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We begin the week on The Daily Dose with a special report from the online journal STAT that reviews the dimensions of the crisis in opioid prescribing for patients with chronic pain. While not breaking new ground in the discussion, the report offers a... ...
A former Buddist monk and current Chief Zen Officer brings to light the enormous benefits of mindful meditation. It's not as difficult, or as "out there," as you may think, and may bring people in pain great relief. ...
In an environment of escalating scrutiny over controlled medications, frontline practitioners who prescribe them for pain therapy need to take the appropriate steps to demonstrate "prescribing for a legitimate medical purpose while acting in the usual course of professional practice." Jennifer Bolen, JD, longtime PAINWeek faculty member, and founder of ...
UDT is the preferred tool in patient centered care, and is increasingly important in risk management. Heit and Gourlay discuss how it can offer clinicians insight into patient identification, treatment, and monitoring, and provide objective data for... ...
Dr. Weaver discusses the consequences of alcohol use disorder (AUD) for the development and management of chronic pain syndromes. Techniques for screening for AUD, and motivational interviewing as a therapeutic technique are also considered. ...
Chronic pain patients who fail standard treatments represent a growing problem, and a dilemma for health care providers. A pain specialist and senior PAINWeek faculty member discusses what we know about treatment failure, and outlines some elements... ...
This segment introduces the concept of virtual reality and offers an exploration of its utility in combination with other cognitive behavioral therapies in pain management. ...
Osteoarthritic conditions and resultant pain are common in most clinicians' practice. Dr. Stanos discusses the role of central sensitization in pain causation, and the benefits and risks associated with various pharmacological treatment options. ...
Fibromyalgia remains a challenge to diagnose and to treat. Dr. Stanos discusses some of the complexities of the condition, and some recent insights into etiology. Options for primary care intervention are also considered. ...
The available research provides scant evidence in support of medication or interventional procedures for reducing pain associated with functional impairment. Dr. Pohl outlines the elements of a more comprehensive treatment approach that engages... ...
As mobile technology has become more ubiquitous and widely used by all age groups, its potential for pain management has become more apparent. Dr. Reid reviews the current landscape for devices and apps, and considers some challenges to the adoption... ...
Why is complex regional pain syndrome a frustrating and challenging patient presentation? This segment outlines some of the reasons, and offers some pointers on diagnosis and treatment. ...
Dr. Reid reviews some of the age-related complications of geriatric pain management, and discusses the safety and efficacy of both pharmacologic and alternative treatment modalities. The value of collaborative models of care delivery for this patient... ...
The existence of opioid induced hyperalgesia as a side effect of chronic opioid therapy has been debated. A pain specialist offers his perspective on its reality and manifestations, and what the primary care clinician can do in response. ...
The cost of treating chronic pain now exceeds $500 billion annually, and conventional approaches deliver more failures than successes. Dr. Kaplan discusses why our failure is rooted in a misunderstanding of the problem, and asserts that the... ...
A geriatric psychiatrist discussed the epidemiology and screening process for these frequently comorbid conditions, and why considering these chronic conditions as linked may improve treatment outcomes in older patients. ...
A number of validated risk assessment tools are available to the prescribing clinician, and their use is increasingly important in the current environment for opioid therapy. A clinical psychologist and Certified Pain Educator summarizes what the... ...
Treating Chronic pain often reveals misalignments between patients and healthcare providers, including incongruity of expectations over what constitutes success. Dr. Zacharoff considers why and how the mismatch may arise, and how it might be... ...
Over the last 15 years, more epidural steroid injections are being administered by more providers. Dr. Joshi, an interventional pain physician and anesthesiologist, considers the etiology of musculoskeletal pain, and unravels some of the perceptions... ...
Dr. Jay recounts the case of a patient in pain whose examination was pathophysiologically normal in all respects. Where should the clinician look for clues? Successful treatment may depend on connecting the seemingly unrelated facts. ...
