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Darbe Rotach; Pauline Anderson; Darryl Nobles; Susan Jeffrey; Allison Shelley; Megan Brooks | March 29, 2017
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Top News From AAPM 2017: Slideshow
Darbe Rotach; Pauline Anderson; Darryl Nobles; Susan Jeffrey; Allison Shelley; Megan Brooks | March 29, 2017 | Contributor Information
Pain specialists from around the world gathered in Orlando, Florida, to hear the latest news in their field during the American Academy of Pain Medicine (AAPM) 2017 Annual Meeting, held March 15 to 19.
Top News From AAPM 2017: Slideshow
Darbe Rotach; Pauline Anderson; Darryl Nobles; Susan Jeffrey; Allison Shelley; Megan Brooks | March 29, 2017 | Contributor Information
The theme of this year's meeting — "Pain Is a Public Health Problem" — emphasized the extent to which pain affects the population and the pressing need for pain medicine clinicians to address this major public health burden through evidence-based treatments and practices, conference planners said. Among the highlights:
Novel kappa opioid receptor agonist is a promising alternative to current opioids.
Simulation learning teaches pain medicine students about opioids.
Top News From AAPM 2017: Slideshow
Darbe Rotach; Pauline Anderson; Darryl Nobles; Susan Jeffrey; Allison Shelley; Megan Brooks | March 29, 2017 | Contributor Information
Opioids Linked to Hospital-Acquired Pneumonia
Patients prescribed fentanyl, morphine, or codeine in the 100 days before being hospitalized have an increased risk for pneumonia while in the hospital, results of a new study suggest. Among 40,403 inpatient admissions in the Kaiser Permanente health system over about 4 years, there were 242 cases of hospital-acquired pneumonia (0.60%), a rate slightly below the national average. But among the 20,399 patients who had received any inpatient fentanyl, codeine, or morphine, the rate was 0.79%, compared with a rate of 0.39% for the 20,004 who had no inpatient fentanyl, codeine, or morphine. The relationship is probably due to immune suppression, researchers speculate. "This is just a signal finding, but it makes me think that in vulnerable patients, such as those who are already immune suppressed, including HIV patients and those on biologics, we might want to weigh immunosuppressive effects of opioids when we make decisions about how we prescribe," said study presenter, Andrea Rubinstein, MD, Permanente Medical Group, Santa Rosa, California.
Top News From AAPM 2017: Slideshow
Darbe Rotach; Pauline Anderson; Darryl Nobles; Susan Jeffrey; Allison Shelley; Megan Brooks | March 29, 2017 | Contributor Information
Positive Feedback From Communities Using Naloxone Nasal Spray
Naloxone nasal spray (Narcan, Adapt Pharma) effectively reverses the effects of opioid overdose, with response times similar to those reported for intramuscular administration of naloxone, a new survey suggests. "Looking at the results of this survey, believe me, I was very pleasantly surprised with what I saw," said lead researcher, George K. Avetian, DO, senior medical advisor for Delaware County, Media, Pennsylvania. "People in my county are seeing phenomenal results with this product. We're going to continue to use it because it's very effective, it's safe, efficient and fast-acting." Dr Avetian noted that to make this effective, a county needs four pieces of the equation. "You have to have leadership convinced and engaged, the medical community has to buy into the process, law enforcement has to buy into the process, and the general public has to be involved. We are fortunate; all four pieces of the equation are there," said Dr Avetian.
Top News From AAPM 2017: Slideshow
Darbe Rotach; Pauline Anderson; Darryl Nobles; Susan Jeffrey; Allison Shelley; Megan Brooks | March 29, 2017 | Contributor Information
Novel Compound Promising Alternative to Current Opioids
CR845, a novel kappa opioid receptor agonist, relieves pain and doesn't carry many of the side effects of currently prescribed opioids, hint results of a phase 2 proof-of-concept study. The 81-patient study found that CR845 (Cara Therapeutics) is safe and effective for patients with osteoarthritis pain. CR845 attaches to kappa opioid receptors in the peripheral nervous system and doesn't cross the blood-brain barrier, so it doesn't carry some of the "baggage" that currently prescribed opioids do, said Joseph Stauffer, DO, an anesthesiologist and chief medical officer of Cara. The drug has no "abuse liability" and it also doesn't cause respiratory depression. He listed several other advantages, too. "The drug will not make you chronically constipated; the drug will likely not be scheduled; and the drug is excreted through the kidney so there's no chance for drug-to-drug interactions." The company is running phase 3 pivotal trials in patients having a hysterectomy and those undergoing surgery to fix a hernia in the abdomen.
Top News From AAPM 2017: Slideshow
Darbe Rotach; Pauline Anderson; Darryl Nobles; Susan Jeffrey; Allison Shelley; Megan Brooks | March 29, 2017 | Contributor Information
Simulation a Promising Pain Medicine Teaching Tool
As the country continues to face an epidemic of opioid misuse, medical schools should consider using simulation and immersive learning to teach students about the safe management of these drugs, Jordan L. Newmark, MD, Division of Pain Medicine, Stanford University, California, told delegates. "One reason we have this opioid epidemic is the lack of education surrounding opioids. I'm a very strong advocate for the use of simulation," he said. "It's a powerful technique that should be considered when we're trying to teach about opioids." Dr Newmark presented data on his center's use of this strategy. Simulation uses professional or amateur actors who play out various patient-doctor scenarios. It's a teaching technique often used in other fields, including surgical anesthesiology. "It's still pretty limited in the area of pain, although it's catching on," said Dr Newmark. "I want to see this grow in the pain world as it's grown in the anesthesiology world."
