Speaker: Reconstructive procedures will advance field of pain surgery and treatment

Practicing in the field of pain management requires neurosurgeons to be good listeners and problem solvers.

SAN FRANCISCO — The field of pain surgery and treatment can be a daunting, but rewarding career path for a resident or fellow looking for a challenge, according to the head of the Department of Neurological Surgery at Oregon Health and Science University in Portland, Ore.

Kim J. Burchiel

The topic of pain is heavily embedded in the curriculum for neurosurgery students and it is a field with an exciting future, Kim J. Burchiel, MD, FACS, FAANS, said in a presentation.

“I believe pain surgery is part of the corpus of neurosurgery. It is really the discipline of the strong, and I mean people that can take on difficult problems. It is not for the weak. The requirements for practicing in pain surgery are the ability to listen to the patient, to remember that they are in control, they are defining the problem, not you,” Burchiel said during a lecture.

Many talents necessary

Anyone considering practicing in the field of pain management needs the strength to deal with and help patients who can be difficult at times, Burchiel said.

“You have to be able to accept imperfect results and that is really difficult for neurosurgeons, and you have to strive to do better. I think that is what we all try to do in this area in particular,” he said.

During his presentation Burchiel discussed how the history of pain surgery rests heavily on the shoulders of “destructive surgeries” that destroyed neuropathways. Later procedures were developed in the 1960s and 1970s, such as neuromodulation, a technique that is still widely used today.

“[It] is still a very important part of our field, and I believe we are on the forefront of new operations, such as reconstructive surgeries, that will allow for this field to go forward,” Burchiel said.

He discussed cordotomy, which is still used today and remains a successful procedure that is supported as such by the literature.

Treating pain without surgery

Pain management remains a challenging field for neurosurgeons and other health care practitioners and Burchiel said those entering the field need to understand how to deal with pain treatment with non-surgical, as well as surgical treatments.

“If you are considering entering into the field of pain surgery and pain medicine, you have to know something about treating pain from a non-surgical standpoint,” Burchiel said. “It is an important aspect of our profession and we have to understand how patients come to our attention and how to sort patients out that need surgery and those that don’t.”

As for the future of pain surgery, Burchiel tasked young individuals in the field to pay close attention to new technology coming from overseas and to harness the research and information coming from laboratories throughout the country. But, pain surgery is not for the weak, and it is one of the rare medical professions where surgeons need to know their limitations. He said they have to have the strength of character to be able to tell a patient, “This is where my knowledge stops and this is where I do not have anything to offer you.”

Challenging, satisfying

Despite the challenges and the difficulty of the profession, Burchiel said the field will not disappoint someone who is looking for a challenge.

“You need to sustain research by doing the research. You need to learn how to do it. We need better studies and we need the class 1 evidence to show what we do works,” according to Burchiel.

He also urged individuals to publish their related work to help advance the field.

“Basically, I want you to get involved. I want you to be in the forefront of this field. I can tell you I entered this field with a little trepidation after my residency, but I have never been disappointed,” Burchiel said. – by Robert Linnehan

Reference:

Burchiel KJ. Expanding neurosurgery: Neurosurgery and pain treatment. Presented at: American Association of Neurological Surgeons Annual Meeting; April 5-9, 2014; San Francisco.

For more information:

Kim J. Burchiel, MD, FACS, FAANS, can be reached at the Department of Neurological Surgery, Oregon Health and Science University, 3303 SW Bond Ave., Portland, OR 97239; email: burchiek@ohsu.edu.

Disclosure: Burchiel has no relevant financial disclosures.