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15 Articles in Volume 21, Issue #4
Advanced Practice Matters: Needs Assessment in Pain Management Training
Analgesics of the Future: Novel Capsaicin Formulation CNTX-4975
Ask the PharmD: How to Improve Medication Adherence in Chronic Pain Management
Behavioral Medicine: Applying Mindfulness-Based Stress Reduction for Comorbid Pain and PTSD
Case Report: Multimodal Management of Osteoarthritis
Commentary: The PCP's Role in Preventing Chronic Back Pain
Guest Editorial: Structural Racism in Pain Practice and How to Combat the “Hidden Curriculum”
Hypermobile Ehlers-Danlos Syndrome: An Update on Therapeutic Approaches for Pain Management
Male Clinicians as Allies in Women’s Leadership: What Your Female Peers Want You to Know
Meet the Women Changing Pain Medicine
Perspective: It’s Time to Advocate for Early Interventional Pain Management
Research Insights: Is Spinal Fusion Surgery Being Overused in Back Pain Care?
Tips from the Field: Treating Pain in an Under-Resourced State
Utilizing Music Therapy to Manage Chronic Pain
Woman to Woman: Leaders Share Advice for the Next Generation of Pain Medicine Clinicians

Meet the Women Changing Pain Medicine

From pain research to daily practice to advocating for policy change, PPM speaks to the women pushing pain medicine forward.

In this special roundtable, leading women clinicians discuss being outsiders in a male-dominated industry, making names for themselves in policy, research, and practice, representing the BIPOC community, and more.

 

INTRODUCTION

We know that women have higher response rates to pain, experience more chronic pain conditions, and face more disparities in research about and care for their pain. Pain in women, along with its bedside partner – mental health – has become so prominent in clinical settings and at-home conversations that HealthyWomen launched a Chronic Pain Advisory Council earlier this year. In just the past few years, PPM's own recent special reports dove into gender bias around women’s pain, gender gaps in pain medicine, and the never-ending search to adequately assess and treat chronic pelvic pain in women. We even launched a new series on overlapping pelvic pain disorders to address growing needs in this often overlooked set of conditions.

We could go on to provide even more statistics and data about how pain is – and is not – treated in women, but instead we are going to pay homage to the women treating pain.

Women in the Pain Medicine Workforce

According to the most recent data from the Association of American Medical Colleges (2019):

  • Of the 5,858 pain medicine and pain specialists in the US, women represent just 19% or 1,113 of them
  • Women make up 48% of medical students 

In related specialties, women make up approximately:

  • 26% of active anesthesiologists
  • 31% of neurologists
  • 36% of PM&R physicians

The Accreditation Council for Graduate Medical Education's (ACGME) data for 2019-2020 shows that women make up about:

  • 33% of anesthesiology residents
  • 23% of pain medicine fellows

As of 2019, there were 2,016 ANCC Pain Management Certified Nurses, with no details on how many are women, but as pointed out by Dr. Maureen F. Cooney, every nurse is a pain management nurse if directly involved in the care of patients (more from her below).

Despite their lower numbers, women are becoming a dominating force in the pain medicine field – they are establishing practices, building organizations, developing medical devices, and leading laboratories that are making game-changing pain research and treatment discoveries. And in clinical pharmacy – an increasingly collaborative partner in evidence-based pain management and medication adherence – women now make up 56 to 58% of the workforce, yet they make less money compared to their male counterparts (we will save that discussion for another report).

Here, in this special roundtable, we – Practical Pain Management (PPM) – provide a closeup look at the women leading, running, and motivating pain practice across the United States and beyond. When we began this feature, we were inundated with recommendations of women to include – unfortunately, we could not include profiles of them all but list their names below.

Meet our leaders and hear what they have to say, from feeling like an outsider in a male-dominated field, to making a name for themselves in policy and research, to leading all-women pain practices, to representing the Black, Indigenous and People of Color (BIPOC) community in pain medicine.

