Non-drug pain management: promising techniques

José De Andrés Ibáñez, president of the European Society of Regional Anesthesia and Pain Treatment (ESRA) in Spain.

Jose De Andres Ibanez is president of the European Society for Regional Anesthesia and Pain Management (ESRA) in Spain and head of the Anesthesiology, Resuscitation and Pain Treatment Service of the Valencia-General Hospital Department. This year, the aforementioned Society celebrates its 25th anniversary in San Sebastián, the place where its first council was held a quarter of a century ago. In an interview with Medical Writingits president talks about the challenges that the Society has overcome, what its future goals are, and the important training offer offered by the group for professionals in the specialty.

ESRA Spain has become, after three decades of existence, a benchmark as a medical society within the field of Anesthesiology in our country. How important is Spanish representation in the European scientific society?

Of course, our integration, just as Spain joined the European Union, brings about an agreement with the societies that, in some way, currently govern the standards, clinical practice guidelines and scientific development. ESRA, the European Society for General Anesthesia and Pain Management, is the oldest Society in existence. It was created in 1982 and Spain always sought its integration as a country and to have a presence in the forum; we now have representation on the board of that company. From there our obligation is established, which is linked to the activity: we decide which activities are marked in our country.

What values ​​would you highlight from society?

For us the main thing would be to be able transmit at a Spanish level all the guides that are marked at an international level and that all the countries that belong to the society are following. We, as one more, are integrating these international standards in the good practice of regional anesthesia and pain treatment in Spain.

One of the pillars of ESRA Spain is its training program for professionals in Regional Anesthesia and Pain Treatment. What have been the greatest achievements in this field and what offer currently exists?

ESRA was a pioneer in being able to integrate continuous training programs, and what is more important, at the same time certify them with credits and, later, have knowledge accreditation systems. We had diplomas in Regional Anesthesia and Treatment of Acute Pain and now, more recently, also a European Diploma of Chronic Pain Treatment. It is a society that, at all times, has had the training of anesthesiologists as its fundamental objective, but has also had its accreditation system as an essential pillar. I think that the greatest achievement we have had since this society is being able to train, but also accredit professionals, an essential element in their career.

Also, as a result of work carried out by ESRA Spain with international society, an advance is that diplomas can be issued in Spanish. It is one of the activities that we carry out within the annual congress, that is, we promote all the training activity, but also the diploma is developed during the celebration of the congress, which is an added value for all the participants.

What innovations do you expect in the short and medium term future in the treatment of pain?

In the approach to pain, pharmacology is in development, but perhaps due to the time needed to test the products, and the difficulties of the pharmaceutical companies, we do not have short-term expectations of great changes. Nevertheless, everything that involves non-pharmacological techniques is very promising. Through technology we are having active patient management possibilities that allow us, both in the treatment of acute pain and chronic pain, to have a very broad and adequate portfolio of services.

To give an example, from anesthesiology we have always worked on pain control through nerve transmission. Now we have the ability, I think in the short term, for neuroregulation techniques with types of currents to allow very adequate control of the pain experienced by patients.

In these years, in which the great advances in the field of pain stand out, in what way would you say that these techniques have managed to reduce patient visits to their doctor and, therefore, have relieved the pressure of care, also improving the quality of care? patient’s life?

Technological development itself has made it possible for us to propose actions that have a certain time of action. We are talking in many cases of months. For example, the implantation of certain systems within the patient’s body allows regulate the origin of pain and thereby reduce the source that is causing this. Thus, much longer times of pain efficacy are achieved. In addition, as the patient can self-regulate their treatment, it can be adapted to their routine. In the end, every day has a need and, whether it is rest or physical activity, it will have different requirements. This makes the systems are adapted to the needs of the patient. When it is not an implanted system and what we have is a treatment, we achieve prolonged effectiveness times, which allows the patient to have a much longer follow-up.

With the new Royal Decree on Specialties already published, what training development in these fields of pain and locoregional anesthesia should Anesthesiology have?

