The management of chronic noncancer pain with opioid medications is controversial. The negative consequences have been described as a public health emergency and the efficacy of chronic opioid therapy remains a subject of significant debate. Despite recommendations that chronic opioid therapy not be utilized until other methods fail, there remains a large population of patients for whom no other therapy has been effective and a large cohort of people who have been treated for years with...

Buprenorphine was developed by UK based Reckitt & Colman Products and released in the United Kingdom in 1978. That same year, a clinical study determined that buprenorphine could be helpful in reducing cravings of pure opioids in patients with an opioid abuse disorder. Then, a separate study published in 1982 demonstrated that buprenorphine offered excellent analgesia with a blunted abuse liability. Buprenorphine is a partial agonist at the mu-opioid receptors and an antagonist at the...

The use of opioids to treat chronic pain has become quite contentious in recent years. Things get even more confusing when we consider adding an adjuvant analgesic in the mix. Does this reduce or heighten risk? The audience can decide where to throw spitballs when 2 practitioners debate 2 separate topics. First, is the use of cannabis plus an opioid likely to provide an enhanced clinical effect (eg, allow for opioid dose reduction and by extension, harm), make no difference, or possibly...

In previous presentations, Dr. Jay has discussed the pathophysiology, neuroanatomical, and other aspects of fibromyalgia. In this activity, all of that will NOT be discussed, so the focus can be only on the diagnosis and treatment of fibromyalgia and restless leg syndrome. Treatment will be covered in depth, not the phenomenology that is the complex neuroanatomical and neuropathological backgrounds of these diatheses. The goal is to provide clinicians with practical information to be...

The prevalence of back pain continues despite the many treatments available, without any single treatment being a panacea. In routine clinical practice there has been a tendency of clinical examinations to become more cursory, largely influenced by increasing demands of time and arguably an overreliance upon technology. It has been suggested that the failure to adequately differentially diagnose the cause of back pain can account for clinical failures in treatment. The purpose of this...

Today’s providers are limited by time and must work with extreme efficiency. And yet for many, 100% of their time is used trying to treat 20% of their patients’ problems. This presentation will address the problem of chronic pain, provide simple tools to use during any office visit, and explain the power of positive and negative thoughts on the chronic pain experience.

Several recent studies have found intriguing links between gut microbes, rheumatoid arthritis, and other diseases. Additional studies have shown the interactions between the central nervous system, enteric nervous system, and the gastrointestinal tract, suggestive that gut microbiota appears to influence the development of emotional behavior, and stress- and pain-modulation systems. In the age of modern medicine, it is easy to forget that we change our body chemistry every time we eat. The...

Pain is common in the aging population. Findings from an NIH funded study looking at the impact on pain in the older adult found that over 50% of people surveyed had pain within the last month, often in more than one location. Despite the high prevalence of pain, pain often remains undertreated, resulting in impaired cognition, decreased socialization, sleep disturbances, and a reduced quality of life. Our bodies react differently to medications due to medical comorbidities and metabolic...

This course will review the scientific evidence for/against opioid therapy, risk mitigation, and different methods of opioid tapering. Providers need guidance to determine which patients may or may not benefit from opioids. While most pain patients on opioid therapy manage opioids safely, the risks are detrimental to some patients and society. Clinicians are faced with contradictory professional advice and legal mandates/scrutiny. Many patients are exposed to risk due to inappropriately...

Understanding the mechanisms that drive a persistent pain process is critical for effectively treating pain in any patient. While it is common to treat pain from a primary nociceptive perspective, this approach often fails in patients with central sensitization. Pain mechanism based classifications can help clinicians make recommendations that may improve functional outcomes and enhance patient adherence by identifying primary pain mechanisms. This course will offer practical tips for...

Course DescriptionWhen we practitioners approach complex medical problems (whether pain, depression, or even GERD) that have psychological and lifestyle components and we do so with minimally monitored drug-only therapies, we may bounce from one “wonder drug” to another and end up bewildered or worse. These problems need complex approaches that address the component parts and we can’t just rely on finding the next wonder drug. Perhaps it’s part of the American mindset: wanting a pill to fix...

Forced downward titration has been broadly implemented throughout the country as a direct result of the CDC Guideline for Prescribing Opioids for Chronic Pain. Prescribing clinicians feel pressured to follow the CDC’s recommendations of dose limits to avoid regulatory sanctions, and pharmacists feel a corresponding obligation to intervene in accordance with the CDC guideline and corporate policies. In many instances, prescribers have refused to treat opioid-requiring pain patients,...

