ASRA Pain Medicine Update

We invited several ASRA special interest groups (SIGs) to provide updates on their groups’ recent activities, particularly in light of the cancellation of the spring meeting. ASRA now has 22 different SIGs with a wide range of interest areas. We invite you to learn more about the SIGs and join here.

In this article, you'll find updates for the following SIGs:

Cannabis in Acute and Chronic Pain

Education in Regional Anesthesia

Green Anesthesia

LGBTQA

Pain and Substance Use Disorder

Ultrasonography in Pain Medicine

Cannabis in Acute and Chronic Pain

by Mark Wallace, MD, Professor of Anesthesiology, Chair, Division of Pain Medicine, Department of Anesthesiology, University of California San Diego, and Brent Yeung, MD, Assistant Clinical Professor,  Department of Anesthesiology and Pain Medicine, University of California, Irvine

Cannabis has been used to treat painful conditions for thousands of years in all corners of the globe.  It is one of the oldest plants cultivated by humankind and has been utilized for a myriad of symptoms including pain throughout human history.^[1] The National Academies of Sciences, Engineering, and Medicine’s 2017 report and review on “The Health Effects of Cannabis and Cannabinoids” concluded that there was substantial evidence for the use of cannabis and cannabinoids for the treatment of chronic pain in adults.^[2] However, there is little formal education on the topic of cannabis throughout medical education. How should patients consume cannabis? What are the risks? What type of pain conditions are amenable to cannabis treatment? Where does cannabis fall in the analgesic continuum? Can I prescribe or recommend cannabis to my patients even though it is a federally illegal drug? These are common queries of clinicians who are considering cannabis as an additional analgesic for their patients.   

There is a continued need to bridge the gap of our medical knowledge and provide high level evidence to support the use of cannabis in various pain states. 

The opioid epidemic was declared a public health emergency by the United States in October 2017.  With the changing legal landscape of cannabis coupled with the onset of the opioid epidemic,  there has been an urgent need to approach the treatment of pain with a new lens. This has resulted in a shift toward using cannabis as an alternative treatment for pain by patients. Unfortunately, many begin using cannabis without consulting their healthcare providers.^[3] The ever-increasing number of cannabis products and extracts in the marketplace further complicates the formation of a cannabis treatment plan for a specific patient.^[4] Furthermore, there is a lack of guidance for clinicians on how to advise their patients on cannabis use; therefore, we must be prepared to answer and educate both patients and practitioners on proper cannabis use to enhance benefits and reduce risks.^[3]

Addressing these challenges is the purpose of our newly created Cannabis in Acute and Chronic Pain SIG. We want to provide education and develop best practices for those who are interested in the role of cannabis when used in both the acute and chronic pain setting.  There is a continued need to bridge the gap of our medical knowledge and provide high-level evidence to support the use of cannabis in various pain states.  We hope to build a group of physicians with this common interest to evaluate the evidence and share clinical experiences with cannabis to facilitate research, education, and best practices for the use of medical cannabis in the treatment of acute and chronic pain.  Overall the SIG’s goals and objectives are the following:

1. Educate ASRA members and the broader medical community about the endocannabinoid system and how endogenous and exogenous cannabinoids affect patient perception of pain.
2. Identify the role of cannabinoids in particular pain states. Share clinical experiences in regards to efficacy of particular cannabinoid concentrations, dosing, and routes of administration as well as side effects encountered and the potential consequences of short- or long-term use.
3. Discuss and review relevant clinical studies and pending trials.
4. Encourage collaboration among colleagues interested in initiating or advancing research and/or clinical trials.
5. Establish best practice guidelines for practitioners who may consider utilizing cannabis in their treatment plans.
6. Discuss the legal landscape surrounding cannabis and its use across the country. 

Future Meeting

The first scheduled Cannabis SIG meeting will be held during the 19^th Annual Pain Medicine Meeting In Las Vegas, NV in November 2020.

