Focus On Stopping Pain Epidemic

[Guest guest]

Focus On Stopping Pain Epidemic

http://www.medicalnewstoday.com/articles/97663.php

The public health problem that needs to be addressed next is the

epidemic of pain, according to pain medicine physicians who came

together to discuss the latest in pain research and treatment at the

24th Annual Meeting of the American Academy of Pain Medicine (AAPM),

February 12-16 at the Gaylord Palms in Kissimmee (Orlando), Florida.

" In recent decades, Americans, with the help of their physicians,

have been asked to stop smoking and lose weight. Now it is time to

focus our efforts on undertreated pain, " says B. Todd Sitzman, MD,

MPH, AAPM President and medical director of Advanced Pain Therapy,

PLLC, a comprehensive pain clinic affiliated with Forrest General

Hospital Cancer Center in Hattiesburg, Miss.

An estimated 60 million Americans live with chronic pain, a condition

that is more prevalent among the elderly. As the 75 million Baby

Boomers move toward retirement, more and more Americans are expected

to have untreated or undertreated pain. Pain is vastly undertreated

for a variety of reasons including misconceptions regarding opioid

addiction, lack of access to care, cultural norms, and physician

concerns about prescribing pain medications for chronic pain.

Pain Medicine is a medical specialty which utilized multiple

modalities to diagnosis and effectively manage chronic pain.

Additionally, pain medicine physicians deliver comprehensive care by

combining techniques from several medical specialties. For instance,

physical medicine techniques can be complemented by psychiatry and

neurosurgery skills. " We treat pain aggressively to help our patients

live fulfilling, productive lives, " Sitzman adds.

Plenary Briefs

The Decade of Pain, Keynote Speaker, Cousins, MD

Persistent pain is a disease in its own right; this concept is now

leading to new specific treatments aimed at physical, psychological,

and environmental components of this major disease, including genetic

predisposition.

" In the future, the diagnosis and treatment of persistent pain will

be markedly different, " continues Cousins. " Instead of using drugs

that provide only symptomatic relief, such as morphine, new drugs,

such as NaV1.8 blockers, will target the disease process. "

Persistent pain has a prevalence of 1 in 5 of the population and the

Pain Management Research Institute studies reveal an annual cost of

$1.85 billion per 1 million population.

" Medical specialists have recognized that additional specialist

training in pain is needed, " says Cousins. " Too few pain medicine

specialists are being trained, and not enough patients are getting

access to effective treatments. Pain management needs to become a

fundamental human right: a bundle of initiatives will be needed in

medicine, law, ethics, politics, " concludes Cousins.

Altered Central Nervous System Processing in Chronic Pain, M.

Bushnell, MD

" Chronic pain is associated with changes in the brain and can lead to

premature aging of the brain, with an accelerated loss of gray

matter, " Bushnell comments. " Similar changes are found in other

stress-related disorders, such as post-traumatic stress disorder. "

She adds that chronic pain patients also have neurochemical changes

in the brain.

" Many chronic pain patients complain of problems with concentration

and memory. These complaints could be related to the structural and

chemical changes that appear to take place in the brains of chronic

pain patients. Patients should be aware that chronic pain may have an

impact on their lives that extends beyond just the direct effects of

living with pain, " concludes Bushnell.

Opioid-Induced Hyperalgesia, Jianren Mao, MD, PhD

Opioid analgesics can increase pain under certain clinical

conditions, which is referred to as opioid-induced pain. According to

Mao, opioid analgesics can activate the cellular mechanisms

responsible for pathological pain. He says there is a cross-talk

between mechanisms of pain and opioid-induced pain, and opioid-

induced pain can contribute to chronic pain conditions.

" Opioid-induced pain is an unwanted adverse consequence from opioid

therapy, which hampers the opioid analgesic effect for chronic pain

management, " remarks Mao. " Rational use of opioid analgesics may

minimize the impact of opioid-induced pain and improve clinical

outcomes of opioid therapy. More clinical and preclinical studies are

needed to understand the mechanisms of opioid-induced pain and to

guide clinical use of opioid analgesics. "

Motion Preservation: A Paradigm Shift in Spine Surgery,

, MD

Motion sparing treatment of the spine is rapidly gaining interest.

says that the early results for disc arthroplasty,

interspinous process device and dynamic stabilization are

encouraging; however, long-term results are lacking and further

research is needed.

