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50 minutes | 4 days ago
Achieving Change from Within: Use of Motivational Interviewing
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 presentation will introduce the audience to MI, review the concepts underlying it, and discuss its specific application in pain settings.
44 minutes | 11 days ago
Medication Assisted Therapy: New Opportunities in Treatment
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 manage patients with addiction, but one specific aspect of the legislation was focused at nurse practitioners and physician assistants: providing greater access to care by easing the restrictions on who could provide MAT after completion of continued education. Nurse practitioners and physician assistants caring for patients with chronic pain and addiction need continued education and empowerment to accept this level of responsibility. This session will look at the history of addiction, past therapies, current therapies, and the future of addiction, specifically how it intersects with chronic pain management.
45 minutes | 25 days ago
The Death of Caesar: Psychological Stages of Grief and Chronic Pain
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, there are common feelings that most of us share: denial, anger, bargaining, depression, and acceptance. Elizabeth Kübler-Ross’s five stages of grief outlined in her 1969 book, On Death and Dying, may help patients better understand what they are going through. Frontline providers can help patients better cope with the grief that often has no resolution by understating the limitations of their illness, listening and trying to understand what they are going through, looking for signs and completing a thorough psychosocial assessment, and organizing psychoeducational support groups and other interventions. The goal is to transform their experience into something livable and bearable.
87 minutes | 25 days ago
Part 2: Transformative Care for Myopain: Enhancing Long-Term Success in Myofascial Pain
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 clinically make the biggest impact. The first is recognition of the contribution of the fascia to myofascial pain and fibromyalgia, and improving diagnostic skills promoting early recognition. Along with better recognition of myofascial pain, effective treatment will incorporate evidence-based manual therapies and myofascial self-care. The second key to success is utilizing a transformative care approach that integrates comprehensive patient self-management training and coaching to empower patients to address the many risk factors that can lead to delayed recovery and chronic pain. This activity will describe the growing body of evidence for fascial dysfunction contributing to pain in fibromyalgia and myofascial pain, along with research supporting the effectiveness of manual therapies either performed by a therapist or as part of a myofascial self-treatment program. Reimbursement for transformative care with telehealth coaching with online technology will also be covered by Drs. Fricton and Liptan.
74 minutes | a month ago
Transformative Care for Myopain: Enhancing Long-Term Success in Myofascial Pain and Fibromyalgia
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 clinically make the biggest impact. The first is recognition of the contribution of the fascia to myofascial pain and fibromyalgia, and improving diagnostic skills promoting early recognition. Along with better recognition of myofascial pain, effective treatment will incorporate evidence-based manual therapies and myofascial self-care. The second key to success is utilizing a transformative care approach that integrates comprehensive patient self-management training and coaching to empower patients to address the many risk factors that can lead to delayed recovery and chronic pain.
74 minutes | a month ago
Get Your Specimens in Order: The Importance of Individualized Test Orders
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, attendees will learn how to identify the elements of medical necessity, efficiently and effectively document medical necessity for drug testing and use of drug test results in the ongoing care of the patient, and locate and use payer medical policies and coverage determinations. Attendees will be given 3 tools to reinforce learning objectives: a checklist for medical necessity documentation, sample summaries of payer medical policies, and templates for documenting use of drug test results and tailoring ongoing treatment decisions to the individual patient.
54 minutes | a month ago
Nutritional Pain Management
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 daunting for clinicians feeling inadequate preparation to provide guidance. Fortunately, nutrition pain management can often be provided in staged interventions based on patient status. This session will review why nutrition is often overlooked, as well as the foundational science of how it can both promote and relieve pain. The session will discuss how to evaluate nutritional status and initiate foundational anti-inflammatory interventions. Also to be examined is the role of nutritional supplementation in individualized cases including vitamin D, omega-3s, magnesium, and other emerging nutrients. The session will conclude with a discussion of how to combine nutritional interventions as a long-term strategy for improving both pain and metabolic status.
44 minutes | 2 months ago
Manual Therapies for Pain Management
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.
43 minutes | 2 months ago
Neurogenic Thoracic Outlet Syndrome
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, pharmacological therapies, and the more contemporary, and minimally invasive, cervicothoracic intramuscular treatments with botulinum toxin.
56 minutes | 2 months ago
Blinded by the Light: The Danger of Idiopathic Intracranial Hypertension
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.
53 minutes | 2 months ago
Let’s Get Physical! Musculoskeletal Pelvic Pain
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 this complexity is an interplay between muscles and neurons including maladaptive neuronal plasticity associated with widespread muscle pain that may manifest beyond the pelvis. This presentation will provide an overview of key abdominopelvic musculature and their contributions to pelvic pain, screening for musculoskeletal dysfunction, and components of a musculoskeletal pelvic pain examination. A focus will be placed on reviewing the pelvic anatomy and hormonal/life states related to sex specific musculoskeletal pain, such as pregnancy, endometriosis, and sexual pain. Additionally, the presentation will discuss the role of different musculoskeletal specialists such as physiatrists and physical therapists in identifying and treating musculoskeletal pain conditions.
