President’s Message

Message from the President

MachadosmDear colleagues,
The AANS/CNS Joint Section on Pain has been working to advance research and education in neurosurgical pain care. Such initiatives have included a new hands-on course for neurosurgeons who wish to incorporate pain procedures such as spinal cord stimulation and intrathecal infusion in their practices, led by Julie Pilitsis and Steven Falowski. In prior years we dedicated didactics to the management of neuropathic pain, trigeminal neuralgia and lumbar pain. In 2016 and 2017 we will further these efforts with major initiatives aimed at advancing education in pain management, especially in the area of ablative procedures for cancer pain.

Ablative central nervous system procedures were once commonly performed by neurosurgeons for the management of chronic pain, in particular cancer pain. The advent and popularization of neuromodulation technology has led to a revolution in the field of pain medicine, with significant advantages to patient care given the reversibility and adjustability of neurostimulation. However, neuromodulation is not effective for all patients and is not cost effective in many patients suffering with terminal cancer. Some chronic pain conditions, in particular chronic cancer pain and select deafferentation syndromes such as brachial plexus avulsion can benefit significantly from CNS lesioning procedures including cordotomy and dorsal root entry zone (DREZ) ablation. Unfortunately, while these procedures continue to be performed by a few experts, less neurosurgeons are experienced with CNS ablation today than in the past, partially due to the predominance of neurostimulation as the tool of choice. The reduced access to neurosurgeons experienced in ablative procedures is a significant concern and can negatively impact the quality of pain care nationwide.

Neurosurgeons should play an integral role in the care of patients with chronic cancer pain and can provide significant improvements in quality of life without the side effects of high dose systemic opioid use, despite the risks of surgical interventions. In an effort to regain our role in cancer pain care and advance our opportunities for training on ablative procedures the AANS/CNS Joint Section on Pain will offer new didactic as well as hands-on courses for neurosurgeons who are already in practice as well as residents and fellows in the coming years. Further, we are working with colleagues in oncology and palliative care medicine to improve the interdisciplinary collaboration in cancer pain care.

The Joint Section on Pain has also increased its awareness for the need to develop opportunities for neurosurgeons in training or those who have recently graduated from residency to advance their knowledge and experience in chronic pain care. While training in pain management is a requirement of every program, we recognize that further training is often necessary particularly for those who wish to make pain management a significant portion of their practices. To honor John C Oakley, a great educator, pioneer and advocate for the role of neurosurgeons in pain medicine, we have now established a fellowship to fund neurosurgery pain education. The Oakley Fellowship will support a 2-3 month traveling experience to a center of excellence in pain care. Eligible applicants will be residents PGY4 or later or neurosurgeons within two years of finishing residency.

Candidates should submit a 500 word proposal summarizing their goals and identifying the mentor and institution where the training will take place. Candidates should submit their up-to-date CV and the mentor’s CV as well as a letter of support from their Chairman or Program Director. Help is available in identifying potential mentors and sites. Please submit applications to Andre Machado, Chair, Joint Section on Pain ([email protected]). Applications are due on August 1st 2016. The successful applicant with be notified by Oct 15.

Finally, we invite all colleagues who have pain care as a significant part of their practices, as well as those who would like to develop an interest in pain management, to join our section. We would like to also encourage you to become a member of our section. For membership application, please apply via the MyAANS website or email Karen Yoshikawa directly at [email protected] Medical students, residents and fellows are encouraged to apply. We invite you to attend and participate in our biannual meeting in 2017 as well as our sessions during CNS and AANS annual meetings.

Andre Machado
President, CNS/AANS Joint Section on Pain