Photos courtesy of Ron Zimmerman, Joshua Prager, MD, and Allison Gandey.
Tuesday, October 3, 2023
Photos courtesy of Ron Zimmerman, Joshua Prager, MD, and Allison Gandey.
Authors
Tom Collins
Freelance Writer
Medscape Medical News
Medscape
New York, NY
Disclosure: Tom Collins has disclosed no relevant financial relationships.
Joshua Prager, MD
Director of California Pain Medicine Center and Center for Rehabilitation of Pain
Syndromes
University of California, Los Angeles
Los Angeles, California
Disclosure: Joshua Prager, MD, has disclosed no relevant financial relationships.
Editor
Martha Kerr
Conference News Editor
Medscape Medical News
Medscape
New York, NY
Disclosure: Martha Kerr has disclosed no relevant financial relationships.
The American Academy of Pain Medicine 2010 Annual Meeting took place February 3 through 6 in San Antonio, Texas. Among the highlights of this year's meeting were:
Spinal cord stimulation (SCS) is effective at relieving visceral pain, including pain from pancreatitis;
A linear support vector machine (SVM) can pinpoint the site of pain or other intense signal, such as craving, in the brain;
A retrospective study finds that a disproportionate number of opioid-related deaths are due to methadone overdose;
The anti-nerve growth factor tanezumab showed efficacy in phase 2 trials for the treatment of 3 disparate types of pain – osteoarthritis of the knee, interstitial cystitis and chronic lower back pain;
Functional magnetic resonance imaging (fMRI) may be useful in the identification the site of pain; and
Sodium oxybate showed efficacy in an international phase 3 trial of patients with fibromyalgia and an application for expanded labeling has been submitted to the FDA to include the treatment of this condition.
"This meeting showcases pain medicine as a specialty — in its entirety, across all the different modalities of treatment," said AAPM 2010 conference cochair Ajay D. Wasan, MD, of Harvard Medical School, Boston, and the Pain Management Center, Brigham and Women's Hospital in Chestnut Hill, Massachusetts. "No other pain meeting does that."
In the opening sessions of the AAPM meeting, Cecil B. Wilson, MD, president-elect of the American Medical Association (AMA), reiterated the AMA's commitment to pain medicine and provided examples such as hosting a summit on pain medicine in conjunction with the last AMA annual business meeting. He emphasized the importance of pain medicine in the overall delivery of healthcare as an important component.
AAPM 2010 Keynote Speaker Daniel B. Carr, MD, Saltonsall Professor of Pain Medicine, Department of Anesthesia, Tufts University School of Medicine, Boston, Massachusetts, told meeting attendees that 17% of the US gross domestic product is now spent on healthcare, the highest percentage of any country in the world. Unfortunately, he said, the greater expenditure is not associated with substantial improvements in healthcare quality compared with countries with lower expenditures.
Using maps of brain activity from 8 study participants, Neil R. Chatterjee, BS, from the Department of Anesthesia, Division of Pain Management, Stanford University, California, and colleagues trained a linear support vector machine (SVM) to classify heat stimuli as painful or nonpainful. SVM performed with 87% accuracy and a greater than 95% negative predictive value in assessing whether subjects were experiencing pain on heat stimulus. See Functional MRI Combined With a Support Vector Machine May Discern Pain for more information.
The use of a virtual reality experience during wound care for combat-related burns showed that the average worst pain score fell from 6.25 to 4.5 with the virtual-reality experience (P = .046) compared with wound care alone. Lead investigator Peter DeSocio, DO, from the US Army Institute of Surgical Research Burn Center at Brooke Army Medical Center in Fort Sam Houston, Texas said the findings show "there is hope for making an agonizing procedure more bearable."
"It's taken an excruciatingly unbearable procedure and actually made it tolerable. That's what these data show. The pain score is irrelevant. It's not about the pain score. It's about [intervening in] these affective components of pain," noted Ajay Wasan, MD, assistant professor at Harvard Medical School in Boston, Massachusetts, and cochair of the AAPM 2010 annual meeting. See Virtual Reality Helps Combat Burn Victims Through Wound Care Treatment for more information.
