PRESIDENT’S MESSAGE

Our Academy, Our Mission, Our Work!pme_1223 1299..1302

This publication finds me at the half-way point of mytenure as president of the American Academy of PainMedicine. It is therefore timely to review our academy’sgoals and progress, reflecting upon and inspecting ourwork together as a committed and talented group ofmanagement team members and volunteer leaders. Toshare highlights of the year-to-date, I have created a“virtual interview,” posing questions (Q’s) to key leadershipamong the various domains of our ongoing initiatives. Itrust that you will find their responses to be as informativeand inspiring as have I, and that they may motivate you toseek out a position in the Academy’s infrastructure ofcommittees and related working groups so that you mayexercise your enthusiasm for our mission in similarly tan-gible ways—and strive to become the next leaders of ourAcademy. I have asked Phil Saigh, our Executive Director,to lead the way, answering questions designed to providean overview of our status, with details and perspective tofollow, provided by those committee chairs overseeing thevarious topical areas.

Interviewee: Phil Saigh, AAPM Executive Director

Q: Phil, what are the basic tenets of the AAPM2011–2013 Strategic Plan?

The AAPM Strategic Plan can be summed up in a sen-tence: “AAPM will become the recognized authority forappropriate and effective pain care through its knowledge,scholarship, and commitment.” These bold words serveto articulate the commitment that the Academy has madeto the specialty of Pain Medicine, especially its physicianmembers and their patients.

Specifically, the AAPM Strategic Plan embodies four prin-cipal goals:

• AAPM will achieve recognition of Pain Medicine as aprimary medical specialty within the ABMS.

• AAPM will expand its educational offerings in the areasof content, audience and format.

• AAPM will advocate for and develop research andscholarship programs with a focus on establishing arepository for the information that leads to pain treat-ment protocols.

• AAPM will be diversify its funding sources and willincrease revenue.

These four goals, under the aegis of AAPM’s commitmentto represent the specialty of Pain Medicine, are the drivingforces of virtually all of the Academy’s resources.

Q: How is the organization progressing in achievingits goals?

The Strategic Plan became operational with the beginningof the 2011 calendar year. The budget was crafted; theBoard adopted its oversight role; and, committee workplans were generated. By mid-2011 AAPM had alreadyachieved several milestones relating to the StrategicPlan.

For example, in the area of Specialty Recognition, theAcademy has participated in substantive conferences withrepresentatives of the American Society of Anesthesiolo-gists (ASA), the International Spine Intervention Society(ISIS), the American Society of Interventional Pain Physi-cians (ASIPP), and the North American NeuromodulationSociety (NANS) about the future of the field of Pain Medi-cine. These conferences have been marked by a spirit ofcooperation and frankness that will serve to unify the field,allowing us all to speak with a more forceful and influentialvoice, especially among policy-makers, regulators andpayers. Clearly, these organizations are looking toward thebigger picture of how pain care will be delivered in thefuture.

No less significant are the Academy’s efforts in Educa-tion. In addition to an incredibly successful AnnualMeeting in 2011, with an even more ambitious agendaset for 2012, the Academy has launched a collabora-tive effort with the Federation of State Medical Boards(FSMB), which serves as the conduit to 70 state licensingboards for physicians, and the American Pain Foundation(APF), which represents thousands of individuals (patients)suffering from significant, life-changing, pain. Togetherthese three organizations have prepared a comprehensiveeducational proposal focused on educating all physici-ans and other prescribers in the safe and responsibleuse of prescription opioid medications. While opioids areonly one means of addressing chronic pain, they are ameans often employed by primary care physicians, andthe Academy has stepped forward by recognizing itsresponsibility in serving as a leading educational entityto help ensure the safe and responsible use of thesemedicines.

In terms of taking a leading role in the developmentof Research and Scholarship Programs, the AAPMResearch Committee has been working hard at establish-ing a protocol by which AAPM member physicians willbe able to collect patient outcomes data in a national

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repository. The plan calls for this data to subsequently beavailable for studies to determine quantitatively the effi-cacy of care options provided by physicians. AAPM hashad discussions with several external organizations thathave developed software and analytics that will supportthis activity. We plan on having one of these organiza-tions develop applications specifically for the Academy’smembership.

