RAPM Focus

• Episode 40: Hidden Influence? Unmasking Conflicts of Interest from Randomized Clinical Trials on Spinal Cord Stimulation for Chronic Pain

  In this episode of RAPM Focus, Editor-in-Chief Brian Sites, MD, speaks with RAPM Editor Ryan D’Souza, MD, and Nasir Hussain, MD, following the October 2024 publication of “Hidden Influence? Unmasking Conflicts of Interest from Randomized Clinical Trials on Spinal Cord Stimulation for Chronic Pain.” Let’s set the stage first. Spinal cord stimulation, or SCS, is a therapy that involves implanting a device that sends electrical signals to the spinal cord, aiming to disrupt pain signals before they reach the brain. It’s a rapidly evolving field with a lot of promise, but it also attracts substantial investment from medical device companies. Now, when we talk about conflicts of interest, or COIs, we’re referring to situations where a researcher’s personal interests, particularly financial ones, have the potential to cloud their professional judgment and influence the outcomes of their research. Think of it this way: if a researcher is financially tied to a company that makes a specific SCS device, might they be more inclined to see their research results in a favorable light? That’s the concern. Dr. Ryan D’Souza is an associate professor and pain medicine physician at Mayo Clinic. He is the Director of Neuromodulation, and Director of the Inpatient Pain Service. He serves on the Board of Directors of the North American Neuromodulation Society and also serves in leadership roles for ASRA Pain Medicine. Dr. D’Souza has authored over 150 peer-reviewed publications and serves on several editorial boards. Dr. Nasir Hussain is a pain medicine physician and anesthesiologist at the Ohio State University. He is an assistant professor, associate program director for the anesthesiology residency, and assistant program director of the chronic pain fellowship. Dr. Hussain has authored over 110 peer-reviewed publications in leading journals in the field, and has presented his work nationally at several conferences. *The purpose of this podcast is to educate and to inform. The content of this podcast does not constitute medical advice, and it is not intended to function as a substitute for a healthcare practitioner’s judgement, patient care, or treatment. The views expressed by contributors are those of the speakers. BMJ does not endorse any views or recommendations discussed or expressed on this podcast. Listeners should also be aware that professionals in the field may have different opinions. By listening to this podcast, listeners agree not to use its content as the basis for their own medical treatment or for the medical treatment of others. Podcast and music produced by Dan Langa. Find us on X @RAPMOnline, LinkedIn @Regional Anesthesia & Pain Medicine, Facebook @Regional Anesthesia & Pain Medicine, and Instagram @RAPM_Online.

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• Episode 39: Beyond the block: a canvas for well-being and conversation in anesthesiology and pain medicine

  In this episode of RAPM Focus, Alopi Patel, MD, speaks with K. Elliott Higgins III, MD, and Courtney Burns, MD, about their powerful pain palette essay, “Beyond the block: a canvas for well-being and conversation in anesthesiology and pain medicine.” This essay accompanies Healing Emotional Wounds—a community-engaged art piece by medical and scientific illustrator Morgan Granzow.   Dr. Higgins is the director of health and well-being for UCLA’s department of anesthesiology and perioperative medicine, a physician health officer for UCLA Health, and a practicing anesthesiologist with subspecialty expertise in regional anesthesia and acute pain medicine. His research focuses on measuring and understanding health care professional well-being through a systems lens. As founding leader of the Well-Being Influencers Survey for Healthcare (WISH) research consortium, he led the development of WISH, a validated tool designed to assess perceptions of organizational conditions that shape well-being rather than individual states like burnout. He also co-chairs the American Society of Anesthesiologists’ well-being research working group and serves as both a member and change maker coach for the National Academy of Medicine’s Action Collaborative on Clinician Well-Being and Resilience. Dr. Burns is an anesthesiology resident physician at Vanderbilt University Medical Center and member of the BH Robbins Scholars Physician-Scientist Development Program. Her research interests include clinician well-being among the anesthesiology workforce, psychological sequelae of adverse clinical events, and the association of clinician occupational well-being challenges with health care quality and patient outcomes. She is experienced in the medical humanities and has leveraged both visual art and narrative medicine in promoting well-being among students and clinicians. She also serves as a member of the American Society of Anesthesiologists’ Committee on Physician Well-Being and the Society for Education in Anesthesia’s Committee on Well-Being. Inviting reflection and dialogue within the RAPM community and beyond, this artwork isn’t just visual—it’s a conversation starter. By incorporating language that emerged from guided reflection, it aims to create safer, more compassionate clinical environments. Whether displayed in break rooms, pain clinics, or perioperative spaces, it offers clinicians a moment to pause, see themselves in others’ words, and feel less alone. This discussion explores how this project seeks to destigmatize emotional struggles in medicine, promote well-being, and serve as a catalyst for further research—whether through focus groups, interviews, or broader institutional efforts. Most importantly, this piece reminds us that healing isn’t just for our patients—it’s for us, too. View more of Morgan Granzow’s medical and scientific illustrations here. 