Counterfeit medications are a cause of decreased wellness, increased morbidity, and even death. An anesthesiologist and interventional pain physician reviews the origin of counterfeit medications, describes some anti-counterfeiting technologies and... ...
Doctors Gourlay and Heit, specialists in the arena of pain and addition, explore some of the more common issues confronting the primary care clinician in the management of long-term opioid prescribing. The focus is on the challenges of the inherited... ...
Doctors Gourlay and Heit, specialists in the arena of pain and addition, explore some of the more common issues confronting the primary care clinician in the management of long-term opioid prescribing. The focus is on the challenges of the inherited... ...
Patients with pain often report feeling discounted by health care providers, family, coworkers and caregivers. Dr. Geraghty comments on the etiquette of successful patient communication so that patients feel validated and better treatment outcomes... ...
A professor and department chair of adult and gerontology nursing offers an overview of best practice recommendations for obtaining assessment information from older patients with pain. Different strategies to engage in patients with cognitive... ...
Pain management practices are facing stiffer financial headwinds due to cuts in reimbursement for office visits and procedures, and escalating overhead expenses. Dr. Florente discusses the adoption of nontraditional ancillary services as a creative... ...
Most workers compensation claims involve pain treatment, and most of that therapy involves pharmaceuticals. Dr. Foster overviews the trends and treatment guidelines that primary care practitioners should be aware of, to achieve the best outcomes for... ...
Who is at risk for transition from acute to chronic pain, and why is this progression difficult to predict? Dr. Zacharoff considers these questions, and outlines some strategies for the clinician to engage to reduce the risk of transition. ...
Beyond its role in treating opioid dependence, methadone has unique benefits that make it a viable option for chronic pain management. But with these come multiple pitfalls, for which the risks of methadone therapy may outweigh its benefits for some... ...
High-quality research on the safety and efficacy of medical cannabinoids as pain therapy has long been impeded by an adverse regulatory environment. Even as the prominence of medical marijuana continues to grow--in part due to the public health... ...
Prescription Drug Monitoring Programs (PDMPs) are widely available, but not yet uniformly used. A clinical pharmacist and associate professor evaluates the current landscape, and what can be improved to enhance their utility in curbing substance... ...
In response to the escalating crisis of opioid abuse and overdose fatalities, states are adopting dosage thresholds as part of their prescribing guidelines. A clinical pharmacist and public policy professor summarize the public health landscape that... ...
A clinical health psychologist discusses the diverse effects of chronic pain on adolescent patients, with consideration for how this phase of life differs from both childhood and adult stages. These differences have implications for the experience of... ...
Stem cell therapy is among the newest innovations in the management of chronic pain and degenerative disease, and offers the most promising outlook in terms of success and prognosis. The technique of stem cell extraction is easy and can be done... ...
Dr. McPherson comments on recent consensus guidelines for methadone prescribing, with background on the properties of this analgesic that render it both an attractive and challenging opioid for pain clinicians. Special considerations for patients... ...
Clinicians involved in pain management face a practice environment that is in constant flux. In this segment, an attorney with deep experience in the medico-legal issues confronting pain practitioners outlines steps that they can take to stay current... ...
A discussion of the challenges of effective patient/provider communications about chronic pain conditions. Drs. Cheatle and Schatman outline how new models of shared decision making and patient mindfulness can help improve the quality of the... ...
Recent technological advances have prompted the increasing use of ultrasound for anatomical visualization during pain management procedures. Dr. Bottros reviews the basics of ultrasound, its application in a range of pain management procedures, and... ...
In patients with advanced illness, pain medication regimens may be inappropriately prolonged, due to clinical inertia or misperceptions over continued benefit. This segment considers the process for evaluating the medication decision in advanced... ...
Although prescription medications are of great benefit to many patients with chronic non-cancer pain, there are significant complications for patients who are either addicted or in recovery. Dr. Durham, a clinical pharmacist, professor of pharmacy,... ...