Plus, in separate pieces, our experts share:

A closeup look at the women clinicians raising the ladder in pain practice and pain management. (Image: iStock)

 

 

THE WOMEN IN THE OFFICE: PAIN MANAGEMENT & PRACTICE

 

Jessica B. Jameson, MD, FASA
President and Founder, Society of Women Innovators in Pain Management
Co-Founder, Axis Spine Center, Idaho
Secretary, Women in Neuromodulation, North American Neuromodulation Society

What motivated you to take on career leadership roles, and what challenges did you have to overcome along the way?

Dr. Jameson: I have always felt strongly that in order to make changes in anything, you have to be willing to step forward and lead. This leadership mentality stems from my time in the military. When I looked around and thought to myself, “I wonder if other women are experiencing these same challenges, I sure wish I could ask 15 other women this question,” I decided to create what I wanted and needed but didn’t see. So, I grabbed some of my friends, colleagues, and other rockstar female docs who I didn’t even know, and we founded the Society of Women Innovators in Pain Management (WIPM). Creating something like WIPM from scratch certainly had its challenges. As with any new entity, the onus is on the group to prove value to its members. I think that the WIPM society fills a void when it comes to women in the field. It provides an avenue for discussion, collaboration, and career development that you just don’t find elsewhere.

How do you feel you have helped to shape a space for women to lead in a male-dominated medical discipline? 

Dr. Jameson: I hope that my persistence and using my voice to create meaningful discussion has allowed other women to see that there are many of us in this space who are willing to lead, teach, and mentor. Despite the small numbers of women in pain management globally, we have a presence and a platform and something unique to offer the field. 

Why do we need more women pain practitioners and how can they impact the field positively? 

Dr. Jameson: I firmly believe that women pain physicians approach things with a different and unique mindset. We offer a view on our patients and the field of pain medicine that is not necessarily better, but different than our male counterparts. This difference and diversity of thought is what makes us all better as practitioners and improves the lives of patients.

Have you ever felt like you were an outsider at a pain conference or professional meeting, by just being a woman? 

Dr. Jameson: Oh sure, I’ve felt like an outsider – many times. I’ve heard comments and jokes at meetings with leadership that are condescending and demeaning. It’s a chance to educate when these things happen. It’s a chance to point out another perspective or view on something. I think that much of the difficulty we face as women stems from a lack of understanding. My grandfather used to tell me that we teach people how to treat us, and I think that is true of all humans, not just women. However, I think the impetus is on me and my female colleagues to teach others how to interact with and support us.

 

MAUREEN F. COONEY, DNP, FNP-BC, PMGT-BC, AP-PMN, ACHPN
Family Nurse Practitioner, Pain Management, Westchester Medical Center, New York
Adjunct Associate Professor, Family Nurse Practitioner Program, Pace University
President, American Society for Pain Management Nursing

How would you say the role of pain management nursing has evolved over time?

Dr. Cooney: In the 30 years since the establishment of the American Society for Pain Management Nursing (ASPMN) in 1990 by a few nurses who were passionate about pain care, the roles of nurses in pain management have been clarified and expanded. Pain management nursing now includes nurses who provide direct care, advanced practice nurses (APNs), nurse leaders, nurse educators, and nurse researchers.

While pain management nursing involves providing direct care to patients across the life-span in a wide range of settings, nurses also have active roles in lecturing, mentoring, and educating other colleagues and healthcare professionals in formal academic positions and in professional venues to improve knowledge of safe and effective pain care. These nurses actively conduct and publish research in the field of pain management as well.

Today’s pain management nurses have embraced the practice of providing integrative multimodal, opioid-sparing approaches to pain care and they have become experts in a variety of evidence-based complementary therapies such as cognitive, energy, behavioral, and movement practices in conjunction with traditional approaches. Perhaps most important, pain management nursing has acquired a voice in national healthcare decision-making.

What changes have you seen in pain care during the pandemic, and what do these changes mean going forward?

Dr. Cooney: As we know, the pandemic imposed many challenges for healthcare providers and patients with pain, and resulted in the need for creative approaches to pain care. Many pain management nurses were temporarily redeployed to support testing and COVID care efforts – but they never abandoned their roles as advocates for patients with pain, and continued to provide pain interventions when many patients with pain also became ill with the virus. In addition, telehealth visits gave pain management nurses the opportunity to see how patients were using and storing their opioids and other medications and provide education to improve safety.