A retrospective study of 24 patients with severe visceral pain related to chronic pancreatitis, conducted by Leonardo Kapural, MD, PhD, Director of Pain Management Clinical Research and Associate Professor of Anesthesiology at the Cleveland Clinic in Ohio, and colleagues, showed that spinal cord stimulation was effective in relieving the pain, and pain relief was sustained throughout the year of follow-up. See Spinal Cord Stimulation Shows Good Long-Term Results for Visceral Abdominal Pain for more information.
Patients who received spinal cord stimulation in the Cleveland Clinic study were able to significantly reduce their opioid intake, from 125 mg of morphine equivalents at baseline to 50 mg at follow-up 1 year later. See Spinal Cord Stimulation Shows Good Long-Term Results for Visceral Abdominal Pain for more information.
Methadone was linked to a disproportionately high number of opioid-related deaths, reported Lynn R. Webster, MD, from Lifetree Clinical Research and Pain Clinic of Salt Lake City, Utah, even though methodologies differed significantly and data were inconsistent in his retrospective study. See Deaths From Methadone Overdose Disproportionate to Number of Prescriptions for more information.
PainACTION, a behavioral adjunct to medical care for migraine headache, is an online intervention that shows promise as an important element of a comprehensive management approach. Migraineurs are taught to identify and manage headache triggers, and to engage in other self-management and coping behaviors, explained Jonas Bromberg, PsyD, of Inflexxion in Newton, Massachusetts. See Migraine Patients Get Results Using Interactive Web Site for Support for more information.
Carisoprodol, 250 mg 4 times daily, resulted in clinically meaningful improvement in functional status within 3 days in patients with acute muscle spasm of the lower back compared with placebo. The mean baseline pain score improved 31.1% compared with 17.2% for placebo by day 3, reported William J. Wheeler, PhD, of Meda Pharmaceuticals in Somerset, New Jersey. See Carisoprodol Effective at Lower Dose of 250 mg for more information.
Tanezumab, a humanized antinerve growth factor (NGF) antibody, showed efficacy in reducing pain in patients with severe osteoarthritis of the knee, chronic low back pain, or interstitial cystitis in a 16-week trial, reported by Leslie Tive, PhD, from Pfizer Inc in New York City. Adverse events were generally transient and not associated with substantial or clinically meaningful neurologic deficits. See More Favorable Results With Tanezumab for Various Pain Types for more information.
A symposium highlighted the physiologic effects of the multiple active pharmacologic compounds in cannabis, a controversial option for the treatment of neuropathic pain. Afterward, Joshua Prager, MD, of the University of California, Los Angeles, and member of California's Medical Evidence Evaluation Advisory Committee, said, "As a pain physician who practices in California where medical marijuana is legal, I have chosen not to prescribe cannabis because I have felt that multiple medicines we can prescribe for pain are far more potent than marijuana. There is little question that the medical marijuana controversy in California is more political than it is medical.... Studying marijuana's efficacy in humans will be quite challenging because controlled studies will difficult to conduct for a variety of factors." See Breaking News in Pain Medicine for more information.
Research conducted at Fort Sam Houston, Texas, and reported by Peter A. DeSocio, DO, showed that virtual reality significantly reduced pain-related brain activity on functional magnetic resonance imaging during wound care in combat burn patients compared with those undergoing wound care alone. See Virtual Reality Helps Combat Burn Victims Through Wound Care Treatment for more information.
A second Phase 3 study and the first international study of sodium oxybate, reported by Robert M. Bennett, MD, of Oregon Health Sciences University in Portland, showed that 4.5 to 6.0 g per night was efficacious and well tolerated in patients with fibromyalgia, substantially reducing pain by more than 30% on the pain visual analog scale (PVAS). Sodium oxybate also produced clinically meaningful improvements in function and patient global status. See Sodium Oxybate for Fibromyalgia Does Well in First International Phase 3 Trial for more information.
Photos courtesy of Ron Zimmerman, Joshua Prager, MD, and Allison Gandey.
Authors
Tom Collins
Freelance Writer
Medscape Medical News
Medscape
New York, NY
Disclosure: Tom Collins has disclosed no relevant financial relationships.
Joshua Prager, MD
Director of California Pain Medicine Center and Center for Rehabilitation of Pain Syndromes
University of California, Los Angeles
Los Angeles, California
Disclosure: Joshua Prager, MD, has disclosed no relevant financial relationships.
Editor
Martha Kerr
Conference News Editor
Medscape Medical News
Medscape
New York, NY
Disclosure: Martha Kerr has disclosed no relevant financial relationships.