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• Episode 38: Current state of the pain medicine match: perspective and an eye to the future

  In this episode of RAPM Focus, executive editor Steven Cohen, MD, discusses the September 2024 publication of “Current state of the pain medicine match: perspective and an eye to the future,” with Meredith Barad, MD, Anuj Aggarwal, MD, and Lynn Kohan, MD. This letter explores the rationale behind reassessing the NRMP’s utility for pain medicine, examining historical and current trends, and considering the implications of withdrawing from the match. Despite a recent decline in applicants and an increase in unfilled positions, the APPD advocates for continued participation in the match. The match ensures equitable and stable recruitment, preventing the chaotic pre-match environment of competitive, early offers. Data from similar specialties highlight the pitfalls of non-match systems, such as increased applicant pressure and reduced program visibility. The APPD supports maintaining the NRMP match while implementing reforms like preference signaling to address evolving challenges. The APPD aims to preserve the match’s benefits and ensure a stable future for pain medicine fellowship recruitment. Dr. Barad is a clinical associate professor in anesthesiology (pain) and neurology at Stanford. She is the co-director of the Stanford Facial Pain Program and focuses on headache and facial pain. She completed her undergraduate work at the University of Texas at Austin and graduated from Stanford University Medical School in 2003. After her internship at Santa Clara Valley Medical Center in San Jose, CA, she went on to a neurology residency and pain fellowship at Stanford. She is board certified in neurology, headache, and pain. She is the associate division chief of education and program director for the pain fellowship. She is the current president of the American Pain Program Directors. She serves as the chair of the headache and facial pain special interest group for the American Academy of Pain Medicine and is on the editorial board of Pain Medicine. Dr. Aggarwal is a clinical assistant professor of anesthesiology and the associate program director of the pain medicine fellowship at Stanford University, where he specializes in headache and orofacial pain. In addition to his work in pain medicine, he helps lead the teaching of medical students serving as director of pharmacology and as associate director for the Science of Medicine.  Dr. Kohan is a professor of anesthesiology and pain medicine at the University of Virginia. She is the division chief and the chronic pain program director. She serves on the board of directors for national pain societies including ASRA Pain Medicine. *The purpose of this podcast is to educate and to inform. The content of this podcast does not constitute medical advice, and it is not intended to function as a substitute for a healthcare practitioner’s judgement, patient care, or treatment. The views expressed by contributors are those of the speakers. BMJ does not endorse any views or recommendations discussed or expressed on this podcast. Listeners should also be aware that professionals in the field may have different opinions. By listening to this podcast, listeners agree not to use its content as the basis for their own medical treatment or for the medical treatment of others. Podcast and music produced by Dan Langa. Find us on X @RAPMOnline, LinkedIn @Regional Anesthesia & Pain Medicine, Facebook @Regional Anesthesia & Pain Medicine, and Instagram @RAPM_Online.