References

1. Russo, Ethan B. “History of Cannabis and Its Preparations in Saga, Science, and Sobriquet.” ChemInform, vol. 38, no. 47, 2007, doi:10.1002/chin.200747224.
2. The Health Effects of Cannabis and Cannabinoids: the Current State of Evidence and Recommendations for Research. The National Academies Press, 2017.
3. Hill, Kevin P., et al. “Cannabis and Pain: A Clinical Review.” Cannabis and Cannabinoid Research, vol. 2, no. 1, 2017, pp. 96–104., doi:10.1089/can.2017.0017.
4. Smart, Rosanna, et al. “Variation in Cannabis Potency and Prices in a Newly Legal Market: Evidence from 30 Million Cannabis Sales in Washington State.” Addiction, vol. 112, no. 12, Apr. 2017, pp. 2167–2177., doi:10.1111/add.13886.

Update on the Education in Regional Anesthesia SIG 

by Reva Ramlogan, MD, Vice-Chair of the Education in Regional Anesthesia SIG and Assistant Professor, University of Ottawa, and Colin McCartney, MD, Chair of the Education in Regional Anesthesia SIG and Professor, University of Ottawa

The mission of the Education in RA SIG is to develop and advance evidence-based best-practices in regional anesthesia training, within the context of competency-based education. The SIG strives to promote international collaboration in developing evidence-based instructional and assessment strategies for regional anesthesia. We have grown over the past 3 years to more than 1500 members. The SIG leadership maintains engagement with members through 5 liaison committees and provides members with resources that may aid them in their careers as educators. A review of SIG activities is presented at the annual spring meeting. In light of the cancellation of this year’s meeting, we present a summary of activities, plans for the future, and opportunities within the SIG.

The SIG strives to promote international collaboration in developing evidence-based instructional and assessment strategies for regional anesthesia.

Website Committee

Dr. Sylvia Wilson (Medical University of South Carolina) took over from Dr. Brian Allen (Vanderbilt University Medical Center) last year as the website liaison. The website has collated resources for members interested in reviewing workplace-based assessment tools, providing structured feedback, simulation-training and new technologies for UGRA training. Following the inception of ASRA Connect a number of interesting dialogues have occurred. ASRA Connect is the discussion forum for SIG members to exchange ideas and ask questions to colleagues. In fact, this sparked one of the research activities that the SIG will be undertaking next.

Podcast / Webcast Committee

Led by Dr. Jaime Ortiz (Baylor College of Medicine), the podcast committee has conducted a podcast on the current state of UGRA education (Episode 24: Drs J. Ortiz, D. Ludwin, C. McCartney), as well as the value of simulation for UGRA training (Episode 32: Drs J. Ortiz, A. Kumar, H. Sviggum). These sessions have been hosted by Dr. Raj Gupta through the ASRA RAPP. If you don’t have the time to review the latest literature, this is a good place to start for a quick overview and lively discussion.

CME Committee

The CME committee, led by Dr. Stuart Grant (Duke University) coordinate submitting panel suggestions and educational content to the ASRA Scientific/Education Planning Committee. At last year’s meeting, SIG members contributed to an “Ask the Experts” session on teaching the teachers, as well as “The Modern Learner”. This committee also contributes to the website resources under professional development. Dr. Grant’s article on “How to be a Good Moderator” is particularly insightful. Keep an eye out for more education content from the SIG at the next ASRA meeting.

Newsletter Committee

The Newsletter committee, led by Dr. Adam Jacob (Mayo Clinic), writes quarterly articles on a variety of topics in medical education that are distributed to members via email. These correspondences also help to keep members engaged in the SIG as well as updated on the SIG activities. The archives of the SIG newsletters can be accessed from the SIG website. A number of special articles have also been submitted to ASRA News. Some highlights include:

