Education:

Undergraduate
State University of New York at Stony Brook
Stony Brook, N.Y.
B.S. Biology/Spanish 1979

Medical School
Mount Sinai, School of Medicine
New York, N.Y.
M.D., 1983

Internship
Pediatrics
New York Hospital
Cornell University Medical Center
New York, New York
1983 - 1984

Residency
Anesthesiology
Mount Sinai University Hospital
New York, N.Y.
1984 -1986

Fellowship 1
Pediatric, Vascular & Neuro Anesthesia,
Columbia Presbyterian Hospital, New York, N.Y.
Ed Miller, MD - Chief of Service
1986-1987

Fellowship 2
Pain Management/Regional Anesthesia
Texas Tech University Medical Center, Lubbock , Tx
Gabor Racz, MD - Chief of Service
1989 - 1990

Academic Appointments:

Assistant Professor
Department of Anesthesiology
Tulane University Hospital,
New Orleans, La
1987 - 1989 Coordinator: Morbidity & Mortality Conference

Hospital Appointments & Professional Experience:

Anesthesiology & Pain Management
Highland Hospital
Lubbock, Texas 1990-1992

Anesthesia & Pain Medicine Group Practice
Longview Regional & Mother Francis Hospital
Good Sheppard Hospital, Longview and Tyler, Texas 1993-1996

Group Practice: East Texas Orthopedics & Sports Medicine
Tyler, Tx 1996 - 1999

East Texas Neurology LLP
Pain Medicine 1999 - 2001

Spinal Diagnostics & Interventional Pain Medicine, 2001-Present

Licensure:

• State of Texas
• and Others

Exams:

Diplomat; National Board of Medical Examiners 1984
FLEX Part 2 1987

Certification:

• 2006 Fellow of Interventional Pain Practice (FIPP) via World Institute of Pain
• 2004 Recertification ABA special qualifications in Pain Management
• 1989 Diplomat American Board of Anesthesiology
• 1995 Diplomat American Academy of Pain Medicine
• 1994 ABA special qualifications in Pain Management
• 1992 Diplomat American Academy of Pain Management

Membership on Hospital Staffs:

• Texas Spine & Joint Hospital, Tyler, Texas
• Mother Frances Hospital, Tyler, Texas
• East Texas Medical Center, Tyler, Texas
• Tyler Rehabilitation Hospital, Tyler, Texas
• Longview Regional Hospital, Longview, Texas
• Longview Ambulatory Surgery Center, Longview, Texas
• Consulting Staff at UT Health Center

Professional Organizations:

National

• American Academy of Anesthesiologists
• American Academy of Pain Management
• American Academy of Pain Medicine
• International Anesthesia Research Society
• American Society of Regional Anesthesia
• American Pain Society
• International Association for the Study of Pain
• American Medical Association
• International Spine Intervention Society
• American Society of Interventional Pain Physicians

Regional

• Texas Medical Association
• Texas Society of Anesthesiology
• Texas Pain Society, Founding Member
• Smith County Medical Society

Lectures

• Feb 1988
  "Oxygen Therapy", Mardi Gras Anesthesia Update, New Orleans, Louisiana
• May 1988
  "Anesthesia and the Critically III Patients", Roosevelt Hospital, Guatemala City
• Mar 1989
  "Diagnosis and Treatment of Pulmonary Embolism", Tulane University Hospital, New Orleans, Louisiana
• May 1989
  "Anesthetic Considerations in Neonates", Tulane University Hospital, New Orleans, Louisiana
• April 2002
  "Spinal Pain Generator Workup", Big Sky Mountain
• May 2002
  Radiofrequency Course Keynote Speaker, Fort Worth, Texas
• Oct 2002
  Chronic Pain Evaluation & Treatment, UTHC, Tyler, Texas
• Oct 2002
  Radiofrequency Course Keynote Speaker, Phoenix, Az
• Oct 2003
  Opioid Management in Chronic Pain, Tyler, Texas
• Sept 2004
  Spinal Pain Generator w/u & Opioid Management; Missoula, Montana

General Background & Special Interests of Dr. Laurence Rosenfield:

Dr. Rosenfield is a board certified, fellowship trained physician specializing in pain management. He is in active clinical practice and has been since completing his fellowship in 1989. Neuromodulation, spinal cord stimulation, and intrathecal opiate catheters are among the many advanced pain control therapies which are taught in pain fellowship. The first 3 years of his practice were in academics. He held a faculty appointment at Tulane University Hospital in New Orleans, teaching residents, and medical students while caring for patients at the University Medical Center Hospital.