Unfortunately, some patients suffered significant setbacks to pain care during the pandemic as they might not have had access to telehealth or remote visits. Others may have met obstacles in terms of transportation, and lost access to physical therapies, behavioral therapies, and ready access to medications needed to address pain. Sometimes, the only access to pain care came in the form of telephone calls with pain providers.

For some patients with chronic pain, group visits with other patients with pain, facilitated by pain management nurses skilled in cognitive and behavioral therapies were coordinated to offer a means of actively addressing pain.

 

MAGDALENA ANITESCU, MD, PHD
Chair, Women in Neuromodulation, North American Neuromodulation Society
Professor, Anesthesia and Critical Care/Program Director, Multidisciplinary Pain Medicine Fellowship/Section Chief, Pain Management Services, University of Chicago Medicine

You specialize in caring for patients with pain due to primary and metastatic cancer, as well pain in cancer survivors. How did your interest in treating pain in cancer patients develop?

Dr. Anitescu: I have always been interested and fascinated by the complexity of cancer pain. For example, the significant impact that pain management treatments and interventions can have on a patient’s quality of life and the change in their mood the minute that the pain was going away. Since fellowship, performing a celiac plexus block on a patient suffering in pain was almost magical, as she/he started joking and conversing once the pain was gone. As a junior attending in a large academic institution, it was not hard to find like-minded physicians to help those patients.

When I joined the University of Chicago almost 20 years ago, I started collaborating first with palliative care colleagues and we started helping more and more patients. Soon we expanded our portfolio and included treatment of spine metastases with kyphoplasty as well as intrathecal drug delivery systems. Soon enough, our team grew to include radiation oncology, medical oncologists, interventional radiologists, etc, and we all met at the cancer committee meeting to discuss ways to improve cancer care and cancer pain.

What are some of the challenges of treating women with cancer-related pain?

Dr. Anitescu: Women are stoic beings; sometimes you know they must have incredible pain based on disease progression and images, but they report pain scores of 5 or 6. Some other challenges I have seen are related to family involvement. For example, young cancer patients with young children often have  an extra stressor as they worry about leaving their children without a mother. It does break your heart in those situations, but you need to be supportive and give them strength and help as much as you possibly can.

Chronic pain is often linked to, or can lead to, mental health disorders such as depression. Do you think female clinicians have a better understanding and acknowledgment of this? Can they better identify it, treat it?

Dr. Anitescu: Every clinician is different in this aspect. I remember that we conducted a study a few years back looking at the health locus of control (the way patients perceive who is in charge of their care) of the patients suffering from chronic pain. We found that patients with chronic pain fall into three categories: those with an internal locus of control and who are convinced they can participate in their care and are always engaged in their discussions with physicians; those with an external locus of control called powerful others, whose beliefs are that “doctor knows best” and listen to their physicians’ instructions always; and the final category, with an external locus of control called chance, who believe that nobody can help them.

We discovered that chance patients are more depressed than the rest and less likely to engage in their care. I believe a female physician would make a big difference with these patients, by patiently explaining and engaging with them so they can be steered perhaps to one of the other categories.

 

MORGAN POLLARD, MD
Founder, Align Interventional Pain

How did you get your women-led practice going? What motivated you? What obstacles have you had to overcome as an all-woman practice?

Dr. Pollard: I started my own practice out of fellowship. I always wanted to be in private practice, and I’m motivated by having control of my own schedule. I took out a loan and hired two employees and started marketing for referrals. I am in my sixth month, so I am still building. One obstacle has been opening up during the COVID-19 pandemic, but we are getting busier.

What do you think are the benefits of women in pain having a female doctor?

Dr. Pollard: There is an element of comfort if you can relate to your doctor. Women make most decisions in the household, such as what doctor the family members see. I read a prior study that polled patients and found that women prefer a woman doctor but most men don’t care if they see a man or woman. That is a generalization of course, but it seems to hold true.

I have had women come to see me and say they feel more comfortable with me. I hope all my patients are comfortable with me!

As rising practitioners in the field of pain management, where do you hope the field goes when it comes to treating pain in both women and men?