52 minutes | 3 months ago
La Femme Migraneur
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 migraine.
51 minutes | 3 months ago
Acute Pain in Patients With Active Substance Use Disorder
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 thresholds, physical dependence and withdrawal, tolerance, impaired immune response, and behavioral issues such as opioid seeking and poor coping skills. Clear goals of care and use of engaging communication methods are essential to deliver optimal inpatient care and smooth plans for hospital discharge. This session will cover key principles to working with this population including 1) improving patient safety and healthcare outcomes by treating underlying OUD; 2) optimizing pain relief for necessary surgical and medical treatment by providing multimodal analgesia; 3) facilitating access to medication treatment programs upon discharge; 4) empowering patients and providers by promoting clear, just, and equitable treatment of pain; and 5) protecting communities by promoting discharge opioid prescribing habits that minimize risk.
57 minutes | 4 months ago
I'm Not a Doctor, But I Play One in DC
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, nearly 20 million of whom experience pain that interferes with daily life or work activities. As noted by the Pain Management Best Practices Inter-Agency Task Force (PMTF) in its December 2018 draft report, the trend of healthcare professionals opting out of treating pain has exacerbated the shortage of pain management specialists, leaving some patients without access to individualized care. In this session, a partner in a Washington, DC based health law firm will discuss recent legislative and regulatory activity at the federal level and trends in criminal enforcement. He will also discuss noteworthy developments at the state level and analyze the anticipated benefits, drawbacks, and unintended consequences of such actions on people with pain and those who treat them. Topics will include the implications of recently passed comprehensive opioid legislation—the SUPPORT for Patients and Communities Act; a draft report on pain management best practices by PMTF and the pushback against it; and efforts to reform the federal approach to investigating controlled-medication prescribers.
52 minutes | 4 months ago
Causalytics – You’re in Pain, and it’s All Your Fault
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 formulating decisions about pain treatment, the subjective nature of chronic pain and determining the context of how pain is affecting a person’s life may often be challenging. What we might not be aware of is how other more subtle forces can potentially influence us and have a negative impact on the care we provide for patients—the things that we “bring into the examination room.” This session will focus on how things like precognitive thinking, implicit biases, explicit biases, impressions about patient characteristics and even their demographics may potentially alter our judgment and create disparity. Suggestions will be presented to help recognize and reflect about how we can make sure that the pain care we deliver is not compromised by these things we might not consider, even though they are there.
48 minutes | 4 months ago
Lost in the Weeds: The Past, Present, and Future of Hemp in Pain Management
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 enormous implications in medicine and the treatment of pain. However, although the oversight of hemp has essentially been transferred from the DEA to the USDA and individual states, the FDA still retains its authority “to regulate products containing cannabis or cannabis-derived compounds” such as CBD. Accordingly, in an effort to inform healthcare professionals about this rapidly changing field, this presentation will discuss the history of hemp, its legality, derivatives, and its potential future in pain treatment.
39 minutes | 4 months ago
Putting the FUN in Dysfunctional: Pain Management Options in Renal and Hepatic Dysfunction
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 will leave this course feeling more confident in your ability to provide pain pharmacotherapy to patients with renal or hepatic impairment.
54 minutes | 4 months ago
Insight into Preclinical Drug Discovery and Translational Medicine
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 utilize a variety of approaches such as compound libraries, combinatorial chemistry, fragment based lead discovery, high-throughput screening, in silico modeling, in vitro human receptor assays, CRISPR and AI (artificial intelligence). This session provides a painless introduction to what goes on in modern preclinical drug discovery and translational medicine. Three case studies will illustrate the concepts and the resultant clinical analgesic molecules.
52 minutes | 5 months ago
Moving Mountains: Shifting the Pain Management Paradigm
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 pain management in light of the growing national opioid crisis. The emphasis of this new program is to shift the facility’s focus away from a traditional biomedical curative pain management approach to one that emphasizes a more comprehensive biopsychosocial approach, which can empower patients to take on more responsibility for their pain management and overall functionality. Attendees will learn how this new comprehensive pain management approach has shifted the focus from “fix me” to “teach and empower me.” This journey of “moving mountains” will be illustrated by examining the pitfalls and specific challenges that were faced, as well as the pathways explored, to overcome and rise above these challenges. The end result will reinforce the main goal of realigning the therapeutic relationship to being patient-centered vs provider-driven with the emphasis on improving overall quality of life and functionality. This focus will also speak on the paradigm shift not only for the patients but also for the providers/staff in order to create a common language that is shared facility wide in the realm of pain management.
73 minutes | 5 months ago
Stem Cells and Regenerative Medicine for Nonresolving Inflammation
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 relatively new to most people, there is a wide variety of treatments and technologies available. We will discuss the various stem cell and growth factors in regenerative medicine and conditions, such as neurological, degenerative changes, osteoarthritis, and tendinitis that have been treated with them.
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