American Society of Regional Anesthesia and Pain Medicine

The American Society of Regional Anesthesia and Pain Medicine (ASRA, also branded as ASRA Pain Medicine) is a 501(c)(3) medical professional society headquartered in Pittsburgh, Pennsylvania, with more than 5,000 members in 66 countries. ASRA publishes the evidence-based guidelines that physicians in North America use to time regional anesthesia procedures around anticoagulant medication, and it monetizes access to those guidelines through annual meeting registrations, journal article processing charges, and a paid mobile reference app. In April 2025 the society converted its ASRA Coags mobile app from a one-time $3.99 purchase to a $6.99 annual subscription, locking out prior buyers. In May 2026, a free physician-built reference app called CoagRef that summarized the same publicly downloadable guidelines was pulled from the Apple App Store after its developer received legal demands from lawyers representing what he described as "a large organization in anesthesiology"; ASRA is the only anesthesiology organization that publishes a competing Coags-branded reference app.

American Society of Regional Anesthesia and Pain Medicine

Basic information
Founded	1923 (original); 1975 (re-founded)
Legal Structure	Non-Profit
Industry	Medical professional society, Clinical guideline publisher
Also known as	ASRA, ASRA Pain Medicine
Official website	https://asra.com/

Background

An earlier society of the same name was founded in 1923 as a tribute to Gaston Labat. The current society was founded in 1975, led by Alon P. Winnie, MD, and is also associated with founding members L. Donald Bridenbaugh, Harold Carron, Jordan Katz, and P. Prithvi Raj. On November 18, 2021, the society added "Pain Medicine" to its short name, accompanied by a refreshed brand logo and visual identity.

The society is headquartered in Pittsburgh, Pennsylvania. It is registered with the IRS under Employer Identification Number 51-0163222 and has been tax-exempt since October 1975 as a 501(c)(3) public charity. The official journal, Regional Anesthesia & Pain Medicine (RAPM), was first published in 1976 and has been published in partnership with BMJ since early 2019. As of 2025-2026 the journal's editor-in-chief is Brian D. Sites, MD. The society's president is Steven P. Cohen, MD, and its executive director is Elizabeth Smith, CAE, who took the role on June 26, 2023.

For fiscal year 2024, ASRA reported total revenue of approximately $4.87 million and total expenses of approximately $4.51 million on its IRS Form 990. Executive director compensation for the same filing was reported as $156,275 in base pay plus $11,797 in other compensation, for total compensation of $168,072.

Consumer impact summary

ASRA controls the canonical North American evidence-based guidelines for timing neuraxial procedures in patients on anticoagulants, and those guidelines are clinically load-bearing because mistiming a dose can produce spinal epidural hematoma and permanent paralysis. The full-text PDFs of the guidelines are hosted under a "FREE" access tier on the BMJ journal site, but the underlying copyright is retained by the society and the publisher, with reuse routed through the Copyright Clearance Center. Despite that free-to-read posture for the journal article, ASRA monetizes a guideline-derived mobile reference app at $6.99 per year and has used legal demands to remove at least one free, no-subscription competing reference app from the Apple App Store. Prior one-time purchasers of the ASRA Coags app were not grandfathered when the app shifted to a subscription in April 2025, prompting refund requests, App Store reviews calling the change a "bait and switch," and a 1.3-star aggregate rating across 391 reviews as of May 2026.

Organizational structure and pricing

ASRA's membership categories and annual dues are published on its categories-of-membership page. Regular and international physician members pay $422 per year. Joint members with the African (AFSRA), Asian-Oceanic (AOSRA-PM), European (ESRA), and Latin American (LASRA) sister societies pay $70 per year. Affiliates pay $165 per year. Young Professionals memberships are tiered: $200 for one year, $267 for two years, and $334 for three years.

The 51st Annual Regional Anesthesiology and Acute Pain Medicine Meeting, scheduled for April 2026, is priced at $1,055 for members and $1,630 for non-members for in-person attendance.

