Pain Matters Podcast Network

Join us for an enlightening episode of the Pain Matters Podcast, where we dive deep into the world of medical cannabis and its implications for pain management. 

Hosts Shravani Durbhakula, MD, MPH, MBA, and Mustafa Broachwala, DO, are joined by Mark Steven Wallace, MD, a Pain Management Specialist and Professor of Anesthesiology at UC San Diego Health, who brings more than two decades of experience in cannabis research.

In this episode, you’ll discover: 

• Biologics of Cannabis: Dr. Wallace dives deep into the pathophysiologic mechanism at play regarding endocannabinoid receptors and the mechanism of actions of cannabis in the body, especially as it relates to pain.
• Medical Cannabis vs. Opioids: Dr. Wallace shares his observations on the lack of tolerance development in patients using medical marijuana compared to traditional opioids.
• Regulatory and Dosage Challenges: Insights into the complexities of prescribing and dosing medical marijuana, and how these factors impact patient care.
• Therapeutic Potential: Discussion on the conditions that respond well to medical cannabis based on current research and clinical experience.
• Patient Stories and Outcomes: Real-world examples of how medical cannabis has impacted patients' lives, particularly in managing chronic pain.
• Future of Cannabis in Medicine: Dr. Wallace's thoughts on the evolving landscape of medical cannabis research and its future potential in healthcare going forward.

This episode is a must-listen for healthcare providers interested in understanding the nuanced role of cannabis in pain management and those looking to integrate evidence-based cannabinoid therapies into their practice.

Be sure to subscribe so you don’t miss Part 2 of this nuanced discussion and to find out what’s next for medical cannabis in pain medicine. 

Join us for Part 2 of our engaging series on the necessary reforms in pain medicine training as we explore potential changes that could significantly enhance the quality and effectiveness of pain medicine education.

Hosts Shravani Durbhakula, MD, MPH, MBA, and Mustafa Broachwala, DO are joined once again by esteemed experts Scott Gregory Pritzlaff, MD, Associate Professor and Pain Medicine Fellowship Director at UC Davis Health, and Sayed Emal Wahezi, MD, Professor and Pain Medicine Fellowship Director at Montefiore Medical Center, to delve deeper into the structural adjustments and implications of extending training periods in pain medicine.

Tune in to hear:

• Structural Changes and Educational Enhancements: Discussing the risks & benefits of: extending fellowship duration,  truncating baseline specialty training years, creating a pain residency, re-establishing graduation case numbers, and more. How do we make training comprehensive and attract a more dedicated cohort of trainees?
• Diversity and Accessibility: Examining how changes in training duration might impact the diversity of applicants and accessibility of pain medicine as a specialty.
• Mentorship and Peer Learning: Highlighting the importance of mentorship and peer learning that changes in training could facilitate, enhancing both professional growth and patient care.
• Controversies and Challenges: Addressing the potential challenges and controversies associated with implementing longer training periods, such as funding, accreditation, and acceptance within the broader medical community.
• The Need for Collaboration: Discussing the need for a unified voice in pain medicine and collaboration across specialities and societies to achieve mutual advocacy goals & better training. 

This episode is critical for educators, trainees, and healthcare policymakers interested in understanding and shaping the future of pain medicine training.

Join us in a critical discussion on the urgent need for reform in pain medicine training programs. 

In this enlightening episode of the Pain Matters Podcast, hosts Shravani Durbhakula, MD, MPH, MBA, and Mustafa Broachwala, DO, engage with experienced pain medicine program directors to delve deep into the current state, gaps, and proposed changes surrounding pain medicine fellowships.

Tune in as we’re joined by Scott Gregory Pritzlaff, MD, Associate Professor and Pain Medicine Fellowship Director at UC Davis Health, and Sayed E. Wahezi, MD, Professor and Pain Medicine Fellowship Director at Montefiore Medical Center as well as a board member of the Association of Pain Program Directors, to share unique insights into the complexities of pain medicine training.

In this episode, you'll hear about:

• The Current State of Pain Medicine Training: Insights into the existing structure of pain medicine training programs and their limitations.
• Challenges with Fellowship Durations: A detailed discussion on the implications of the current short durations of fellowships and how they may not adequately prepare physicians for the complexities of pain management.
• Interdisciplinary Education: The importance of integrating diverse medical disciplines within pain medicine training to enhance understanding and patient care.
• Potential Reforms: Proposals for extending fellowship durations and making pain medicine training more comprehensive and interdisciplinary.