Dr. Pollard: There have been exciting advancements in the past 5 or so years regarding minimally invasive pain therapies. I hope we continue this trajectory, but we walk a fine line of being too open to unproven technology as opposed to too restrictive of emerging helpful therapies. The field as a whole needs to continue to look at data, and not just reimbursement, when making patient care decisions.

 

THE WOMEN FIGHTING FOR CHRONIC PAIN AWARENESS: ADVOCACY & POLICY

VANILA M. SINGH, MD, MACM
Clinical Associate Professor, Department of Anesthesiology, Perioperative and Pain Medicine, Stanford School of Medicine
Immediate Former Chief Medical Officer, US Department of Health and Human Services (HHS), Office of the Assistant Secretary of Health
Chairperson, Best Practices Pain Management Inter-Agency Task Force, HHS

A lot of your work includes translating pain research into policy efforts and patient advocacy. Why do you feel this is important in general, and how does your role as a woman and a member of the BIPOC community drive your ambition and passion for this work?

Dr. Singh: If there is anything that I have learned in my career at the intersection of medicine and policy, it is that policy can often be well-intentioned but often ineffective. It has always been important to me to see well-intentioned policies executed in an impactful way that really helps people. It is up to us as experts in these fields to ensure that important policies do not get watered down or lost in the scuffle of government.

In addition to my medical background, I have always had an interest in history, politics, and economics. These subjects are critical to understanding how the world works and our country has evolved. That is why I had decided to double major at UC Berkeley where I studied molecular & cell biology and economics. I saw the value and importance of market forces and I learned government policy often determines them. 

To have a true impact in medicine you must also understand other stakeholders and in particular our government and how it works to shape policy. My education and career experiences have helped me appreciate the importance of seeing the “big picture” to truly understand market forces and then to alter them. To effect positive change for patients and people it always starts with advocacy through policy and education as well as keeping the pulse of the trenches – this is essential for success in these areas.

As far as being a woman, I can say that the road has been filled with hurdles partly related to the field of (pain) medicine but also due to the innate nature of the evolving roles of women in leadership. I feel strongly about the people I care for. My role as a mother, a daughter, a sister, and an aunt has helped me develop the patience and empathy that helps my work with patients. As a woman in this field, I have undoubtedly experienced discrimination that, at one time, I chose to ignore or deny because I simply wanted to avoid the negative repercussions. Despite these challenges, I chose to forge ahead and not let issues distract me from my goals. I am thankful that things are changing, and we can now speak openly about the very real disparities that continue to exist for women.

Despite your great success in the field, including running the Pain Management Inter-Agency Task Force (see a prior conversation) and serving as CMO at HHS, have you ever felt like you were an outsider at a pain conference or professional meeting, by just being a woman?

Dr. Singh: Absolutely, I have had this feeling on many occasions. It was when I finished my residency over 20 years ago – when women were slowly starting to join and surpass men in the ranks in medicine. You hardly ever saw a female leader or chairperson. Back then, women in medicine had to rely on each other for support and you would be lucky to have that sort of mentorship. As women in the field of medicine, we have a shared experience of sometimes but all too commonly being made to feel like an outsider in our own place of work. On the positive side, experiences like these help women build trust with each other. These relationships are often maintained outside of professional activities as well. We stick together because we trust each other and that has helped bring about change and equality for women in this field.

What has frustrated you most throughout your career? And simultaneously, what do you love most about your work  – what motivates you?

Dr. Singh: The most frustrating aspect of medicine is not being able to provide the care that you know your patients need.  Sadly, I have felt this frustration a lot over the years – often due to issues with the healthcare system, failing treatments, and limited choices. However, over time I realized that a frustrated state is a wasted state and this energy was better channeled to learning and understanding how these decisions were made and I get involved in the process of healthcare policy instead of dwelling on my frustration. I learned how appropriations for funding and resources were being driven to areas like research and development, academia and industry and I used that knowledge of the system to better advocate for patients.

I believe strongly that an essential part of the profession is advocating for a better situation for our patients to have better outcomes. This to me is really the human element of the profession. And, without a doubt, the most fulfilling part of what I do is an impact positive outcome on people’s lives. That is what has fueled my passion for this industry and why I have dedicated my life to this work.

