is an implanted device that allows us to send electrical signals to the nerves in the spinal cord. And what it does is it replaces the painful sensation that the patient gets from their chronic pain with either a more pleasant sensation or just mutes that painful sensation altogether. Doesn’t affect their strength in their legs, none of that. We implant this device similar to how a pacemaker might be implanted, where there’s nothing, no wires or anything hanging out, everything is under the skin, and then turn it on so it delivers electricity to the spine and helps treat the underlying cause of pain for this particular patient. So we go back to our little 87-year-old—she was super cute by the way—and she came back after her implant and she said—we asked her, "Well, Ms. So-and-So, how are you doing today?" She said, "Well, I don't—I think I’m maybe about 25, 30 percent better. My pain’s down about maybe 30 percent." I said, "Oh, really? Well tell me, what have you been up to these last few days?" And she said, "Well, yesterday I baked three pies and I cleaned the kitchen, and now I just—I feel like my pain is just about the same." I said, "Oh, so let’s recap. So prior to us doing this, you couldn’t walk from your bed to the bathroom without your walker, and yesterday you baked three pies and cleaned the kitchen. That is excellent! You are really improving your function with this. I am so proud of you." And she kind of chuckled. But it really highlights that if we just ask a patient to focus on their pain score on the zero to one score or a zero to ten score, rather, it’s not an objective measure—it’s subjective. And if you wake up, if you don’t sleep well the night before, your pain may be higher than if you had a good night’s rest. But you really can’t argue with what you’re able to actually do, your actual ability to demonstrate function. And that’s what we want people to focus on. We want to create this paradigm shift where instead of focusing on a pain score, we focus on the function that the patient is able to demonstrate. And that’s really what we’re wanting to highlight throughout our treatment here at the University Center for Pain Management, but wider here at the University of Tennessee and beyond. And that’s part of what we’re going to highlight at the Targeted Pain Treatment conference this March 5th.
Erin Freeman: One thing I appreciate so much about you is that you are such an advocate for continuing education, especially in the evolution of pain management. And so with that said, talk to us about the focus of the upcoming Targeted Pain Treatment conference and what is the impact of this type of collaborative educational experience for healthcare providers?
Dr. Stephanie Vanterpool: I am so glad you asked me that question because this is an excellent opportunity for us to talk about the importance of all healthcare providers being aware of how to appropriately assess and treat pain. There can be an underlying attitude or belief that pain management is only for specialists, but really, every patient that we see has had pain at some point in their life, whether you’re a pediatrician or a geriatrician, whether you’re seeing somebody in urgent care or whether you’re seeing them for their well visit as a family practitioner. Any one of those patients that you see has likely experienced pain at some point. So it behooves all of us as healthcare providers to understand enough about how to appropriately assess and diagnose pain and also to understand the appropriate treatment options that are out there to treat the source of pain. I’m glad you mentioned the conference because that was part of what we wanted to use our platform here at the University of Tennessee to do, which was to increase the awareness and knowledge of our healthcare providers across the continuum to be able to appropriately assess and treat pain in any patient that they saw. So the conference is called the Targeted Pain Treatment Conference and it will be held March 5th this year, 2021. Because of pandemic situations, of course, it will be virtual. This is our third annual conference—our first two were held live, of course. And the focus of this conference, oddly enough, is called Focus on Function. Because I want us to highlight the link between pain and function or physical activity, and the link between function and physical activity and overall health. So some people who may say, "Oh, I don't treat pain, I leave that to a specialist," may not realize that by allowing a patient to continue with pain or by not actively treating their pain, that patient’s function is then going to decline because they’ll either not be able to do what they needed to do in the past or they may have further weakening or loss of muscles or some other functional decline that then affects their overall health. So it does impact every healthcare provider if we don’t allow our patients to improve or optimize their function. So the theme of this year’s conference, as mentioned, is Focus on Function. And our goal is going to be to really solidify the link between function and health and the link between pain and appropriate pain management and treatment and assessment and treatment and improving overall physical activity and function or function optimization. The target audience for this conference is really any healthcare provider who treats any patient. Pretty broad, right? Everybody qualifies. So any healthcare provider treating any patient that is interested in helping their patient optimize their function and their functional status and really optimize their health, those would be somebody who would really benefit from attending this conference. We’ve in the past really focused our attendance and our recruitment on primary care or non-pain specialists because we want patients to have access to this type of pain assessment and treatment, to have access to clinicians who understand the basics of how to get to the underlying cause of pain and then make a referral if needed to a specialist or at least initiate a targeted pain treatment plan to get that patient on the right track in terms of improving their overall health and function.
Erin Freeman: What’s the best way that healthcare providers can register to attend the conference? And we’ll be happy to put this type of information links to it on our podcast website, but why don’t you kind of talk through what some of those options are and what any deadlines might be?
