Academic Medical Publishing in Pain Medicine, 2014: Trends and Opportunities

1. Academic Medical Publishing in Pain Medicine, 2014: Trends and Opportunities EXPERT PANELISTS: Marty Cheatle, PhD, Section Co-editor Norman Harden, MD, Associate Senior Editor Ajay Wasan, MD, MS, Section Co-editor Rollin M. Gallagher MD, MPH Editor-in-Chief, Pain Medicine rgallagh@mail.med.upenn.edu

2. Contributors David A. Fishbain M.D. Professor of Psychiatry, and Adjunct Professor of Neurological Surgery and Anesthesiology, Univ. of Miami School of Medicine Senior Editor, Pain Medicine Jerome Schofferman, MD SpineCare Medical Group, San Francisco Spine Institute Section Co-Editor: Pain Medicine Colleen Healy Managing Editor: Pain Medicine cmh53@comcast.net

3. There is lots to write about:Remember the R’s • Relevant and timely content • Rational and Readable writing • Randomized Controlled Trials • Review Articles - Systematic • Retrospective Studies, at least Level 3 • Reports – • Commentary: Forensic, Ethical, Clinical Issues • Cases (reserved for relevance to conceptual and research literature) • Letters – Interesting cases, comments on articles

4. Our content: ‘Chronification’ of Pain as a Disease • Pathology: • Muscle atrophy, • weakness; • Bone loss; • Immuno- • compromise • -Depression • Pathophysiology of Maintenance: • Radiculopathy • Neuroma traction • Myofascial sensitization • Brain, SC pathology (atrophy, reorganization) • Psychopathology • of maintenance: • Encoded anxiety • dysregulation • - PTSD • -Emotional • allodynia • -Mood disorder Acute injury and pain • Central • Sensitization • Neuroplastic • changes Disability -Less active -Kinesophobia -Decreased motivation -Increased isolation -Role loss Peripheral Sensitization: New Na+ channels cause lower threshold Neurogenic Inflammation: - Glial activation - Pro-inflammatory cytokines - blood-nerve barrier dysruption RM Gallagher 2009

5. Our content: Biopsychosocial Chronic Pain Outcomes • Quality of life • Physical functioning • Ability to perform activities of daily living (ADLs) • Work • Social consequences • Marital/family relations • Intimacy/sexual activity • Social role and friendships • Legal • Psychological / CNS morbidity • Fear, anger, suffering • Sleep disorders • Loss of self-esteem • Neuroplasticity • Clinical depression • Bioethical conundrum • Medical consequences • Accidents • Medication side effects • Immune function • Societal consequences • Health care costs, disability, lost workdays • Business failures, higher taxes

6. A Population-based Approach to Pain Care Relative proportion of pain care, by setting Gallagher RM, AAPM 2008; Dubois, Gallagher, Lippe, PAIN MED 2009 Tertiary care: PM Subspecialties - Neuroremodeling - Gene therapies - Neurostimulation - Rehabilitation Centers (Gallagher, AAPM 2008) Tertiary Care Subspecialty, tertiary prevention Secondary care: Pain Medicine - Biopsychosocial assessment ** pain generators, mechanisms ** perpetuating factors: peripheral, CNS, psychosocial - Biopsychosocial Formulation - Goal-oriented plan - Multi-modal treatment • PAIN • MEDICINE • Practice • Training • Research Secondary Care Specialty, Subspecialty, Secondary / tertiary prevention • Primary care • Mech. Based Drug Algorithms • Stepped Behavioral Care • Physical Therapy • Office procedures Primary Care Specialty, Primary / secondary prevention Self-care - meditation - exercise - web-training - social modeling -social supports Self Care, Community Care Primary/secondary Prevention Disease Management POPULATION IN PAIN

7. Optimize the Potential for Acceptance and Publication of a Manuscript in Pain Medicine Submit Manuscripts: • That you or your colleague want or need to read • That advance the science and practice of Pain Medicine: Level 1-2 • That are well written and illustrated • That are well referenced and citable • That are interesting