 

ANITA GUPTA, DO, MPP, PHARMD

Distinguished Fellow of the National Academies of Practice; Faculty, Adj. Assistant Professor, Johns Hopkins School of Medicine

A lot of your work includes translating pain research into policy efforts and patient advocacy. Why do you feel this is important?

Dr. Gupta: Empowering patients as change agents leads to focus-driving impact. In the United States, the ongoing drug and opioid crisis combined with the COVID-19 pandemic have created widespread calls to address aggregate use. The well-cited statistics are sobering for all of us but policy and advocacy have the power – amid the devastation – to elevate the voices of patients and their families as change-makers and to redefine these public health challenges. I believe we are all equal stakeholders with patients in a collaborative healthcare effort. Evidence demonstrates that when we empower our health, patient outcomes improve. As an anesthesiologist on the frontlines of the opioid crisis, we are treating more actively involved patients and appreciating more that the value of the patient’s voice lies in their own lived experience. Ultimately, we are learning that what matters to patients is specific to their health outcomes, and sometimes different from the priorities initially planned by their healthcare team. 

See also, Dr. Gupta’s (and others’) advice for male colleagues in pain medicine and for women entering the field.

 

MONICA MALLAMPALLI, PHD, MSC
Senior Scientific Advisor, Scientific and Strategic Initiatives & Head, Chronic Pain Advisory Council, HealthyWomen
Biomedical Scientist
Women’s Health Advocate

You are helping to lead HealthyWomen’s new Chronic Pain Advisory Council. Why was this important to you personally and professionally?

Dr. Mallampalli: Chronic pain and its comorbidities are the leading chronic conditions that affect women in the United States. Professional interest comes from knowing that the scientific literature has identified sex differences in chronic pain, but that never translated into clinical practice. Plus, I saw chronic pain as a recurring theme, even when conversations were centered around other chronic conditions.

In terms of personal interest, I had met some amazing women pain warriors and their stories really touched my heart. Knowing that these women were not believed by the healthcare professionals and not receiving the care they needed due to barriers and challenges drove me to hold HealthyWomen’s first summit in 2019 to exclusively address the issues that affect women living with chronic pain. Subsequently, we have continued to highlight issues in chronic pain specific to women on HealthyWomen.org, and in our new council which will serve as a collective authority advocating for more education, awareness, and care for women living with chronic pain.

Have you ever felt like you were an outsider at a pain conference or professional meeting, by just being a woman?

Dr. Mallampalli: I did not experience this at a pain conference, but I did experience this at a sleep conference in 2013 where there was nothing being addressed specifically on sleep health in women. However, much has changed since then. This experience, however, led me to address the issue of sex differences in sleep in my own work. 

What challenges have you had to overcome as a woman leader, and as a member of the BIPOC community, in a male-dominated field?

Dr. Mallampalli: Academia tends to be a male-dominated field. My male professors in India discouraged me from coming to the US to pursue my doctorate degree because they never had a female student do this before. I have also experienced similar bias in the US on a couple of occasions, from both men and women. I have never let these comments bother me and have always followed my dreams and my interests, which have led me to be a successful leader. I have also had some great women mentors who have served as role models and have been a source of inspiration.

           

THE WOMEN WHERE IT STARTS: PAIN RESEARCH, TRAINING, AND EDUCATION 

BETH DARNALL, PHD
Associate Professor, Anesthesiology, Perioperative and Pain Medicine
Stanford University School of Medicine
Director, Stanford Pain Relief Innovations Lab
Creator, Empowered ReliefTM

You run your own research lab at Stanford and have become a known name in the field, especially in pain catastrophizing, psychology, opioid therapy, fibromyalgia, patient-centered tapering, and effective long-term outcomes. What has motivated your career and what challenges have you had to overcome?

Dr. Darnall: My career as a pain psychologist was motivated mainly by working with patients, the positive feedback I received, and the gratification of seeing their lives improve. I began research on scalable treatments out of sheer necessity as individual treatment is limiting in terms of the volume of patients you can treat and reach. So, I began authoring books, developing group interventions and then extending those further into the digital space for further scalability. I am motivated to help the largest number of people, recognizing that the most scalable treatment options will be insufficient for many. At a minimum, everyone should have equitable access to a basic level of evidence-based behavioral pain treatment that is convenient to receive and low burden. It is a population approach to pain treatment.