Dr. Stephanie Vanterpool: Certainly. So the Targeted Pain Treatment Conference can be accessed through the UT Graduate School of Medicine, and I’m going to give the link to it to you for you to put in the show notes. If you Google Targeted Pain Treatment Conference, honestly, it comes up as one of the first links and you’ll be able to go to the conference webpage to register. The registration period is up until the date of the conference, which is March 5th, 2021. However, early registration discount is currently available up until February 5th, after which the prices will increase to the final rates. It’s important to note this is going to be a virtual conference via livestream, which means that you would need to attend the conference in real time to obtain the CME, the continuing medical education credits. But the recordings of the conference will be available for 30 days afterwards for those who may want to review or view the recordings again. You can earn up to 7.25 continuing education credits, and these credits are available for both CME, Board of Nursing, physical therapy, etc. I want to encourage others, and that brings up a good point. We have several distinguished speakers that are going to be speaking at the conference and from multiple disciplines. We will have physical therapists both from University of Tennessee and also from Chattanooga. We also have pain management specialists from right here at University of Tennessee, and also we have some special guest lecturers from University of Arkansas for Medical Sciences, board-certified neurosurgeon Dr. Erika Petersen, and also another board-certified pain physician and colleague of mine, Dr. Jonathan Goree, who would be speaking on some of the ways that we can use minimally invasive intervention and also neuromodulation, which is a type of procedure that can be used to treat underlying pain transmission. Both of those things can be used to help improve pain and function. I encourage everybody to check out the website and check out the agenda for further details on what will be presented, but it promises to be an interactive conference. We will have case presentations where attendees will have an opportunity to participate and answer in real time what they would do for the patients. And we’ll also be reintroducing the Targeted Pain Treatment Toolkit, which is a resource that we have put together to allow clinicians to practice what they learned during the conference and actually take it and implement it in their own practice.
Erin Freeman: In addition to you being such an advocate for these educational efforts, for those in our listening audience that are just in pain, let’s talk about how they can find you and those within your practice that can also help them with their pain management.
Dr. Stephanie Vanterpool: Well thank you for bringing that up, because that is a very important component of making sure we care for all of our patients. So I practice at the University Center for Pain Management in Knoxville. It’s a division of University Anesthesiologists. They can find us at www.ucpmk.com, or they can request—and there we’ll have all information about referrals and how to become a new patient. We do request and require physician or healthcare provider referrals, and that is really for a matter of accountability for us to be able to communicate with somebody else in their healthcare team the treatment plan that we have for the patient. And it also makes sure that we’re able to access the records we need because our goal when we see these patients is to really provide quality care that allows us to accurately diagnose the cause of pain and target the treatment to the cause as efficiently and effectively as possible. So the more information we’re able to gather before the patient shows to their first appointment, the more rapidly we’re able to start that treatment plan that targets the underlying cause or causes of their pain.
Erin Freeman: Well, I’ve had the benefit of being a patient of Dr. Vanterpool’s and she has helped me out tremendously. I had difficulty sleeping and I was experiencing pain and just couldn’t function the way that I felt that I needed to be functioning. And it’s important to know that you don’t have to live in pain. You may always experience pain to a certain extent, but there are ways to effectively manage your pain. And so I’m very happy that Dr. Vanterpool was able to help me the way that she has, and I encourage anyone that’s listening that’s in pain to know that there are specialists like Dr. Vanterpool that can help you.
Dr. Stephanie Vanterpool: Thank you, Aaron, for that. And I just want to—you bring up a very good point—is that a lot of what we do and part of one of my roles, I’m also the co-chair for Diversity and Outreach Committee at the North American Neuromodulation Society. And as the outreach co-chair, one of my goals is to really make sure that we are reaching the appropriate audiences to let them know that there are options alternative to either living in pain or just feeling like they have to be on medications, because neither one of those is necessarily a good option for any patient. We talk about three types of outreach that we provide: outreach to patients, outreach to clinicians or providers, and outreach to our pipeline. In order to increase access to care for patients, so they know number one that these treatments are out there, that they don’t have to live and suffer in pain. And number two, that we can get patients to the right place in a timely fashion so they’re not languishing in an office or in a practice that does not know what to do with them but does not know where to send them. And then it’s also important for us to reach out to the pipeline—the pipeline being those young men and women who may be in high school, college, medical school, in residency training that are learning about the management of pain or learning about medicine in general, and to just encourage them to not forget the importance of function and not forget the importance of physical activity and not forget how important it is that they are able to optimize function and physical activity for their patients. Because that is a critical component of how we can improve health and wellness in our overall population. But outreach to patients, similar to what we’re doing right now with this podcast, where somebody may be listening that may be dealing with pain. Outreach to providers or clinicians, that’s what we’re doing with the Targeted Pain Treatment Conference, that’s one example of that type of outreach. And then in terms of mentorship efforts, I work with several young students personally, but I encourage all of us to really reach out to those—give a hand back to those behind us who are coming along—and encourage them to explore how they can potentially contribute to improving and optimizing the health and function of the patients they’ll eventually or currently interact with.
Erin Freeman: Thank you. And Dr. Vanterpool, thank you so much for sharing these stories with us today. And thank you for the impact that you’re having in the healthcare industry, in our community and beyond. You’re making a difference in the lives of so many. So thank you so much for joining us today.
Dr. Stephanie Vanterpool: It has been my pleasure, Aaron. Thank you for having me.
Erin Freeman: We hope you’ve enjoyed today’s Sweet Tea and Strategy podcast. To hear more, visit https://www.google.com/search?q=thinkackerman.com. We appreciate you listening. Cheers to the next edition of Sweet Tea and Strategy.