Without a multidisciplinary approach, chronic pain can be difficult to treat, leading to suffering and impaired quality of life. Neurosurgeons have a long and rich history of innovation in the surgical treatment of pain, from procedures such as trigeminal rhizotomies, intrathecal delivery of medication, spinal cordotomies and dorsal root entry zone (DREZ) lesioning, and cortical and deep brain stimulation. As neurosurgeons, our advocacy efforts ensure patients’ access to adequate pain management options. To aid in these efforts, the AANS-CNS Joint Section on Pain was established in 1990 with the mission to advance the role of the neurosurgeon in pain management through education, advocacy, and research. Currently, the Joint Section on Pain plays a vital role in advocating for patients with chronic pain by developing and promoting the use of evidence-based practices and working with legislators, other physician societies and federal agencies to ensure adequate access to surgical interventions. The section advocates for the use of a comprehensive approach to pain management that includes pharmacological treatment along with interventions such as physical therapy, pain psychology and surgery.
It is unfortunate that neurosurgeons are sometimes overlooked as experts in pain management, leading to patients being deprived of access to proven options for pain relief. The Join Section on Pain assisted policy development throughout the opioid crisis; members have served on neurosurgery’s delegation to the AMA House of Delegates as well as national task forces convened by the AMA, National Institutes of Health, and the Institute of Medicine. As participants in this process, the section has advocated for the use of non-opioid treatments for pain, including access to early neuromodulation, while promoting responsible opioid prescribing practices. This meant ensuring that neurosurgical interventions for pain were at the forefront when addressing the opioid crisis and related legislature.
Ablative interventions for cancer pain are an example where, without neurosurgical advocacy, adequate insurance coverage would be unavailable. The Joint Section has developed evidence-based guidelines for these procedures, improving coverage policies, and pain management and oncology colleagues as to neurosurgical options for treating malignancy-related pain.
The section actively participates through the AANS and CNS in the Multispecialty Pain Workgroup (MPW), a national group including representatives from NANS, ASRA, ASA, and ASPN, among others, that provides unified advocacy for pain patients by collaborating on federal legislation, reviewing insurance coverage policies for interventional pain therapies, and developing new while reviewing existing CPT codes.
The Joint Section on Pain also educates and trains neurosurgeons and other healthcare professionals allowing for the implementation of best practices and guidelines to ensure that patients receive the best possible care. Guidelines development and technological advancement are critical functions of the section, creating the John Oakley Fellowship ensures the future of the field. This grant will be awarded to a senior or recently graduated neurosurgical resident for funding additional training in neurosurgical pain management.
Through the volunteerism of its members, the AANS-CNS Joint Section on Pain advocates for patients with chronic pain. By promoting a comprehensive approach to pain management, evidence-based practices, education and training, and policies that support access to care, the section champions delivery of timely, adequate, and evidence-based care for those in pain.