A different topic is prescription opioids. In 2008, patients were coming to me because they wanted help stopping opioid medication and support was not available to them. Today, patients come to me for help maintaining opioid prescriptions that they need, and little support is available to them. While these are two ends of the continuum, in both cases the solution is patient-centeredness. In my work, writing, research, lectures, and invited testimony to Congress and the FDA, I oppose reductive opioid prescribing limits that prevent patients from accessing needed treatment. Patients are not a monolith, and neither is chronic pain. I fiercely advocate for individualized pain care.

The challenges I have experienced in my career are not unique to me. Beginning my academic career at an institution where there were few colleagues in my area was a major challenge. It is much harder to progress without strong environmental support and collaborative opportunities, but fortunately, that changed when I moved to Stanford. Here, I am surrounded by fantastic clinical and research colleagues.

When do you think we as a society are going to get past the pain research gap to truly understand how pain impacts women and to treat them effectively?

Dr. Darnall: I don’t have a crystal ball, but I can say that I would love to see more research on the social impacts of pain in regard to sex/gender and race, and effective interventions that target social impacts.

Have you ever felt like you were an outsider at a pain conference or professional meeting, by just being a woman?

Dr. Darnall: Definitely I have been an outsider—but I attribute it to being outside of a particular professional social “circle” versus related to my gender. I have certainly encountered individuals who I would politely characterize as having “gender bias,” but they never had authority over me, so while it was annoying, it was ultimately inconsequential. In the big picture, my gender has not been a barrier. 

 

TINA DOSHI, MD, MHS*
Assistant Professor, Pain Medicine, Johns Hopkins University
Clinical Researcher
Founding Member/Chair, Women in Regional Anesthesia and Pain Medicine (WRAPM) Special Interest Group, American Society for Regional Anesthesia and Pain Medicine
Appointed Member, Neuropathic Pain Special Interest Group (NeuPSIG) Trainee Subcommittee International Association for the Study of Pain

When do you think we as a society are going to get past the pain research gap to truly understand how pain impacts women and to treat them effectively?

Dr. Doshi: We need to view sex as a biological variable, so we need to be more sophisticated in how we design, analyze, and interpret pain research studies. For preclinical studies, that means including animals of both sexes and analyzing the data together and separately to understand the biological basis of potential sex differences in pain. For clinical studies, that means understanding the target population, recruiting a pool of research participants that reflect that population, and stratifying analyses by sex. All of these things require larger sample sizes and often multisite collaboration, which requires financial support and robust research infrastructure. So, to get past the pain research gap, we as a society need to be willing to put in the resources to expand and improve pain research in general.

Have you ever felt like you were an outsider at a pain conference or professional meeting, by just being a woman?

Dr. Doshi: I’ve never really felt like an outsider by virtue of being a woman, but I’ve certainly had experiences of being keenly aware that my perspective is very different because I am a woman. Women make up less than 20% of practicing pain physicians, so I think almost every woman in the field experiences being “the only woman in the room” at some point in time. I don’t think that it’s ever an intentional thing to make a woman feel excluded, and I’ve personally never felt uncomfortable when it’s happened to me. 

However, I think the danger in those situations is to view the one woman as representative of all women, when in truth every individual has their own unique set of skills and experiences, which are in part shaped by sex and gender. I think when we see someone as “the only” X, Y, or Z in the room, we shouldn’t thrust her or him into the role of being a spokesperson for an entire gender or race, or demographic group. Instead, we should view the person as an individual and take it as an opportunity to delve into why our profession isn’t as diverse as we’d like it to be, and how we can bring more diverse viewpoints into that room.

More advice from Dr. Doshi on power-sharing and training.

 

MAY CHIN, MD
Professor, Anesthesiology & Critical Care Medicine
Co-Director, Spine and Pain Center 
Program Director, Pain Medicine Fellowship at George Washington University School of Medicine and Health Sciences

How do you think the COVID pandemic differentially affected the careers of women in pain management, and what can practice leaders/organizations do?

