Cite as: Provenzano D. President’s message: working for a better future. ASRA Pain Medicine News 2023;48. https://doi.org/10.52211/asra050123.001.

It is with great honor and with understanding of the high-level responsibility of the position that I ascend to be the 32 ^ndPresident of the American Society of Regional Anesthesia and Pain Medicine (ie, ASRA Pain Medicine). First, I will thank the ASRA Pain Medicine Board and Executive Directors, home office team, and many volunteers for all their efforts during the last 48 years. As we all know, the original American Society of Regional Anesthesia was founded in 1923 by Dr. Gaston Labat and his colleagues. Learn more about the history of ASRA Pain Medicine here.The society was then “re-founded” in 1975 by Drs. L. Donald Bridenbaugh, Harold Carron, Jordan Katz, P. Prithvi Raj, and Alon P. Winnie. Since 1975, ASRA Pain Medicine became the leader in all aspects of pain medicine (acute, transitional, and chronic pain) with a community of more than 11,000 professionals, including 5,000 paid members in 66 countries on six continents.

During the last two years, my dear friend and colleague, Dr. Samer Narouze, has been an exemplary leader for ASRA Pain Medicine, demonstrating a strong moral compass and a high degree of clinical, research, and academic integrity. I personally am truly grateful for his leadership, friendship, and passion for ASRA Pain Medicine. He has worked relentlessly for the society. Dr. Narouze led many projects, including advancement of science through multiple guidelines and the rebranding efforts of ASRA Pain Medicine with emphasis on all aspects of pain management. ¹ I fully embrace the vision of “a society wholly devoted to the management of the entire spectrum of pain in all its forms and phases of care” that is focused on collaborating, removing silos, and extending care beyond interventions.

My Journey at ASRA Pain Medicine

I became interested in the field of pain medicine in 1999 when I rotated on the acute pain service with Dr. Eugene Viscusi at Thomas Jefferson University. At that time, I was fascinated by how regional anesthetic techniques could be utilized to provide significant perioperative pain control following total joint replacement surgery. In addition, we worked on my first publication in regional anesthesia, which examined the safety and efficacy of the popliteal fossa nerve block for foot and ankle surgery.² Eventually, I switched from orthopedic surgery to anesthesiology to continue my journey in the field of pain medicine, which would eventually take me to ASRA Pain Medicine.

ASRA Pain Medicine has been my primary academic home for over 17 years, and through this extended journey filled with great mentors, I am ready for this position. I was first given the opportunity to teach at ASRA Pain Medicine through a Problem-Based Learning Discussion (PBLD) on peripheral catheters that was provided to me by Dr. Nirmala Abraham (2007) after recommendations and support from Drs. James Rathmell and Oscar de Leon Casasola. Then slowly, my academic career started to advance through many activities of ASRA Pain Medicine, including serving on the E-News Bulletin Committee (opportunity provided by Dr. Vincent Chan) with Drs. Colin McCartney and Edward Mariano, Research Committee (2010-2013), Newsletter Committee (Pain Medicine Lead 2011-2014), Continuing Medical Education Committee (2013-2015), vice-chair of the Neuromodulation Special Interest Group, chair of the Bonica Award Committee (2015-2021), Practice Management Committee (2017-2020), delegate to the American Medical Association (AMA) (2019-current), Board of Directors (2015-2019), and the Executive Committee (2019-current). I was also the 13^th Annual Pain Medicine Meeting program chair under Dr. Joseph Neal’s leadership in 2014. It was truly a joy to develop that meeting, and this was just at the time of the transition of ASRA Pain Medicine to self-management.

During this journey, I have met many great friends and been blessed with mentorship from so many individuals, including, but not limited to, Dr. Asokumar Buvanendran, Dr. Honorio Benzon, Dr. Vincent Chan, Dr. Oscar de Leon Casasola, Dr. Marc Huntoon, Dr. Joseph Neal, Dr. Samer Narouze, Dr. Eugene Viscusi, and Dr. Richard Rosenquist. This journey has brought so much happiness and fulfillment to my life. My goal is to continue to mentor individuals just as I was mentored and provide opportunity to all who want to contribute to ASRA Pain Medicine’s mission of relieving the global burden of pain and advancing the science and practice of regional anesthesia and pain medicine to improve patient outcomes through research, education, and advocacy.

Initiatives for the Next Two Years and Where I Want ASRA Pain Medicine to Go

Regional Anesthesia and Pain Medicine (RAPM) Journal

Dr. Brian Sites, who is leading the journal with his editorial board, will have my full support in growing and promoting the journal. Scientific dissemination is critical for the members of ASRA Pain Medicine and the field of pain management. With the advent of open access journals and increasing the number of journals in the pain space, it is critical that RAPM leads the way in providing ethical, evidence-based scientific research that can help inform clinicians and improve patient care.

