In this episode of RAPM Focus, executive editor Steven Cohen, MD, discusses the September 2024 publication of “Current state of the pain medicine match: perspective and an eye to the future,” with Meredith Barad, MD, Anuj Aggarwal, MD, and Lynn Kohan, MD.

This letter explores the rationale behind reassessing the NRMP’s utility for pain medicine, examining historical and current trends, and considering the implications of withdrawing from the match. Despite a recent decline in applicants and an increase in unfilled positions, the APPD advocates for continued participation in the match. The match ensures equitable and stable recruitment, preventing the chaotic pre-match environment of competitive, early offers. Data from similar specialties highlight the pitfalls of non-match systems, such as increased applicant pressure and reduced program visibility. The APPD supports maintaining the NRMP match while implementing reforms like preference signaling to address evolving challenges. The APPD aims to preserve the match’s benefits and ensure a stable future for pain medicine fellowship recruitment.

Dr. Barad is a clinical associate professor in anesthesiology (pain) and neurology at Stanford. She is the co-director of the Stanford Facial Pain Program and focuses on headache and facial pain. She completed her undergraduate work at the University of Texas at Austin and graduated from Stanford University Medical School in 2003. After her internship at Santa Clara Valley Medical Center in San Jose, CA, she went on to a neurology residency and pain fellowship at Stanford. She is board certified in neurology, headache, and pain. She is the associate division chief of education and program director for the pain fellowship. She is the current president of the American Pain Program Directors. She serves as the chair of the headache and facial pain special interest group for the American Academy of Pain Medicine and is on the editorial board of Pain Medicine.

Dr. Aggarwal is a clinical assistant professor of anesthesiology and the associate program director of the pain medicine fellowship at Stanford University, where he specializes in headache and orofacial pain. In addition to his work in pain medicine, he helps lead the teaching of medical students serving as director of pharmacology and as associate director for the Science of Medicine.

Dr. Kohan is a professor of anesthesiology and pain medicine at the University of Virginia. She is the division chief and the chronic pain program director. She serves on the board of directors for national pain societies including ASRA Pain Medicine.

*The purpose of this podcast is to educate and to inform. The content of this podcast does not constitute medical advice, and it is not intended to function as a substitute for a healthcare practitioner’s judgement, patient care, or treatment. The views expressed by contributors are those of the speakers. BMJ does not endorse any views or recommendations discussed or expressed on this podcast. Listeners should also be aware that professionals in the field may have different opinions. By listening to this podcast, listeners agree not to use its content as the basis for their own medical treatment or for the medical treatment of others.

Podcast and music produced by Dan Langa. Find us on X @RAPMOnline, LinkedIn @Regional Anesthesia & Pain Medicine, Facebook @Regional Anesthesia & Pain Medicine, and Instagram @RAPM_Online.

This AI-generated episode of RAPM Focus discusses the May 2024 publication of “Single-bolus Injection of Local Anesthetic, With or Without Continuous Infusion, for Interscalene Brachial Plexus Block in the Setting of Multimodal Analgesia: A Randomized Controlled Unblinded Trial” by Dr. Patrick Rhyner et al.”

For anyone facing shoulder surgery, pain management after the procedure is crucial. In this paper, Rhyner et al. question whether or not a continuous infusion of pain medication through a catheter is better than giving a patient a single injection after having shoulder surgery. The paper discusses a multimodal approach of pain management—dethamexazone, magnesium, acetaminophen, and ketorolac.

In this study, patients undergoing two common shoulder surgeries—shoulder arthroplasty or arthroscopic rotator cuff repair—were divided into two groups, in which one group received a continuous infusion of medication via catheters, or a single dose of pain relief. Results were measured by how much morphine patients needed through a patient-controlled analgesia pump during the first 24 hours after surgery.

*The purpose of this podcast is to educate and to inform. The content of this podcast does not constitute medical advice, and it is not intended to function as a substitute for a healthcare practitioner’s judgement, patient care, or treatment. The views expressed by contributors are those of the speakers. BMJ does not endorse any views or recommendations discussed or expressed on this podcast. Listeners should also be aware that professionals in the field may have different opinions. By listening to this podcast, listeners agree not to use its content as the basis for their own medical treatment or for the medical treatment of others.

Podcast and music produced by Dan Langa. Find us on X @RAPMOnline, LinkedIn @ Regional Anesthesia & Pain Medicine, Facebook @Regional Anesthesia & Pain Medicine, and Instagram @RAPM_Online.

Hosted by RAPM Editor Eric Schwenk, MD, this episode of RAPM Focus welcomes RAPM Associate Editor Mark Bicket, MD, PhD, and medical student Sama Ramo following the recent publication of their original research paper, “Risk Factors for Persistent Postoperative Opioid Use: An Entity Distinct from Chronic Postsurgical Pain,” included in the February 2025 special edition of RAPM, titled “Tackling the Challenge of Chronic Postsurgical Pain.”

Persistent postoperative opioid use results when patients continue to take prescription opioids well beyond the time their pain after surgery would be expected to resolve. In some cases, this is a couple days; in other cases, this is several weeks. There are many challenges associated with prescription opioid use, including the lack of a truly safe dose, so there is risk across the continuum. Patients facing persistent postoperative opioid use potentially confront worse outcomes, higher rates of health care utilization, and higher rates of mortality compared to patients not enduring persistent postoperative opioid use.

Dr. Mark Bicket is an associate professor of anesthesiology with tenure at the University of Michigan and a joint appointment in the Department of Health Management and Policy at the School of Public Health. Additionally, he is co-director of the Overdose Prevention Engagement Network (OPEN). A clinician-scientist and practicing physician anesthesiologist, Dr. Bicket has pioneered evidence-based approaches to reduce opioid-related harms and improve the treatment of persons who experience pain. He currently leads an NIH R01 study examining pain-related outcomes for persons with opioid use disorder who have surgery and serves as PI for two pragmatic trials funded by the Patient-Centered Outcomes Research Institute including the CARES study, an international randomized clinical trial examining commonly prescribed treatments for postoperative pain. He previously served on the National Academy of Medicine ad hoc committee on evidence for opioid prescribing guidelines in 2018-2019 and a workshop on opioid disposal in 2023. Dr. Bicket has advised the White House, FDA, CMS, state governments, and national organizations on pain and opioid issues. His research, which includes 120 peer-reviewed articles, has appeared in JAMA, NEJM, and BMJ, and has been supported by the Foundation for Anesthesia Education and Research (FAER), SAMHSA, and CDC.

Sama Ramo is a second-year medical student at Oakland University William Beaumont School of Medicine. She is a Foundation for Anesthesia Education and Research scholar.

*The purpose of this podcast is to educate and to inform. The content of this podcast does not constitute medical advice, and it is not intended to function as a substitute for a healthcare practitioner’s judgement, patient care, or treatment. The views expressed by contributors are those of the speakers. BMJ does not endorse any views or recommendations discussed or expressed on this podcast. Listeners should also be aware that professionals in the field may have different opinions. By listening to this podcast, listeners agree not to use its content as the basis for their own medical treatment or for the medical treatment of others.

Podcast and music produced by Dan Langa. Find us on X @RAPMOnline, Facebook @Regional Anesthesia & Pain Medicine, and Instagram @RAPM_Online.