Finally, while it may be obvious to state, none of theseinitiatives can proceed very far without adequate res-ources to manage them. To that end the Academy hascommitted itself to identifying New Sources of Revenuethat can support its programs and activities. One of ourmost notable successes is the establishment of the AAPMFoundation. Under the leadership of Alex Cahana, MD,President; Charles Argoff, MD, Secretary; and MarshaStanton, PhD, RN, Treasurer, the AAPM Foundation ispositioning itself to be a significant force in fund-raisingactivities for the profession of Pain Medicine. The Foun-dation held its inaugural Board of Directors meeting at theAAPM Annual Meeting in March 2011.

Q. What do you see as the most exciting outcome ofthe Strategic Plan?

From a procedural perspective, I’m excited by the focusthat the Strategic Plan has brought to AAPM planning. Forseveral years now, the Academy has been refining itsoverall strategic planning processes. The 2011–13 AAPMStrategic Plan is a very real outgrowth of that effort. It’smost assuredly not something that is “gathering dust on ashelf.” Rather it forms the backbone of decision makingand resource deployment for the Academy.

In terms of the actual goals themselves, I think the wordsof Daniel Burnham, the 19th-century architect known forthe establishing the “look” of Chicago, speak well of theeffort:

“Make no little plans. They have no magic to stirmen’s blood and probably themselves will not berealized. Make big plans; aim high in hope and work,remembering that a noble, logical diagram oncerecorded will never die, but long after we are gonewill be a living thing, asserting itself with ever-growinginsistency. Remember that our sons and grandsonsare going to do things that would stagger us. Letyour watchword be order and your beacon beauty.Think big.”—Daniel Burnham, Chicago architect.(1846–1912)

The Academy has laid a significant challenge for itself. . . “AAPM will become the recognized authority forappropriate and effective pain care through its knowledge,scholarship, and commitment.” From the perspective ofthe staff team, this is an exciting and gratifying time to beengaged with AAPM.

Interviewees: Lynn Webster, MD, AAPM Treasurer andCo-chair 2012 Annual Meeting; Sean Mackey MD, PhD,Vice President for Scientific Affairs and Co-chair 2012Annual Meeting

Q: Gentlemen, would you please provide an over-view of how things are shaping up for our upcomingmeeting in Palm Springs?

The 2012 annual meeting promises to be one of bestmeetings AAPM has ever produced. Each year the spe-cialty of Pain Medicine expands its scientific knowledgeand the sophistication pain specialists bring to the fullspectrum of patients suffering from pain. This year theAcademy is inviting leading scientists from diverse areas,such as those who can help us to understand the roleof microglia in neurodegenerative diseases—includingmultiple pain conditions—to those who will discuss thescience of skin permeability, absorption and distribution inpain medication delivery. A new and special focus will beon the tremendous challenges the military is facing withpain and rehabilitation and how their cutting-edge workmay influence advances in civilian practices. The tradi-tional Essentials Course will include important and practi-cal guidance for all physicians practicing pain medicine.Beginner and advanced courses in interventional thera-pies will be offered in a cadaver workshop. Advancedtechniques in ultrasound use in pain management will betaught by leading experts in the field.

And, for the first time, the Academy will offer a compre-hensive course in Safe Opioid Prescribing, specificallydesigned to curb opioid misuse, abuse and unintentionaloverdose deaths. This will be an all day Saturday andhalf-day Sunday program offering 20 CME credits if allthe pre-conference and post-conference assignmentsare completed. The course will include the ResponsibleOpioid Prescribing program which is a collaborative effortof AAPM, APF and FSMB designed to meet the U.S.Food and Drug Administration’s new Risk Evaluationand Mitigation Strategy (REMS) requirements and ensurethat prescribers understand how to be compliant withtheir respective medical boards’ and other regulators’expectations.

It will be a grand educational experience in the beautiful,and usually warm, Southern California desert. We lookforward to seeing you there!

Interviewee: Scott Fishman, MD, Board Member andChair, Legislative and Regulatory Affairs Committee

Q: Scott, what is AAPM doing in response to thepublic health crisis of greatly increased prescriptionopioid morbidity and mortality, and REMSin particular?

AAPM has engaged with the FDA around appropriateanalgesic drug policy well before REMS. We have workedwith FDA from the beginning of the REMS process, bothbehind the scenes as well as publicly in all major hearingsand Federal Register reports. AAPM produced a thoughtfuland comprehensive formal report to FDA that was incor-porated into the Federal Register. Moreover, we testified atofficial hearings on numerous occasions. Members shouldknow that their Academy has been instrumental in guiding

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balanced policy at FDA and continues to help with REMSimplementation.