The scientific journal was invented over 350 years ago, with the number of articles published and number of journals both growing at rates greater than 3%.³ Since the creation of journals, their primary functions have included registration, certification, dissemination, archiving, and more recently navigating. The field of publishing is constantly changing with the push for open access, publications that are live documents, and changes in peer review and social networking. Furthermore, there has been a rapid growth in mega-journals (ie, open access peer-reviewed journals that charge processing fees and publish greater than 2,000 articles per calendar year), which may shorten the lives of existing journals.⁴

As the landscape of publishing changes, we will continue to give Dr. Sites and the editorial team our full support. Furthermore, writing and research takes extensive time, and we need to ensure that the authors are valued throughout the submission process. I have no doubt Dr. Sites will lead the journal in the right direction. Recently some changes have been implemented that will improve the journal; Dr. Sites has invited Dr. Sam Eldabe to serve as the associate editor in chief for pain, and the ASRA Pain Medicine Board provided additional financial support for a new staff position, managing editor, to support the journal. The journal is our best way to disseminate research findings. Dr. Sites has five main goals:

1. Increasing the number of submissions of both randomized controlled studies and large outcome studies in both acute and chronic pain
2. Improving user experience with the submission process
3. Expanding internal resources to help authors with statistical analysis and data presentation
4. Expanding post-production author support
5. Developing special editions on such topics as epidemiology and prevention of the transition from acute to chronic pain.

Dr. Sites will have our full support on these initiatives. We will also continue to push guideline development. Please reach out to the ASRA Pain Medicine home office for assistance if you have any ideas for future guidelines, and information will be provided on the submission process. Current ideas being considered include radiation safety and recommendations for post-procedure physical therapy considerations.

The ultimate success of the journal will depend on collaboration between the RAPM team and ASRA Pain Medicine community. For the journal to flourish and prosper, it will require the community’s support through submissions, scholarly and thoughtful peer reviews, and journal promotion and advocacy. Together, we can help the journal prosper as a major source of scientific value that advances the field of pain medicine. 

Advocacy for the Field of Pain Management and Physicians

Significant challenges have recently increased pressures and stress on the field of pain management and healthcare providers associated with delivering care. Often these challenges have led to burnout, which has been highlighted in a recently published article examining prevalence of burnout in more than 1,000 subspecialty anesthesiologists. Forty-three percent of the responders met established burnout criteria with chronic pain physicians having significantly higher burnout scores than the other three groups of subspecialty (acute, pediatric and cardiac) anesthesiologists.⁵ Burnout has many causes, but clearly multiple factors play a role, including increases in administrative burden, workload, preauthorization demands, declining reimbursement, and loss of leadership control. We must address these systemic issues for the field and ASRA Pain Medicine members.

Although ASRA Pain Medicine’s primary mission was initially dedicated to research and education, a decision was made in 2015 to include a third pillar, advocacy. Much of this push for advocacy came under the guidance of Dr. Oscar de Leon-Casasola, who developed the Practice Management Committee, and Dr. Asokumar Buvanendran, who helped initiate ASRA Pain Medicine’s involvement in the AMA. In 2018, ASRA Pain Medicine applied and was seated in the Specialty and Service Society, and then in June 2022, ASRA Pain Medicine was officially seated in the AMA. ASRA Pain Medicine now has House of Medicine delegates (myself, along with Drs. Gary Schwartz and Richard Chou), Relative Value Scale Update Committee members (Drs. Trent Emerick and Matthew Thames), Current Procedural Terminology Committee members (Drs. Houman Danesh and David Flynn), and a Resident Section representative (Dr. Lee Tian). Partnering with the AMA will allow ASRA Pain Medicine to have influence on many factors that currently affect physicians, including reforming Medicare payments, fighting “scope creep,” fixing prior authorizations, reducing position burnout, and supporting telehealth.

In addition, it is critical that ASRA Pain Medicine remains a strong steward of the field by promoting clinically effective, safe, and economically viable treatments. Multiple concerns about overutilization and indiscriminate deployment of technologies expressed through government agencies have recently plagued the field. Examples of these concerns can be seen in the United States Department of Health and Human Services Office of Inspector General report on Medicare overpayment for neurostimulator implantation surgeries and the United States Food and Drug Administration (FDA) letter to physicians regarding the safety of spinal cord stimulation and the need to conduct a trial before an implant.^6,7

ASRA Pain Medicine will also continue to work with other societies and participate in multisociety efforts through such collaborations as the Multisociety Pain Workgroup (MPW).