• A review of the different simulation models available for UGRA training by Drs. A. Taylor and G. McLeod (SIG Newsletter March 2018)
• A synopsis of 5 recent general medical-education publications relevant to UGRA education by Drs. M. Donnelly, L. Turbitt; S. Orebaugh, R. Nascimento, M. O'Rourke and A. Jacob (ASRA News Aug 2018);
• A summary and comparison of available assessment tools for neuraxial and peripheral nerve blocks by Dr. B. Allen (ASRA News Aug 2018);
• A pro-con article on whether or not we should train non-anesthesiologists to perform peripheral nerve blocks by Drs. M. Woo, P. Rose, R. Ramlogan, R. Nascimento (ASRA News Feb 2019). Also available as a podcast.
• A survey of curriculum design in regional anesthesia programs in the Unites States, by Drs. M. Donnelly and A. Jacob (ASRA News Nov 2019). Also available as a podcast.
• A survey of educators from four different United States anesthesia programs to understand how OSCEs are used in assessing regional anesthesia trainees by Dr. A. Jacob (ASRA News Feb 2020). Also available as a podcast.

Research Committee

The research committee, led by Dr. Alwin Chuan (University of New South Wales), endeavours to investigate and promote the science of teaching regional anesthesia. The committee has been involved in advising international researchers with their studies, as well as conducting our own original research. Dr. Chuan et al. (2018) have written a narrative review of competency-based assessment tools for regional anesthesia¹. Last year, the SIG collaborated with international experts to perform a Delphi survey of research priorities for regional anesthesia education². Simulation and curriculum themed research topics were the highest ranked priorities. These topics will aid in the planning of future SIG initiatives. The top five research priorities identified were:

1. What endpoints/milestones should be achieved on a simulator prior to clinical performance of UGRA? (Simulation)
2. Does simulation training show an improvement in clinical outcomes such as improved efficacy, time taken, and less errors? (Simulation)
3. Which RA blocks should be considered as a core minimum set for all trainees? Are there benefits in teaching a subset of blocks to competency vs broader exposure to all blocks? (Curriculum)
4. Is UGRA knowledge and technical skill generalizable: when does proficiency in one block type transfer to other blocks? (Knowledge translation)
5. Does a rotation through a “block room” provide better learning than programs without a block room? (Curriculum)

The SIG has also conducted an international collaborative randomized controlled trial to determine if UGRA novices with low visuo-spatial ability can improve UGRA proficiency to the level of high visuo-spatial ability novices, when provided with deliberate practice and structured feedback. The results are in, so look for the publication in the upcoming months.

Future Endeavours

The SIG research committee are currently working on a review article on UGRA training, to be published early next year. We are also in the planning stages of an international Delphi study to determine which peripheral nerve blocks should be prioritized in residency training. We would like to hear from you, our members, about what additional resources we can offer. Please send comments, suggestions, and thoughts on increasing member engagement to EDUinRA@ASRA.com.

How to Get Involved

A number of liaison terms have come to an end, and we are currently looking for new leads for the following positions: CME, Webcast/Podcast, Newsletter, and Vice Chair. Please send your CV and Letter of Intent to EDUInRA@ASRA.com. We would like to extend a heartfelt ‘Thank you’ to Drs. Brian Allen, Jaime Ortiz, Stuart Grant, and Adam Jacob for their hard work and contributions to the success of the SIG.

References

1. Chuan A, Wan AS, Royse CF, Forrest K. Competency-based assessment tools for regional anaesthesia: a narrative review. British Journal of Anaesthesia. 2018;120(2):264-273. doi:10.1016/j.bja.2017.09.007.
2. Chuan A, Ramlogan R. Research priorities in regional anaesthesia education and training: An international Delphi consensus survey. BMJ Open. 2019;9(6):e030376. doi:10.1136/bmjopen-2019-030376.

COVID-19 Pandemic: Is Sustainability the Answer to Personal Protective Equipment Shortages?

by Vivian Ip, MB, ChB, FRCA, Associate Clinical Professor, University of Alberta Hospital, Department of Anesthesia and Pain Medicine, Edmonton, Alberta, Canada; Timur Özelsel, MD, DESA, Associate Clinical Professor, University of Alberta Hospital, Department of Anesthesia and Pain Medicine, Edmonton, Alberta, Canada; Rakesh Sondekoppam, MBBS, MD, Associate Professor, Department of Anesthesia, University of Iowa Hospital, Iowa City; and Ban Tsui, MD, MSc, FRCPC, Professor, Stanford University School of Medicine, Department of Anesthesiology, Perioperative and Pain Medicine, Palo Alto. CA

