Todd Sitzman is the medical director of Advanced Pain Therapy at a comprehensive pain clinic in Hattiesburg, Mississippi. As president of the North American Neuromodulation Society (NANS), he reflects on the society’s success, growth, and expanding influence over the past twelve months. Here, he talks to NeuroNews about how he has seen the field change, his hopes for the future, and his interests outside of medicine.
What drew you to medicine, and to neuromodulation and pain management in particular?
I was fortunate to be drawn to medicine at an early age, and never seriously considered any other profession. No immediate family or relatives presented themselves as physician role models, but instead, my interest stemmed from a life-long passion to help people. For me, a career in pain management was a natural fit. I was introduced to pain medicine as a specialty during my anaesthesiology training. There is no other specialty that allows a physician to care for patients utilising his or her knowledge of anatomy, physiology, pharmacology, radiology, and interventional procedures on a daily basis.
Who have been your career mentors, and how have they inspired you?
Over the years I have been influenced by many individuals, and the list continues to grow. Without identifying specific individuals, I most admire those who exhibit compassion, calmness, and respect for others—be it, physician, nurse or receptionist. My professional growth has been influenced by several of my North American Neuromodulation Society (NANS) colleagues, often by challenging me and opening my eyes to different clinical perspectives. I firmly believe that the acquisition of knowledge is never-ending. As physicians, we gain knowledge through didactic education and skills through hands-on training. But, to become a physician in the truest sense, you need selfless compassion.
How have you seen the field of neuromodulation change and develop over your years practising medicine?
Over the past twenty years, I have seen spinal cord stimulation and intrathecal drug delivery undergo continuous innovation, and I am certain that the therapies I utilise now will evolve over the next twenty years. Regarding electrical neuromodulation, I have practised in an era during which technology has evolved from a two-contact single-trial lead to dual sixteen contact percutaneous leads; from single lead bipole arrays to multi-lead, multichannel guarded arrays; from metronomic tonic frequencies to those with registered trademark surnames.
Innovation takes time and is a long-term process and must involve patient improvement over existing therapies. Fortunately, many technologic advances in neuromodulation have resulted in significant improvement in patient outcomes. Whether it be a decrease in pain, improvement in spasticity or movement disorder or an improvement in incontinence, without significant improvement in therapeutic outcome these advances are merely marketing efforts. We have all the benefits from true innovation in the field of neuromodulation.
What has been your most memorable case and what did you learn from it?
My mind does not store and recall “cases” per se. I have so many memorable individual patients and their families. Although I treat between 125 and 150 individual patients weekly, and have done so for more than fifteen years, nearly all are memorable. It may sound cliché, but I strongly feel that I have learned as much, if not more, from my clinical failures as from my clinical successes. An early career pain specialist may not have the knowledge to recognise an adverse event or assumes that it will resolve with time, whereas an experienced pain clinician intuitively looks for early signs of untoward events and treats immediately.
Outside of your own research, what has been the most the most interesting paper or presentation that you have seen in the last 12 months?
I have been to several regional and national meetings over the past year. In particular, I enjoy attending young clinician/investigator presentations. The one that stands out to me was a poster presentation at last year’s NANS meeting. A high school student, working in the lab at a well-respected university, presented on molecular changes in neural tissue exposed to varying electrical fields. She was knowledgeable, well-spoken and poised. I was beyond impressed. She reminded me of a classmate that broke into our high school computer lab on weekends to write code because it was the only time that he could work for 12 to 18 hours without interruption. Back then, there was no such thing as a home PC. Needless to say, he went on to Harvard… I didn’t.
What are any major questions in the field of neuromodulation that remain unanswered?
I believe that the major questions in the field of neuromodulation may not be answered in my lifetime; most involve mechanisms of action. I am okay with this, but would like for us to answer why certain therapies work for some patients and not others? Perhaps a prospective, long-term outcomes registry will give us the answers. NANS is in the early stages of funding and building a cloud-based neuromodulation registry looking prospectively at the many outcome measures including pain relief, IPG life, complications and health care utilization.
My expectations for neuromodulation as a clinical therapy are quite realistic. These are therapies and not cures, and patients should be made clearly aware of this prior to permanent implantation. At best, neuromodulation may serve as the cornerstone of an ongoing treatment regimen, but is rarely monotherapy. Despite unrealistic hype, at present, patients with chronic pain will continue to require longitudinal care using multiple therapies.
Spinal cord stimulation has recently been in the news for its remarkable ability to restore walking in patients with paralysis, how do you see this area of neuromodulation developing in the future?
It is fantastic, and offers hope to millions of individuals with plegic and paretic neuromuscular disorders. NANS has taken a strong role in bringing together scientists, engineers and clinicians with the goal of fostering collaboration in the research and development of implantable medical devices that will eventually be part of clinical practice. In addition to our annual meetings, NANS has sponsored joint meetings with the Neural Interfaces Conference, the Congress of Neurological Surgeons and New York City Neuromodulation Conference. The relationships developed by these collaborative efforts are creating excellent opportunities for sharing new ideas and developing neuromodulation research leading to tomorrow’s therapies.
Should neuromodulation be part of the solution to the opioid crisis in the USA? If so, what are the current barriers and what can be done to change this?
