Advancing Education and Opportunities in Neurosurgical Pain Care

Andre Machado, MD

The Joint Section on Pain works diligently to advance research and education in neurosurgical pain care. In previous years, didactics have focused on the management of neuropathic pain, trigeminal neuralgia, and lumbar pain. Recent initiatives, led by Drs. Julie Pilitsis and Steven Falowski, 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 practice. 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 such as cordotomy and dorsal root entry zone (DREZ) ablation. Unfortunately, while these procedures continue to be performed by some experts, fewer 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.

While there are risks associated with surgical interventions, neurosurgeons can provide significant improvements in quality of life without the side effects of high-dose systemic opioids, and they should play an integral role in the care of patients with chronic cancer pain. In an effort to regain our role in cancer pain care and advance our opportunities for training on ablative procedures, the Joint Section on Pain will offer new didactic and hands-on courses for practicing neurosurgeons, fellows, and residents 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 is also acutely aware of the need to develop opportunities for neurosurgery residents and recent graduates to acquire knowledge and advanced 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 are pleased to announce a new fellowship to fund neurosurgery pain education. The 2016 Oakley Fellowship funds a two- to three-month traveling experience to a center of excellence in pain care. Eligible applicants are residents PGY-4 or later, and 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, an up-to-date CV, their mentor’s CV, and 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, at machada@ccf.org. Applications are due by August 1, and the successful applicant with be notified by October 15, 2016.

Finally, we invite all colleagues who include pain care as a significant part of their practice, as well as those who would like to develop an interest in pain management, to join our section. For a membership application, please apply via the MyAANS website or email Karen Yoshikawa directly at kny@aans.org. 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 at the 2016 CNS Annual Meeting, September 24–28, in San Diego, California.