Dr. Chin: In general, during the first 6 months of the pandemic, there was a drop in patient numbers both in the clinic and in the procedure suites. Some providers were able to transition to seeing a larger number of patients virtually. In these situations, the slight flexibility of hours helped those with young (or older) family members to care for. On the other hand, many in private practice may have seen a decline in revenue due to a drop in clinic patients and procedures, and for some, this may possibly have had an impact on the sustainability of a practice. 

When there was more time at home, some women clinicians may have benefited from more flexible time to work on scholarly activities – for example, contributing to chapters in a book, writing papers or reviews to further academic opportunities while fulfilling teaching/lecturing on a virtual platform.  

Practice leaders and organizations can help by supporting virtual visits with regard to reimbursement. Additionally, they can offer online education on topics such as physical exams during virtual visits or how to improve the efficiency of virtual visits. 

As a professor of anesthesiology, what is important for your female students to understand as they begin their careers in this male-dominated field?

Dr. Chin: They need to understand the importance of “having a seat at the table.” Therefore, they are encouraged to be involved at an educational level or administrative level, for instance. It is important to encourage them to excel – to choose a subject/area they are interested in, seek out expertise in the field, and ask if they may help with projects. Also, I encourage them to be active in pain and anesthesia societies such as ASRA and ASA. They should seek out roles, be it in education or legislation, and they should find a cause and pursue it.

What obstacles have you had to overcome as a woman in medicine over the length of your career?

Dr. Chin: One obstacle I have had to overcome is that I had to work much harder to justify leadership roles, as such roles “automatically” went to male counterparts who may have been less senior or experienced. Also, I was passed over for speaker and moderator roles. I contributed good ideas for topics for future meetings; this was not acknowledged at the time, but my ideas were used subsequently.

 

JUDITH A. PAICE, PHD, RN, FAAN
Director, Cancer Pain Program, Division of Hematology-Oncology/Research Professor of Medicine, at Northwestern University’s Feinberg School of Medicine
Member, Robert H. Lurie Comprehensive Cancer Center
Member, NIH HEAL Initiative Multidisciplinary Working Group

As the director of the Cancer Pain Program at Northwestern University, can you talk about the challenges of translating research into daily practice? Do you find that there are specific challenges for women practitioners in this area?

Dr. Paice: Opportunities for interaction between basic scientists and clinicians have become limited. Shrinking travel budgets limited attendance when meetings were in person. Virtual meetings fostered by the pandemic provide an opportunity to improve access to formal data sharing, yet current platforms do not yet emulate the rich informal networking and conversations that occurred before and after presentations. And we have heard much about the special challenges women face in trying to balance professional and personal responsibilities, including childcare and eldercare, in the time of a pandemic.

How did your interest in treating pain in cancer patients develop? Can you discuss the unique challenges of treating pain in people with cancer?

Dr. Paice: As a brand new staff nurse on an oncology unit I witnessed extraordinary pain and suffering. This was a time long before the introduction of extraordinary therapies such as immunotherapy and targeted approaches. When pain medications were used appropriately, and emotional distress was compassionately addressed, people with cancer had improved quality of life, spending important time with family and friends. Yet there were so many barriers to providing effective cancer pain control, notably around the use of opioids, but also about physical, interventional, and integrative therapies. Unfortunately, these obstacles have intensified in past years with the misapplication of clinical practice guidelines, restrictive regulations, and limited reimbursement.

When do you think we may overcome the pain research gap to truly understand how pain impacts women?

Dr. Paice: Although scientists of all sexes can and should investigate the influence of pain on women, our understanding will grow when more women enter the field, including basic, clinical, population, and implementation sciences. Funding is imperative, as are forums that allow data sharing, discussion, and networking.

 

 

We Could Go On…. Additional Women Leaders in Pain Medicine

Below are some of the additional names – in alphabetical order – recommended for this roundtable who deserve recognition for the work they are achieving in pain medicine. If you believe we missed someone, please email the editor and we may add them to the list.

