At the 2018 American Academy of Pain Management Annual Meeting, a panel discussed approaches to diagnosis and treatment of complex regional pain syndrome (CRPS). The speakers included: R. Norman Harden, MD – Northwestern University, Athens, GA Viviana Tawfik, MD, PhD – Stanford University School of Medicine Complex regional pain syndrome, formerly known as reflex sympathetic dystrophy, is a form of chronic pain affecting the limbs often resulting from minor trauma or surgery. CRPS is a bio psycho social disease. There is a significant psychological component to it. Diagnosis is based on signs of four types: Sensory (pain) Vasomotor (temperature) Sudomotor
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At the 2018 American Academy of Pain Medicine Annual Meeting, Amy Compton-Phillips, MD, EVP, Chief Clinical Officer from Providence Health & Services gave a physician executive’s perspective on the evolving healthcare system. The good news about healthcare is that almost everything is getting better around the world. Life expectancy around the globe is increasing as are infant mortality rates. Access to healthcare and clean water is also improving. What is not getting better are obesity rates in the U.S. and death from poisoning including drug overdoses. The bad news is that healthcare costs are increasing, especially in the U.S. In
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At the 2018 American Academy of Pain Management Annual Meeting, Catriona Burist, DPhy, from Oregon Health Sciences University discussed the State of Oregon’s experience in developing collaborate Care multidisciplinary models for Medicaid patients. The goal of the Oregon Opioid Initiative was to reduce deaths, non-fatal overdoses, and harm to residents from prescriptions while expanding non-opioid pain care. Oregon’s Medicaid program uses Coordinated Care Organizations to provide care to the state’s Medicaid population. These CCOs receive fees based on the number of patients covered and those funds are used to cover services. As part of this initiative, they increased coverage for
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At the 2018 American Academy of Pain Medicine Annual Meeting, a panel discussed how payers and providers can better collaborate to provide treatment that is both cost-effective and evidence based. The panel included: Kimberly George – Sedgwick (moderator) Steven Stanos, DO – Swedish Health System (moderator) Teresa Bartlett, MD – Sedgwick Geralyn Datz, PhD – Southern Behavioral Medicine Associates Jeffrey Livovich, MD – Aetna Insurance James Moore, PhD – Rehabilitation Institute of Washington Comments from the panel included the following: Unfortunately, getting approval for patients to treat in these programs is very challenging. They are not seeing the patients soon
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At the 2018 American Academy of Pain Medicine Annual Meeting a session discussed identifying the ideal candidates for interdisciplinary care. The speakers included: Ravi Prasad, PhD – Stanford University School of Medicine Patricia Cole, PhD – Shirley Ryan AbilityLab There is a big difference between acute pain and chronic pain. Acute pain has a clear pathway for treatment with a fixed end point and usually has a single cause. Chronic pain has many causes and there is no fixed end point for treatment. Immobilization may be essential to treat acute pain, but it can worsen chronic pain. Medications play a
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At the 2018 American Academy of Pain Medicine Annual Meeting, James Atchison, DO, from Shirley Ryan AbilityLab discussed working with patients to build a self-treatment plan. Patients need to be educated on both the physical and mental (cognitive) elements of pain. Physical areas of focus for a treatment program: Posture. Body mechanics/positioning. Pacing. Exercise including strengthening, muscle balance and an aerobic component. Cognitive areas of focus for a treatment program: Relaxation including breathing. Sensitization/desensitization. Graded Motor Imagery including left-right discrimination, localization and mirror. Categories of treatment – Medical: Is work-up complete? Are there known contraindications/restrictions? What are self-imposed limitations/restrictions? Will
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At the 2018 American Academy of Pain Medicine Annual Meeting, a session discussed how pain impacts the brain and how treatments can change this. The speakers were: Kristin Lucas, PT, DPT – Swedish Medical Group Elizabeth Gaffron MOTR/L – Shirley Ryan AbilityLab Pain is a natural protective mechanism that impacts many areas of the brain. The brain reacts differently when processing chronic pain vs acute pain. The brain changes can be reversed through treatment. The brain will trigger production of chemicals in the body that increase many elements of mood and body function. Pain interferes with these chemical productions. Psychological
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At the 2018 American Academy of Pain Medicine Annual Meeting, James Atchison, DO, with Shirley Ryan AbilityLab discussed medication tapering. Opioid reduction/tapering is a key element in any interdisciplinary pain management program. The goal is to reduce the medications while at the same time offering alternative pain management strategies. The goal is not to criticize the patient for using opioids, but instead focus on giving them new tools to assist with their pain. Usually by the time a person gets to a pain management program, it is established that the medication is not solving the problem. The patient may resist
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At the 2018 American Academy of Pain Management Annual Meeting, Ravi Prasad, PhD from Stanford University School of Medicine discussed outcome assessments in pain management. Outcomes tracking challenges: Financial limitations Logistical barriers Uncertainty, what should we assess Implementation of findings Most clinicians are not tracking outcomes because they don’t know how to use this information in their practice, have no infrastructure for this tracking, or many other reasons. They feel outcomes assessments are more important for researchers than practitioners. What would be useful to measure: Medication usage Physical functioning Pain level Pain interference Mood functioning Disability perception Sleep In surveys,
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At the 2018 American Academy of Pain Medicine Annual Meeting, a panel discussed lessons learned from past use of multidisciplinary pain management programs and how to overcome those barriers in the future. The panel included: Kimberly George – Sedgwick (moderator) Dianne Flynn, MD, MPH – Madigan Army Medical Centers Michael Harris, PhD – Pacific Rehabilitation Centers Marcos Iglesias, MD – Broadspire Heather Kroll, MD – Rehabilitation Institute of Washington Jeffrey Livovich, MD – Aetna Insurance Judith Scheman, PhD – Cleveland Clinic The panel discussed a wide variety of topics. The highlights included: Many programs dropped their CARF accreditation but not
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