As pain management makes its own advancements, spine surgeons are putting increased emphasis on multidisciplinary collaborations.
Spine surgeons discuss how pain management’s advances are reshaping the work they do for the better.
Ask Spine Surgeons is a weekly series of questions posed to spine surgeons around the country about clinical, business and policy issues affecting spine care. Becker’s invites all spine surgeon and specialist responses.
Question: How are advancements and collaborations in pain management affecting your surgical work?
David Lee, MD, and Michael Oh, MD. UCI Health (Orange, Calif.): Advancements in pain management and closer multidisciplinary collaboration are reshaping surgical care across the spine continuum. Modern multimodal pain strategies, including prehabilitation and early pain consultations, allow patients to arrive at surgery in a more optimized physiologic and psychological state. Reduced opioid tolerance, less central sensitization, and improved anxiety control often translate into smoother intraoperative courses and more predictable postoperative recoveries.
In parallel, advances in interventional pain techniques — such as targeted nerve blocks, neuromodulation and image-guided procedures — have improved the ability to accurately identify pain generators, refining surgical selection and ensuring patients most likely to benefit are directed toward operative care.
Postoperatively, collaboration with pain specialists has become integral to enhanced recovery after surgery pathways. Multimodal analgesia, regional anesthesia and opioid-sparing protocols facilitate earlier mobilization, shorter hospital stays, and fewer complications, directly impacting surgical outcomes and performance metrics. At the same time, a shift toward evidence-based, multidisciplinary pain care has changed prescribing habits, placing greater emphasis on functional recovery rather than pain scores alone.
This team-based approach, bringing together surgeons, anesthesiologists, PM&R physicians, and pain specialists, supports shared decision-making and ensures the most appropriate interventional or surgical strategy is deployed for each patient across the continuum of care.
Vijay Yanamadala, MD. Hartford (Conn.) HealthCare: Enhanced pain management capabilities have strengthened my ability to serve patients well. When I can partner with skilled pain medicine colleagues offering sophisticated interventional options, my patients have real alternatives to surgery — and I can reserve operations for those with clear mechanical or neurologic indications. These collaborations make me a better surgeon because patients arrive at my office as informed partners who’ve explored appropriate options.
The challenge we all face is distinguishing meaningful conservative care from simply checking boxes. Most pain specialists, like most surgeons, want to help patients avoid unnecessary surgery, but we work within systems that sometimes create perverse pathways where serial interventions become evidence of “failed conservative care” rather than alternative solutions. The best collaborations happen when physicians across specialties share the same goal: getting each patient the right treatment, whether that’s surgery or not.
Christian Zimmerman, MD. St. Alphonsus Medical Group and SAHS Neuroscience Institute (Boise, Idaho): Undoubtedly, the collaborations of pain management in this region have convincingly affected spinal care from non-surgical screenings and options related management to the provider directorates necessary for chronic opioid surveillance and coordination. Many of these complex pain disorders are intersecting and conflicted with preponderant psycho-social issues, which require strict boundaries and contractual methods for control.
With indemnity discretions opposing most antecedent surgical interventions, mandated pre-orthodoxies are fortunately managed at the pain-service level. Lastly, in a manner that is incapable of being disputed, the post-operative management of medications and oversight is thoroughly invaluable.