This discussion is essential for anyone involved in medical education, particularly those in pain medicine, who seeks to understand the future directions of training that could better prepare physicians for the evolving challenges in patient care.

Please subscribe and turn on notifications to ensure you don’t miss part 2 of our Pain Medicine Training discussion. 

• Overview of the FTC's Decision: What the FTC's ban on non-competes means in practice, and why it's not yet enforceable.
• Exceptions and Challenges: Discussion on specific exceptions to the rule, like the carveout for senior executives and how this might affect non-profit and for-profit healthcare entities differently.
• Implications for Physicians: How the ruling could change the dynamics of physician practice models, mobility, and employment negotiations
• Legal and Economic Perspectives: Insight into the broader economic and legal debates surrounding non-compete clauses and their enforceability.
• Future of Physician Employment: Speculations on how this could lead to greater autonomy, innovation, and potential shifts in the healthcare employment landscape.

Join us for a riveting exploration into the rapidly evolving world of artificial intelligence (AI) in interdisciplinary pain medicine. This episode of the Pain Matters Podcast features a thought-provoking discussion on the transformative potential of AI and the ethical challenges it introduces.

Hosts Shravani Durbhakula, MD, MPH, MBA, and Mustafa Broachwala, DO, are joined by two distinguished experts:

• Tinglong Dai, PhD, a Bernard T. Ferrari Professor at Johns Hopkins Carey Business School, co-chair of the Johns Hopkins Workgroup on AI and Healthcare, and a leading voice in the integration of AI within clinical settings. Dr. Dai's extensive media presence and recognition as one of the World's Best 40 Under 40 Business School Professors by Poets & Quants underline his profound impact on AI education and application.
• Nestoras Mathioudakis, M.D., M.H.S., an Associate Professor of Medicine at Johns Hopkins School of Medicine, where his work focuses on medical applications of generative AI. As Co-Director of the Diabetes Prevention & Education Program and a seasoned educator in clinical informatics, Dr. Mathioudakis brings critical insights into the practical and ethical dimensions of AI in medicine.

Tune in to discover:

• AI's Impact on Clinical Practices: Exploring how AI is currently being used to enhance clinical documentation, streamline insurance processes, and support decision-making in patient care.
• Ethical Considerations and Challenges: Discussing the complexities of data integrity, the potential biases in AI algorithms, and the ethical implications of AI in clinical decision support.
• The Future of AI in Medicine: Speculating on the future directions of AI in healthcare, including its role in personalized medicine and the ongoing need for rigorous validation and ethical oversight.
• Real-World Applications and Case Studies: Analyzing specific instances of AI application in healthcare, such as diagnostic support and predictive analytics, and evaluating their outcomes.
• Navigating the Regulatory Landscape: Understanding the implications of recent legal and regulatory developments affecting AI in healthcare.

Find out how AI is reshaping healthcare delivery, enhancing patient outcomes, and posing new questions about the intersection of technology and medical ethics. 

This discussion is crucial for healthcare providers looking to stay informed about the latest developments in AI and its impact on the field of pain medicine.

Join us for a comprehensive exploration into the advocacy and personal dedication that shapes the world of pain medicine. 

In this episode, our discussion hones in on a critical juncture in pain medicine — the anticipation of the Washington Health Technology Clinical Committee's (HTCC) decision on Spinal Cord Stimulation (SCS) coverage. This decision could transform the landscape of pain management for state employees, state-sponsored health plans, and injured workers under Washington Labor and Industries (L&I), reaching over 2.5 million people.

Hosts Shravani Durbhakula, MD, MPH, MBA, and Mustafa Broachwala, DO, are joined by a distinguished panel of guests: Brett R. Stacey, MD, from UW Medicine; and Steven Stanos, DO, and Fangfang Xing, MD, from Swedish Pain Services–all of whom were integral leaders as part of the Washington State Physicians State Spinal Cord Stimulation (SCS) Work Group. We also welcome Richard North, MD, from Johns Hopkins School of Medicine–a pioneer in the field of pain medicine and a historic advocate as it relates to neuromodulation and previous hearings regarding SCS in Washington State. Together, we’ll dive deep into the nuances and state of current and historic healthcare policies, the heroic advocacy work of the Washington State Physicians SCS Work Group, and the broader implications of the impending HTCC decision for providers and patients alike.