Q: AAPM is one of the three members of theResponsible Opioid Prescribing Collaborative. Whatexactly is the ROP Collaborative?

AAPM has partnered with the Federation of State MedicalBoards and the American Pain Foundation to create com-prehensive educational products that will meet the newopioid REMS requirements. FDA has indicated that theyexpect REMS solutions to include professional and con-sumer education. Thus, this Responsible Opioid Prescrib-ing (ROP) Collaborative is an unprecedented joining of thepremier professional and consumer pain organizationswith the FSMB—the overarching body of the statemedical boards that govern the medical standard of care.FSMB produced Responsible Opioid Prescribing, a bookand has had 200,000 copies delivered to physiciansthrough 20 medical boards. The 2nd edition of the ROPbook will be greatly expanded, meeting all requirements ofREMS. This collaborative is quite strategic and representsa formative, high level, and comprehensive response, bothto REMS and the larger public health issues surroundingthe need to optimize outcomes and minimize harms fromthe use of controlled substances in pain management.

Q: How will AAPM members be able to participate inthe offerings of the ROP Collaborative?

The offerings from the collaborative will certainly be avail-able to all AAPM members. However, exactly what will beoffered is not completely settled because the FDA has notyet clarified the exact requirements for REMS. AAPM willmake this information readily available to all members asplans solidify. Please “stay tuned” by checking the AAPMwebsite on a regular basis.

Interviewee: Ajay D. Wasan, MD, Co-Chair, ResearchCommittee

Q: Ajay, what are the reasons for AAPM’s recentemphasis on outcomes and how is this playing out?

Creating a Pain Treatment Outcomes Repository is a keystrategic objective of AAPM, which has been stronglyendorsed and developed by the Research Committee. Inaddition to being a Section editor for Pain Medicine, thishas been my central focus of activity at AAPM. The maingoals are: 1) To encourage individual pain practitioners tocollect individual outcomes data at the point of service; 2)To create a research infrastructure within AAPM thatenables AAPM to support comparative effectivenessresearch; 3) To encourage comparative effectivenessresearch (CER) on a national level by pooling the data fromthousands of patients and disseminating free access tothe data for scientific investigators, and; 4) To transformAAPM into the premier scientific organization for dissemi-nation of this data to the scientific community. AAPM isonly interested in the scientific uses of the repository data.This mission is timely and of great interest to our profes-

sion. This system will allow us to justify the value of ourservices to payers and will improve the quality of caredelivered.

In sum, we have assembled a strong group of AAPMmembers with interest and expertise in this area–initiallyunder the auspices of the Research Committee and morerecently through a special Task Force–assigned to createan operational and business plan that will actualize thegoals I’ve outlined. In the short run, I expect that we’ll beready soon to engage our member to participate in sub-mitting data and use web-based tools to track treatmentoutcomes. This is a critically important step that goes wellbeyond the meager limits of simply assessing a patient’spain intensity and functional ratings at a given point intime. Access to aggregated data on a nationwide level willlead AAPM to be the only pain medicine professionalorganization with the ability to demonstrate the clinicaleffectiveness of our treatments with a high degree ofscientific validity. The system that we employ will allowpractitioners to collect data on their own patients in a rapidand economical manner, and it will create a data basefrom which a research infrastructure can evolve to analyzeand report the results.

As Co-Chairs of the Research Committee, Dr. AlexCahana and I have put forward a model and action plan,endorsed by our committee and the Executive Commit-tee, to realize these goals. Since AAPM does not have thesoftware or information technology infrastructure andexpertise to construct such a system, we have been inten-sively negotiating with several private companies topartner so as to make such a product available to ourmembers. Furthermore, we have worked extensively on aproposal to create the research infrastructure with a homein an academic center. I anticipate that we will close out2012 with a well-defined operational plan for a datarepository and center for pain outcomes research.

Interviewee: Alex Cahana, MD, Chair AAPM Foundation

Q: Alex, why was the AAPM Foundation formed?

The senior leadership and executive board of theAcademy through the foundation ad hoc committee, feltthat there is a need to establish a viable fundraising entityto support the AAPM strategic plan. The Foundation’smission is to address pain as a significant public healthproblem by establishing a specialty in Pain Medicine,advancing physician education and furthering research inthe field. The AAPM Foundation board in its inauguralmeeting in March decided that as the foundation developsits fundraising plans, it is necessary to prioritize the goal ofestablishing pain medicine as a specialty within the ABMS.

