Christopher J. Winfree, MD, FAANS
Chairman, AANS/CNS Joint Section on Pain
The executive council for the American Association of Neurological Surgeons (AANS)/Congress of Neurological Surgeons (CNS) Section on Pain is looking forward to continuing an exciting and productive 2012. Our wish is to enhance the status of pain management in neurosurgery. Unfortunately, interest from the neurosurgical community in the practice of neurosurgical pain management has faded in recent years. There are many reasons for this, including waning reimbursement, lack of evidence to support the use of many pain procedures, the absence of pain education in neurosurgical residency programs and the poaching of these procedures by competing medical specialties. The Pain Section continues to address these issues.
In an effort to improve resident education, we have restructured the course curriculum at the AANS’ and the CNS’ annual meetings. We replaced some of the more esoteric courses that focused on topics of limited interest with a course on neurostimulation. This practical clinic provides detailed instruction on these pain management techniques. The purpose is to stimulate interest in neurosurgical pain management at a grassroots level. Once young neurosurgeons become interested in the field, they tend to become more familiar with the procedures and, thus, become more likely to incorporate them into their practices.
We also are excited to announce our upcoming biennial pre-conference pain seminar at the 2013 AANS Annual Scientific Meeting in New Orleans, to be held April 27-May 1. The seminar’s topic, “An Update on Facial Pain,” should be fascinating, given the recent advancements in the field. We would encourage any neurosurgeon with an interest in facial pain to attend, and we especially wish to invite neurosurgery residents who may be developing an interest in this field. Obviously, the course would be equally appropriate for general neurosurgeons who occasionally treat patients with facial pain.
Working with the Society of Neurological Surgeons (SNS)
, the Pain Section has developed a module for the boot camp course, given to the junior-level neurosurgical residents. By providing the basic working knowledge of neurosurgical pain management to these young residents, our hope is that the quality of pain management improves on the typical neurosurgery service. By educating them early on in their careers, we also endeavor to help residents perform better on the pain segments of their board exams. Maybe they’ll even choose pain surgery as a career.
Although getting more neurosurgeons interested in pain neurosurgery is a priority, the executive council also wishes to examine how well neurosurgeons have been doing in this field. Specifically, we are working with leadership from Self-Assessment in Neurological Surgery (SANS) and The American Board of Neurological Surgery (ABNS) to assess how residents and attendings have performed on the pain portions of these written examinations over the past 10 years. These results represent one of several metrics that can be used prospectively to ensure there is steady improvement in pain performance. If not, then we may make additional adjustments in the curriculum as needed.
Several years ago, the untimely death of John C. Oakley, MD, a prominent neurosurgical pain specialist, yielded the John Oakley Pain Fellowship. This fellowship allows young neurosurgeons to spend time studying neurosurgical pain management. The scholarship is nearly funded, and once we secure contributions from industry in the coming months, we will begin accepting applications for the award. This, hopefully, will generate further interest in the field of neurosurgical pain management.
One of the limitations within the field of pain neurosurgery is lack of evidence to support many of our procedures. Given the recent emphasis on evidence, largely within the context of health-care reform, the Pain Section has embraced the idea of collectively generating evidence in our field. We acknowledge the need for neurosurgeons to participate in outcomes research to comply with new regulations and to generate evidence to justify our surgical techniques. Towards this end, we have formed the Neurostimulation Study Group, composed largely of members of the Pain Section’s executive council. We are in the process of obtaining funding for a variety of outcomes studies involving different forms of neurostimulation. The process has been slowed, however, by the relative paucity of National Institute of Health (NIH) funding in recent years, but we continue to push forward.
A second research project initiated by the Pain Section is investigating the incidence and severity of chronic pain in retired National Football League (NFL) players. Anecdotal evidence suggests that the incidence is high, if not overwhelming. To this point, chronic pain has not been formally studied in this population, as the recent focus has been on head injuries and subsequent neurodegenerative disorders. At present, we don’t know the types of and extent to which retired NFL players suffer from chronic pain. We suspect that a significant proportion of the chronic pain experienced by NFL players may be neuropathic in origin and, thus, potentially amenable to neurosurgical intervention. We hope that the study results will allow the NFL to better address and anticipate the needs of professional football players and learn more about the pain conditions associated with high-caliber physical activity.
The Pain Ssection’s executive council has been working with the Joint Guidelines Committee to rebuild our website. The format consists of a publicly accessible front page, which contains information about the section (including a mission statement), details on the executive council members and other content. A password-protected back page will consist of additional information, largely pertaining to the section’s ongoing research projects.
The executive council of the Pain Section wishes all our neurosurgical colleagues the best for the remainder of 2012. We look forward to continuing to work with you!