Top News From AAPM 2017: Slideshow
Darbe Rotach; Pauline Anderson; Darryl Nobles; Susan Jeffrey; Allison Shelley; Megan Brooks | March 29, 2017 | Contributor Information
Outpatient Pain Service Cuts Costs in "High Utilizers"
An intensive outpatient pain management program incorporating both psychiatric care and pain management can cut costs incurred annually by high utilizers of a healthcare system, reported Steven D. Prakken, MD, director, Medical Pain Service (MPS), Duke University, Durham, North Carolina. "High utilizers are a really difficult population to deal with and they take up a good deal of our time," he said. The population includes many patients with chronic pain, who often have psychiatric comorbidity and tend to be underinsured. Dr Prakken called his service a "deep dive" into functional pharmacology. "It's a process by which we look at all the medications these patients are taking, in detail, figuring out what kind of effects and side effects they have, in detail." The new study included 31 patients referred to the MPS team and treated for an average of 1 year. The intervention led to a 45% reduction in costs; changes in costs per year went from $508,707 to $277,989, a 45% cost savings. "Nearly $9000 a year for each high utilizer was actually saved," said Dr Prakken.
Top News From AAPM 2017: Slideshow
Darbe Rotach; Pauline Anderson; Darryl Nobles; Susan Jeffrey; Allison Shelley; Megan Brooks | March 29, 2017 | Contributor Information
Off-Label Ketamine in Private Pain Clinics
The field of pain management has seen a resurgence of interest in the anesthetic ketamine as a possible therapy for numerous chronic pain conditions, as well as for depression and post-traumatic stress disorder. Because the related studies are small and have had issues with blinding, it's difficult to determine what the efficacy truly is. The popularity of ketamine is, however, not in doubt, as evidenced by the growth of off-label use of ketamine at private pain clinics across the United States. Current ketamine use was discussed during a controversies session here called "Ketamine for Chronic Pain: Panacea or Snake Oil?" An expert panel has already issued a consensus statement on the use of ketamine for major depression, and now the Society of Regional Anesthesia and Pain Medicine is working on its own guideline. But in the meantime, "It's like the Wild West out there," Steven P. Cohen, MD, professor of anesthesiology and critical care medicine and of physical medicine and rehabilitation at Johns Hopkins Hospital and at the Uniformed Services University of the Health Sciences, told delegates during the session.
Top News From AAPM 2017: Slideshow
Darbe Rotach; Pauline Anderson; Darryl Nobles; Susan Jeffrey; Allison Shelley; Megan Brooks | March 29, 2017 | Contributor Information
Pain Rehab Program Reduces Central Sensitization
Patients completing an outpatient interdisciplinary chronic pain rehabilitation program (iCPRP) at the Cleveland Clinic have significantly reduced self-reported central sensitization (CS), assessed using the recently developed central sensitization inventory. "Essentially, we wanted to see what impact iCPRP care has on central sensitization syndromes because, to my knowledge, this has not been tested before," said Xavier Jimenez, MD, from the Center for Behavioral Health, Cleveland Clinic, Ohio. Patients come to the program with a variety of comorbid conditions, including depression, anxiety, addiction, and post-traumatic pain disorder. The iCPRP includes medical care, opioid and benzodiazepine detoxification, psychiatric and psychological assessments, physical and occupational therapy, biofeedback, counseling, and family and group therapy. It's unclear what is contributing to the reduced CS, said Dr Jimenez. "Is it that we improved their depression? Is it that they are less hypervigilant of their symptoms? Is it that something else was the active ingredient? I would argue that it's probably a mix of all of those."
Top News From AAPM 2017: Slideshow
Darbe Rotach; Pauline Anderson; Darryl Nobles; Susan Jeffrey; Allison Shelley; Megan Brooks | March 29, 2017 | Contributor Information
Veterans Opioid Safety Initiative a Success
The Opioid Safety Initiative launched by the US Department of Veterans Affairs (VA) in 2013 has reduced reliance on opioids among veterans across the country and expanded access to nonopioid therapies, reported Friedhelm Sandbrink, MD, a neurologist at the Washington DC VA Medical Center. Between mid-2012 and the end of 2016, researchers documented a significant 31% reduction in the overall number of veterans prescribed opioids, a 36% decrease in the number on long-term opioid therapy, and a 56% reduction in those receiving combination opioid and benzodiazepines. The initiative includes education of providers as well as expanded access to nonpharmacologic treatments, particularly behavior options and complementary modalities. "It makes the totality of opioid use visible within the VA, and it provides feedback to VA leaders and stakeholders in regard to key parameters of opioid prescribing system-wide," Dr Sandbrink told meeting delegates.
Top News From AAPM 2017: Slideshow
Darbe Rotach; Pauline Anderson; Darryl Nobles; Susan Jeffrey; Allison Shelley; Megan Brooks | March 29, 2017 | Contributor Information
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Darbe Rotach
Medscape Senior Photo Editor
New York City
Pauline Anderson
Freelance Journalist
Toronto, Ontario, Canada
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