Q: Why did you accept the position as chair?

As chief of the Division of Pain Medicine at the UW, thebirthplace of modern Pain Medicine and the home ofseveral of our national pain leaders, I understand all toowell the consequences of poor pain assessment and

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Our Academy, Our Mission, Our Work!

management. Our specialty is struggling to deal with therising tide of prescription misuse and abuse and non-discriminative use of image-guided procedures in theabsence of a more comprehensive treatment program,with resultant poor outcomes among our patients. Theneed to provide active solutions to this terribly fragmented,inconsistent and unsustainable health care system issevere. I want to be part of the national solution, and asChair of the Foundation, heading up its mission, providesthe opportunity to make a meaningful difference.

Q: Who serves on the AAPM Foundation?

The ad hoc committee recommended a board of eightMembers and one Chair that should be composed of across-section of constituents considering geographic rep-resentation, occupational background, other affiliationsand personal profile. De facto, all members have demon-strated leadership in the field of pain medicine, high ethicalstandards and the willingness to financially support thefoundation. Also, all Board Members have shown theirability to “open doors” and obtain federal, corporate andphilanthropic support. The Board has representatives fromAAPM and ABPM, as well as non-physicians with a longhistory of interest and involvement in Pain Medicine.

Q: Please explain the initiatives the AAPM Founda-tion will support.

The AAPM Foundation recognizes the need to increasepublic and payer awareness, that chronic pain is a diseasethat requires a specialty for physicians with specifictraining, and that all pain societies need to have uniformstandards of practice based on measuring outcomes.Therefore the AAPM Foundation will support AAPMstrategic goals—together with other physician painsocieties—the promotion of: a joint submission for spe-cialty certification for the ABMS; a joint submission oftreatment guidelines for the national clearing house; andendorsing to its members measurement-based care asstandard of care.

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Interviewee: myself (Perry G. Fine, MD, AAPM President)

Further to the promise I made at our recent “State of theAcademy” meeting that took place during our annualmeeting in Washington, DC, last March, I would like tosummarize some of the extraordinary efforts made by ourcolleagues in their home jurisdictions, under the heading“Local Leadership.” It has been aptly stated that “all poli-tics is local,” and that cannot be over-emphasized, espe-cially at this time in our history when state legislatures are

becoming increasingly involved in issues pursuant to ourspecialty.

Local Leadership

Colorado

In late February of 2011, Local Initiatives Committeemember Lynn Webster, MD and Colorado State Repre-sentative Richard Stieg, MD informed AAPM that theColorado legislature had recently opted not to renew theexisting prescription drug monitoring program in Colo-rado. AAPM drafted a letter in support of Colorado’sPrescription Drug Monitoring Program (PDMP), and sent itto Ms. Edie Sonn at the Colorado Medical Society, and theCenters for Medicare and Medicaid Services (CMS) hadplans to introduce a late bill to resurrect the program. Tofurther emphasize the Academy’s support of PDMPs, acopy of an article previously published in Pain Medicine,titled “Regulating Opioid Prescribing Through PrescriptionMonitoring Programs: Balancing Drug Diversion andTreatment of Pain” was provided as well. In late May,AAPM got the good news that the Colorado PDMP wouldbe renewed with funding by the legislature.

Montana

In January of 2011, the Academy signed on to supportMontana prescription monitoring program bill HB 83. Anaction alert provided by the Prescription Drug AbuseAwareness Program at the Montana Department ofJustice was sent to all AAPM Montana members byMontana State Representative Michael Schabacker, MD.In April, AAPM learned that HB 83 was signed into law bythe governor.

These examples (and I am sure there are several more),demonstrate the power we have to control our destiny onbehalf of the public health when we exercise our authorityand credibility among policy-makers in a constructive andfocused manner. Please become active and exercise yourleadership within your own communities, and let us knowwhat you’re accomplishing.

In conclusion, my thanks to all the “correspondents” whohave taken time from their busy schedules to provideupdates through these interview questions. As AAPMmembers and Pain Medicine readers, your feedback inany way, shape or form will be greatly appreciated. If youare not yet a member, please join today, because, after all,as professionals who care about the health of people livingwith pain, this is our academy, our mission, our work!

PERRY G. FINE, MDPresident

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