Therapy of pain is a challenge and requires special approaches. This course, as part of the Pain Educators Forum (PEF), will build on information provided in other PEF sessions and focus on the prevalence and impact of unrelieved pain, pathogenesis, and treatments of pain. Participants will learn about approaches and advances in therapy of common acute and chronic pain syndromes, and evidence based recommendations for pharmacotherapy of pain will be provided. Pain Therapeutics examines...

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...

The ancient Sumerians first cultivated the poppy plant for its opium in 3000 BC. The analgesic properties of opium were formalized into morphine and later commercialized by Merck Pharmaceuticals in 1827. To this date, morphine and its derivatives are effectively used for treating acute pain. In recent years, however, the overuse of opioids to treat chronic nonmalignant pain has contributed to the prescription opioid epidemic. As society has recognized this problem and our government has...

The United States is struggling with how to deal with two competing problems: the undertreatment of pain and the abuse of opioids. At the same time, millions of people in third-world countries are dying without access to any opioids, even liquid morphine, due in large part to a variety of barriers relating to distance, regulation, and knowledge. Could marijuana be the solution to both problems? Although marijuana continues to remain prohibited by federal law and treaty, several countries...

Motivational interviewing (MI) is a counseling approach that was initially applied to address drinking behavior. At its core, it helps reduce patients’ ambivalence and move them toward action through use of their own intrinsic motivation. Over the years, MI has been applied broadly across different health domains to help shape outcomes. The approach can be particularly beneficial when working with patients who are perceived to be stuck and not making satisfactory progress in treatment. This...

Medication assisted therapy (MAT) for addiction has been available since 2000. Up until 2016, physicians have been the only healthcare providers able to prescribe buprenorphine for opioid addiction. On July 22, 2016, President Obama signed into law the Comprehensive Addiction and Recovery Act (CARA). This is the first major federal addiction legislation in 40 years and the most comprehensive effort undertaken to address the opioid epidemic. CARA incorporated many needed resources to better...

Individuals with chronic pain may lack awareness that they are feeling grief. People who suffer from chronic pain may experience losses in several areas: comfort, sexual function, career, income, self-efficacy, cognitive function, intimacy, pride, joy, self-esteem, self-control, independence, mental health, hope, dignity, and certainty. Providers may overlook these patients biggest loss: themselves. While everyone copes in their own way and experiences their chronic pain condition uniquely,...

Myopain conditions including myofascial pain and fibromyalgia are among the most common disorders causing chronic pain and are a significant cause of suffering, addiction, disability, and healthcare utilization. More than half of the persons seeking care for these pain conditions at 1 month still have pain 5 years later despite treatment. The good news is that successful treatment of these painful conditions is achievable, and this course aims to teach providers the 2 key factors that...

Myopain conditions including myofascial pain and fibromyalgia¬ are among the most common disorders causing chronic pain and are a significant cause of suffering, addiction, disability, and healthcare utilization. More than half of the persons seeking care for these pain conditions at 1 month still have pain 5 years later despite treatment. The good news is that successful treatment of these painful conditions is achievable, and this course aims to teach providers the 2 key factors that...

2018 was not a good year to be on the wrong side of medical necessity when it came to drug testing and ongoing prescribing of controlled medication or substance abuse treatment programs. 2019 is likely to be an expensive year for those who do not proactively take steps to understand medical necessity for drug testing, prescribing controlled medication, and ongoing substance abuse treatment, as payers continue to carefully scrutinize these areas. Using a series of case hypotheticals,...

Multiple guidelines have recently emphasized nonpharmacologic interventions for chronic pain, with the role of nutrition strikingly absent. Given pain’s potential coexistence with metabolic dysregulation, including obesity, metabolic syndrome, and nutrient deficiency, nutrition-based interventions hold promise as an approach for improving pain status in multiple patient populations. Unfortunately, nutritional and dietary approaches can be complex and time consuming to implement and...

This course will provide the principals and practice of osteopathic medicine, showing anatomical unity, structure, and function, and pathways to innate healing. We will provide exam skills to incorporate kinetic chains of motion with movement restrictions. If time permits, there will be demonstrations of counterstrain techniques for the spine and extremities.

Pain represents a foremost feature of neurogenic thoracic outlet syndrome (NTOS). Symptoms include ipsilateral upper extremity pain, sensory loss, shoulder and neck discomfort, arm paresis or edema, headache, and even sympathetic nervous system impairment. This presentation will cover an evidence-based review of the classification, etiology, clinical presentation, diagnostic measures, and surgical treatment of NTOS with a focus on nonoperative therapies such as physical modalities,...

