Summary
This Oklahoma Attorney General Opinion addresses whether the Oklahoma Interventional Pain Management and Treatment Act applies only to chronic pain and whether certified registered nurse anesthetists may perform specified pain-management procedures. The opinion concludes that CRNAs may not perform radiofrequency ablation, but may perform peripheral nerve blocks and lumbar intra-laminar epidural steroid injections when requested by and under the supervision of an Oklahoma-licensed physician.
Topics
Practice areas
Questions Presented
- Whether the Oklahoma Interventional Pain Management and Treatment Act applies only to the treatment of chronic pain.
- Whether a certified registered nurse anesthetist may perform radiofrequency ablation to treat acute pain or an acute exacerbation of chronic pain.
- Whether a certified registered nurse anesthetist may perform peripheral nerve blocks or lumbar intra-laminar epidural steroid injections to treat pain, subject to the Oklahoma Nursing Practice Act and the Pain Management Act.
Holdings
- The Pain Management Act applies only to the diagnosis and treatment of chronic pain as defined by the Act and does not extend to all forms of pain management.
- Certified registered nurse anesthetists are not authorized to perform radiofrequency ablation, whether to treat acute pain or an acute exacerbation of chronic pain.
- Properly licensed Oklahoma CRNAs may perform peripheral nerve blocks and lumbar intra-laminar epidural steroid injections for the treatment of pain when requested by and performed under the supervision of an Oklahoma-licensed allopathic or osteopathic physician, subject to the limitations of both Acts.
Key quotations
“First, the Pain Management Act applies only to the diagnosis and treatment of "chronic pain," as defined therein.” (¶ 1)
“In plain terms, a procedure that by design damages or destroys human tissue--for any reason--is not considered anesthesia and is therefore outside a CRNA's scope of practice authorized by the Nursing Act.” (¶ 11)
“Properly licensed CRNAs in Oklahoma are permitted to perform peripheral nerve blocks and lumbar intra-laminar epidural steroid injections for the treatment of pain upon request, and under the supervision, of an Oklahoma-licensed allopathic or osteopathic physician.” (¶ 18)
Factual background
The opinion concerns the scope of practice of Oklahoma-licensed certified registered nurse anesthetists under the Oklahoma Nursing Practice Act and the Interventional Pain Management and Treatment Act. The procedures at issue were radiofrequency ablation, peripheral nerve blocks, and lumbar intra-laminar epidural steroid injections. The opinion distinguished anesthesia-related medication-delivery procedures, which may be performed by CRNAs under statutory conditions, from radiofrequency ablation, which intentionally damages or destroys nerve tissue.
Procedural history
The Attorney General's Office received requests asking whether the Oklahoma Interventional Pain Management and Treatment Act applies only to chronic pain and whether certified registered nurse anesthetists may perform radiofrequency ablation, peripheral nerve blocks, or epidural steroid injections. The opinion addressed the questions through statutory interpretation of the Pain Management Act and the Oklahoma Nursing Practice Act.