In this episode, you'll learn:

• Historical Context: Context of the history of healthcare policy surrounding SCS in Washington State
• The Vital Role of the Washington State Physician SCS Work Group: A deep dive into the group's efforts and the importance of their advocacy in shaping healthcare policy for pain management in Washington state.
• Understanding the HTCC's Influence and Approach: A breakdown of the Washington HTCC's process, authority, and its critical role in determining the future of SCS coverage.
• Navigating Healthcare Policy in Washington: Insights into the state's healthcare coverage, including the unique aspects of its approach to technology and treatment coverage for a significant portion of its citizens.
• Journey to the HTCC Decision: The key milestones and advocacy efforts that have led to this momentous opportunity to influence pain treatment coverage.
• Implications for Pain Medicine Providers and Patients: Discussing what the HTCC's decision means for the community of pain medicine providers and the patients they serve. We also highlight the AAPM's support for the SCS coverage movement, emphasizing the potential positive impact on patient care and pain management practices.

Tune in and stay informed, get involved, and understand the profound implications of these decisions on the quality of life for countless individuals.

Remember, your involvement and awareness as a pain medicine provider contribute to the advancement and betterment of patient care across the nation.

Note: At the 47:45 mark, we reference that the upcoming hearing is in January of 2024. While this was accurate at the time of the recording, this hearing has been pushed back. The final decision about coverage terms will occur after a meeting on  February 16, 2024.

On this episode of the Pain Matters Podcast, we turn our attention to a Viewpoint article published in JAMA on December 18, 2023 entitled “Corporate Influences on Science and Health—the Case of Spinal Cord Stimulation”. Written by the same lead author of the widely criticized Cochrane Review of Spinal Cord Stimulation (SCS) for Low Back Pain, this recent article blames all physicians who defend SCS for having corporate interests and suggests that no research in any specialty should be influenced by industry.

Hosts Shravani Durbhakula, MD, MPH, MBA, and Mustafa Broachwala, DO, sit down with Nathaniel M. Schuster, MD, from UC San Diego Health. All are authors to responses in Pain Medicine to the Cochrane Review by Traeger et al. –see Pain Matters Episode 21 and articles PMID: 37067491 & PMID: 37195450 by Durbhakula et al. This episode responds to the questionable allegations made by Traeger et al., questioning the integrity of all SCS research and the pain physicians who utilize SCS for patients. We do a fact-check on the JAMA article and take a deep dive into understanding the true nature of corporate influences on SCS.

In this episode, you'll gain insights into:

• Critiquing Corporate Influence: Dr. Schuster and our hosts examine corporate influence in pain medicine research, particularly in the context of SCS treatments for low back pain.
• False Dichotomies in SCS Research: The false dichotomy that physician-scientists who may engage with industry at any level cannot be industry-independent when speaking on the subject of SCS.
• Physician Scientist Integrity: False accusations, including that ALL physicians who responded to the Cochrane Review by Traeger et al,. were influenced by industry.
• Publishing SCS Research: The by Traeger et al. that academic journals should never publish anything with industry ties – in SCS or any field of medicine.
• Reality of SCS Funding: Understanding the intricacies of device research funding as well as the limitations of funding outside of industry (e.g., government funding) and contextualizing the paucity of placebo- or sham-controlled studies.
• Ethics in Academic Societies: Clarifying the policies surrounding conflicts of interest amongst academic societies.
• Debunking Hara et al.: Understanding the methodologic flaws of the Hara et al. study of SCS for Chronic Radicular Pain After Lumbar Spine Surgery.

Listen in as we navigate these complex waters, aiming to provide a balanced perspective on the interplay between industry funding, scientific research, and clinical practice in pain medicine. 

This episode is a must-listen for anyone looking to understand the multifaceted nature of pain medicine in today's healthcare landscape.