Background

Clusters of atypical pneumonia of unknown origin were first described in Wuhan, China in December 2019, which were later found to be caused by a novel coronavirus transmitted to humans from exotic animals.^[1] However, the scale of the devastation was not realized until the mortality rate increased exponentially over a period of days in mainland China. This novel agent resulted in the institution of an unprecedented and strict lockdown of social and industrial activities. The rest of the world watched, and neighboring countries to China began to prepare for another epidemic, similar to Severe Acute Respiratory Syndrome caused by a coronavirus in 2003 (SARS-CoV-1). The explosive outbreak of the SARS-CoV-1 pandemic was curtailed in Asian countries following drastic measures including the closure of borders. Relative to SARS-CoV-1, the coronavirus disease that emerged in 2019 (COVID-19) is more contagious; therefore, the absolute death toll has been higher despite its presumed lower mortality rate. The medical system in the epicenter, Wuhan, was quickly overwhelmed and was required to ration personal protective equipment (PPE) in anticipation of potential shortages. PPE shortages ultimately created a situation where medical personnel were unable to take breaks for water, food or bathroom during an eight-hour shift as hospitals attempted to preserve employee hazmat suits. ^[2]

What is becoming clear is that without appropriate PPE, HCPs cannot operate safely in a “hot zone.” 

COVID-19 is associated with a spectrum of disease presentations, ranging from mild influenza-like-symptoms to respiratory failure requiring mechanical ventilation. The possibility of asymptomatic transmission based on several case reports as well as the rapid transmission rate in nursing homes ^[3],[4],[5] has led to a further increase in the use of PPE and has resulted in a further draining of resources. With globalization, especially when the initial outbreak coincided with the Lunar New Year where millions of people traveled nationally and internationally, COVID-19 has rapidly spread across the globe, leading the World Health Organization (WHO) to declare a global pandemic on March 11, 2020. The first confirmed COVID-19 case in the USA was on January 20, 2020, and 3 months later, the number had exploded to more than a million.

Global Shortages of Personal Protective Equipment

On March 3, 2020, the WHO warned against severe and mounting disruptions to the global supply of PPE, caused by rising demand, panic buying, hoarding, and misuse.^[6] Without appropriate PPE, healthcare providers (HCPs) working on the frontline are risk acquiring nosocomial infections and infecting others. The WHO has called on industry and governments to increase manufacturing by 40% to meet rising global demand. ^[6] Based on WHO modelling, an estimated 89 million medical masks are required for the COVID-19 response each month. For examination gloves, that figure is 76 million, while international demand for goggles stands at 1.6 million per month. ^[6] While the presumed mode of transmission is contact and droplet, barrier precautions such as gowns, gloves, surgical masks, and eye protection are recommended. However, in a hospital setting where the global recommendation of social distancing is usually impossible, continuous masking by patients and medical personnel has recently been recommended in the western hemisphere for a two-way protection given the potential of asymptomatic spread. This approach further drains the already overstretched supply of PPE. The more urgent situation has been accelerated by the increasing number of moribund patients and the lack of N95 respirators available for aerosol-generating medical procedures (AGMPs), such as intubation, bag-mask ventilation, non-invasive ventilation, or cardio-pulmonary compression. Each of these AGMPs have been shown to increase the risk of SARS transmission to HCPs. The most consistent association between AGMPs and HCP infection has been identified as tracheal intubation. ^[7] The situation seems dire, and global competition for PPE has resulted in demand far exceeding the available supply.

