ASRA Pain Medicine Update

Brian F.S. Allen, MD, FASA, FASRA, was nominated by Mary Hargett. Dr. Allen is an associate professor in the Department of Anesthesiology at Vanderbilt University Medical Center (VUMC). Hargett notes that Dr. Allen, “In addition to his very active role in ASRA Pain Medicine for many years, is also the Secretary-Treasurer of the Regional Anesthesia Fellowship Directors Association (RAFDA) and is the person primarily responsible for the formalization of RAFDA. He is also involved in several educational initiatives, including the creation and continued editing of a question bank that is sent out weekly to North American fellowship directors and regional anesthesia fellows. Additionally, he is the person who crafted the ‘common application’ for fellowship candidates, which made things so much easier for candidates to apply to multiple programs.” You can learn more about Dr. Allen by reading his responses to the questions below. 

Do you consider yourself primarily a regional anesthesiologist, an acute pain practitioner, or a chronic pain specialist (or some combination of these)? What led you to choose this specialty?

I see myself as a perioperative physician as well as a regional acute pain medicine (RAPM) anesthesiologist, and sometimes an ambulatory and obstetric anesthesiologist. Essentially, I’d prefer not to be typecast. Regional anesthesiology appealed from the start of training because the applied anatomy aspect felt like a bridge between medical school and residency. I had phenomenal RAPM mentors early whose care revealed the clear benefits nerve blocks had on those patients receiving them. What trainee wouldn’t be smitten with the immediacy of regional anesthesia?

What do you like best about your job? What gets you excited about going to work?

The metaphor of anesthesiologist as shepherd has been central to how I see my role. The day of surgery is one of the most impactful days of a person’s life. What is routine for us in anesthesia is instead unknown and scary to those in our care. The challenge of building rapport and trust with a person and family on one of the most important days of their lives and shepherding them safely through is my favorite aspect of the job. Regional anesthesia creates more options to care for patients, while the perioperative medicine and acute pain models of care extend the reach of anesthesiology outside of the immediate operative period. Using our expertise as true perioperative physicians that care for patients throughout the preparation for surgery and the whole of recovery is where I see the future of our field.

How and when did you get involved with ASRA Pain Medicine?

From the first ASRA Pain Medicine meeting I attended during my residency, I was struck by the indisputably welcoming and collegial environment of the subspecialty. At that meeting in Toronto, I met my future fellowship program director and several future mentors.

Do you feel that your work with ASRA Pain Medicine has had an impact on your career and if so, how?

ASRA Pain Medicine has supported me through my own development, awarding me a scholarship to attend a Harvard Macy course on educational assessment, inviting me to teach at cadaver courses and spring meetings, and supporting the development of RAFDA. The staff and board of ASRA Pain Medicine have provided mentorship and sponsorship across several educational projects.

What leadership positions have you held in the field of regional anesthesia and pain medicine?

I’ve been the RAPM fellowship program director at VUMC for eight years. I’ve also served as acute pain service director and perioperative medicine rotation director at VUMC. I work with the ABA as a MOCA Minute committee member, with the American Society of Anesthesiologists as a committee member for the regional anesthesia education track, and as vice-chair of the RAPM abstract committee. I’m one of the founders of RAFDA and its current Secretary-Treasurer. I represent RAPM as a counselor to the Association of Anesthesiology Subspecialty Program Directors (AASPD). I’m also willing to join any other organization with an acronym—the more complicated, the better!

Is there anything you’d like to tell medical students or residents who are considering a career in anesthesia and/or pain medicine?

My pitch for anesthesiology is a variation of what I like best about the field. You have brief, intense connections with patients that require building trust quickly while caring for them on the most important days of their lives. The immediacy and intensity of this relationship is mirrored in the subspecialty of regional and acute pain, where your care may (or may not) set them on the right path in their recovery in a way that subsequently reverberates through their life.

What has been your proudest career moment? What other professional accomplishments would you like to highlight?

I’m proudest of the work I’ve done that directly continues to provide value to the RAPM community, such as adapting the fellowship common application and administering the distribution of a national, question-based fellowship curriculum annually via text/email to the majority of fellows at the majority of programs in the United States. and Canada. Getting a publication in the New England Journal of Medicine (albeit as 37^th author) was quite a thrill too.

In your opinion, what is the biggest challenge facing the field of regional anesthesia and pain medicine today?

The greatest risks faced by regional anesthesia and pain medicine are the same risks faced by anesthesiology in general: stagnation and drift. A narrow view of our scope of practice in acute pain is a path to complacency. Acute pain medicine is a natural route to true perioperative medicine. We are uniquely positioned among physicians to plan and assist with patients’ preparation for and recovery from surgery. We neglect this role as perioperative physicians at our own peril.

What do you enjoy doing outside of work and why?

My interests include work with Scouting America (formerly Boy Scouts of America) as a previous assistant cubmaster and current Pinewood derby chair, reading speculative fiction, mixing interesting cocktails, hammock camping, and playing boardgames with friends and family (no, not Catan).