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.

Join us as we discuss and provide expert insights into current events impacting our management of pain and substance use disorders. In this episode, host Shravani Durbhakula, MD, MPH, MBA, dives into critical current events and regulatory changes impacting the field of pain medicine and their implications for patient care. She interviews two guests at the forefront of pain medicine, substance use, and addiction: Dr. Antje M. Barreveld, MD, and  Dr. Sudheer Potru, DO, FASA, FASAM.

Dr. Barreveld serves as the Director of Education and Outreach, Co-Founder of Substance Use Services, and the Medical Director of Pain Management Services at Newton-Wellesley Hospital. She also holds a position as an Associate Professor of Anesthesiology at Tufts University School of Medicine and serves on the board of the American Academy of Pain Medicine. Dr. Potru is triple-board certified in anesthesiology, pain medicine, and addiction. He serves as the Director of the Complex Pain Clinic at the Atlanta VA Medical Center and as Assistant Professor at the Department of Anesthesiology at Emory University School of Medicine. 

Tune in to hear the latest on: 

• The FDA's Recent Approval of Over-the-Counter Naloxone: What does this mean for pain medicine providers and their patients? How will it impact the broader opioid crisis and overdose prevention efforts?
• New DEA Requirements for Prescribers of Controlled Substances: We'll unpack these new regulations and how to fulfill them. 
• The Alex Murdaugh Case's Medical Questions: Our guests will provide their expert insights on the complex intersections of pain, substance use, and legality as they emerge in high-profile cases like this one.

Innovative Harm Reduction Approaches, such as the Fentanyl Vaccine: How do these cutting-edge strategies fit into the broader landscape of pain management and addiction treatment?

In the second episode of our two-part conversation with Kathleen Holton, PhD, MPH, she expands on her work with food and chronic pain, taking a closer look at the nutritional supplements and dietary strategies that pain patients can use to manage their conditions. Tune in as she discusses common issues within the American diet and explores how weight, nutrient deficiencies, and dietary misconceptions have played a role in the rise of chronic pain conditions.

Join host Shravani Durbhakula, MD, MPH, MBA, and co-host Mustafa Broachwala, DO, for this episode of the Pain Matters Podcast as they continue their conversation with Dr. Holton about her research on the relationship between diet and pain perception. The three return to discuss practical approaches doctors and patients can take to mitigate inflammation and chronic pain symptoms.

Tune in to discover: 

• The science behind whole food dietary interventions
• Effective supplements for managing pain and inflammation
• How to combat nutrient deficiencies in pain patients
• Diet and weight education

Cochrane Library’s recently published article questioning the clinical benefit of spinal cord stimulation for low back pain has stirred controversy throughout the pain medicine community. In response to these findings, we sat down with neuromodulation specialists & Pain Medicine journal editorial board members,  Zachary McCormick, MD, and Nathaniel M. Schuster, MD, to offer our in-depth reaction and analysis of the March 2023 report. 

In this episode of the Pain Matters Podcast, host Shravani Durbhakula, MD, MPH, MBA, and co-host @Mustafa Broachwala, DO, are joined by Zachary McCormick, MD, Chief of Spine and Musculoskeletal Medicine at the University of Utah & Nathaniel M. Schuster, MD, Associate Clinical Director of the Center for Pain Medicine at UC San Diego. We are live in-person at AAPM’s 39th Annual Meeting in Fort Lauderdale, FL, to discuss the implications of the Cochrane Library’s spinal cord stimulation review and what it means for providers and patients. Additionally, David Caraway, MD, PhD, Chief Medical Officer of Nevro Corp., calls in to give his expert insight on the controversial inclusion and exclusion of certain studies and how this impacts the conclusions of the review. Lastly, we go to Vwaire Orhurhu MD, MPH, author of a widely-read letter to the editor published in JAMA in response to the Hara et al. study, which is critical to the Cochrane Library Review’s conclusions.