Sustainable Options

One of the solutions to overcome PPE shortages is to avoid the need for AGMPs. In this context, regional anesthesia and sedation may represent a very attractive alternative and may become the “new normal.”^[8] However, one must ensure that the sensory/motor block is appropriate for surgical anesthesia to prevent an urgent need for conversion to general anesthesia. Furthermore, level II PPE is still recommended even when avoiding AGMPs. This level of protection requires that HCPs don a surgical mask and barrier PPE while the patient also wears a surgical mask to prevent droplet transmission, with or without supplemental oxygen delivered beneath the mask.^[9]

An alternate solution is to adopt reusable options, and this has prompted the U.S. Food and Drug Administration (FDA) to approve reusable industrial elastomeric respirators and a decontamination system for single-use N95 respirators amid the COVID-19 pandemic.^[10],[11] It seems somewhat intriguing that not many reusable options for PPE were evaluated and approved by FDA prior to the COVID-19 pandemic. The notable advantage of reusable equipment, such as a powered air-purifying respirator (PAPR), is sustainability. With the current pandemic of unknown duration, sustainability will ensure HCPs protection while reducing the environmental burden. Reusable PPE options also offer robust protection with high-quality materials, whereas the disposable options are often of inferior quality and are worse for the environment. The only substantial advantage of disposable PPE is that cleaning/decontaminating is unnecessary. (Table 1) The significant increase in PPE utilization has generated a significant solid waste burden without a feasible path to recycling due to the uncertainties of virus transmission.

Table 1. Advantages and disadvantages of reusable and disposable personal protective equipment (PPE)

In Edmonton, Canada, the routine use of sterile, reusable, water-proof surgical gowns as normal attire in the operating room predates the pandemic. During the pandemic, these gowns are now laundered, without sterilization, for use as a component of HCPs PPE. Reusable goggles and face-shields are used and can be cleaned and decontaminated very easily. Some anesthesiologists use a cotton towel, which again is part of the normal supply in the operating room, as a neck-cover during AGMPs. Elastomeric respirators are also available and many anesthesiologists in Edmonton have been fit-tested on these devices to ensure that PPE remains available should our normal supply of N95 respirators become uncertain. The main disadvantage of reusable respirators are the challenges associated with removing this equipment (doffing) without self-contamination and the lack of validated mechanisms to ensure that devices are reliably cleaned following use. Therefore, the sudden need to generate evidence for safe performance of equipment in a timely manner is often challenging. This begs a question of whether there should be further investigations into sustainable equipment prior to an actual pandemic. What is becoming clear is that without appropriate PPE, HCPs cannot operate safely in a “hot zone.” ^[12]

Conclusion

In the last decade, there has been a shift toward disposable equipment and attire in the operating room that has been generated predominantly by external marketing forces. The environmental burden has further increased during this pandemic. Perhaps a lesson learned from this pandemic is that there is a need to take a closer look at the sustainability of our collective PPE. There is an incredible similarity between PPE supply amid the COVID-19 pandemic and climate change, where sustainability ensures the safety of humanity and should not be overlooked. There should not be a need for a pandemic to examine our shortfall in protecting the health and safety of both the HCP and our planet.

