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March 2010
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A new business model
The DC/NMD pain management practice
By Steven Paul Brown, DC
Multidisciplinary pain treatment practices have become more common and can offer many advantages to a pain management office.
Typically, a multidisciplinary pain treatment practice combines the services of a DC and MD, but you can add medical pain management services to your practice without hiring an MD.
How? Obtain licensure as a Naturopathic Medical Doctor (NMD) and use it as an addition to your chiropractic pain treatment procedures.
Provided you are in one of the 14 states where NMDs can become licensed, obtaining the NMD degree is a one option for you. With this licensure comes a scope of practice similar to that of an MD — you can add the services to your practice to complement and enhance the services you already provide.
What follows are just a few of the services that can increase your practice and allow you to help more people.
Prolotherapy
According to www.prolotherapy.com, the term prolotherapy comes from the word “prolo,” which is short for proliferation, because the treatment causes the proliferation (growth, formation) of new ligament/tendon tissue in areas where it has become weak.
The site says ligaments are the structural “rubber bands” that hold bones to bones in joints and that ligaments can become weak or injured and may not heal back to their original strength or endurance. In the same manner tendons may also become injured and cause pain.
Prolotherapy requires an injection of a nonpharmaceutical mixture of dextrose, lidocaine, and sarapin into ligament and tendons in the body where it attaches to the bone in order to strengthen the already weak regions.
This causes a localized reaction that stimulates the tissue to repair itself. Majority of patients treated with prolotherapy respond within four to six treatments, depending on the health and vitality of the patient.
Neural therapy
Neural Therapy is a conservative, nonsurgical procedure that treats chronic neck and low back pain, according to www.drmarkstrom.com.
For many patients, these episodes resolve in a few weeks. However, in some cases, these short-term episodes turn into chronic, recurring pain, thought to be caused by increased sensitization of the nerve cells that transmit pain signals.
As the site explains, the result is many of these patients progress to a persistent pain pattern that can last for many years. Treatment options usually consist of strong pain medications, invasive spinal procedures, and surgery.
Neural Therapy, however, uses innovative injection techniques in which
Trigger point injections
Trigger point injections consist of injecting a local anesthetic and anti-inflammatory medication into a localized area of muscle spasm and pain, which aids in breaking the spasm and pain cycle.
The procedure usually involves little discomfort and can be repeated on an occasional basis. Most trigger points are improved within two to three injections, and best results are obtained by using some form of muscle therapy and strength training.
Prescription medications
If you are tired of MDs over-and under-prescribing, or prescribing the wrong medications for your patients, licensure as an NMD will allow you to write the prescriptions yourself, eliminating the middleman.
Insurance coverage
Although NMDs are licensed in many states, their services may or may not be covered by insurance (naturopathic medical services are not covered under Medicare) — but patients will pay cash for effective services, regardless of insurance coverage.
However, prescriptions written by an NMD with a valid DEA number are covered by a patient’s prescription coverage, regardless of whether or not the patient has insurance coverage for naturopathic medical services.
NMD degree and licensure
There are six accredited naturopathic medical schools in North America. Although curriculum is four years, DCs can qualify for admission with advanced standing status.
The basic science courses, physical medicine courses, and part one of the national boards will be accepted as transfer credits, which shortens the curriculum to about two and a half years if attending full time. Just as in chiropractic, there are state and national board examinations for licensure.
An NMD license allows you to add services to your practice that complements and enhances the services you already provide and makes you and your office a very unique and valuable healthcare resource.
Mark H. Strom, NMD, of the Arizona Pain Clinic in Scottsdale, Ariz., says “With physical therapists going to the doctor of physical therapy (DPT) degree and adding orthopedic joint manipulation to their scope of practice, DCs need an expanded scope of practice to remain competitive in the pain management field.”
Obviously, this type of practice isn’t for everyone. If you have the time, money, and enthusiasm to increase your education and scope of practice, you could be creating a new type of doctor who offers a wider variety of services to the public, and makes more money while doing it. It’s a win-win situation for you and your patients.
Steven Paul Brown, DC, is a board-certified acupuncturist and physiotherapist serving Tempe, Ariz. He can be reached at drbrown@brownchiro.com or through www.brownchiro.com.
DISCLAIMER: The suggestions in this article are based on the laws governing the practice of chiropractic and naturopathic medicine in Arizona, and the information on admission to naturopathic medical school is based on the program at the Southwest College of Naturopathic Medicine in Tempe, Ariz.
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