Although pain affects people of all ages, older adults are at increased risk for chronic pain and resultant disability, as well as for transition from acute to chronic pain. In a "graying" America, it is important for clinicians to understand... ...
Must opioid therapy work for everyone to be a valid part of the treatment armamentarium? Dr. Passik considers some of the consequences of "absolutist thinking" that are leading members of the pain community to unnecessarily harsh self-judgements.... ...
A specialist in pain and substance abuse discusses findings from the research on vulnerable populations in the pain community. Patients with pain and concurrent substance use disorders are particularly at risk for depression and suicidal ideation. To... ...
The enforcement arms of both commercial and government payor plans are focused on reimbursement claims for clinical laboratory services. Ongoing changes to billing and coding for services further complicate the picture for practitioners. Here's... ...
Visceral pain can be debilitating, and can degrade a patient's quality of life. It is often hard to localize, and can refer to other parts of the body. Dr. Christo discusses some aspects that differentiate visceral pain and some options for... ...
Are pain and pleasure part of a neurochemical continuum? Some evidence suggests that the brain's pleasure chemical, dopamine is involved in the response to pain. Research has also examined the relationship between dopamine and endogenous opioids.... ...
A variety of metabolic disorders, such as diabetic peripheral neuropathy, can predispose the patient to peripherial nerve entrapment and lower extremity pain. A podiatric surgeon focusing on lower extremity nerve surgery outlines what clinicians... ...
The role of diet in provoking inflammation and subsequent pain is substantially underappreciated. Dr. Blatman offers pointers to frontline clinicians on what to look for and how to educate patients on the importance of nutrition and dietary selection... ...
A clinical professor of pharmacy offers some insights for primary care on best practice in opioid prescribing. Dr Atayee discusses the importance of risk assessment, competence in dosing and titration, and alternate routes of administration,... ...
A discussion of the keys to correctly diagnosing and treating low back pain: orthopedic conditions that include musculoskeletal, discogenic, osseous, and nerve related entities. ...
Fascia may be the most underappreciated tissue in the body. Dr. Blatman discusses how fresh advances in our understanding of the anatomy are informing our grasp of the causes of myofascial pain, and helping to develop more effective treatments for... ...
Why is chronic regional pain syndrome such a frustrating and challenging patient presentation? Dr. Cheatle considers this question, and outlines a successful algorithm for treating the condition at its onset. He also discusses an emerging treatment... ...
A panel of legal and compliance experts discuss some of the issues confronting prescribers of controlled substances in the management of patients who may be abusing and/or diverting their medications. How should clinicians negotiate the terrain... ...
Dr. Atayee overviews some recently approved medications for treatment of opioid-induced constipation, nausea from chemotherapy, and insomnia. Clinical evidence is scarce, but all bear further investigation. ...
Small fiber neuropathies are becoming better understood, from recognition of their frequency, to more accurate diagnosis and recognition of causal factors. A prominent neurologist overviews this often underappreciated condition and outlines some... ...
A specialist in orthopedic regenerative medicine overviews a therapeutic option for musculoskeletal pain that carries a low risk profile while delivering high success rates. In use for many years, newer advanced forms of prolotherapy are now part of... ...
Dr. Rader is a practicing physician and clinical researcher in lower extremity conditions. Here he offers a synopsis of Morton's Neuralgia, including pathophysiology, diagnosis, and treatment options, including better alternatives to the most... ...
Dr. Mackey summarizes his PAINWeek presentation on the mechanisms and impact of neuropathic pain, with guidance on clinical assessment and approaches to treatment with emphasis on pharmacological options. ...
A gynecologic pain specialist discusses vulvodynia in the context of other women's pain conditions, with guidance on pain mechanisms and differential diagnosis. With a prevalence of 8% to 20% of the patient population, vaginal pain is deserving of... ...
An occupational therapist and practicing attorney discusses the power of engagement as a means to improving outcomes in patients with chronic pain conditions--and why this approach is good public policy as well. ...
