The University of New Mexico Pain Consultation and Treatment Center (UNM Pain Center) opened in December 2011 in response to high rates of prescription opioid deaths in New Mexico. The center provides personalized pain care to more than 10,000 patients each year, with a focus on supporting and coordinating pain care in primary care settings, extending the capacity for pain care through "Project ECHO," and coordinating with integrative therapies, including chiropractic.
The pain center acts as a "consultation clinic" and only accepts referrals from primary care providers (PCPs). The center focuses on patients with moderate to severe pain and high-impact pain, working in collaboration with PCPs. The pain center's goal is to stabilize patients and return them to their PCPs for ongoing care. This has the secondary effect of training PCPs on what types of care may be most effective for their patients.
While the percentage of patients at the center who see a chiropractic physician within the department is less than the national average, many of the patients have chiropractors outside the center. The main barrier is that Medicaid does not cover chiropractic services. The New Mexico Chiropractic Association is currently in discussions with the Human Services Department to establish a pilot project to allow for Medicaid reimbursement. Once the funding is in place, it will increase access to chiropractic for those with Medicaid – 40 percent of the population in New Mexico.
Another barrier is the relative lack of providers in the state. Thirty-one of the 33 counties in New Mexico are underserved with respect to all providers. Hundreds of new chiropractors will be required once Medicaid funding is in place.
One of the key aspects of the UNM Pain Center is Project ECHO (Extension for Community Health Outcomes). The Program for Chronic Pain started in 2008 to enable UNM providers to educate clinicians across the region on best practices for pain management through didactic and case-based training. ECHO has expanded to include participants from more than 9,000 cities in over 180 countries. The goal is to reach 1 billion people throughout the world by 2025.
Thus far, at least eight chiropractic physicians have been involved. The more chiropractic physicians are involved in ECHO presentations, the more opportunity to suggest patients get treated by a chiropractor near them.
Dr. Michael Pridham is a DC currently involved with the UNM Pain Center. He serves in the UNM Health Science Center Human Research Protections Office, on its Institutional Review Board and as a Scientific Community Member. Reflecting on the past few years, he observes, "The profession has been benefiting from the work within the UNM Pain Center by increasing the number of providers who are knowledgeable about what chiropractic physicians do. I frequently get questions such as, 'Do chiropractors treat sciatica?' and statements such as, 'I didn't know chiropractors can treat vertigo.' Being in the department increases the awareness of the conditions that we treat. Our presence in the department shows the new providers that our profession is up to the challenge of treating complex painful conditions."
As he looks towards the future, Dr. Pridham notes: "I believe that there will be endless opportunities for chiropractic physicians at the UNM Pain Center, and throughout the hospital. We have had Dr. George Simmons working within the Center For Life for more than a decade. Dr. Lucy Whyte Ferguson has worked in the Pain Department for years and she is now working on a study of using myofascial therapy and adjustments for children with scoliosis. Dr. Kenzo Kase and I have presented courses on [kinesiology taping] at Project ECHO. Others, such as Dr. James Lehman, pioneered the field of working in hospital groups decades ago in New Mexico. My vision is to have an entire chiropractic medicine department and to have residencies for newly graduated chiropractors, and even for well-seasoned practitioners."
Many relevant diagnostic signs are not performed deliberately by the examiner or by the patient at the examiner’s direction. They are observed as the patient reacts to their condition. Fortin’s finger sign, Minor’s sign, and Vanzetti’s sign are three examples of this principle.
On Feb. 1, 2024, two more legislators – John R. Carter (R-Texas) and Robert “Bob” Good (R-Va.) – co-sponsored the Chiropractic Medicare Coverage Modernization Act of 2023, bringing the co-sponsor total to 155, two more than the total achieved over the entire two-year congressional cycle in which identical legislation last appeared (2021-22).
While working at the Lovelace Medical Center in Albuquerque, N.M., one of the primary care physicians stated that imaging every patient prior to receiving chiropractic was not medically necessary. It was at that point I reconsidered the need for the imaging of every patient to avoid malpractice.
