ASRA Pain Medicine Update

Cite as: Oweidat A. Interview with the 2024 Gaston Labat Award Recipient: Dr. Christopher L. Wu . ASRA Pain Medicine News 2024;49. https://doi.org/10.52211/asra020124.007.

Adeeb Oweidat: You are recognized as an exceptional leader and researcher within the field of regional anesthesia and acute pain medicine. Can you outline your journey? What personal qualities or characteristics have been most important along the way, and how did you decide to focus on regional anesthesia?

Christopher L. Wu: Coming out of medical school, my intent was to pursue a career in private practice anesthesiology. After my case report was accepted for publication early in my CA-2 year at the University of Rochester, I started to assist faculty with some of their academic projects, which led to my decision to stay in Rochester to pursue a career in academic medicine. Subsequently, I moved to Johns Hopkins where I was able to establish myself as an expert on outcomes research in regional anesthesia and acute pain. My most recent move was to Hospital for Special Surgery (HSS)/Weill Cornell Medicine. Among my numerous roles there, I oversee efforts in clinical research in the department of anesthesiology at HSS.

I feel that my persistence, curiosity, creativity, and adaptability are the personal qualities that have been most important in my career. These characteristics have allowed me to overcome many obstacles as my career advanced. I focused on regional anesthesia and acute pain management when I started my career at the University of Rochester as this was the area of interest of my first mentor, Dr. Frederick Perkins. Fred is an outstanding clinician, who has an encyclopedic knowledge of regional anesthesia and acute pain literature. I could not have asked for a better first mentor and role model.

AO: Which individuals have been important to you as mentors, sponsors, or collaborators? What did they do that impacted you and your career?

CLW: Throughout my career (University of Rochester, Johns Hopkins, Hospital for Special Surgery/Weill Cornell), I have had a series of outstanding individual mentors, sponsors, and advisors. In addition, the ASRA Pain Medicine community has been a significant source of support throughout my career. There are numerous individuals who have contributed to my success, and I look forward to acknowledging them in my Labat lecture. My mentors and sponsors provided me with inspiration, counsel, and opportunities. The success I have had in my career is the result of their dedication and guidance.

AO: In your view, which aspects of your work have been most impactful to the clinical practice of regional anesthesia or anesthesia in general?

CLW: I feel that my outcomes research in regional anesthesia has had the greatest and lasting impact to the clinical practice of regional anesthesia. My research group was one of the first to utilize meta-analytic technique and database analysis to demonstrate the beneficial impact of regional anesthesia on patient outcomes and to publish these findings in high impact journals. The research I have led and been involved with has helped clinicians, policymakers, and administrators demonstrate the clear benefits of regional anesthesia and analgesia in the perioperative period. More recently, I attempted to impact our practice and research of regional anesthesia with thought pieces on the use of regional anesthesia in space and the benefits of regional anesthesia in preventing greenhouse gases.

AO: With the perspective of time, which of your studies has had the most impact?

CLW: I would have to say that my JAMA meta-analysis¹ showing that epidural analgesia regardless of analgesic agent, location of catheter placement, and type and time of pain assessment provided better postoperative analgesia compared with parenteral opioids has had the greatest impact. At that time, there was still uncertainty about the analgesic benefits of epidural analgesia and a fair amount of resistance to using perioperative epidural analgesia. I undertook this meta-analysis in part to provide my colleagues with an article that they could present to others (eg, surgeons, administrators, policymakers, and insurers) demonstrating the analgesic benefits of perioperative epidural analgesia. With that being said, I still hold out hope that the concepts laid out in my articles on gene therapy for pain management^2,3 will ultimately come to fruition. Just imagine if our chronic pain patients could take a pill (possibly containing antisense targeted at nociceptive receptors or messengers) that would take away all if not most of their pain. The societal and individual benefits would be incredible.

AO: How do you define success?

CLW: Although there are many ways to define success, I feel that my academic success is rooted in my research, teaching, mentoring, and service where I have been able to make a meaningful and hopefully long-lasting contribution to our specialty. I am especially thankful that during this journey, I have been able to inspire and help elevate others around me with my success.

