35-1 Podiatric Pain Management: Update 2024



Pain management remains an understudied yet nuanced, growing endeavor for the podiatric physician and surgeon. Laws and regulations surrounding opioids, which are designed to educate prescribers, have failed to take into account that each and every prescriber would best benefit from education in their specialty beyond just the general pharmacokinetics of opioids.

Prescribers know that opioids can be addicting. We know “not to prescribe too much.” Many states have cut down on what we can prescribe for acute pain, and national laws such as the Drug Enforcement Administration’s Medication Access and Training Expansion (MATE) Act now require almost all prescribers with DEA registration/licensing to partake in eight hours of opioid-related training. However, the very same MATE Act has excluded podiatric medical societies and organizations (i.e., the American Podiatric Medical Association, American College of Foot and Ankle Surgeons, American College of Podiatric Medicine, etc.) from providing/participating in that eight hours of required education. This is truly a tragedy. Not only is it clear discrimination, but if the point of such teaching is peer-to-peer education for prescribers on what they can improve upon in their area of expertise, the MATE Act has failed both podiatry and the public.

For decades, podiatric physicians and surgeons have led the way in providing stellar pain management to patients with foot and ankle pathology. Giants and living legends within our profession (such as Dr. Robert G. Smith, DPM, MSc, RPh, FNAP and others) have advanced podiatric pain management forward for years. Discrimination within the MATE Act, while hugely unfortunate, is “chump change” to what many of our DPM predecessors had to face; they were truly “Happy Warriors.” The team behind this issue and I are proud to stand on their shoulders. We dedicate this issue to these men and women as a small “thank you” for taking us this far, while acknowledging that we still have more work to do.

The team who have put together this issue of Foot and Ankle Quarterly worked hard to introduce you to important, timely opioid-related research conducted for our profession, by members of our profession. In this special issue, you will learn various strategies and approaches – both conceptual and concrete – to enhance your pain management strategy. Our main focus is on the postoperative period, but these same principles can be applied to any aspect and stage of podiatric pain management.

If you have any questions, concerns or thoughts, please don’t hesitate to reach out to me for discussion at Brandon.M.Brooks@dartmouth.edu.

Kind regards,
Brandon M. Brooks, DPM, MPH



35-1 In this issue:

  • FEATURE ARTICLE: A Brief Guide to Postoperative Prescribing Practice after Foot and Ankle Surgery
    Brandon M. Brooks, DPM, MPH
    • Opioid-Prescribing Approaches: One-Size-Fits-All vs. Patient-Centric and Procedure-Focused among Podiatric Physicians. A Cross-Sectional Study
      Commentary by Malachi Brown, MS3 and Brandon M. Brooks, DPM, MPH
    • American Podiatric Surgeons’ Postoperative Multimodal Analgesic-Prescribing Practice: A 2019 to 2020 National Survey
      Commentary by Ashley M. Nettles, DPM
    • Post-Procedural Opioid-Prescribing Practice in Nail Surgery: A National, Questionnaire-Based, Cross-Sectional Study with Recommendations
      Commentary by Malachi Brown, MS3 and Brandon M. Brooks, DPM, MPH
    • The Diabetic Foot-Pain-Depression Cycle
      Commentary by Tiffany T. Tran, DPM
    • The Opioid Use Agreement in Foot and Ankle Surgery: An Addition to Your Informed Consent
      Commentary by Tiffany T. Tran, DPM
    • The Anesthetic Effects of Lidocaine with Epinephrine in Digital Nerve Blocks
      Commentary by Tiffany T. Tran, DPM
    • Cognitive Bias in Postoperative Opioid-Prescribing Practice
      Commentary by Brandon M. Brooks, DPM, MPH and Bradley M. Brooks, DO
    • Concomitant Use of Spasmolytics and Opioids for Postoperative Pain after Foot and Ankle Surgery: Fair or Foul?
      Commentary by Bradley M. Brooks, DO
    • Postoperative Opioid-Prescribing Practice in Foot and Ankle Surgery
      Commentary by Camille P. Ryans, MPH, DPM, DABPM, FACFAS
    • Podiatry and the Opioid Epidemic: A Call to Action
      Commentary by Bradley M. Brooks, DO
  • AUDIO LECTURE 1: Evidence-Based Opioid Prescribing Pearls in Foot and Ankle Surgery, Part 1
    Brandon M. Brooks, DPM, MPH
  • AUDIO LECTURE 2: Evidence-Based Opioid Prescribing Pearls in Foot and Ankle Surgery, Part 2
    Brandon M. Brooks, DPM, MPH