Tune in to discover:

• In-depth scientific analysis and reaction to the curious findings, generalizations, and omissions from the review
• How to interpret the Cochrane Library’s recent findings and what they actually might mean for clinical practice. 
• What this review means for patient care and the future of SCS in pain medicine 

Reference: 

Traeger AC, Gilbert SE, Harris IA, Maher CG. Spinal cord stimulation for low back pain. Cochrane Database of Systematic Reviews 2023, Issue 3. Art. No.: CD014789. DOI: 10.1002/14651858.CD014789.pub2. Accessed 29 March 2023.

Pain is invisible and highly subjective—for physicians, overcoming these barriers requires interpreting the signs of pain through a patient’s actions and words. This can be a delicate process, since the next step a provider takes to relieve a patient’s pain can have long-term effects on their outcome.

Exploring the nuances of patient advocacy, Stephanie Vanterpool, MD, FASA, MBA, Pain Medicine Specialist, Anesthesiologist, and Director of Comprehensive Pain Services at the University of Tennessee Medical Center, has dedicated her career towards strategically empowering patients to advocate for themselves and towards educating clinicians outside of pain medicine to advocate for their patients’ pain.

In this episode of the Pain Matters Podcast, host Shravani Durbhakula, MD, MPH, MBA, and co-host Mustafa Broachwala, DO, are joined by Stephanie Vanterpool, MD, FASA, MBA to discuss how physicians can empower patients by listening to their needs to identify effective pain treatments.

Tune in to discover:

• Approaches clinicians can take to be a better advocates for patients in pain
• What physicians can do to avoid medical gaslighting
• How to balance patient autonomy and evidence-based medicine
• How to address pain in different cultural contexts

References

1. Kennel J, Withers E, Parsons N, Woo H. Racial/Ethnic Disparities in Pain Treatment: Evidence From Oregon Emergency Medical Services Agencies. Med Care. 2019;57(12):924-929. doi:10.1097/MLR.0000000000001208
2. Todd KH, Samaroo N, Hoffman JR. Ethnicity as a risk factor for inadequate emergency department analgesia. JAMA. 1993;269(12):1537-1539.
3. Houghton IT, Aun CS, Gin T, Lau JT. Inter-ethnic differences in postoperative pethidine requirements. Anaesth Intensive Care. 1992;20(1):52-55. doi:10.1177/0310057X9202000110
4. Hollingshead, Nicole A et al. “The Pain Experience of Hispanic Americans: A Critical Literature Review and Conceptual Model.” The journal of pain vol. 17,5 (2016): 513-28. doi:10.1016/j.jpain.2015.10.022
5. Xu X, Luckett T, Lovell M, Phillips JL. Cultural factors affecting Chinese migrants' perceptions and responses to cancer pain and its pharmacological management: A convergent mixed-method study [published online ahead of print, 2022 Mar 24]. Palliat Support Care. 2022;1-9. doi:10.1017/S1478951522000360
6. Elhakim M, Dexter F, Pearson ACS. US critical access hospitals' listings of pain medicine physicians and other clinicians performing interventional pain procedures. J Clin Anesth. 2019;58:52-54. doi:10.1016/j.jclinane.2019.05.005
7. Eaton, Linda H et al. “Use of Self-management Interventions for Chronic Pain Management: A Comparison between Rural and Nonrural Residents.” Pain management nursing : official journal of the American Society of Pain Management Nurses vol. 19,1 (2018): 8-13. doi:10.1016/j.pmn.2017.09.004
8. Chen CH, Tang ST, Chen CH. Meta-analysis of cultural differences in Western and Asian patient-perceived barriers to managing cancer pain. Palliative Medicine. 2012;26(3):206-221. doi:10.1177/0269216311402711
9. Ng, Brandon W et al. “The influence of Latinx American identity on pain perception and treatment seeking.” Journal of pain research vol. 12 3025-3035. 8 Nov. 2019, doi:10.2147/JPR.S217866

The history of our medical institutions is fraught with racial prejudices that have shaped our understanding of pain in black patients, leading to unequal treatment across our healthcare system. Working to dismantle these disparities, Aderonke Pederson, MD, has dedicated her career to bridging the treatment gap. Her groundbreaking work addresses faults in our current system, increasing the quality and accessibility of care in communities that have historically been overlooked or exploited by medical institutions.