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• Episode 37: Single-bolus Injection of Local Anesthetic, With or Without Continuous Infusion, for Interscalene Brachial Plexus Block in the Setting of Multimodal Analgesia

  This AI-generated episode of RAPM Focus discusses the May 2024 publication of “Single-bolus Injection of Local Anesthetic, With or Without Continuous Infusion, for Interscalene Brachial Plexus Block in the Setting of Multimodal Analgesia: A Randomized Controlled Unblinded Trial” by Dr. Patrick Rhyner et al.” For anyone facing shoulder surgery, pain management after the procedure is crucial. In this paper, Rhyner et al. question whether or not a continuous infusion of pain medication through a catheter is better than giving a patient a single injection after having shoulder surgery. The paper discusses a multimodal approach of pain management—dethamexazone, magnesium, acetaminophen, and ketorolac. In this study, patients undergoing two common shoulder surgeries—shoulder arthroplasty or arthroscopic rotator cuff repair—were divided into two groups, in which one group received a continuous infusion of medication via catheters, or a single dose of pain relief. Results were measured by how much morphine patients needed through a patient-controlled analgesia pump during the first 24 hours after surgery. *The purpose of this podcast is to educate and to inform. The content of this podcast does not constitute medical advice, and it is not intended to function as a substitute for a healthcare practitioner’s judgement, patient care, or treatment. The views expressed by contributors are those of the speakers. BMJ does not endorse any views or recommendations discussed or expressed on this podcast. Listeners should also be aware that professionals in the field may have different opinions. By listening to this podcast, listeners agree not to use its content as the basis for their own medical treatment or for the medical treatment of others. Podcast and music produced by Dan Langa. Find us on X @RAPMOnline, LinkedIn @ Regional Anesthesia & Pain Medicine, Facebook @Regional Anesthesia & Pain Medicine, and Instagram @RAPM_Online.

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• Episode 36: Risk Factors for Persistent Postoperative Opioid Use: An Entity Distinct from Chronic Postsurgical Pain

  Hosted by RAPM Editor Eric Schwenk, MD, this episode of RAPM Focus welcomes RAPM Associate Editor Mark Bicket, MD, PhD, and medical student Sama Ramo following the recent publication of their original research paper, “Risk Factors for Persistent Postoperative Opioid Use: An Entity Distinct from Chronic Postsurgical Pain,” included in the February 2025 special edition of RAPM, titled “Tackling the Challenge of Chronic Postsurgical Pain.” Persistent postoperative opioid use results when patients continue to take prescription opioids well beyond the time their pain after surgery would be expected to resolve. In some cases, this is a couple days; in other cases, this is several weeks. There are many challenges associated with prescription opioid use, including the lack of a truly safe dose, so there is risk across the continuum. Patients facing persistent postoperative opioid use potentially confront worse outcomes, higher rates of health care utilization, and higher rates of mortality compared to patients not enduring persistent postoperative opioid use. Dr. Mark Bicket is an associate professor of anesthesiology with tenure at the University of Michigan and a joint appointment in the Department of Health Management and Policy at the School of Public Health. Additionally, he is co-director of the Overdose Prevention Engagement Network (OPEN). A clinician-scientist and practicing physician anesthesiologist, Dr. Bicket has pioneered evidence-based approaches to reduce opioid-related harms and improve the treatment of persons who experience pain. He currently leads an NIH R01 study examining pain-related outcomes for persons with opioid use disorder who have surgery and serves as PI for two pragmatic trials funded by the Patient-Centered Outcomes Research Institute including the CARES study, an international randomized clinical trial examining commonly prescribed treatments for postoperative pain. He previously served on the National Academy of Medicine ad hoc committee on evidence for opioid prescribing guidelines in 2018-2019 and a workshop on opioid disposal in 2023. Dr. Bicket has advised the White House, FDA, CMS, state governments, and national organizations on pain and opioid issues. His research, which includes 120 peer-reviewed articles, has appeared in JAMA, NEJM, and BMJ, and has been supported by the Foundation for Anesthesia Education and Research (FAER), SAMHSA, and CDC. Sama Ramo is a second-year medical student at Oakland University William Beaumont School of Medicine. She is a Foundation for Anesthesia Education and Research scholar. *The purpose of this podcast is to educate and to inform. The content of this podcast does not constitute medical advice, and it is not intended to function as a substitute for a healthcare practitioner’s judgement, patient care, or treatment. The views expressed by contributors are those of the speakers. BMJ does not endorse any views or recommendations discussed or expressed on this podcast. Listeners should also be aware that professionals in the field may have different opinions. By listening to this podcast, listeners agree not to use its content as the basis for their own medical treatment or for the medical treatment of others. Podcast and music produced by Dan Langa. Find us on X @RAPMOnline, Facebook @Regional Anesthesia & Pain Medicine, and Instagram @RAPM_Online.

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