Hofstra Med Students Train In Opioid-Alternative Pain Treatment

UNIONDALE, NY. — Students at the Zucker School of Medicine at Hofstra/Northwell learned an innovative pain treatment technique Wednesday as part of the school’s Pain and Addiction Care Education week, taking part in an hour-long training session on femoral nerve blocks, a technique used to manage pain in patients undergoing hip replacements.

Pain and Addiction Care Education is a weeklong seminar at the Zucker School of Medicine that teaches third-year medical students about pain management, specifically the impact that the misuse of opioids can have on patients, their families and their communities. Additionally, the week of education teaches students how to help patients manage their pain while minimizing the risk of substance misuse.

Femoral nerve blocks, medical school officials said, are a minimally invasive alternative to opioid prescription. The procedure involves using an ultrasound to guide the placement of an injection that blocks the transmission of pain signals from the affected area to the rest of a patient’s body. That injection, school officials said, can help avoid the use of painkillers.

“It's an alternative, but it's one that's becoming best practice for individuals that may come in with a hip fracture into the emergency department,” Zucker professor and Northwell vice president Dr. Sandeep Kapoor told Patch. “Instead of the old school, ‘knee jerk’ ways of prescribing medication to satiate that individual's pain, alleviate that individual's pain, utilizing a nerve block, which is very much localized, and will prevent pain at that localized area without the additional risk of exposing the body, let's say, to the more harmful medications.”

Kapoor is a professor of emergency medicine, psychiatry and science education at the Zucker school, as well as Northwell's vice president of emergency medicine addiction services. While the nerve block can serve as an alternative to opioid prescription, Kapoor said the goal is not to eliminate opioid prescription altogether. Instead, Kapoor said, the goal was to teach medical students about responsible prescribing practices and suitable alternatives, allowing them to make more educated decisions when treating pain in the future.

"There is this misnomer out there that all opioids are bad, and we cannot have our students feel that way, because opioids do have a place in medicine," Kapoor said. "So the goal here is not to drive less prescribing. It's better and educated prescribing."

After a lecture on the different kinds of painkillers that can be prescribed, Zucker students got hands-on training with femoral nerve blocks, using “phantom” dummies to simulate the process of performing an ultrasound on a patient’s hip to pinpoint the location of a nerve block injection.

For third-year students like Trey Feldeiser, the pain education program is a valuable opportunity to learn about not only the pain their future patients may suffer, but the things they might develop dependencies on in addition to the pain.

“I think it's a special week because throughout medicine and everything, everybody that we deal with deals with pain,” Feldeiser said. “And many of our patients also deal with different addiction, substance use disorder, alcohol use disorder, gambling use disorder, stuff like that. And I think education on that, in general, is not as prevalent in most medical education. So I think it's special that we get a full dedicated week of that.”

For California native Bianca Chandler, learning about addiction alongside her classmates was a chance to see addiction normalized. As someone who grew up around the disease, Chandler also said it was “validating” to see it taught about in med school.

“I actually come from a family with a lot of addiction, and firsthand experience. My father is in active addiction, and has been for most of my life. My aunt and my older half-sister, as well. And so I think that it gives the other students who aren't familiar with the firsthand impact that it has on the entire family dynamic, it's really impactful listening to the families talk about sort of the process of going through, watching a family member struggle with a disease like this,” Chandler said. “I resonated with [it] very heavily throughout the entire thing. I feel like it was validating for me….I think it also normalizes the fact that substance use disorders are very prevalent, and it's in every family, or in most families.”

When asked what this week of education could mean for her future in the medical field, and that of her classmates, Chandler said it had made her feel more empowered as an advocate for the people she’ll someday treat.

“I think it's made me feel more comfortable being the voice that stands in support and advocacy for this group of people, especially in the healthcare system,” Chandler said. “I've seen medical professionals across different hospital systems, individually, maybe not treat patients so well, because they're [saying], ‘Oh, they're the regular. They're just here because they want to sandwich.’ And I feel like this really is motivating to [say], ‘No, I can say something. I'm watching other attendings who currently work in the space say that they speak up, and I should feel comfortable to do that too.’ And that it's okay to speak up and that they still have their jobs, and people still want to work with them.”

For Kapoor, teaching students about lower risk approaches to pain management doesn’t just equip them to become better medical professionals, it’s the kind of lesson that could help change healthcare altogether.

“It means the world, it really does. It's really gratifying and validating, how interested they are,” Kapoor said. “The reality is, the norms of the past that we've all been forced to follow, this week challenges that. And the challenge is that we are thoughtful later…These kids are agents of change, they're going to leave and go to residency and become physicians and go throughout this country with a better knowledge base, a better awareness and a better skill set than the average bear out there, which, if anything, is going to provide better community care.”