AO: What has been your most rewarding accomplishment?

CLW: The most rewarding accomplishment in my career has been the success of my numerous mentees, many of whom have become well recognized academicians and mentors in their own right. I have had many outstanding mentors, and when I have thanked them for their time and effort, their response invariably is to “pass it on.” Gratefully, I have had the opportunity to do so.

AO: What drives your professional curiosity?

CLW: Very early in my career, the relative gaps in my knowledge drove my curiosity, leading to my asking clinical and research questions of why one option (eg, regional anesthesia) might be preferable over another particularly for individual patients. With time, my interests have broadened to examine clinical and research questions of how we might affect care of larger populations. Ultimately, my professional curiosity is driven by my desire to improve the care of our patients. Most importantly, professional curiosity means that you are honest with yourself about your biases as the results of your study may be completely opposite of what you expected to find. Rather than be disappointed, view this as an opportunity to explore why this was the case.

AO: Can you describe one or more of the most difficult challenges in your career and how you overcame it or them?

CLW: Actually, one of the more difficult challenges in my career occurred only recently. Approximately 6 years ago, I moved from Johns Hopkins Hospital to Hospital for Special Surgery (affiliated with Weill Cornell) where more than 32,000 surgical procedures are performed annually with the vast majority performed under regional anesthesia alone. In essence, I went from a quaternary academic medical center where I only supervised trainees and did not deliver a solo anesthetic for over 20 years to the top ranked orthopedic hospital where I deliver solo anesthesia frequently, and my regional anesthetics need to work close to 100% of the time. Even though I had achieved quite a bit academically and was very high in the hierarchy at Hopkins, my mindset and approach were that in some ways, I was starting over at an entry level position in my new department and needed to re-establish myself. I am indebted to my colleagues at Hospital for Special Surgery and Weill Cornell Medicine, who have welcomed and supported me during this successful transition.

AO: As you look back, has there been a defining moment in your career? If so, can you describe it?

CLW: Although there are many defining moments in my career and certainly being the recipient of the Gaston Labat Award is a pinnacle in anyone’s career, the defining moment in my career was when Dr. Denise Wedel kindly invited me to give my first podium lecture on regional anesthesia and outcomes at the spring ASRA Pain Medicine meeting. This was my first lecture at the national level and provided much needed exposure early in my career. This also coincided with an “inflection point” in my career where I felt the trajectory of my academic career subsequently progressed at a much higher rate with more opportunitiesbeing offered to me.

AO: Where do you see the most potential for future research in regional anesthesia? Which questions may be most influential to future practice?

CLW: My Labat lecture and accompanying manuscript will address what I believe will provide the most potential for future research in regional anesthesia. Certainly novel regional techniques or medications may be part of the future of regional anesthesia; however, I believe the most significant impact that regional anesthesia may have on the practice of medicine is if we study the benefits of regional anesthesia on large trends (eg, underutilization of regional anesthesia/disparities in care, increase in worldwide surgical volume/regional anesthesia in resource-limited settings, continued growth of the geriatric population with concurrent multimorbidity, and climate change) thus maximizing the potential impact of regional anesthesia. In terms of outcomes, I also believe we need to stop thinking about regional anesthesia-analgesia as a unimodal intervention but more as part of a multimodal package to influence patient outcomes. An example of this is the use of regional anesthesia-analgesia as an integral part of enhanced recovery pathways, which have been shown to decrease perioperative morbidity and length of hospital stay.

AO: How much data do you believe is required before new techniques or technologies should be widely adopted?

CLW: I typically am not one of the first adopters of a new technique or technology. I applaud and admire colleagues who continue to innovate in these areas. Once a few large-scale observational studies or well done randomized controlled trials have been published, I am willing to incorporate novel approaches in my own practice. It would take a significant amount of peer reviewed literature for a new technique or technology to be widely adopted (eg, as part of a guideline).

