The following information will be needed for your submission.

Submission Content
Abstract Category
(submitters will choose one)

• Scientific Abstracts  **Institutional Review Board (IRB) approval or waiver required for submission**;
  • Acute Pain
  • Chronic Pain
  • Regional Anesthesia
  • Emerging Technology
  • Education
  • Case Series (5 or more patients) **Patient informed consent required for submission.
• Medically Challenging Cases: Report of up to 4 cases having a similar presentation; case series of 5 or more patients must be presented as a scientific abstract. **Patient informed consent required for submission.
• Safety/QA/QI Projects
  • This offers a showcase for Resident quality improvement projects with a focus on chronic pain.
  • IRB approval is not required for this category.

Abstract Title (limited to 130 characters including spaces in sentence format)

Submitting Author Details: The submitting author will receive all communications regarding the abstract and is responsible for informing the other authors, as necessary.

Co-Author(s) Details: Name, contact information, role, credentials (author, co-author, presenting author), and display/list order. PLEASE NOTE: If the submitting author is also a co-author, they must be added to this list or their name will not be included on the abstract or certificate of recognition sent following the meeting. 

Abstract Body: Strictly limited to 500 words over the following content areas:

• Introduction
• Methods (including statement of IRB approval/waiver, IND approval, patient informed consent, etc.)
  • An IRB approval statement must be included along with checking the IRB box under attestations.
  • An investigator cannot him/herself determine if the IRB is needed or not. This can only be done by the IRB. If the your organization’s IRB policy states that, as long as there is no identifiable patient information in the case report, it is IRB exempt, this needs to be stated and documentation must be available upon request. For example, a statement could say, “As the case report is devoid of patient identifiable information, it is exempt from IRB review requirements as per (please provide name of organization) policy.”
  • Document any off-label indications and IND approvals, if applicable.
• Results / Case Report
• Discussion
• References (max. 5 references, not included in 500 word count)
• Tables (not included in 500 word count)
  • Maximum 3 tables of 10 rows x 10 columns
  • File type must be one of the following: .pdf, .jpg, .jpeg, .png
• Images (not included in 500 word count)
  • Patient faces must be entirely covered
  • File type must be one of the following: .pdf, .jpg, .jpeg, .png
  • Maximum 2 images
  • Maximum file size of each image is 30 MB
  • Maximum pixel size is 600(w) x 800(h) pixel

Important Considerations

• Abstracts are subject to rejection if all instructions have not been followed.
• No promotional content of a commercial entity may be included (brand/trade/product names, photos, logos, company names, etc.).
• If necessary for clarity, a trade/product name may be included parenthetically once in the materials and methods section, but no more, and not in the abstract title. If more than one company makes the product, all applicable trade names are identified.
• Any off-label indications should be clearly documented within the Material and Methods section as such.
• The most common reasons for author revision requests and rejection include lack of IRB approval statements and/or missing informed consent documentation.  Please double check your abstract prior to submission. 

Mandatory Attestations

Conflicts of Interest Disclosure

All submissions require disclosure of financial or other relationships with ineligible companies producing, marketing, re-selling, or distributing health care goods or services consumed by, or used on, patients. Disclosure must include the company name(s) and nature of relationship (honoraria/expenses, consulting/advisory board, funded research, royalties/patent, stock options, equity position/ownership, employee, other similar relations). Disclosure is required for the submitting author over the last 24 months.

 Institutional Review Board (IRB) and/or Animal Use Committee Approval (select one)

• IRB and/or animal use committee approval was either obtained or waived for the study. IMPORTANT: Abstracts must include this approval/waiver statement within the Materials and Methods section.
• This is a medically challenging case and IRB approval may not be mandatory, but I will adhere and document the process for IRB approval at my organization.  

Patient Informed Consent and Protected Health Information (select all that apply)

• Patient informed consent was obtained for submission of a case report. IMPORTANT: abstracts must include this consent statement under methods and materials, or the abstract will be rejected without review.
• All patient protected health information has been de-identified; patient faces are entirely covered.
• This is a scientific abstract with no patient protected health information.

Off-Label Drug Use (select all that apply)

• If my study involves off-label use of drugs placed near the neuraxis, I have obtained an FDA IND and/or I have followed the conditions set forth regarding such experimentation as described within the How to Format Data for Presentation in the Regional Anesthesia and Pain Medicine Journal.
• If my study involves off-label use of drugs for peripheral nerve block, I have obtained IRB approval and documented under methods and materials section.
• All off-label indications have been clearly indicated as such in the abstract. IMPORTANT: Abstracts without this text will be rejected.
• There are no off-label indications included.

Trade Names (select one)

• No promotional content of a commercial entity is included (brand/trade/product names, photos, logos, company names, etc.).
• If necessary for clarity, a trade/product name is included parenthetically once in the materials and methods section, but no more, and not in the abstract title. If more than one company makes the product, all applicable trade names are identified.

 Copyrighted Material (select one)

• There are no copyrighted figures, images, or content in my abstract.
• If copyrighted figures, images, or content are contained in my abstract, I have obtained the necessary permission from the copyright owner.

 Oral Presentation

 I would like my abstract to be considered for oral presentation during the moderated poster sessions. (If not, will not be considered for best of meeting or patient safety awards.)

 Yes

 No

 Research Award

I am a resident or fellow ASRA Pain Medicine member and would like to be considered for a research award. (ASRA  Pain Medicine membership is required for award eligibility. Join now.)

 Yes

 No

 Agreement and Submission

• I reviewed this abstract and all information is correct. I accept that the content of this abstract cannot be modified or corrected after final submission; I am aware that it will be published exactly as submitted.
• I and all others listed as (co-)authors contributed substantively to the writing, review, and work described by this abstract, and further affirm that it was not prepared or written by anyone not listed as an author.
• I am the sole owner and/or have the rights of all the information and content. The publication of the abstract does not infringe any third-party rights including, but not limited to, intellectual property rights. I herewith grant ASRA Pain Medicine a royalty-free, perpetual, irrevocable nonexclusive license to use, reproduce, publish, translate, distribute, and display the abstract content. 
• Submission of the abstract constitutes my consent to print and/or electronic publication (eg. meeting website, program, other promotions, etc.).
• The submitting author is responsible for informing the other authors about the status of the abstract.
• It is the author’s responsibility to maintain necessary documentation for all attestations (IRB approval/waiver, patient informed consent, copyright, etc.). ASRA Pain Medicine is not liable for any issues arising from improper documentation.
• I understand that my abstract may be immediately rejected and/or removed from any publication if it does not thoroughly comply with all of the above requirements.