The management of chronic noncancer pain with opioid medications is controversial. The negative consequences have been described as a public health emergency and the efficacy of chronic opioid therapy remains a subject of significant debate. Despite recommendations that chronic opioid therapy not be utilized until other methods fail, there remains a large population of patients for whom no other therapy has been effective and a large cohort of people who have been treated for years with opioids. Many new patients are still started and maintained on chronic opioid therapy. This course describes ..read more

Buprenorphine was developed by UK based Reckitt & Colman Products and released in the United Kingdom in 1978. That same year, a clinical study determined that buprenorphine could be helpful in reducing cravings of pure opioids in patients with an opioid abuse disorder. Then, a separate study published in 1982 demonstrated that buprenorphine offered excellent analgesia with a blunted abuse liability. Buprenorphine is a partial agonist at the mu-opioid receptors and an antagonist at the kappa receptors. Mu-opioid receptor activity produces the analgesic effects of buprenorphine, while a stro ..read more

The use of opioids to treat chronic pain has become quite contentious in recent years. Things get even more confusing when we consider adding an adjuvant analgesic in the mix. Does this reduce or heighten risk? The audience can decide where to throw spitballs when 2 practitioners debate 2 separate topics. First, is the use of cannabis plus an opioid likely to provide an enhanced clinical effect (eg, allow for opioid dose reduction and by extension, harm), make no difference, or possibly cause more harm. The second debate will evaluate the use of gabapentin plus an opioid. On one hand, we have ..read more

In previous presentations, Dr. Jay has discussed the pathophysiology, neuroanatomical, and other aspects of fibromyalgia. In this activity, all of that will NOT be discussed, so the focus can be only on the diagnosis and treatment of fibromyalgia and restless leg syndrome. Treatment will be covered in depth, not the phenomenology that is the complex neuroanatomical and neuropathological backgrounds of these diatheses. The goal is to provide clinicians with practical information to be utilized upon seeing patients following the conference ..read more

The prevalence of back pain continues despite the many treatments available, without any single treatment being a panacea. In routine clinical practice there has been a tendency of clinical examinations to become more cursory, largely influenced by increasing demands of time and arguably an overreliance upon technology. It has been suggested that the failure to adequately differentially diagnose the cause of back pain can account for clinical failures in treatment. The purpose of this discussion is to assist clinicians in the development of a more problem focused examination to enhance the dif ..read more

Today’s providers are limited by time and must work with extreme efficiency. And yet for many, 100% of their time is used trying to treat 20% of their patients’ problems. This presentation will address the problem of chronic pain, provide simple tools to use during any office visit, and explain the power of positive and negative thoughts on the chronic pain experience ..read more

Several recent studies have found intriguing links between gut microbes, rheumatoid arthritis, and other diseases. Additional studies have shown the interactions between the central nervous system, enteric nervous system, and the gastrointestinal tract, suggestive that gut microbiota appears to influence the development of emotional behavior, and stress- and pain-modulation systems. In the age of modern medicine, it is easy to forget that we change our body chemistry every time we eat. The quality and composition of our food has the power to increase or decrease body wide inflammation and modu ..read more

Pain is common in the aging population. Findings from an NIH funded study looking at the impact on pain in the older adult found that over 50% of people surveyed had pain within the last month, often in more than one location. Despite the high prevalence of pain, pain often remains undertreated, resulting in impaired cognition, decreased socialization, sleep disturbances, and a reduced quality of life. Our bodies react differently to medications due to medical comorbidities and metabolic changes due to the aging process itself. Understanding the correct choices of analgesic utilizing a multimo ..read more

This course will review the scientific evidence for/against opioid therapy, risk mitigation, and different methods of opioid tapering. Providers need guidance to determine which patients may or may not benefit from opioids. While most pain patients on opioid therapy manage opioids safely, the risks are detrimental to some patients and society. Clinicians are faced with contradictory professional advice and legal mandates/scrutiny. Many patients are exposed to risk due to inappropriately executed opioid tapering. Suicide rates are rising, and illicit drug use including overdose deaths from synt ..read more

Understanding the mechanisms that drive a persistent pain process is critical for effectively treating pain in any patient. While it is common to treat pain from a primary nociceptive perspective, this approach often fails in patients with central sensitization. Pain mechanism based classifications can help clinicians make recommendations that may improve functional outcomes and enhance patient adherence by identifying primary pain mechanisms. This course will offer practical tips for evaluation of patients with mixed pain mechanism presentations and includes an interactive discussion of multi ..read more