References

1. Kandola A. Coronavirus cause: Origin and how it spreads. https://www.medicalnewstoday.com/articles/coronavirus-causes (Accessed April 25, 2020)
2. Project HOPE. 2019 Novel Coronavirus Situation Report #1 – January 27, 2020 https://reliefweb.int/report/china/2019-novel-coronavirus-situation-report-1-january-27-2020 (Accessed April 25, 2020)
3. Kimaball A, Hatfield KM, Arons M et al. Asymptomatic and presymptomatic SARS-CoV-2 infections in residents of a long-term care skilled nursing facility-King County, Washington, March 2020. Morbidity and Mortality Weekly Report. 2020;69(3):377-381.
4. Rothe C, Schunk M, Sothmann P et al. Transmission of 2019-nCoV infection from an Asymptomatic contact in Germany. N Eng J Med 2020;382:10
5. Chang D, Xu H, Rebaza A et al. Protecting health-care workers from subclinical coronavirus infection. The Lancet Respiratory Medicine 2020, Feb 13 Doi:10.1016/S2213-2600(20)30066-7.
6. Chaib F. Shortage of personal protective equipment endangering health workers worldwide. WHO News release March 3 2010. https://www.who.int/news-room/detail/03-03-2020-shortage-of-personal-protective-equipment-endangering-health-workers-worldwide (Accessed on April 25, 2020)
7. Tran K, Cimon K, Severn M et al. Aerosol generating procedures and risk of transmission of acute respiratory infections to healthcare workers: a systematic review. PLoSone 2012;7(4):e35797.
8. Ip V, Ozelsel T, Sondekoppam R et al. COVID-19 pandemic: the 3 R’s (reuse, refine and replace) of personal protective equipment (PPE) sustainability. Can J Anesth 2020. Doi.10.1007/s12630-020-01674-9
9. Uppal V, Sondekoppam R, Lobo C et al. Practice recommendations on neuraxial anesthesia and peripheral nerve blocks during the COVID-19 pandemic. ASRA Newsletter May 2020.
10. Hinton D. US Food and Drug Administration approval of elastomeric respirator. https://www.fda.gov/media/135763/download (Accessed April 25, 2020)
11. US food and Drug Administration approval of decontamination system for single-use N95 respirator. http://www.fda.gov/media/136529/download (Accessed April 25, 2020)
12. Ip V, Ozelsel T, Sondekoppam et al. Coronavirus disease 2019 (COVID-19) pandemic: Greater protection for healthcare providers in the hospital ‘Hot zones’? Anesth Analg 2020. Doi: 10.1213/ANE.0000000000004880.

LGBTQA+ Special Interest Group

Hello! My name is Steven Ethier, and I am currently an acute pain and regional anesthesia fellow/soon-to-be faculty at the University of Wisconsin – Madison. This year, I helped create the LGBTQA Special Interest Group (SIG) for ASRA with the help of quite a few colleagues from around the country. Given that we are an incredibly new SIG, I wanted to take the time to introduce our mission, objectives, and some of the plans that this SIG has for the future.

Working together, we can identify disparities in care that patients experience due to their gender identity and sexual orientation

The reason for creating a SIG for LGBTQA members within ASRA is to create a formal community that addresses any current disparities that stem from sexual orientation, gender identity, and gender expression related to our field of practice. As we are constantly striving for equality, equity, and inclusivity, I believe it is important to work together in order to learn and grow effectively.

ASRA’s mission is to relieve the global burden of pain. To achieve such a feat, we must make an effort to connect with each and every person and empathize with their own particular burdens. Furthermore, this group will maintain the core values that ASRA upholds: integrity, innovation, inclusiveness, service, compassion, and wellness. One literature review demonstrated that 4% of Americans identify themselves as a part of the LGBT community and that this group is at increased risk of cardiovascular disease, substance abuse, and psychiatric illness. Health care providers need to work together and educate each other in order to decrease prejudice and discrimination as well as improve treatment approaches.^[1]

Many of us are likely aware of this information and are wondering what we can do to actually help the LGBTQA community. Working together, we can identify disparities in care that patients experience due to their gender identity and sexual orientation, create an inclusive and accepting environment for this sensitive issue, and work to identify pathways and provide education that might improve the care that we provide and the quality of life for our patients. In more specific terms, this SIG plans to research the benefits of regional anesthesia for gender affirming surgery, create a mentorship-type program for residents and medical students, create a lecture series from distinguished guest speakers, and brainstorm ways to promote equality in the perioperative setting.

Registration to this SIG is open (and free!!) and we are happily accepting applications! This is a SIG that welcomes all regardless of gender identity or sexual orientation. If you have any questions ideas or would like to become more involved in this SIG, please do not hesitate to contact me at the e-mail listed below. Thanks!