Expanding ASRA Pain Medicine’s Reach

Although ASRA Pain Medicine has over 5,000 members there is still room for growth and additional inclusion with diversification of members. Currently, most of our members are anesthesiologists. However, as we all know, many specialties are involved in the practice of pain medicine, including physiatry, neurology, emergency room medicine, and surgical subspecialties. It is time to welcome these specialties, so we can all move forward in further advancing the specialty. To advance this initiative, the two fall meeting program chairs (Drs. Alexios G. Carayannopoulos and Dr. Christine Hunt) are physiatrists.

We also need to continue to work with our international colleagues. I plan to strengthen the relationship between our sister societies, including the European Society of Regional Anesthesia and Pain Therapy (ESRA) and the Latin American Society of Regional Anesthesia (LASRA). We will continue to foster relationships with the other regional anesthesia societies, the African Society for Regional Anesthesia (AFSRA) and the Asian & Oceanic Society of Regional Anaesthesia and Pain Medicine (AORSA). We also look forward to growing our relationship with the Egyptian Foundation for Interventional Pain Practice as a future model for international engagement.

Cultivating Relationships with Residents and Fellows

Resident and fellow education is clearly the future of pain medicine. ASRA Pain Medicine will continue to lead this process. We will continue to cultivate and emphasize our relationship with the Association of Pain Program Directors (APPD) and the newly formed Regional Anesthesia and Acute Pain Medicine Program Directors group. We also look forward to the leadership of Drs. Sayed Wahezi (faculty advisor, pain), Jamie Baratta (faculty advisor, regional), and Siyun Xie (Resident Section Committee chair) as they lead the resident section.

We will also continue to grow and support ASRA Pain Medicine Hot Topics, which have been led by Dr. Rene Przkora for chronic pain and Drs. Kristopher Schroeder and Jaime Baratta for acute pain and regional anesthesia. This has been a fantastic educational avenue for topics relevant to trainees, including optimizing medication management strategies, using interventional techniques, and understanding the business of pain medicine. At the 22nd Annual Pain Medicine Meeting this fall, we will have dedicated content for fellows for learning multidisciplinary pain medicine and the appropriate deployment of interventional techniques that have a sound evidence base.

Conclusion

In conclusion, the field of pain medicine is facing many challenges, including physician burnout, economic viability, reduction in patient access, and alterations in the publication of scientific articles. None of these challenges are insurmountable. With the strength of ASRA Pain Medicine, the enthusiasm of our volunteers, our journal, our position in the AMA, and our financial viability, which will be preserved, these challenges can be addressed and overcome. Our future is bright. I look forward to working with you during the next two years. We will continue to lead the way in the field and the entire spectrum of pain medicine (acute, transitional, and chronic).

References

1. Schroeder KM, Sites BD, Narouze S. ASRA Pain Medicine: an established society with an updated vision. Reg Anesth Pain Med 2021;46(12):1029-30. https://doi.org/10.1136/rapm-2021-103137
2. Provenzano DA, Viscusi ER, Adams Jr SB, et al. Safety and efficacy of the popliteal fossa nerve block when utilized for foot and ankle surgery. Foot Ankle Int 2002;23(5):394-9. https://doi.org/10.1177/107110070202300504
3. Rallison SP. What are Journals for? Ann R Coll Surg Engl 2015;97(2):89-91. https://doi.org/10.1308/003588414X14055925061397
4. Ioannidis JPA, Pezzullo AM, Boccia S. The rapid growth of mega-journals: threats and opportunities. JAMA  2023;329(15):1253-4. https://doi.org/10.1001/jama.2023.3212. 
5. Hyman SA, Card EB, De Leon-Casasola O, et al. Prevalence of burnout and its relationship to health status and social support in more than 1000 subspecialty anesthesiologists. Reg Anesth Pain Med 2021;46(5):381-7. https://doi.org/10.1136/rapm-2020-101520
6. Medicare overpaid $636 million for neurostimulator implantation surgeries. S. Department of Health and Human Services Office of the Inspector General. https://oig.hhs.gov/oas/reports/region1/11800500.asp. Published October 1, 2021. Accessed March 25, 2023.
7. Conduct a trial stimulation period before implanting a spinal cord stimulator (SCS) - letter to health care providers. S Food & Drug Administration Letters to Health Care Providers. https://www.fda.gov/medical-devices/letters-health-care-providers/conduct-trial-stimulation-period-implanting-spinal-cord-stimulator-scs-letter-health-care-providers. Published September 3, 2020. Accessed March 25, 2023.