From the Editor's Desk: ASRA's Universe is Expanding

Feb 1, 2020, 22:28 PM by Kristopher M. Schroeder, MD

“Dogs and cats living together . . . mass hysteria!” - An immortal phrase uttered by Peter Venkman in the 1984 movie Ghostbusters. Although we are past the season of battling ghosts, he expressed well the difficulties many have with understanding the complexities of practicing a form of medicine that may be just outside of their clinical bubble.

“...Now the formerly chasmic divides between acute and chronic pain management are breaking down.”

Many ASRA members exist in one distinct group and have little reason to interact with those outside of their professional silo. The divisions might fall along practice lines, with those predominately practicing acute and regional anesthesia demonstrating little interest in chronic or interventional pain medicine. The reverse can certainly be true, where those practicing chronic or interventional pain medicine exhibit little interest in what occurs in the immediate perioperative period and how pain is managed in that arena. Physicians have similar silo tendencies in the clinical arena, where they might demonstrate little interest in trying to intellectually collaborate with NP/ PA or surgical colleagues. Prior to assuming the role of ASRA News editor, I spent little time peering across the aisle at what my physician colleagues in chronic or interventional pain management were interested in or what other medical professional colleagues’ approach to pain management looked like.

But now the formerly chasmic divides between acute and chronic pain management are breaking down. Procedures, approaches, or treatment algorithms formerly strictly confined to one persuasion or the other are finding a home in their colleagues’ practices. For example, chronic pain physicians are now using abdominal fascial plane blocks, formerly isolated to the treatment of acute surgical pain associated with abdominal incisions, to diagnose and treat abdominal nerve entrapment syndromes. Patients with chronic pain and complex regional pain syndrome may now benefit from either an acute pain procedure (peripheral nerve catheter placement) or acute pain medication (ketamine).

With increasing knowledge of sonoanatomy and comfort with ultrasound-assisted procedures, regional anesthesia and acute pain management practitioners are more comfortable performing procedures formerly thought to be outside of their scope of practice. Those providers might be more available in the inpatient setting and therefore more able to provide acute services. For example, in some locations regional anesthesia providers might be more available and able to provide stellate ganglion blocks for patients with recurrent or recalcitrant ventricular tachycardia.

Collectively, we are becoming aware of just how interconnected the practices of acute and chronic pain management truly are. We are recognizing that aggressive perioperative pain management might affect the development and degree of chronic pain following surgical procedures. The idea that those practice changes may extend the impact of anesthesiologists far beyond the surgical procedure is a very intriguing proposition. At the same time, patients presenting for surgical procedures with a history of significant opioid agonists or mixed agonist-antagonist administration can benefit greatly from the perioperative management skills and advice provided by providers generally focused on chronic pain management.

While specialized training certainly has value (I am not yearning to run out and insert an intrathecal pump), the lines between ASRA members are beginning to blur. With that in mind, I encourage all ASRA members to expand their horizons and attempt to understand the literature and perspective of their pain management colleagues. What might this mean? From a selfish perspective, I would love for every member to read (or listen) to every article in each edition of
ASRA News or peer across the aisle at what those with a different pain management focus are publishing in Regional Anesthesia and Pain Medicine. At your own institution, seek out opportunities to collaborate with other pain management specialists. Finally, consider attending the less-aligning annual meeting (I attended the 18th Annual Pain Medicine meeting in fall 2019 and found the unique perspective—and New Orleans beignets—incredibly rewarding). ASRA has an expanded universe to offer, and accessing it requires minimal effort to obtain massive benefits.

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