Minimally Invasive Spine and Pain Interventions (MIPSI) are going to be game changers in healthcare Industry. Dr (Maj) Pankaj N Surange MD, FIPP, FIAPM Director, IPSC India Hon Secretary, Indian Society for the study of Pain, National Introduction The need of a specialty arises as the burden of the disease increases. Pain medicine is one such new paradigm of medicine that require specialists who are trained to understand the distinctive needs of patients who suffer from chronic and complex pain. Pain medicine is a discipline of medicine which deals with subacute, chronic and intractable and resistant painful conditions principally with minimally invasive interventional techniques. Acute pain for various conditions is managed by the specialist of that field and perioperative pain is managed mainly by Anesthesiologists. Interventional techniques are minimally invasive, non-surgical procedures including percutaneous precision needle placement, with placement of drugs in targeted areas or ablation of targeted nerves; and some surgical techniques for the diagnosis and management of chronic, persistent, or intractable pain such as laser or endoscopic discectomy and spine procedures, Vertebroplasty, intrathecal infusion pumps, and spinal cord stimulators. (1) There is overwhelming evidence showing an association of chronic pain with significant economic, societal, and health outcomes. (2,3) With increasing geriatric population and even more alarming, the young population getting affected with chronic pain. A study from across 42 countries identified that self-reported chronic pain amongst adolescent populations was common: 20.6% of young people experienced pain in at least two sites of headache, stomach, and backache. Chronic pain affects up to 30% of those aged 18–39 yr. (4) A survey conducted by Indian Society for the study of pain showed 43% of patient with chronic pain consulting pain physicians belong to young age group between 25-45 years of age. Further, along with enormous costs and disability associated with reduced functioning, overuse of opioids and related fatalities have been well described. (5,6,7) Severe and chronic pain can impair mobility and function as well as reduce general quality of life, thereby posing barriers to human flourishing and productivity. Prevalence of Chronic pain worldwide. According to a study published by the National Centre for Biotechnology Information (NCBI) in 2015, around 19.6% of the individuals aged between 20 to 60 years were suffering from low back pain worldwide. (8) According to a study published by the Centres for Disease Control and Prevention (CDC) in 2012, around 20.3% of the population in the U.S. suffer from lower back pain. As per the report of the American Academy of Pain Medicine (AAPM) 2012, over 100 million people suffer from chronic pain.

1. Setting of
Pain management facility
Dr (Maj) Pankaj N Surange
MBBS, MD, FIPP, FIAPM, AMPH (INDIAN SCHOOL OF BUSINESS)
Fellowship spine endoscopy (Germany and Korea)
Director, IPSC India
Hon Secretary, Indian Society for study of Pain
Ex-Chairman, WIP India Section

2. Indian society for the study of Pain:
1986
More than 3000 Life time members
Pain medicine is a superspeciality
DM in Pain Medicine
Post MD Fellowship National Board
Post Doctoral Courses
Fellowship and certification exams
started in 2016- FIAPM

3. Pain
Management
facility
• All the types of establishment which
are managed by specialist doctors of
modern medicine with specific
certification on pain medicine

4. Pain
Clinic
A single pain physician working
within the complex of healthcare
institute and multispecialty
Hospital
or
Independently out of the complex

5. Day care or Ambulatory Pain centres
• A health care delivery facility focusing upon
the diagnosis and management of patients
with chronic pain.
• Such centres have facilities to perform
interventional procedures and admit
• patient on a day care basis.

6. Multidisciplinary pain clinic
A health care delivery facility staffed by physicians of
different specialties and other non-physician health
care providers who specialize in the diagnosis and
management of patients with chronic pain
Does not include research and admission facilities in its
regular programs

7. Multidisci
plinary
pain
center or
Pain
departme
nts:
An organization of health care professionals
and basic scientists which includes research,
teaching and patient care related to acute and
chronic pain
Inpatient and outpatient programs are
offered in such a facility.

8. They should have certification approved by Indian society for the study of pain. These include
but not limited to are:
• Fellow Indian Academy of pain medicine
• Post-doctoral certificate course
• Fellowship national board of examination
• DM in pain medicine
• Diploma in pain medicine (Irish Board Certified)
• International board certified pain physicians.
All pain management facilities must have trained pain
medicine specialists.

9. The pain service must be conducted in accordance with the
Medical Council of India's code of medical ethics.
NMC Guidelines 2022
INDEMNITY INSURANCE OF ALL THE PRACTIONERS IN THE
PMF is must under the category of pain medicine.

10. Out Patient Facilities
• Scope of services and not in scope of services should be well
placed at the reception area.
• Rights and responsibilities
• Examination couch, adequate seating, examination tools and
clinical hand washing facilities.
• preserve the patient's privacy, modesty and dignity:
Consultation Room

11. • Operating / procedure Room
Facilities for monitoring, airway and respiratory support and
resuscitation, including defibrillation, must be available at all sites.
Check list, as provided by ISSP, should be verified before the procedure
Anaesthesia machine and facilities for general anaesthesia
The procedure to be done under strict aseptic precautions. Follow ISSP
guidelines on aseptic precautions.
Procedures needing GA, RA or MAC, MUST be provide by
Anesthesiologist and not by the anesthesiologist performing the
procedure.

12. Equipment's
Fluoroscope
The operating table should be fluoroscopy compatible
RF Machine
Conventional and Pulsed
+- Cooled RF
Ultrasound Machine
+-
Spine Endoscopy system
+-

13. Recovery Room
Recovery beds
Recovery staff
Crash Cart
Clear Discharge criteria

14. • Other Essential Requirements
provision of diagnostic services e.g. laboratory, radiology (X
Ray and Ulatrasound)and neurophysioloqy.
Regularly scheduled quality improvement and peer review
activities
comprehensive patient record system is a must.
An audit system is a must for both diagnosis and
treatment outcomes
Proper record of opioids

15. Compliances
Day care Centre or Pain
management Clinic
• Shop establishment act
• Bio-Medical Waste
Multidisciplinary Pain
management
Facility/Hospital
• Registration with state medical
authority

16. PCPNDT
Certificate
PNDT Certificate
Centre Registration
State authority/Shop Establishment)
PNDT Application for centre
registration
Ownership/ rent Agreement
Layout of Place
Registration of the doctor
Inspection
Procurement
(PNDT of the company and
Quotation)
PNDT Certificate
Buy the machine Installation report
Form "F" Submit the NIL report every month.

17. AERB Certificate
Registration of centre UID and PW eLORA
Procurement
Company
Model
Installation Quality Check
Machine is Registered
TLD Bedges

18. ISSP ACCREDITATION