In honor of Black History Month, Pain Matters Podcast host Shravani Durbhakula, MD, MPH, MBA, and co-host Mustafa Broachwala, DO, are joined by Aderonke Pederson, MD, Assistant Professor of Psychiatry at Harvard Medical School and Director of Research Equity for the Clinical Trials Network and Institute at Massachusets General Hospital, to discuss the history of racial inequality in our healthcare systems and how we can overcome the prejudices that influence how doctors treat chronic pain.  

Tune in to discover:

• The history of racial exploitation in the U.S. healthcare system
• How racial biases impact the treatment of pain in black patients
• The implications of racial disparities on the black experience
• How physicians can address disparities in pain treatment

When we’re young, we often hear the phrase “you are what you eat.” While this is true, it doesn’t paint the full picture. Kathleen Holton, PhD, MPH, has dedicated her career to mapping the ways food can influence pain pathways in our bodies, studying the chemical processes behind physical pain and its psychiatric comorbidities. Her groundbreaking research on glutamate receptors has shown that a dietary approach may hold the answer, offering promising results for treating conditions such as fibromyalgia and migraines.

In this two-part episode of the Pain Matters Podcast, host Shravani Durbhakula, MD, MPH, MBA, and co-host Mustafa Broachwala, DO, are joined by Kathleen Holton, PhD, MPH, Associate Professor of Health Studies at American University, to discuss the science behind managing pain with diet and how these systems work within the body.

Tune in to discover:

• How food impacts the central nervous system response to pain
• Why changes in diet often relieve physical pain and psychiatric symptoms
• Chronic diseases that can benefit from a dietary approach
• The role of glutamate in pain processing

Exploring the boundaries of pain management, the Psychedelics and Health Research Initiative (PHRI) pursues groundbreaking research on the therapeutic potential of psychedelics for pain patients. By examining how these psychoactive compounds act at the intersection of pain, identity, and memory in our brains, Dr. Furnish’s work has challenged our understanding of pain mechanisms while paving the way for novel treatments that may offer effective long-lasting relief.

In this episode of the Pain Matters Podcast, host Shravani Durbhakula, MD, MPH, MBA, and co-host Mustafa Broachwala, DO, are joined by Associate Professor of Anesthesiology and the Medical Director of PHRI at UC San Diego Health, Timothy Furnish, MD, to discuss the background, mechanism of action, and potential efficacy of psychedelics for pain management and what they tell us about pain pathways in the brain. 

Tune in to discover:

• An overview of the history and background in medicine and culture
• How psychedelics influence pain pathways
• Psychotherapeutic practices in pain medicine
• Novel therapies and prospective clinical trials for phantom limb pain
• What psychedelics mean for the future of pain medicine

Working on the pandemic’s front lines, Soo Kim, MD, was part of the medical team at Johns Hopkins University that first identified and treated signs and symptoms of Long COVID and its chronic pain symptoms. Her groundbreaking involvement in one of the first Post-Acute COVID Syndrome (PACS) Clinics has since become the blueprint for how many physicians treat acute and chronic pain among Long COVID patients.

In this episode of the Pain Matters Podcast, host Shravani Durbhakula, MD, MPH, MBA, is joined by special guest host Mustafa Broachwala, DO, to interview the Director of Pain Medicine at Mt. Sinai Hospital, Soo Kim, MD, to discuss her contributions to Long COVID research and some of the novel therapies she’s developed and encountered to treat COVID-19-related pain.

Tune in to discover:

• How doctors first discovered the existence of Long COVID
• The science behind Long COVID-related pain syndromes
• Diagnostic tools for identifying certain Long COVID-related pain syndromes 
• Novel therapies to treat neuropathic and neuralgic pain in COVID-19 patients