2014 Newsletter

Julie Pilitsis, MD, PhD
Chair, AANS/CNS Joint Section on Pain

As this issue of Pain News goes to press, I am fortunate enough to be taking over the role of chair of the pain section. I would first like to offer my sincere thanks both to the outgoing section chair, Dr. Christopher Winfree, who has done the yeoman’s work over the last two years and to Dr. Andre Machado, who has succeeded in publishing Pain News after its brief hiatus. We look forward to rejuvenating the newsletter as well as our section’s outreach over the next two years.

To that end, our Executive Council at the recent meeting has agreed on the following mission statement:

The mission of the AANS/CNS joint section on pain is to maintain the role of the neurosurgeon in pain management through education, advocacy, and research.

Our goals during the next two years and my tenure as chair are to:
1. Increase resident education and participation in the section.
2. Advocate for our patients through collaboration with other specialties and organizations.
3. Set up a sustainable framework to solidify the future role of the neurosurgeon in multidisciplinary field of pain management.

Improved Education

Specifically, to increase education and participation in the section, we will offer all residents’ complementary membership in the section. A benefit of membership will be to receive these newsletters in an effort to keep them abreast of recent advances in the surgical management of pain as well as the advocacy efforts of the section in combination with the Washington Committee. We also will begin to offer the John Oakley fellowship to senior residents interested in further exploring the discipline. This fellowship will sponsor travel to an outside institution for 6 weeks to 6 months. Additionally, as the pain section has historically been one of the smallest sections, residents may more easily serve on committees and play a major role in our initiatives including the development of guidelines and curricula in pain management discipline. Any interested residents and/or medical students should contact me directly at jpilitsis@yahoo.com.

To maintain resident interest, it is essential that surgical management of pain remain a core component of their education. The William Sweet Award at this year’s AANS went to a project looking at this very topic. The presented survey demonstrated that very few residency programs are offering a well-rounded experience in pain. To that end we continue to work with AANS, CNS, and SNS leadership to develop curricula for the Matrix and MOC projects. Additionally, we will work with the Education committees of our parent organizations to use multimedia to highlight the key curricula to make them accessible for residents in all neurosurgical programs.

We continue a strong presence at the national meetings during practical clinics, breakfast and lunch seminars, during the general sessions and session specific sessions. This year’s AANS featured our Loeser lecturer Sean MacKey and an exciting debate on surgery versus radiosurgery for trigeminal neuralgia featuring Drs. Kim Burchiel and Doug Kondziolka. Pain topics were also featured in a series of breakfast seminars, practical courses, the international symposium and the midlevel plenary session. The focus of the upcoming CNS pain section session is: We are hopeful that speaker Allan Bausbaum will be speaking at Sunday’s plenary session. The next biennial pain symposium will be in San Francisco on April 4, 2014. The topic will be “The Management of low back pain.”

Continued Advocacy:

There are greater than 100 million patients in the US living with chronic pain. In 2011, the Institute of Medicine concluded that there is a “need for a social transformation in the way pain is perceived, judged, and treated.” This resulted in the creation of the PAINS group discussed in Dr. Jason’s Schwalb’s report later in this newsletter. As mentioned in Dr. Jason Schwalb’s report on the PAINS initiative in this newsletter, it is essential for us as pain and general neurosurgeons to have a seat at the table. Many in the group were unaware of how effective classic surgery can be for pain complaints, e.g. lumbar decompression for neurogenic claudication. Thus the topics being discussed in the pain community whether it be the role of classic spinal surgery and/or the reclassification of hydrocodone as discussed in Dr. Josh Rosenow’s contribution are pertinent to all neurosurgeons. We will continue to work with our small but passionate section as well as the Washington Committee to be advocates for neurosurgery in policy decisions. We will continue to be active in the Guidelines Committee on far-reaching issues.

The IOM and the PAINS group concur that more clinical and translational pain research is essential, to help us treat our patients effectively. We as a group and as individuals can help to this end by prospectively collecting and publishing outcomes. Using our scientific backgrounds, we need to and are able to design simple studies to answer fundamental questions about diagnosis, therapeutics, and prognosis. Ultimately, additional well done studies will lead to a more evidence, better practices and better patient care.

A Sustainable Framework

In order to reach our goals of education, advocacy and continued support of the pain neurosurgeon, it is essential for our section to improve our outreach and promote these issues to the general neurosurgical population as well as patients and patient advocacy groups. The patient suffering with pain needs to know that we are hearing their issues and working towards them and are making progress. Chronic pain is often isolating and people lose hope. Over the coming months we will update our website to this end. We will continue to work with the social media outlets established by the Washington Committee and the PR departments of our parent organizations to contribute to the education of neurosurgeons, pain providers, primary care physicians and patients.

I look forward to the next two years and look forward to seeing many of you at the CNS 2013 and at the next pain section satellite meeting the Friday before the AANS 2014 in San Francisco. Save the date!