The opioid crisis in the USA is a complex problem requiring an equally complex solution. As a therapeutic modality to treat pain, of course neuromodulation can be part of the solution to avoid long-term exposure to opioids and to minimise the risk for opioid addiction. Opioid addiction and overdose-related deaths are worldwide health concerns. However, while minimally invasive neuromodulation therapies may offer one solution to avoid long-term opioid therapy, it is naïve to believe that their use will make a dent in the number of opioid-related deaths; the majority of which are from illicit use of opioids.
Current barriers to neuromodulation therapy patient access include restrictive insurance policies and falling clinician reimbursement. NANS has worked hard to advocate for patient access to neuromodulation therapy by partnering with other medical specialties, medical societies, industry and media. The NANS Policy and Advocacy Committee has lead the charge for maintaining and enhancing patient access by directly challenging restrictive worker’s compensation, commercial insurance and governmental policies that restrict the use of these valuable therapies. We now have a seat with the American Medical Association House of Delegates and visibility at the AMA’s RUC and CPT committees. Our influence has never been greater, and will continue to expand thanks to NANS’ growing membership and individual member efforts.
What are your current research interests?
My focus in clinical research is the treatment of chronic pain, regardless of the source. The NANS bylaws specifically prohibit the President from serving in a consulting relationship with industry during the term of his or her office. As such, I have divested from industry-sponsored clinical research, paid and unpaid, for the two years of my presidency. This allows me to maintain an unbiased, conflict-free perspective when making NANS Board decisions.
You have been a member of the North American Neuromodulation Society (NANS) for 16 years, how have you seen it grow and what has it accomplished?
I have seen the annual meetings grow from a few hundred to several thousand; from single track meeting agendas to those with three parallel tracks; from venues seating a few hundred to multiscreen auditoriums seating a thousand; from a handful of corporate sponsors to scores of industry sponsors. I believe that NANS’ growth is directly reflective of ongoing science of neuromodulation: basic science and clinical research.
In your role as president for the North American Neuromodulation Society what have you achieved, and what are your hopes for the future of the society?
This year marks the 25th anniversary of NANS. We are planning on several events to celebrate this milestone starting with our January 2019 annual meeting and continue throughout the year. In addition to our annual meeting, we will present at the national Consumer Electronics Show (CES) with our industry partners in order to showcase neuromodulation as a growing therapeutic field among other rapidly-growing medical technologies. In addition, this year we developed a patient-focused website: AskAboutPain.com. This website provides brand-neutral information to patients about neuromodulation therapies, and is a valuable resource for our members and their patients.
As I reflect on 2018 NANS activities, I can succinctly say it has been an “organizational success”. Through my years on the NANS Board, I can attest that our success is truly a team effort. Our team of dedicated NANS professional staff, board members, committee members and physician members have devoted countless hours of personal time and are responsible for NANS’ accomplishments. I have every confidence that we will continue to celebrate our success and growth into the future.
What are the highlights of the 2019 annual meeting?
Last year over 2900 total attendees joined us for our annual meeting in Las Vegas, USA. This year is NANS 25th NANS anniversary and we anticipate even greater attendance. This year’s annual meeting theme is “The Science Behind Successful Outcomes”. With the dedicated efforts of NANS’ Scientific Program Chair, David Provenzano, the content of our annual meeting will offer current, engaging and innovative neuromodulation educational content. We will once again offer our pre-meeting hands-on cadaver course to over 150 pain fellows and neurosurgery residents, in addition to hands-on courses for neurology residents and engineers designed for them. We will expand this offering to include certification of attendance for peripheral nerve stimulation. I would like to acknowledge and commend the efforts of the NANS’ pre-meeting workshop co-chairs Michael Fishman, Michael Hanes, Bryan Hoelzer, and Jonathan Riley.
What are your interests and hobbies outside of medicine?
I am fortunate to enjoy my leisure time outside of medicine on a weekly basis. My “hobby” outside of medicine is music, specifically jazz. Growing up in New Orleans I was exposed to wonderful sounds of jazz, brass band and funk. There is music playing continuously in my fluoroscopic suite and in the operating room. On weekends I travel to my small studio flat in the French Quarter, a 90-minute drive from my home and office. With a dozen music venues within five blocks, I rarely pass up an opportunity to enjoy live music.
2010–Present: Director, Bellevue Surgery Center, Hattiesburg, USA
2005–Present: Medical Director, Advanced Pain Therapy, Hattiesburg, USA
2003–2005: Medical Director, The Center for Pain Medicine Wesley Medical Center; Hattiesburg, USA
1998–2003: Assistant Professor of Anaesthesiology Mayo Medical School, Rochester, USA
1997–2003 Consultant, Anaesthesiology and Pain Management, Mayo Clinic; Jacksonville, USA
2003–Present: American Society of Interventional Pain Physicians
2002–Present: North American Neuromodulation Society
2003–Present: Mississippi Pain Society
2001–Present: Southern Pain Society
Honours and awards (selected)
2013: Patient Advocacy Award, American Society of Interventional Pain Physicians
2012: Hubert L. and Renee S. Rosomoff Award for Excellence in Pain, Southern Pain Society
2012: Distinguished Service Award, American Academy of Pain Medicine
2011: President’s Distinguished Service Award, Southern Pain Society
2008: Patient Access Advocacy Hero Award, Medtronic Neuromodulation. North American Neuromodulation Society Meeting
2005: Ambassador of the Year Award, National Pain Awareness Campaign
2003: Scientific Merit Award (clinical poster presentation), 19th Annual Meeting of the American Academy of Pain Medicine