• AANS/CNS Joint Section on Pain: Advocating and Educating

    Author: Jason Schwalb, MD

    It has been a pleasure serving as Chair of the Joint Section on Pain for the past two years and working with our wonderful Executive Committee. When I was elected to this position, I did not expect that it would be at a time of increased focus on Neurosurgical procedures for pain due to the onslaught of the opioid crisis and subsequent legislation. As a result, the section has played an increased role in advocacy for the neurosurgical community and our patients.

    With the help of the Pain Section leadership, the Washington Committee has advocated that there should not be any federal legislation limiting the size of opioid prescriptions after surgery. I wrote an OpEd piece, published in the Detroit Free Press1 last summer, delineating the complexities of opioid prescribing for acute pain in patients with underlying chronic pain. The new Draft Report on Pain Management Best Practices: Updates, Gaps, Inconsistencies, and Recommendations from HHS2 suggests that they are listening to our suggestions. Drs. Rosenow, Winfree and I worked with the Washington Committee and the AMA) to submit our formal comments on this promising document. We were subsequently invited to participate in a roundtable discussion with Dr. Vanila Singh, Chief Medical Officer of the Department of Health and Human Services about this report.

    Although we are a small specialty, it has been heartening to see that our input is considered valuable. Currently, there is neurosurgical representation on the following committees:

    1. AMA Pain Care Task Force
    2. Medicare Evidence Development & Coverage Advisory Committee (MEDCAC)
    3. National Academies of Science, Engineering, and Medicine’s (National Academies) new study committee titled “Evidence-based Clinical Practice Guidelines for Prescribing Opioids for Acute Pain”
    4. AMA Opioid Task Force

    In addition to our work advocating for our colleagues and patients, we are addressing new challenges that have not gained much attention… yet. Recent developments in tracking software in devices hold promise in improving programming and outcomes. However, there are also significant privacy issues. A recent case of a murderer being caught on the basis of data from a Fitbit3 out the utility in the data, but there are also potential issues of data being subpoenaed in cases of disability, or determination of fault in auto accidents or adultery. We are currently not adequately warning patients about these issues before implanting them with such devices. Emily Levin, MD and Erika Petersen, MD will be taking the lead in developing a policy, OpEds, information brochures and, potentially, a separate consent, with the help of CSNS and ASSFN that we hope can be endorsed by the AANS and CNS.

    However, the Pain Section is not just an advocacy group. We play an important role in education as well. A Google group for “Pain Neurosurgery” is being administered by Zaman Mirzadeh. This has allowed members of the Pain Section to post deidentified cases for advice from other members of the group, with significant interest. It is only open to members of the Pain Section. We have had several posts a month with broad responses from the membership outside of the Executive Committee.

    Our biennial meeting took place in March, immediately before the Spine Summit, entitled “Expanding Your Toolbox: The Treatment of Spine and Peripheral Nerve Disorders”. Our closing reception was the opening reception for the Spine Summit. We had increased attendance and industry support compared to prior meetings. We will be moving to an annual meeting schedule in coordination with the Section on Disorders of the Spine and Peripheral Nerves. We expect this will further disseminate neuromodulation and ablative techniques to spine and peripheral nerve surgeons.

    Given the number of issues we are addressing, we welcome increased involvement in the Pain Section from our neurosurgical community. Please join the section to support these efforts, obtain the benefits of membership and volunteer your energy and ideas.


    > In addition to our work advocating for our colleagues and patients, we are addressing new challenges that have not gained much attention… yet. Recent developments in tracking software in devices hold promise in improving programming and outcomes. However, there are also significant privacy issues. <


    References
    1. Schwalb, Jason. New 7-day opioid law will burden Michigan’s patients, doctors: Opinion. Detroit Free Press, June 8, 2018.
    2. Draft Report on Pain Management Best Practices: Updates, Gaps, Inconsistencies, and Recommendations (2019). Accessed from www.hhs.gov/ash/advisorycommittees/pain/reports/2018-12-draft-report-on-..., 7.23.19
    3. Hauser, Christine. Police Use Fitbit Data to Charge 90-Year-Old Man in Stepdaughter’s Killing. New York Times, October 3, 2018.

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