Integrative Pain Management is a multidimensional approach that combines interventional medicine with behavioral modalities. This segment discusses the concept and its benefits. ...
Has The Decade of Pain had a positive impact on the caliber of pain education in the US? A prominent pain educator and practitioner offers an assessment of pain education today, including lessons learned from the past that may guide future... ...
By advancing from a problem/solution perspective to a holistic life coaching approach in the management of chronic pain, both clinician and patient can achieve better, more satisfying, longer lasting outcomes. ...
When patients are taught about the physiology of their pain, their treatment outcomes improve. Dr. Schopmeyer discusses the role of Therapeutic Neuroscience Education in promoting an understanding of the role of the brain in producing pain. ...
Dr. Schatman critiques the present state of affairs in medical marijuana and illuminates a more promising path for exploration in pain therapy. ...
Dr. Saenger advocates for the inclusion of CAM therapies in the pain treatment decision, and discusses the evidence supporting several modalities ...
Dr. Mackey is Division Chief for Pain Medicine at Stanford University, and is the current President of the American Academy of Pain Medicine. Here, he summarizes his PAINWeek 2014 lecture on the neurophysiology of pain transmission, with a focus on... ...
A professor of occupational therapy discusses VTE and the various reasons why the clinician may overlook the diagnosis when patients present with the classic symptoms of pain. ...
Dr. Zacharoff sketches the background history of Prescription Drug Monitoring Programs, and offers an assessment of how well they are performing and how they can be improved. Watch the segment for recommendations on what you need to know to... ...
A podiatrist offers a review of some painful foot and ankle conditions that are commonly seen in private clinical practice. ...
Dr. Robeck describes her clinical experience with group interaction in the provision of pain care and addiction management in the VA setting. ...
A nurse practitioner and Certified Pain Educator discusses some of the changes in the healthcare landscape and complexities of medical practice that confront nurse practitioners as part of the pain management team. ...
An epidemiologist looks at opioid therapy from the perspective of dose vs risk relationships, and comments on how communities can better harness local initiative and interest to combat overdose events. ...
Drs. Carter and Schatman consider the consequences that would accrue from the removal of opioids from the therapeutic options for chronic pain. The segment also discusses the characteristics of a "better" opioid, and the research understanding... ...
Drs. Carter and Schatman consider the consequences that would accrue from the removal of opioids from the therapeutic options for chronic pain. The segment also discusses the characteristics of a "better" opioid, and the research understanding... ...
Diabetes is associated with various changes in the gastrointestinal tract that are discussed here. Dr. Bottros also covers some recent advances in understanding the pathogenesis, and offers some options for treatment of GI pain. ...
An attorney discusses the role and importance of laboratory test reports in a medical legal proceeding, and gives examples of how they are used to indicate compliance/noncompliance. ...
Some further observations on the role of opioids, including advice to the primary clinician as they approach the prescribing decision. ...
A discussion of the research breakthroughs that have occurred in the understanding of centralized pain, and an outline of approaches to pain management.   ...
Dr. Argoff comments on the appropriate role of opioid analgesics as part of therapy for chronic noncancer pain, with observations on protecting legitimate access while preventing abuse. ...
Many chronic pain conditions can be treated successfully and efficiently with office-based procedures. This segment discusses the rationale for performing these and outlines some common practices. ...
The conclusion of a 2-part discussion. Some specific limitations of UTD as a clinical tool are examined. Drs. Gourlay and Heit also consider the role of opioids in chronic pain management, with balanced regard for the risks of pain and addiction. ...
An examination of the prominent musculoskeletal pain conditions in women through different stages of life, including some strategies for treatment. ...
What would the world be like without opioids? Dr. Clark hypothesizes on the implications for patients with pain, and on what the characteristics of a "better" opioid might include. ...
A consideration of the relationship between pain, depression and suicide ideation, with practitioner insights into mitigating the risk of suicide in patients with chronic pain conditions. Recorded at PAINWeek 2013. ...