Within the profile of the anesthesiologist, pain control is our fundamental factor. This is the origin of comfort, which in the end, both in surgical anesthesia and in the postoperative period, or in the chronic facet of a disease, is what is desired. The problem is the lack of time when carrying out our training. The training time for this specialty is four years, compared to other specialties that have five. The duration itself has been a limiting factor since the training content of the specialty, over the years, has been growing. Thus, we have the problem of how to be able to transmit to the training specialists all the content that they have to have in the time we have.

Now, both in the short term and in the future, our expectation is that decision-making bodies understand the great content that our specialty has and be able to improve training time so that professionals can access all this knowledge.

What have been your greatest challenges and your greatest satisfaction during these years as president of the scientific society?

Without a doubt, the biggest challenge has been how to deal with external threats. For example, all the changes or difficulties that have arisen as a result of the pandemic. During that period we have very limited meetings, and it has also changed the way in which they were made. Like all societies, we have modified the way in which we maintain contact with partners. In addition, without a doubt, the economic phases that the country itself has not accompanied, because it has also been a difficulty. We have always adapted to the economic, social and health horizon and our challenge has always been to be one step ahead of the difficulties of the environment.

On the other hand, our satisfaction has been 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. In scientific meetings we have to comply with all health regulations, at that time very strict due to covid, and even so there was a huge participation and no incidence or outbreak derived from the congress. It was a way of consolidating ourselves as a society. We arrive at this 2022 congress with full capacity.

This year, the ESRA Spain Annual Meeting is being held in San Sebastian. What stands out from this edition?

He stressed that we are going to celebrate 25 uninterrupted years of meetings. It is a quarter of a century of training activity of ESRA Spain. it is a satisfaction return to our point of origin because 25 years ago, in 1997, the first council was held in San Sebastián. From the training point of view, we have the most exciting current issues. In addition, the training becomes absolutely interactive. We propose a theoretical training because today we can access it by electronic means in a massive way. Our approach is to have the best educators and teachers and that this offer is presented in an interactive way.

Next year, this scientific appointment will be in Oviedo, do you expect to introduce anything new? What issues do you think will star in the 2023 congress?

The 2023 congress program is in production. The thing is that, to have the most up-to-date themes, you have to work on them as they happen. If they are raised a long time in advance, we lose this freshness. But yes, there are already clear issues. Also, Oviedo is a city that traditionally stands out for being a MIR training center with a lot of prestige, and this forces us to have training at the level of the name of the city. ESRA Spain has always advocated completing the training of the MIR that is still being trained, normally in the third and fourth year of specialization. Our great commitment is that they find a complement to what they are learning in their own hospitals.

The fact of going to a city that has great prestige in education is an incentive to have a program that is up to the task.

It is not long before the ESRA Spain Annual Meeting celebrates its 30th edition. How have they achieved this great development as a scientific society? What do you expect from the future of ESRA Spain?

The great development of ESRA has always been to look at the partner. As head of the company, we have always tried to avoid what is seen in other organizations: a great hypertrophy of its own structure and its own orders, leaving the partner as an additional element. Us we have always looked at the participant and follower as the key element to continue making society a focus of attention for these people.

We believe that competition is very important, we always have to look at how things are being done in our environment. The ideal is to always learn from who we think is doing well, and we try to do better, with all the humility, but with all the effort that implies the improvement of the day to day. Whoever thinks he has done well and has reached his optimum point does not have good internal management. Our management is the day-to-day analysis and knowing that we can do better. For it we always look at the participants and followers, and ask them what they want from us and how we can do better. We look to the future seeking excellence at the same time that scientific knowledge advances, as well as the way in which scientific knowledge is transferred. Training mechanisms are going to change over time and ESRA will always be attentive to being able to integrate new developments into its training program.

Although it may contain statements, data or notes from health institutions or professionals, the information contained in Medical Writing is edited and prepared by journalists. We recommend the reader that any questions related to health be consulted with a health professional.

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