CORRECTION (11:10-11:50): SCS for FDA requires a premarket approval (PMA). There is no need for clinical data if it is possible to prove equivalence. For external powered devices where RF is the predicate device, FDA 510k pathway is required.

Recorded during the 2023 AAPM Annual Meeting, Shravani Durbhakula, MD, MPH, MBA, and co-host Mustafa Broachwala, DO, navigate this multifaceted topic alongside two esteemed guests: Dan Brounstein, Chief Strategy Officer with Saluda Medical, and Yele Aluko, MD, MBA, Ernst & Young  Americas Chief Medical Officer.

In this episode, we explore:

• Industry Collaboration: A deep dive into the history and current state of the relationships between pain clinicians and the industry, and what firewalls to remain ethical
• Clinician Transparency: Discussion around potential conflicts of interest and the call for transparency in disclosures not just as conferences but on social media and modern platforms.
• The Clinician's Value: Understanding why physician input is essential for industry to cater to real-world clinical needs, and how clinicians can contribute ethically.
• Patient-Centric Outcomes: How does this relationship directly impact patients, and what does it mean for their care and well-being?
• Challenges on the Horizon: How does industry navigate artificial intelligence in healthcare, cybersecurity, and diversity in clinical trials? 

Join us as we delve deep into the pivotal March 18, 2023 local coverage determination (LCD) that has shaken the pain medicine community by limiting access to sacral lateral branch radiofrequency ablation and imposing stringent documentation requirements to demonstrate the medical necessity for sacroiliac (SI) joint injections.

In this episode, host Dr. Shravani Durbhakula, MD, MPH, MBA, and co-host Dr. Mustafa Broachwala, DO, tackle the contentious LCD that threatens to restrict options for patients suffering from chronic SI joint pain and their dedicated doctors. To shed light on this vital issue, they're joined by Zachary L. McCormick, MD, Chief of Spine and Musculoskeletal Medicine at the University of Utah School of Medicine and Deputy Editor-in-Chief for AAPM’s journal, Pain Medicine;  Lynn Kohan, MD, Chief of Pain Medicine and Fellowship Director at the University of Virginia School of Medicine; and Steven Cohen, MD, the Chief of Pain Medicine at Johns Hopkins School of Medicine and Senior Executive Editor for Pain Medicine.

All guests come with a wealth of experience and insight, having been at the forefront in addressing the ramifications of this LCD.

Join host Shravani Durbhakula, MD, MPH, MBA, and co-host Mustafa Broachwala, DO, as they discuss a rising, yet often overlooked, issue - workplace violence in healthcare settings, particularly in pain management.

Our featured guest for this episode is Mercy Udoji, MD, CMQ, FASA, pain physician and associate professor at Emory University School of Medicine, and a renowned expert on workplace violence in the medical field. She is the senior author of the 2023 article, "Violence in the Pain Clinic, the Hidden Pandemic". This seminal piece of work shines a light on the escalating incidences of workplace violence against healthcare workers, which has markedly intensified since the onset of the COVID-19 pandemic. It also underscores the particular susceptibility of pain clinicians to workplace violence. Lastly, Dr. Udoji discusses strategies to prevent such situations and action we can take when they arise.

We also welcome W. Michael Hooten, M.D., from the Mayo Clinic to share astonishing results from a recent workplace violence survey conducted by AAPM wherein more than 80% of respondents noted they had called security in their practice for a workplace disturbance in the past year. 

Tune in to discover:

• Vulnerability of Pain Clinicians: Why are people who treat pain patients particularly susceptible to violence, and how has the pandemic exacerbated this problem?
• The Connection between Patient and Worker Safety: It's a given that healthcare systems prioritize patient safety and outcomes, but does the same attention extend to worker safety?
• Risk Factors: What are the key risk factors that predispose healthcare settings, and especially pain providers, to episodes of violence?
• Predicting Violent Behavior: How can we identify signs of impending violent behavior in the clinic, and what can be done to prevent or mitigate such situations?
• Training Gap: We'll discuss the conspicuous lack of training around workplace violence for pain medicine practitioners.
• Tips for Safety: Dr. Udoji will share practical advice on what to do if you are confronted with a violent situation in your clinic.

Listen now for this critical conversation as we aim to shed light on workplace violence and explore preventive strategies to safeguard ourselves and our peers better.