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.

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