Contact Information

ASRA’s LGBTQA SIG website: https://members.asra.com/special-interest-groups/lgbtqa/

ASRA’s LGBTQA SIG e-mail: LGBTQASIG@asra.com

Reference

1. Hafeez H, Zeshan M, Tahir MA, Jahan N, Naveed S. Health Care Disparities Among Lesbian, Gay, Bisexual, and Transgender Youth: A Literature Review. Cureus. 2017;9(4):e1184. Published 2017 Apr 20. doi:10.7759/cureus.1184

Pain and SUD SIG Update

by Mercy A. Udoji, MD, CMQ, Assistant Professor, Emory University School of Medicine and Staff Physician, Atlanta VA Medical Center, and Sudheer Potru, DO, Director, Complex Pain and High-Risk Opioid Clinic, Atlanta VA Medical Center, and Assistant Professor, Department of Anesthesiology at Emory University School of Medicine in Atlanta, GA 

The ASRA Pain and SUD Special Interest Group was formed with the enthusiastic endorsement of ASRA leadership, when a group of attendees at the 2019 ASRA Spring Meeting shared their concerns about the increasing numbers of patients with opioid or other substance use disorders (SUDs) who present to the operating room or pain clinic settings. Our nation’s current opioid crisis is well-documented and the increased light shed on mental health has also revealed our health system’s current inadequacies in treating patients with several different substance use disorders.

This SIG is specifically directed at increasing the knowledge base and sharing clinical pearls and interests pertaining to treatment or management of substance use disorders

This SIG is specifically directed at increasing the knowledge base and sharing clinical pearls and interests pertaining to treatment or management of substance use disorders and is open to any ASRA member with interest in the intersection of acute pain, chronic pain, addiction medicine, and/or the education of anesthesia personnel regarding SUDs.

At the time of publication, we have one podcast on the member portion of the ASRA website discussing the steps to achieve addiction medicine board certification and details about acquiring an X-waiver to prescribe buprenorphine for opioid use disorder. The next anticipated podcast will be an interview with Dr. Michael Sprintz, a Houston-based triple-board-certified anesthesiologist, pain physician and addictionologist who himself battled substance abuse issues during his residency in anesthesiology.

In addition, our Pain/SUD SIG team actively collaborates with other societies to address substance abuse issues. For example, our webcast liaison Dr. Bisi Lane and our chair, Dr. Sudheer Potru, are currently representing ASRA as part of the new ASA/ASRA/ASAM Ad Hoc Working Group on Substance Use Disorders. This working group is tasked with assisting these organizations identify deficiencies in education and provide tools to teach anesthesiologists and pain physicians about clinical treatment of patients with SUDs. 

As we look ahead, we anticipate discussing the benefits and drawbacks of mandating X-waivers among pain medicine trainees, perioperative management of SUD patients, the approach to polysubstance use disorder in the pain clinic, and other areas of interest to our membership!

Ultrasonography in Pain Medicine SIG

Michele Curatolo, MD, PhD, Professor of Anesthesiology and Pain Medicine, University of Washington, Seattle, and Roderick J Finlayson, MD, FRCPC, Professor, Department of Anesthesia, McGill University, Montreal, Canada

The use of ultrasound guidance (US) for chronic pain procedures has witnessed enormous growth in the last decade. The SIG for Ultrasound in Pain Medicine is enthusiastically supporting the ASRA mission of advancing the field of pain medicine through education and training.  These efforts have been made possible thanks to the engagement of exceptional faculty and ASRA staff. This SIG and the training provided is of particular value given the limited opportunities to obtain structured training in US-guided pain procedures in fellowship programs.

The SIG for Ultrasound in Pain Medicine is enthusiastically supporting the ASRA mission of advancing the field of pain medicine through education and training. 

This SIG has made significant contributions to ASRA over the past year and have significant future plans.  The SIG has supported the organizing committee of the 2019 Fall Meeting. Several hands-on US workshops have been planned and were successfully conducted at the Fall Meeting. These workshops are well attended, confirming the great interest in this field and the strong need for training. Hands-on workshops are additionally organized for each spring in Chicago.

The SIG has supported the organization and conduct of the Pain and MSK Interventional Ultrasound Certification, which is held twice a year, in conjunction with the hands-on workshops.

Recent advancements have included improvements in the SIG’s website and launched the Ultrasonography in Pain Medicine SIG community as a component of the ASRA Connect online community. A highly appreciated service is the delivery of SIG newsletters that focus on topics related to US in pain medicine and may include descriptions of nerve blocks that are uncommonly performed or updates on available evidence and published literature relevant to US guidance in pain medicine.