Sandy Christiansen, M.D., wants to use the power of research and collaboration to help alleviate her patients’ pain.
An assistant professor of anesthesiology and perioperative medicine in the OHSU School of Medicine, Christiansen came to OHSU in 2016. She started her research career as an anesthesia fellow at Johns Hopkins University under the mentorship of Steven Cohen, M.D., who has continued to involve Christiansen in nationwide studies through her position at OHSU.
“Steve encourages his trainees to build research careers and supports their growth,” she said. “For any junior researcher, having that kind of mentorship and encouragement is a fantastic way of getting into it. Now, I’m able to design and execute my own research projects.”
During OHSU Research Week, May 1 to 5, she and her colleague, Alex Woodrow, D.O., will present data from a cross-sectional survey study providing insight about how well pain medicine physician fellowships at academic health centers across the country prepare physicians to treat cancer-related pain with minimally invasive procedures. Christiansen is one of very few researchers with a clinical focus on using interventional pain techniques to ease cancer pain.
“I can only think of five other clinician-researchers with this focus across the country,” she said. “Many patients don’t know that interventional options exist for their cancer-related pain, and even if they do, it’s incredibly difficult to find doctors with this expertise.”
Neurolysis is one example of an interventional procedure that Christiansen uses. The technique involves inserting needles next to the spine to interrupt the pain signaling pathway from cancers in abdominal and pelvic organs.
“This kind of pain can be incredibly debilitating and difficult to control using opioids alone,” she said.
However, for many patients, access to these types of interventional techniques is limited by insurance coverage.
Christiansen is working on a retrospective analysis assessing the pain outcomes for patients covered by Medicaid under the Oregon Health Plan. In 2016, Oregon Medicaid stopped covering most interventional pain management procedures, such as epidural steroid injections for low back pain, while expanding coverage of alternative and complementary therapies, such as massage. Christiansen notes that alternative therapies can be helpful for patients, and generally have minimal side effects compared to many pain medications.
But they aren’t for everybody.
Christiansen, a first-generation immigrant from Poland, suspects this is leading to disparities in pain outcomes among low-income patients covered by Medicaid. Furthermore, it may ultimately drive up costs overall when patients resort to higher-risk spine surgeries as an alternative.
“If the whole point of the policy change was to save health care resources, yet instead is shunting patients to expensive surgeries, that’s a big deal,” she said.
She is starting with a subset of 200 randomly selected patients from the overall cohort.
Over the long term, Christiansen is convinced this kind of research ultimately leads to better care of patients with chronic pain. She said she’s grateful that her career at OHSU has enabled her to carve out time for research while continuing to care for patients — a model she hopes to inspire in the first- and second-year medical students she teaches through the Clinical Skills Lab.
“My department has been incredibly supportive to give me dedicated research time,” she said. “Having that ability to do research concurrently with seeing patients allows me to have an understanding of what’s going on in the field, at the grassroots level. All of my research questions come from working with patients.”