In this 2-part segment, Dr. Passik discusses some of the lessons learned during and following the Decade of Pain Control and Research, and implications for the appropriate engagement of opioid therapy in chronic noncancer pain management. Click... ...
In this 2-part segment, Dr. Passik discusses some of the lessons learned during and following the Decade of Pain Control and Research, and implications for the appropriate engagement of opioid therapy in chronic noncancer pain management. Click... ...
Are you prepared to deal successfully with this frequently encountered, yet poorly studied condition? This discussion defines the phenomenon of chronic postsurgical pain, explores the causes of transition from acute to chronic pain, and examines some... ...
A review of obesity-related pain, including links and comorbidities, assessment measures, and techniques for initiating the patient discussion about the conditions. Dr. Bonakdar offers valuable insight into the current understanding of the condition... ...
Proper documentation is both an ethical and legal duty of healthcare providers, particularly with respect to opioid therapy. Attorney Bolen discusses critical documentation skills, and outlines common mistakes that clinicians may make in maintaining... ...
There's much that you can do to help your patients with postherpetic neuralgia--including how you manage referrals. In this segment, a professor of neurology offers insights for primary care clinicians on diagnosing and managing postherpetic... ...
Quantitative Sensory Testing can provide clinically useful information on potential mechanisms that may contribute to a patient's pain. Dr. Fillingim discusses the methodology and its application to patient evaluation and treatment selection. ...
Dr. Fitzgerald discusses the different kinds of urogenital pain that are commonly encountered, and examines present and emerging approached to treatment, including an assessment of the effectiveness of opioids. ...
A prominent psychiatrist and pain educator discusses the challenge of managing patients with chronic pain who also suffer with borderline personality disorder and depression, including the special difficulties associated with demanding, noncompliant,... ...
Some further observations on the role of opioids, including advice to the primary clinician as they approach the prescribing decision. ...
Dr. Argoff comments on the appropriate role of opioid analgesics as part of therapy for chronic noncancer pain, with observations on protecting legitimate access while preventing abuse. ...
Some observations on pain mechanisms, diagnostic testing and back pain that underlie an effective clinical approach to management and treatment. ...
Observations on the challenges confronting both patients and practitioners in underserved rural areas. ...
Dr. Robeck is a physician with the Veterans Health Administration.  This segment examines some comordidites associated with chronic pain among returning veterans. ...
An occupational therapist and attorney explains this experiential tool for pain management and how it integrates into a clinician's therapeutic plan. ...
Some observations in 2 parts on the state of pain education by PAINWeek 2012 Keynote Speaker Daniel Carr; where it is today, and what can be improved. ...
Observations by a pain management educator and lawyer on some key issues for pain medication prescribers. ...
A discussion of spinal cord stimulation- description, appropriate pain conditions, considerations of patient selection and management of patient expectations. ...
Dr. Walker is an assistant professor of pharmacy practice, and a practitioner in palliative care. This segment discusses topical and transdermal medications, indications for use, and their role in the therapeutic plan. ...
Dr. Blatman discusses some of the health and pain concerns that women confront at mid-life, and offers some non-pharmacologic options for treatment ...
Some observations on pain mechanisms, diagnostic testing and back pain that underlie an effective clinical approach to management and treatment. ...
Dr. McPherson is an acclaimed professor of pharmacy, primary care practitioner and consultant in hospice and palliative care. Here, she discusses some of the issues surrounding medical marijuana. ...
Observations by a pain management educator and lawyer on some key issues for pain medication prescribers. ...
Observations on the effectiveness of music as an element of pain therapy. ...
Dr. Blatman offers insights into the role of nutrition in pain management, including foods that may increase pain and inflammation, and foods that assist in their modulation. ...
Exploring strategies for balancing the needs of patients, physicians and other stakeholders in pain management. ...