  • Amy Baxter, MD, Chief Medical Officer and CEO, Pain Care Labs; Developer, MDEA-Winning Buzzy physiologic pain blocker and VibraCool
  • Inna Belfer, MD, PhD, Program Director, Basic and Mechanistic Research in Complementary and Integrative Health Branch, Division of Extramural Research, NIH
  • Andrea (Nicol) Chadwick, MD, Associate Professor, University of Kansas Medical Center; pain researcher and fibromyalgia expert
  • Luana Colloca, MD, PhD, MS, Associate Professor, Pain and Translational Symptom Science/Adjunct Anesthesiology Professor, University of Maryland Schools of Nursing and Medicine
  • Julie Fritz, PT, PhD, addresses chronic pain management through physical therapy and research. She serves as distinguished professor of PT and athletic training and as the associate dean for research, College of Health, at the University of Utah.
  • Carmen R. Green, MD, Professor of Anesthesiology and OBGYN, University of Michigan (UM) School of Medicine, and of Health Management and Policy, UM School of Public Health; attending physician, UM Back and Pain Center; Faculty Associate for a number of UM’s specialized institutes and programs, including: Research on Black Americans; Group Dynamics; Research on Ethnicity, Culture, and Health, Health Behavior, and Health Education; and Health Policy and Innovation. Dr. Green’s research has addressed healthcare policy and reform and disparities in healthcare.
  • Danielle Bodzin Horn, MD, Assistant Professor of Clinical Anesthesiology, University of Miami
  • *Theresa Mallick-Searle, MS, RN-BC, ANP-BC, Nurse Practitioner, Division of Pain Medicine, Stanford Health Care, California; CO*OR REMS Education Faculty, Nurse Practitioner Healthcare Foundation; Master Faculty of Advanced Pharmacology, ASPMN (Read her Advanced Practice Matters column)
  • Suzanne Manzi, MD, Partner at Performance Pain & Sports Medicine, TX
  • Barbara St. Marie, PhD, AGPCNP, FAANP, FAAN, Assistant Professor, University of Iowa College of Nursing
  • Susan M. Moeschler, MD, Director-at-Large for NANS; Chair, Women in Pain Medicine SIG, AAPM, Course Director, for Mayo GRIT
  • Shachi Patel, MD, Owner of Delmarva Pain and Spine Center, DE
  • Erika Petersen, MD, first female professor of neurosurgery in Arkansas, UAMS
  • Dawn A. Sparks, MD, Physicia/Owner/Founder/Medical Director, Lighthouse Healing, HI
  • Kathryn G. Schubert, MPP, President, Society for Women’s Health Research
  • Marsha Stanton, PhD, RN, Pain Management Nurse; Trustee, PA Foundation, CA
  • Natalie H. Strand, MD, Director, Pain Research and Director, Neuromodulation, Mayo Clinic Arizona, AZ
  • Andrea Trescot, MD, Past President, American Society of Interventional Pain Physicians; former professor, University of Washington (UW) Seattle; previous Director, Pain Fellowship Programs, UW and University of Florida.
  • Stephanie G. Vanterpool, MD, MBA, Treasurer, Women in Neuromodulation; Board of Directors of North American Neuromodulation Society (NANS)
  • Gina Votta-Velis, MD, PhD, Associate Professor, Clinical Anesthesiology and Surgery, University of Illinois at Chicago; Anesthesiologist, Jesse Brown West Side Veterans Administration Hospital; recognized as an ASRA trailblazer along with Drs. Chin and Anitescu above
  • Carol A. Warfield, MD, Anesthesiologist (Ret), Harvard Medical School; pain researcher and author
  • Jackie Weisbein, DO, PM&R clinician at Napa Valley Orthopaedic, CA
  • *Kathryn A. Witzeman, MD, FACOG, Immediate Past President, International Pelvic Pain Society; Associate Professor, OBGYN, Univ Colorado School of Medicine; Founder, Women’s Integrated Pelvic Health Program, Denver Health Medical Center (Read her new column on pelvic pain disorders)

*Members of the PPM Editorial Advisory Board

Last updated on: August 13, 2021
Continue Reading:
Male Clinicians as Allies in Women’s Leadership: What Your Female Peers Want You to Know
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