Regional Anesthesia & Pain Medicine operates as a hybrid open-access journal. Authors who select a Creative Commons open-access license pay an article processing charge of $2,800 if they are ASRA members and $3,890 if they are not. The journal encourages author deposit of preprints on not-for-profit servers such as medRxiv and does not treat preprint posting as prior publication. A subscription to RAPM is bundled with ASRA Pain Medicine membership.

Products and services

ASRA's principal products sold to consumers are its mobile reference apps, its journal, and its annual meeting. The society publishes three iOS reference apps that summarize its clinical guidelines:

• ASRA Coags summarizes the anticoagulation timing guidelines (Horlocker et al. 2018, fourth edition; Kopp et al. 2025, fifth edition). The app has been distributed since at least 2014 and was developed at Vanderbilt University Medical Center under Rajnish Gupta, MD and Matthew McEvoy, MD, with code by Mustard Seed Software, LLC. A December 14, 2024 Wayback Machine capture of the App Store listing shows the app priced at $3.99 with no subscription. On April 21, 2025, ASRA shipped version 4.0, which converted the app to a $6.99 annual subscription or free-with-membership access model. See Incidents below.
• ASRA LAST implements the society's local anesthetic systemic toxicity (LAST) checklist for treatment of an emerging local-anesthetic overdose.
• ASRA Timeout provides a procedural pre-block checklist.

The society's apps page describes the suite as part of its educational mission and lists the Coags pricing as "Subscription-based app: $6.99/annually or free with ASRA Pain Medicine membership."

In addition to the mobile apps, ASRA publishes the peer-reviewed digital newsletter ASRA Pain Medicine News (formerly ASRA News) and operates its annual meeting program.

Incidents

Cease-and-desist against the CoagRef app

Main article: ASRA cease and desist against CoagRef

In May 2026, Rishi Kumar, MD, a cardiothoracic anesthesiologist who publishes a suite of free clinical reference apps at rkref.app, announced on his public Facebook page that he was removing CoagRef, a free no-subscription iOS reference app he had written, from his websites and from the Apple App Store after receiving legal demands from lawyers representing what he described as "a large organization in anesthesiology." CoagRef summarized the same anticoagulation timing recommendations addressed by ASRA Coags, drawn from the publicly downloadable BMJ guideline PDFs published in Regional Anesthesia & Pain Medicine. Kumar's post does not name the organization that sent the demands; the only anesthesiology organization that publishes a competing Coags-branded reference app whose underlying guidelines drive both products is ASRA, which makes the linkage circumstantial rather than confirmed by the developer. The CoagRef App Store listing at apps.apple.com/us/app/coagref/id1462215262 currently returns a 404 "The page you're looking for can't be found" error, confirming the takedown. ASRA has not publicly addressed the CoagRef takedown, and its own apps page contains no statement about the matter.

ASRA Coags app subscription bait-and-switch

On April 21, 2025, ASRA shipped version 4.0 of the ASRA Coags iOS app. The App Store version history records the v4.0 release notes only as "Update the ui and contents," with no disclosure that the app would now require an annual subscription. Before that update, an archived December 14, 2024 Wayback capture of the App Store listing showed the app priced at $3.99 as a one-time purchase with no subscription component. After the update, prior purchasers reported being locked out of content they had previously paid for and required to enroll in a $6.99 annual subscription or in ASRA Pain Medicine membership to regain access. On May 1, 2025, a Student Doctor Network thread titled "ASRA Coags App now Membership Only" documented the lockout; one poster in that thread wrote that they had asked ASRA for a refund "as my paid for app was no longer functional" and had been offered "a year free" instead. A July 21, 2025 follow-up thread documented that the policy remained in place "despite the backlash." App Store reviewer Blahghg posted on the App Store on June 12, 2025:

I paid for this app (one time fee) and now they are charging a yearly subscription fee to use it. This is a bait and switch.

The app's overall App Store rating sat at 1.3 stars across 391 ratings as of the May 2026 capture.

See also

• ASRA cease and desist against CoagRef
• Click-to-cancel
• Bait-and-switch