• A Prescriber Education Initiative: the American Society of Anesthesiologists Joins Broad Based Task Force
    Citing the statistic that opioid abuse and addiction are claiming 44 lives per day in the US, the American Society of Anesthesiologists announced last week that they are joining the American Medical Association (AMA) Task Force to Reduce Opioid Abuse and along with its recommendations to prescribers to combat this health crisis. The AMA Task Force to Reduce Opioid Abuse is comprised of 27 physician, specialty, state, and other healthcare organizations, including the American Dental Association, that are committed to identifying ways to combat this public health crisis and move swiftly to implement those practices across the country. The new initiative will seek to significantly enhance physicians’ education on safe, effective, and evidence-based prescribing. As a first line of attack, the task force is mounting a campaign to urge physicians to register for and use state-based prescription drug monitoring programs (PDMPs) as part of the decision-making process when considering treatment options. When PDMPs are fully funded, contain relevant clinical information, and are available at the point of care, they have been shown to be an effective tool to help physicians identify patients who may be misusing opioids and to implement treatment strategies including referrals for those in need of further care. PDMPs will be discussed at PAINWeek 2015. For more information, read an interview with Dr. Foster, who will be presenting the course, PDMP’s—A Nail in Search of a Hammer. How do clinicians use PDMPs? Read about it here. Read a news story about the initiative here. Did you know that some PDMPs are tailored to ER environments? Click here to learn more. A link to the AMA web page on PDMPs with other resources for prescribers may be found here.      
  • Implantable Technology for Spinal Cord Stimulation Provides Good Efficacy, Avoids Side Effects
    A new addition to the treatment armamentarium for chronic back and leg pain may be on the horizon, according to researchers from Wake Forest University School of Medicine. Results of a study published in the online first edition of Anesthesiology report that patients who received a novel high frequency form of spinal cord stimulation (SCS) therapy experienced significantly greater, long-term relief for both of these chronic pain conditions, when compared to a traditional low frequency form of SCS therapy. The new treatment, called HF10™ therapy, uses proprietary high frequency pulses of 10,000 Hz, compared to traditional SCS which uses frequencies of 40 to 60 Hz. HF10 therapy also provides pain relief without the paresthesia (a stimulation-induced sensation commonly perceived as tingling or buzzing) that masks a patient’s perception of pain, which is typical of traditional SCS. SCS implantation has become an increasingly popular therapeutic option for patients with chronic pain who would otherwise be treated surgically or with opioid medication. But the acceptability of traditional low frequency SCS is compromised by the discomfort produced by the buzzing sensations of paresthesia. In the new study 171 patients with chronic back or leg were implanted at 10 comprehensive pain treatment centers. Of these, 90 patients received HF10 therapy, while 81 patients had traditional SCS. The researchers noted a 50% or greater reduction in reported pain at 3 months postprocedure in over 80% of both back and leg pain sufferers who underwent HF10 therapy. None of the group members reported sensations of paresthesia. Read more about this therapeutic alternative here. The online journal abstract may be read here.  
  • Discovery of Inflammation/Delirium Link May Enable Better Identification and Treatment
    New research published in Journals of Gerontology, Series A: Biological Sciences and Medical Sciences concludes that inflammation, an immune response that develops as a protective response to harmful stimuli, plays a role in the onset of delirium in older adults. The study was led by researchers at Beth Israel Deaconess Medical Center (BIDMC), Boston. Delirium is a complication of hospitalization for older adults, occurring in up to 64% of patients and is associated with a 2 to 3 times increase in the later development of dementia. The study found that patients affected by delirium had significantly elevated levels of the inflammatory marker interleukin-6 (IL-6) 2 days after surgery, as well as elevated levels of IL-2. Together, these findings may help clinicians identify patients at greatest risk of developing delirium and aid in the treatment of this condition. Senior coauthor Edward Marcantonio, MD, commented, “With strong evidence for the involvement of IL-6 and evidence for the involvement of IL-2 in patients with delirium, it appears that inflammation is indeed a basic mechanism underlying this condition. Delirium may be an inflammatory response gone awry.” By developing a better understanding of the role that inflammation may play in delirium onset, clinicians may be able to better identify patients at high risk and develop new interventions to produce better outcomes for seniors, posthospitalization. Read a news story about the findings here. The journal article may be read here.  
  • Spinal Risk Factors in Women Can Be Successfully Addressed
    Results of a new study indicate that gender-specific differences in human spinal structure are present from birth. The findings, published online in advance of publication in Journal of Pediatrics suggest that the observed difference may be an evolutionary response to the differing demands on the female spinal column during pregnancy. The difference could also contribute to women’s higher incidence of scoliosis and osteoporosis, as well as greater susceptibility for fractures later in life. The authors note, however, that the likelihood of these events can be mitigated with exercise and nutrition, suggesting the importance of individualized health care early in life. The study, involving 35 newborn boys and girls, used MRI to measure vertebral cross-sectional dimensions, a key structural determinant of the vertebra’s strength. The researchers found that the vertebrae were 10.6% smaller on average in newborn females than in males. The mechanisms underlying the observed structural difference were not identified in the research, but the authors postulate a series of complex interactions of sex steroids, growth hormone, and insulin-like growth factor. Read a news story about the investigation, with link to the journal article, here.
Daniel Carr, MD, FABPM
Pain Research, Education, and Policy Program
Department of Public Health and Community Medicine
Tufts Medical Center
Boston, MA


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