Pelvic pain affects one-quarter of reproductive age women. Dr. Fitzgerald discusses the impact of pregnancy on pelvic pain, and the role of rehabilitation strategies in treatment. ...
Some observations on pain mechanisms, diagnostic testing and back pain that underlie an effective clinical approach to management and treatment. ...
Some observations in 2 parts on the state of pain education by PAINWeek 2012 Keynote Speaker Daniel Carr; where it is today, and what can be improved. ...
An examination of intrathecal drug therapy- the benefits, and clinical considerations of patient selection and managing treatment expectations. ...
A summary of acupuncture and auricular therapies as alternative medicine techniques, and the role of stress and anxiety in pain progression. ...
Observations by a pain management educator and lawyer on some key issues for pain medication prescribers. ...
Dr. McPherson discusses what the primary care clinician should know about initiating methadone therapy, including an outline of some of the precautions that should be considered with this opioid. ...
Dr. McPherson is an acclaimed professor of pharmacy, primary care practitioner and consultant in hospice and palliative care. This segment explores topical and transdermal pain relievers. ...
Chronic pain can be significantly influenced by psychological factors, and proper recognition and treatment can contribute to clinical success. ...
An occupational therapist and attorney discusses some of the special challenges presented by individuals with autism, for pain educators and clinicians dealing with pain. ...
Dr. Robeck is a physician with the Veterans Health Administration.  This discussion introduces the Primary Care Medical Home and its applicability to non-VA clinical settings. ...
A 2-part discussion of chronic headache; differential diagnosis and treatment approaches. ...
An examination of common pain presentations, their diagnosis, and options for treatment. ...
Awareness and engagement of instructional design methodologies can be of significant benefit to clinicians engaged in pain management. Pain education is a critical component of pain therapy, and Dr. McPherson discusses how these principles can... ...
A discussion of CAM therapies that are now being incorporated into pain treatment guidelines, the clinical indications for their use, and a spotlight on evidence-based dietary supplements for pain conditions ...
An examination of some of the gender based differences in the experience of pain, and in response to treatment modalities. ...
A 2- part examination of some of the chronic pain syndromes that are common in older adults, and the special considerations relating to pharmacology that arise from the physiology of older patients. ...
A 2- part examination of some of the chronic pain syndromes that are common in older adults, and the special considerations relating to pharmacology that arise from the physiology of older patients. ...
An in-depth, 4- part examination of opioid risk assessment in the primary care setting; the need, the tools; the clinician responsibilities. ...
An in-depth, 4- part examination of opioid risk assessment in the primary care setting; the need, the tools; the clinician responsibilities. ...
An in-depth, 4- part examination of opioid risk assessment in the primary care setting; the need, the tools; the clinician responsibilities. ...
An in-depth, 4- part examination of opioid risk assessment in the primary care setting; the need, the tools; the clinician responsibilities. ...
A discussion of medical marijuana in the arsenal of treatment options for pain, including clinical indications and practical legal considerations associated with the use of cannabinoids. ...
Dr. Jay discusses some of the issues confronting patients and clinicians in the current environment of cancer pain therapy. ...
Diabetes can lead to a variety of pain-inducing changes in the gastrointestinal tract. Dr. Bottros outlines some of these, and discusses options for treatment. ...
Studies indicate that various neuromuscular disorders are often accompanied by chronic pain. Dr Carter discusses this relationship and some options for treatment that are available. ...
Dr. Passik comments on the debate over opioids as appropriate for chronic non-cancer pain, identifying some shortcomings in the arguments from both sides. ...
A discussion of the role of adjuvants and co-analgesics in pain management, focusing on awareness and management of adverse effects of these therapies. ...
Dr. Herndon shares insights from the implementation of a chronic pain management program within a large family medicine program. ...
Peripheral Artery Disease (PAD) is a common comorbidity in diabetics, and can be very painful. Dr. Bottros discusses how PAD differs in diabetic and non diabetic patients, how to diagnose it, and some options for treatment. ...