" The rationale for motion preservation technology is to avoid fusion

thereby decreasing the likelihood of adjacent segment degeneration

will allow earlier return to activities, maintain viscoelastic

properties of the motion segment, reduce surgical morbidity, and

decrease postoperative bracing requirements, " explains.

says that the short-term outcomes of lumbar and cervical

arthroplasty are comparable to fusion, while interspinous process

distraction has been shown to have significantly better results than

epidural steroid injections in spinal stenosis patients.

" Motion sparing technology offers hope that reduced secondary

diseases as a result of altered mechanics from surgery will be

avoided. Additionally these techniques may be associated with

shortened recovery time and earlier return to activities, " concludes

.

Who Needs Back Surgery? A. Deyo, MD, MPH

Several lines of evidence suggest we may be doing too much back

surgery in the United States. The evidence that this may be true

includes expert opinion, comparison with other countries, geographic

variations in surgery rates within the US, rapid increases in certain

types of surgery, patient outcomes in areas with high or low surgical

rates, and the preferences of patients when they are well informed.

According to Deyo, surgery offers better relief from leg pain, or

sciatica, than from back pain. Whether it helps people who have back

pain alone is controversial.

" Even in situations where surgery is likely to be of benefit, there

is a choice, and reasonable people may choose for or against surgery

depending on their own preferences and values, " Deyo

continues. " Patients should be involved in the decision-making. "

" Back surgery is not helpful for everyone with low back pain; only

those with some very specific conditions who also have leg pain with

their back pain may benefit. Even then, surgery rarely offers a

complete cure, and a choice of either surgical or non-surgical

treatment is usually reasonable. Patients should understand that even

people without back problems/pain often have abnormal MRI scans of

the spine, so an abnormality doesn't necessarily mean surgery is

going to help. Surgery is only likely to help if the MRI images match

up with specific symptoms and findings on a doctor's examination.

It's always wise to consider a second opinion when back surgery is

recommended, " he concludes.

Quality Patient Care, AMA President Nielsen, MD, PhD

As a champion of medical quality, Nielsen represents the AMA on

initiatives including the National Quality Forum, the AMA Physician

Consortium for Performance Improvement, and the Ambulatory Care

Quality Alliance.

State of Drug Diversion in the United States, Joranson, MSSW

This presentation will define diversion and discuss various types of

diversion and the nonmedical uses of opioid pain medications that

create illicit demand. It also will address the important distinction

between diversion of prescribed versus unprescribed prescription

analgesics and diversion control methods that target sources of

diversion without interfering in medical practice and patient care.

Sources of information about diversion will also be provided.

The Dark Side of Addiction: Relevance to Pain Medicine, Koob,

MD

The conceptualization of drug addiction as a disorder that consists

of neurobiological adaptive mechanisms involved in emotional

processing may be relevant to pain management and addiction

vulnerability.

" Addiction has been conceptualized as a syndrome that moves from an

impulse control disorder to a compulsive disorder to produce

excessive drug intake and loss of control over drug intake.

Impulsivity is driven by key neurochemical elements, " says Koob.

Acute withdrawal from all major drugs of abuse produces increases in

reward thresholds, increases in anxiety-like responses, and increases

in CRF levels in the brain. CRF antagonists block excessive drug

intake produced by dependence. " This brain stress response system as

hypothesized has a critical role in driving the compulsivity

associated with the loss of control over drug seeking behavior and

may be a potential site for overlap with the emotional component of

chronic pain. These same neurochemical circuits may be a key

component of the normal neurocircuity of emotional processing that is

vulnerable to disruption in other psychopathology associated with

reward function, " Koob concludes.

The Nature and Nurture of Pain, Jeffery Mogil, PhD

Pain is associated with much interindividual variability, including

the propensity to develop chronically painful pathologies after

injury or infection. Genetic-linkage mapping efforts in mice and

targeted genetic association studies in humans are beginning to

identify the genes underlying much of the variability noted in these

traits.

" In our laboratory, we have recently uncovered a number of genes

associated with thermal and inflammatory nociception, " explains

Mogil. " These efforts may lead to new clinical treatments for pain or

facilitate the patient-centered, individualized treatment of pain

using current pharmaceuticals. In addition, we are now paying greater

attention to the identification of environmental factors that affect

pain behavior in mice. We have recently observed modulation of pain

in mice by purely social factors. These data can be interpreted as

providing evidence for the existence of empathy for pain in this

subprimate species. "

" The AAPM annual meeting is a gathering of pain medicine experts from

across the country who spend three days together sharing information

about the latest research, patient care, and regulatory issues that

affect the practice of pain medicine, " says Dr. Sitzman.