AO: Do you have advice to offer current trainees or early career professionals who seek to do research in regional anesthesia?

CLW: What I have noticed in mentoring and discussing research with current trainees or early career professionals who seek to do research in regional anesthesia is that they often tend to be almost hyper focused on studying a specific block or additive. Although it is difficult to do in the current environment where academic time is limited due to increasing clinical commitments, I do believe it is important for early career professionals who seek a long-term career in research in regional anesthesia to take time to broaden their viewpoint by understanding the literature, discussing research ideas with senior colleagues, and taking time to determine where gaps may be in the literature.

AO: How has your involvement in ASRA Pain Medicine contributed to your success, and how has your relationship with ASRA Pain Medicine evolved over time?

CLW: ASRA Pain Medicine has been an integral part of my success. Many individual members of ASRA Pain Medicine have generously provided guidance/mentorship and have been crucial to my achievements. The society has been and continues to be very welcoming for and supportive of junior faculty. I have been fortunate to have been involved with many ASRA Pain Medicine committees early on and subsequently served on the board of directors and ran one of the spring annual meetings. Currently, most of my efforts are focused on Regional Anesthesia & Pain Medicine, the official publication of ASRA Pain Medicine where I serve as one of the executive editors.

AO: How much of your success would you attribute to hard work, and how much would you attribute to luck or other factors?

CLW: As Samuel Goldwyn said, “The harder I work, the luckier I get.” Certainly, the success I have enjoyed can be attributed to a bit of both as the harder one works, the more chances or opportunities will present themselves. However, behind every success is often years of hard work, trial and error, and failures.

AO: What do you love about your job?

CLW: Although I do enjoy my research and academic pursuits, the one aspect about my job that provides immense joy is the clinical challenge of delivering an outstanding regional anesthetic for my orthopedic patients and surgeons. For instance, I often provide regional anesthesia alone (with IV sedation) for many total shoulder replacement surgeries. Only 0.83% of cases in the United States receive regional anesthesia as the primary anesthetic.⁴ It is incredibly satisfying to me for a patient to wake up at the end of a total shoulder replacement surgery totally pain free, happy, and able to be discharged to home within one or two hours after arriving in the PACU. The total shoulder replacement patients who stay overnight are invariably also very happy with their anesthetic experience when I see them the next morning.

AO: Last, is there anything else that you would like to share about yourself or your career for our readers?

CLW: At this point in my career, I receive immense satisfaction from mentoring trainees and junior faculty. Fortunately at HSS, we have not only our own regional anesthesia fellows but also anesthesiology residents from Weill Cornell, Johns Hopkins, Georgetown, Columbia, and UCSF. Even though I might only work with these trainees only a few times during their time at HSS, I have been able to help them clarify their career goals and find possible paths to achieve those goals. In addition, I have a network of informal mentees, nationally and internationally, who can contact me any time they need advice or mentorship. I highly encourage those who are in a position to mentor to make it an integral part of their careers as it is incredibly fulfilling although one needs to recognize that there may be occasional disappointments (eg, difficulty in transitioning from being a mentee to being a mentor, mentees overlooking your contributions to their career success). Mentoring will enhance how one views his/her academic career and is something that can continue long after one decides not to continue clinical work.

References

1. Block BM, Liu SS, Rowlingson AJ, et al. Efficacy of postoperative epidural analgesia: a meta-analysis. JAMA 2003;290(18):2455-63. https://doi.org/1001/jama.290.18.2455
2. Wu CL, Garry MG, Zollo RA, et al. Gene therapy for the management of pain. Anesthesiology2001;94:1119-32.
3. Wu CL, Garry MG, Zollo RA, et al. Gene therapy for the management of pain. Anesthesiology2001;95:216-40.
4. Gabriel RA, Nagrebetsky A, Kaye AD, et al. The patterns of utilization of interscalene nerve blocks for total shoulder arthroplasty. Anesth Analg 2016;123(3):758-61. https://doi.org/10.1213/ANE.0000000000001472