8. How to Get Published: Get involved • Know your journal, and the opportunities it presents: philosophy, sections, editors • If it belongs to a society or societies, know your societies • Know your area and want to say something important about it • Know (learn) how to write – keep trying • Volunteer as a reviewer • Attend journal club

9. Know your journal: Pain Medicine Pain Medicine Vol 1(1); March 2000

10. Survival “ It is not the strongest of the species that survive, nor the most intelligent, ….but the ones most responsive to change” Charles Darwin

11. Know your journal: Pain Medicine Volume 12(3); March 2011

12. Pain Medicine 2010 Downloads: Top 10 Articles Represent 12% of Downloads

13. Pain Medicine 2010 Downloads: Top 10 Articles Represent 12% of Downloads

14. Pain Medicine 2010 Downloads

15. Pain Medicine 2010 Downloads

16. Stretch yourself: Become an author!! Memory, Learning and CNS plasticity • Hippocampus presents new opportunities • Detailed memory retrieval, highly plastic in different learning environments, flexibly responsive to current learning requirements • New neurons are constantly being born even into older age, and if not used to develop learning, die in two weeks. • Use these!! • Do not lose these!! (M Cozolino, 2006)

17. “Research is the ultimate blue collar profession” • David Baltimore, President, Rockefeller Foundation

18. FUNCTIONAL EVOLUTION OF THE SPINE 2011 Author,Reviewer, Editor

19. As an author:1) Think like Editorial Board: What do they want? 2) Think like Reviewers: What do they not want? • Editors chosen because of expertise & commitment: They want to see interesting, novel, well-written papers in their sections and journal They are very busy people!! • Reviewers usually chosen because of: • Expertise in the field • The quality & timeliness of prior reviews • Availability & willingness to review • Teaching ability – up to a point!! • They are very busy people! • Reviewing can be felt as a burdensome duty. Therefore, please do not be careless or sloppy! Every spelling and grammatical error activates the punishment center in a reviewer’s or editor’s brain

20. Three reasons cited most often for acceptance of a manuscript: • Timely and relevant to a current problem • Manuscript is well written, logical and easy to comprehend 3. If a study, it was well designed and had appropriate methodology

21. Reviewers’ instructions when evaluating a manuscript

22. Manuscript: The Whole • Topic • relevant? • interesting? • Manuscript presentation • well written • logical • easy to comprehend To Pain Medicine Readership Readability

23. Reviewing Manuscript: The Whole • Read the manuscript over • Subject • Relevant? • Timely? • Readability • Good • Acceptable • Poor Good Science ± Good Poor Minor Revision? Reject Major Revision ?

24. Authors: Responding to the Editor’s letter and Reviewers’ Comments. Check your ego at the door!! • Remember: Editorial work is largely voluntary and for the good of the field • All reviewers have been rejected before • All suggestions should not be taken personally • Editor usually screens pejorative remarks • Do not respond with anger or frustration • Write a detailed letter of response to each point: • Where in the text you made a change • What the change was • If you disagree, say why respectfully Make it easy to re-review your manuscript!!

25. REJECTION!!! Integrated care for injured backs & egos “And how does that make you feel about your father?” (Editor )

26. Six most common reasons for rejection • incomplete or insufficiently described statistics • Over interpretation of the results • Suboptimal or insufficiently described means of measuring data

27. Six most common reasons for rejection • Sample population was too small or selection biased • Text difficult to follow • difficulty following the logical flow of the manuscript is the hardest to repair • gives reviewers headaches / back pain • Insufficient problem statement

28. There is lots to write about:Remember the R’s • Relevant and timely content • Rational and Readable writing • Randomized Controlled Trials • Review Articles - Systematic • Retrospective Studies, at least Level 3 • Reports – • Commentary: Forensic, Ethical, Clinical Issues • Cases (reserved for relevance to conceptual and research literature) • Letters – Interesting cases, comments on articles