In 1990 after his pain medicine fellowship with the world renowned late Dr. Samuel Lipton and Dr. Gabor Racz he left Texas Tech University Hospital and entered private practice in Lubbock Tx where he began studying spinal diagnostics. He acquired skills such as intervertebral provocation discography, medial branch blockade, and transforaminal epidural nerve root blocks which help with spinal pain generator localization. This can be therapeutic and it can aid the spinal surgeon to determine which spinal segment is symptomatic analogous the role of a cardiologist working in concert with heart surgeons.

In late 1992, he left the University town of Lubbock and moved to Tyler, Texas where he has been treating patients with acute and chronic pain for over 14 years.

He has extensive experience with discography including cervical, thoracic, and lumbar. His expertise includes facet and medial branch blocks, radiofrequency neurotomy, spinal cord and occipital nerve stimulation, intrathecal opiates and implantable pumps, and many other diagnostic, therapeutic, and neurolytic nerve blocks.

The Problem of Pain:

Chronic Pain is a massive disease burden affecting an estimated 20% of adults and rising to 50% of the elderly population. Musculoskeletal and neuropathic disorders along with headache and trauma are examples of painful conditions creating an economic, social, and medical burden on the individual, the family, and our society. The undertreatment of pain has been identified as a major public health issue. The Joint Commission on Accreditation of Healthcare Organizations (JCAHO) has suggested that pain is the fifth vital sign and should be monitored just like blood pressure, pulse, temperature, and respiratory rate.

Adequate pain relief is not obtained by 40% of patients with moderate to severe chronic pain, 70% of patients with cancer related pain, and the majority of patients who suffer from chronic non-malignant pain. The consequences of poorly controlled pain can be devastating. Unrelieved pain can produce a plethora of medical problems including weight loss, anorexia, fever, unstable angina, myocardial infarction, deep venous thrombosis, infection, hypertension, immobility, weakness, fatigue, atelectasis, pneumonia, delayed gastric emptying, constipation, increased risk of cancer and decreased cancer survival. Chronic Pain may also cause fear, anger, depression, anxiety, sleep disturbances, irritability, listlessness, helplessness, hopelessness, frustration, or cognitive dysfunction.

According to a consensus statement among twenty leading pain and health organizations including the DEA published on October 23, 2001, "Effective pain management is an integral and important aspect of quality medical care, and pain should be treated aggressively." They further noted that "focusing only on the abuse potential of a drug, however, could erroneously lead to the conclusion that these medications should be avoided when medically indicated - generating a sense of fear rather than respect for their legitimate properties."

Treatment options for chronic pain include interventional approaches such as nerve blocks and surgery, rehabilitative medicine including physical therapy and exercise, psychological approaches, and pharmacological therapies. Opioids have long been a mainstay of cancer pain treatment. Over the past 10-15 years a growing number of randomized clinical trials and clinical practice have demonstrated that opioid analgesics may be used safely and effectively without intolerable side effects, functional deterioration, or aberrant drug-related behavior in patients with chronic non-cancer pain.

The general consensus is to use opioids for chronic pain after conservative therapy has been unsuccessful. Opioid medications are available as short-acting or longer acting preparations reflecting the duration of pain relief they generally provide. The use of long acting opioids has many advantages in treating chronic pain. A longer acting medication allows for fewer daily doses which improves patient compliance. Blood levels are more consistent throughout the day reducing side effects caused by peaks and valleys in serum concentrations of the medication. Patient's sleep patterns are also improved with longer acting medications that allow for uninterrupted sleep without the need to wake and take an additional dose.