Forced downward titration has been broadly implemented throughout the country as a direct result of the CDC Guideline for Prescribing Opioids for Chronic Pain. Prescribing clinicians feel pressured to follow the CDC’s recommendations of dose limits to avoid regulatory sanctions, and pharmacists feel a corresponding obligation to intervene in accordance with the CDC guideline and corporate policies. In many instances, prescribers have refused to treat opioid-requiring pain patients,...

This session is designed to familiarize learners with the principles of the neurobiology of the traumatized patient and illuminate the salient concepts that are germane to the presentations and treatment of patients with chronic pain. At the conclusion of this activity, practitioners should be able to identify several key aspects of behavior and presentation in patients with chronic pain who have a history of trauma, as well as utilize these concepts when interacting and treating these...

There are various types of studies that are necessary to perform in order to determine their clinical relevance. The process extends from benchtop to bedside side and includes various special populations like pediatrics and geriatrics. This course addresses various elements related to the study of analgesics. Novel improved preclinical animal models in analgesic studies are examined. The unique issues of unusually high placebo and nocebo effects in analgesic which can lead to confusing...

Chronic pain is much more than a physical sensation. It can be all-encompassing and often impacts an individual in a multitude of ways, spawning discouraging, painful, or unwanted psychological experiences such as thoughts, feelings, and memories as well as functional limitations. The natural approach might be to dedicate time and expend energy and resources (emotional, psychological, financial, etc) to controlling or avoiding these uncomfortable experiences. However, increasing evidence...

Spirochetal infection symptoms include muscle pain, nausea, vomiting, abdominal pain, and many others. Lyme disease can cause joint pain and stiffness, fatigue, flu-like symptoms, and sleep problems, among others. Depending on the species of bacteria involved, symptoms may be quite painful and range from acute to chronic. How are patients infected? What treatments work best? Although an “appropriate” treatment for the various stages of infection is not universally accepted, this course will...

The healthcare community is at a crossroads as the opioid crisis rages in America – how to provide effective pain management while preventing opioid abuse and addiction. This session will explore evidence-based opioid-sparing pain management techniques and how they are improving patient outcomes and quality of life while also reducing overall costs.

The Pain Management Best Practices Inter-Agency Task Force identified inconsistencies and fragmentation of pain care as gaps in US healthcare that limit best practices and patient outcomes. The report encourages coordinated care and cites the collaborative stepped model of pain care, as adopted by the Department of Veterans Affairs and the Department of Defense health systems as a best practice. The session will address the challenges and successes of VA’s pain care transformation towards...

This presentation will focus on the development of a clinical decision tool to standardize opioid prescribing for patients with sickle cell disease. Pain is the hallmark symptom of sickle cell disease, which is often managed by hematologists or primary care physicians. Currently, there is no clinical decision tool or any type of standardization regarding opioid prescribing among these patients. The Management of Sickle Cell Disease guidelines, published in JAMA in 2014, states that there...

Chronic pain and alcohol consumption are both very common in the general population, and alcohol is often used to numb both physical and emotional pain. The epidemiology of co-occurring pain and alcohol use will be discussed in this presentation. In addition, we will review the latest evidence surrounding the interaction between alcohol consumption and pain. Moderate alcohol use has been associated with improved pain related outcomes for certain pain conditions. However, both excessive...

Virtually all healthcare professionals have some degree of altruism and a strong desire to help patients in need. As healthcare continues to evolve, the burdens on clinicians change as well. While most of us have been taught that providing a “medical home” to patients along with shared decision-making is the most ethical way to provide effective healthcare, many are finding that other stakeholders may potentially derail those worthy intentions. While insurers are not often considered to be...

There are many potential underlying causes for neck and upper extremity pain. All too often, only the most common conditions such as a disk herniation or carpal tunnel syndrome are explored. The purpose of this course is to review other common problems (such as radiculitis), and not so common (such as rib arthropathy pain syndromes) that can affect the neck and upper extremities. Attention will be given to clinical pearls for recognizing when patients present with such problems, as well as...

Psychosocial factors have become increasingly recognized as important moderators and determinants of the pain experience. One such factor that has garnered great empirical attention is pain catastrophizing. Pain catastrophizing has been described for more than half a century, yet many frontline practitioners continue to be unfamiliar with the construct. It is conceptualized as a negative cognitive affective response to anticipated or actual pain and has been associated with a number of...