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Pain division update

2020 brought a new decade and almost immediately two events of epic proportions: the COVID-19 global pandemic and Black Lives Matter (BLM).
Aerial shot of Stanford campus
Image credit: Andrew Brodhead

2020 brought a new decade and almost immediately two events of epic proportions: the COVID-19 global pandemic and Black Lives Matter (BLM). COVID-19 forced us to rapidly change how we deliver health care to our patients, conduct research and educate our trainees — all while keeping our patients, ourselves and our families safe. BLM forced us to look inside and ask difficult questions about racial inequities, biases and basic human rights. By extension, BLM forced a much-needed revisiting of disparities in pain care in our country.

Aerial of the Stanford Medicine Outpatient Center in Redwood City, CA
Aerial image of the Stanford Medicine Outpatient Center in Redwood City, CA. (Image credit: Conveyance Media)

While COVID-19 presented challenges, it also offered new opportunities to innovate with digital technologies. The Stanford Pain Management Center, under the leadership of clinic chief Ming Kao, MD, Ph.D., was the first clinic at Stanford to move to 100% video visits using telemedicine platforms. While the Pain Center was a “ghost town,” our clinicians were all at their homes, wearing a dress shirt, and undoubtedly pajama bottoms, while determining how to deliver optimal care remotely. While challenging to perform a physical examination virtually, we adopted creative solutions to have the patient perform maneuvers remotely that allowed us to do so. Probably to no one’s surprise, many patients preferred video visits rather than battle the Bay Area traffic each way to see us in person. Indeed, despite an initial drop in patients when COVID-19 emerged, we quickly returned to and exceeded our prior year’s patient volumes.

Many of the major innovations in health care assessment and delivery have come during times of crises and war. They include tourniquets during Roman wars, modern infection control during the Crimean War in the 19th century, triaging of mass casualties during World War 1, and adoption of Alexander Fleming’s discovery of penicillin becoming broadly used during World War II. COVID-19 will similarly leave a mark. To date, we found that COVID has forced adoption and advancement of video visit technologies by at least five to 10 years. We are currently strategizing how to use this technology to expand our reach of pain care into traditionally cost model of health care has been upended. In the future, how will we best use the tremendously expensive brick and mortar structures to deliver health care – particularly when much can be delivered remotely?

Finally, our pain division continues to expand our reach into the broader Bay Area with the introduction of network sites, or satellite clinics. With the opening of the Pain Management Center in Livermore, which is led by Garret Morris, MD, we now have eight network sites allowing us to better serve a catchment area of over eight million people, many with chronic pain.

Entrance to Stanford Hospital at 500 Pasteur Drive
Entrance plaza to Stanford Hospital at 500 Pasteur Drive (Image credit: Will Pryce)

Under the leadership of Einar Ottestad, MD, director of Acute Pain Service (APS), the APS has grown exponentially over the past few years. It now has a complement of nine full-time advanced practice practitioners, or APPs, to provide uninterrupted clinical coverage, thereby allowing more educational time for fellows and residents. They will need this expanded service to cover the recent opening of the new Stanford Hospital at 500P. Finally, at 500P, Beth Darnall, Ph.D., Ottestad and Sean Mackey, MD, Ph.D., division chief for pain medicine, are leading a hospital-wide effort to improve the management and assessment of patients with pain.

Pain education, under the leadership of Meredith Barad, MD, program director, and Anuj Aggarwal, MD, associate program director, has continued innovating despite the challenges of COVID-19. Working collaboratively with former Pain Medicine Division Chief Bill Brose, MD, and Stanford Health Care, they have been developing an update (V2.0) to Advancing Communication Excellence at Stanford (ACES)— a course aimed at improving clinician-patient communications. This is of particular importance to the pain medicine division due to the frequently challenging communications needed around patients’ pain and treatments. Additionally, working with pain psychologist Heather King, Ph.D., they have developed a wellness program for our fellows. Finally, Aggarwal is leading an effort to develop a new CME course at Stanford on pain management for community physicians. It is part of our ongoing efforts to more broadly increase pain management knowledge for all those who care for people in pain.

Pain research continues to be strong within the division. When COVID hit, research halted across campus. Fortunately, the division’s research efforts quickly pivoted to focusing on data analysis, and manuscript and grant writing. The past several months have seen the greatest output of manuscripts and grants in the division’s history. Additionally, multiple grants were awarded this year. Vivianne Tawfik, MD, Ph.D., was awarded a prestigious NIH R35 grant to develop approaches to monitor dysfunctional myeloid-lineage cells and modulate specific targets for novel therapeutics that will improve post-injury recovery.

Mackey was awarded an FDA grant to characterize patient decision-making related to opioid and other therapies. Finally, Mackey noted that the continued investment in developing junior investigators has been paying off. Multiple young researchers in the division were awarded NIH K and FAER grants, including: Behnaz Jarrahi, M.S., Ph.D., (NIDA K25); Vafi Salmasi, M.S., MD, (FAER MRTG); Chelsea Shover, Ph.D., (NIDA K01); Ken Weber, Ph.D., (NINDS K23); Sophia You, M.S., Ph.D., (NIDA K23); and Maisa Ziadni, Ph.D., (NIDA K23). “The future of pain research and development of new therapies is in the hands of these young investigators, and our future looks bright,” Mackey says.

This article originally appeared in the 2020-2021 issue of Stanford Anesthesia magazine.

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