Idiopathic intracranial hypertension (formerly called pseudotumor cerebri) is a cause of headache, along with optic nerve edema, and can lead to permanent visual loss. This course will address how to diagnose it, how best to treat it, and other topics including subgroups and issues of “outliers.” This is a frequently missed diagnosis, and important to include in a differential diagnosis.

Pelvic floor muscle dysfunction is associated with pelvic pain, physical disability, and sexual dysfunction. Prevalence estimates of musculoskeletal dysfunction in various pelvic pain conditions, including endometriosis, vulvodynia, and painful bladder syndrome, range from 21% to 80%. In addition to being associated with other painful conditions, pain originating from pelvic floor muscles may refer to other body parts such as the lumbar spine, sacroiliac joints, hips, and abdomen. Adding to...

Despite being one of the more frequently noted triggers for migraine, estrogen and its role in the pathology of migraine is still unknown. This talk discusses the current understanding of the role of estrogen in the headache experience. We will start by touching on the clinical experience the field has gathered and then dig into the fledging science on the role of estrogen in the brain, periphery, and blood vessels, and the hypothesis on how these pathways and interactions might trigger the...

Opioid use and addiction have soared in the United States over the past 20 years, and drug overdoses have become the leading cause of injury death. Persons with opioid use disorder (OUD), particularly those injecting opioids, frequently require hospitalization and encounter need of acute opioid analgesia for trauma, surgery, infection, and other medical conditions. Treatment of acute pain in persons with OUD present challenges for acute pain management including altered nociception...

At the 2018 Department of Justice (DOJ) Opioid Summit, then-Attorney General Jeff Sessions remarked that opioid prescribing had reached its lowest point in 18 years. Still, the DOJ is committed to reducing opioid analgesic prescriptions an additional 30% to 33% within the next 3 years. More than ever, prescribers of controlled prescription medications are under intense scrutiny from lawmakers, regulators, and payers. At the same time, some 50 million adults in the US have persistent pain,...

Assessment, diagnosis, treatment plan formulation, implementation, and follow-up are processes familiar to clinicians and are the main drivers of safe and effective chronic pain treatment. However, many other things influence our clinical decision-making, including the continuing controversies about the role of opioid analgesics in the management of chronic pain, the “opioid epidemic” our nation faces today, and the fear of regulatory scrutiny just to name a few. Additionally, when...

Marijuana and hemp are genetically distinct cousins of the genus Cannabis sativa L., yet they have been erroneously associated with each other for the past 80 years. That all changed in December 2018 when Congress removed hemp from the federal Controlled Substances Act and legalized the plant and its derivatives such as cannabidiol (CBD), a substance which has received a great deal of attention for its potential to treat a variety of medical conditions. This change is historic and has...

It’s your worst clinical nightmare: providing dosing recommendations for opioid and/or nonopioid pain medication treatment for a patient with renal or hepatic impairment. Even scarier, a patient with end-stage renal or hepatic disease! Put your panic aside and learn about the INs and OUT of managing opioid and/or nonopioid pain medications, and why some medications might need adjustment and others may not. From metabolism and metabolites to creatinine clearance and Child-Pugh score, you...

It is becoming increasingly common to hear a new analgesic drug molecule described as a “biased ligand,” being “peripherally restricted,” or as having been “engineered.” What do these terms mean? How are such drugs designed or discovered, and how do you even know that you have one when you have one? For that matter, how are any modern analgesic drugs designed or discovered these days? It’s definitely not your father’s preclinical drug discovery lab any more. Modern drug discovery labs...

In 2010, the Captain James A. Lovell Federal Healthcare Center became the first fully integrated facility caring for active duty, veterans, retirees, and dependents in the US. This presented healthcare professionals with unique challenges including how to address pain management in such a diverse population. In 2017, a core team was tasked with the creation of a comprehensive pain management program to address their facility’s need for a cohesive and interdisciplinary approach to chronic...

Humans have been searching for the Fountain of Youth for millennia, from Herodotus to Ponce de León. Some people feel that regenerative medicine, a field that encompasses stem cells, growth factors, and other cell mediating proteins, is that magical fountain, while others, including some physicians, members of various regulatory committees, and some in the media, believe it is a fad. As with many emerging topics, there is curiosity and confusion. While the regenerative medicine field is...

Despite the widespread acceptance of medicinal and recreational cannabis use internationally and domestically, marijuana remains federally illegal in the United States. For this reason, there are significant legal implications to clinical practice. Clinicians are unprepared to answer questions regarding legality or safety of cannabis use, and unprepared to counsel their patients on use or abstinence, particularly for pain management. This session will explore legal implications, discuss...