The Team Approach to Spinal Cord and Dorsal Root Ganglion Stimulation: A Guide for the Advanced Practice Provider

Abstract

From the Division of Pain Medicine, Department of Anesthesiology and Perioperative Medicine, Mayo Clinic, Rochester, MN (J.M.H., C.M.H.); Pain Specialists of Austin, Killeen, TX (B.M., P.M.); The Spine and Nerve Center of the Virginias, Charleston, WV (A.C., T.R.D.); and Ainsworth Institute of Pain Management, New York, NY (J.T.-B.). B ecause of shortages in the US primary care workforce in the 1960s, the role of the nurse practitioner and physician assistant emerged. The tasks of these individuals are often considered similar, and together they are known as advanced practice providers (APPs). The nurse practitioner is an advanced practice registered nurse who has completed additional training and education, earning a master’s or doctoral degree. Physician assistants train for an additional 2 years beyond a Bachelor of Arts or Science degree to earn a physician assistant degree. Many APPs have become more specialized through APP residency programs or specific on-the-job training. Most states allow all APPs to have full or partial prescribing capabilities, including controlled substances. Given the expanding population of individuals with chronic pain, some practices have begun using APPs to properly care for increasing numbers of patients. This has allowed patients improved access to specialized evaluation and chronic pain treatment options. One such therapy that has grown tremendously during the past 2 decades is neuromodulation, specifically spinal cord stimulation (SCS) and dorsal root ganglion stimulation (DRGS). Multiple randomized controlled trials have proven SCS to produce more cost-effective and superior patient outcomes compared with repeated surgery or conventional medical management. A newer technology, DRGS, was shown to be more effective than SCS for certain patients. Together, these 2 advanced treatment modalities have helped countless patients live a better and more fulfilling life. To date, the role of the APP in the care of the neuromodulation patient has not been defined in the literature. Throughout this paper, we