Drug-free pain management: promising techniques
José De Andrés Ibáñez, President of the European Society of Regional Anesthesia and Pain Management (ESRA) in Spain.
ESRA Spain has become, after three decades of existence, a benchmark as a medical society in the field of anesthesiology in our country. How important is Spanish representation in the European scientific community?
Of course, our integration, just as Spain joined the European Union, leads to an agreement with the societies that somehow currently govern standards, clinical practice guidelines and scientific development. ESRA, the European Society for General Anesthesia and Pain Management, is the oldest existing society. It was established in 1982 and Spain has always sought to integrate as a country and have a presence in the forum; we now have representation on the board of this company. From there, our activity-related obligation is established: we decide which activities are flagged in our country.
What values would you bring out from society?
For us, the most important thing would be to be able to transmit to the Spanish level all manuals that are marked at the international level and that all the states which belong to the society follow. We, as one more, integrate these international standards into the good practice of regional anesthesia and pain management in Spain.
One of the pillars of ESRA Spain is its training program for specialists in regional anesthesia and pain management. What are the biggest achievements in this area and what offer is there at the moment?
ESRA pioneered the ability to integrate continuing education programs and, more importantly, at the same time certify them with credits and later have knowledge accreditation systems. We had diplomas in regional anesthesia and acute pain management, and now, more recently, as well European Diploma in Chronic Pain Management. It is a society that has always had the training of anesthesiologists as its primary goal, but has also had its accreditation system as its main pillar. I think the biggest achievement we have since this society is being able to train but also accredit professionals, an essential element in their career.
Also, as a result of the work done by ESRA Spain with the international community, this is progress diplomas may be issued in Spanish. This is one of the activities that we do within the framework of the annual congress, that is, we promote all the educational activity, but also the diploma is developed during the celebration of the congress, which is an added value for all participants.
What innovations do you expect in the short to medium term in pain management?
In the approach to pain, pharmacology is evolving, but perhaps due to the time it takes to test products and the difficulties of pharmaceutical companies, we do not have short-term expectations for major changes. However, anything that involves non-pharmacological techniques is very promising. Through technology, we have active patient management capabilities that allow us, in both acute pain and chronic pain management, to have a very broad and adequate portfolio of services.
For example, from anesthesiology we have always worked pain control through nerve transmission. We now have the capability, I think in the short term, of neuroregulatory techniques with types of currents to allow very adequate control of the pain experienced by patients.
In these years of major advances in pain, how would you say these techniques have been able to reduce patient visits to their doctor and therefore ease the burden of care while also improving the quality of care ?life of the patient?
Technological development itself has made it possible for us to offer actions that have a specific time of action. In many cases we are talking about months. For example, the implantation of certain systems in the patient’s body allows regulate the origin of pain and thereby reduce the source that causes it. Thus, much longer times of pain efficacy are achieved. In addition, since the patient can regulate his own treatment, it can be adapted to his routine. After all, every day has a need, and whether it’s rest or physical activity, there will be different requirements. This makes systems are adapted to the needs of the patient. When a system is not implanted and what we have is a treatment, we achieve extended times of effectiveness, which allows the patient to have a much longer follow-up.
With the new Royal Decree on specialties now published, what training development in these areas of pain and locoregional anesthesia should anesthesiology have?
Within the anesthesiologist profile, pain control is our primary factor. This is the origin of comfort, which ultimately, whether in surgical anesthesia or in the postoperative period or in the chronic aspect of the disease, is what is desired. The problem is in lack of time in conducting our training. Training in this specialty is four years, unlike other specialties, which are five. The duration itself is a limiting factor, as the study content of the major has grown over the years. Thus, we have the problem of how to be able to convey to the trainers all the content that they need to have in the time that we have.
Now, both in the short term and in the future, our expectation is that the decision-making bodies understand the great content that our specialty has and can improve the training time so that professionals have access to all this knowledge.
What have been your greatest challenges and your greatest satisfactions during these years as president of the scientific society?
Without a doubt, the biggest challenge is how to deal with external threats. For example, any changes or difficulties that have arisen as a result of the pandemic. During this period we have very limited appointments, and also changed the way they were made. Like all societies, we have changed the way we keep in touch with partners. In addition, without a doubt, the economic phases that the country itself did not accompany, because this was also a difficulty. We always have adapted to the economic, social and health horizon and our challenge has always been to stay one step ahead of environmental challenges.
On the other hand, our satisfaction was that even during the pandemic we had virtual congresses and the follow-up was massive. And immediately, in September of last year, we were the first company to hold a physical event. At the scientific meetings we have to follow all the health regulations, at that time very strict due to covid, and yet there was a huge participation and no cases or epidemic arising from the congress. It was a way to consolidate ourselves as a society. We arrive at this convention in 2022 at full capacity.
This year the ESRA Spain Annual Meeting takes place in San Sebastián. What’s different about this release?
He emphasized that we will celebrate 25 years of continuous meetings. This is a quarter century of ESRA Spain’s training activity. it is satisfaction back to our point of origin, because 25 years ago, in 1997, the first council was held in San Sebastian. From a learning perspective, we have the most exciting current issues. In addition, the training becomes absolutely interactive. We offer theoretical training because today we have mass access to it electronically. Our approach is to have the best lecturers and teachers and to present this offer in an interactive way.
Next year this scientific appointment will be in Oviedo, do you expect to introduce something new? What issues do you think will be addressed at the 2023 convention?
The program of the congress for 2023 is being drawn up. The thing is, to have the hottest topics, you have to work on them as they happen. If they are grown for a long time beforehand, we lose that freshness. But yes, there are clear problems already. Also, Oviedo is a city that has traditionally stood out as a MIR training center with a lot of prestige, and this requires us to have training at the level of the name of the city. ESRA Spain has always advocated the completion of MIR training, which is still taught, usually in the third and fourth year of specialization. Our great commitment is that they find a complement to what they learn in their own hospitals.
The fact of going to a city with great prestige in education is an incentive to have a program that is up to the task.
Not long after, ESRA Spain’s annual meeting celebrated its 30th edition. How have they achieved this great development as a scientific society? What do you expect from the future of ESRA Spain?
ESRA’s big development has always been to look to the partner. As a person in charge of the company, we have always tried to avoid what is seen in other organizations: a great hypertrophy of our own structure and of our own orders, leaving the partner as an additional element. Us we have always looked at the participant and the follower as a key element to continue making society the focus of these people’s attention.
We believe that competition is very important, we should always look at how things are done in our environment. The ideal is to always learn from the one we think is doing well, and we try to do better, with all humility, but with all efforts that imply improvement every day. Anyone who thinks they have done well and reached their optimum point does not have good internal management. Our management is the daily analysis and the knowledge that we can do better. For him we always look at participants and followers and ask them what they want from us and how we can do better. We look to the future, seeking excellence both as scientific knowledge advances and the way scientific knowledge is transferred. Training arrangements will change over time and ESRA will always be open to integrating new developments into its training programme.
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