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Opioid Patient Protection Recommendations accepted for publication in Mayo Clinic Proceedings

October 1, 2020, CHICAGO, Illinois – A multidisciplinary consensus panel convened by the American Academy of Pain Medicine Foundation has issued new recommendations in Mayo Clinic Proceedings about ensuring patient protections when tapering opioids. The recommendations offer guidance to pain specialists and primary care providers—as well as patients, payors, and regulators—about the intricacies of opioid reduction.

In recent years, prescribers in the United States have made considerable efforts to reduce or discontinue opioids in patients who have taken them long term. While opioid reduction efforts have had generally beneficial effects, there have been unintended consequences. Abrupt reduction or discontinuation has been associated with harms that include serious withdrawal symptoms, psychological distress, self-medicating with illicit substances, uncontrolled pain, and suicide. Key questions remain about when and how to safely reduce or discontinue opioids in different patient populations. The consensus panel recommendations include clear, evidence-informed steps providers can take to clarify the indications for tapering long-term opioids and how to ensure patient safety throughout each step of a taper.

“Clinicians face dilemmas when caring for patients taking opioids, as various guidelines, patient preferences, and clinical impressions of risks and benefits may be in conflict,” says AAPM Past President Edward Covington, MD, lead author of the AAPM Foundation project. “Our findings indicate that harm can result from abrupt tapers and emphasize the importance of balancing patient collaboration and desires with clinician responsibility to prescribe wisely.”

The consensus panel’s recommendations are the result of a rigorous and collaborative process, including consensus-building discussions, analysis, and interpretation of data. “We convened a consensus panel of experts in long-term opioid treatment, substance use disorders, and opioid reduction with the goal of providing useful criteria for dose continuation versus reduction along with strategies for the comfortable and humane tapering of opioids, when indicated,” Dr. Covington said.

Hear more from Dr. Covington by viewing this video interview he conducted with co-author Mark Sullivan, MD PhD.

Recommendations also address topics such as patient factors that increase risk with long-term opioid therapy, indications for tapering long-term opioids, common withdrawal symptoms, and buprenorphine initiation in patients on opioids for pain. Several of the panelists presented a Spotlight Session about this project at AAPM’s 2020 Annual Meeting. A recording of this session is available on demand in the AAPM Education Center at no cost for members and $25 for nonmembers.

About AAPM

The American Academy of Pain Medicine is the premier medical association for pain clinicians and their treatment teams with some 2,000 members. Now in its 36th year of service, the Academy’s mission is to advance and promote the full spectrum of multidisciplinary pain care, education, advocacy, and research to improve function and quality of life for people in pain. Information is available on the Academy’s website at painmed.org.

About AAPM Foundation
The AAPM Foundation was created in 2011 to support the American Academy of Pain Medicine’s (AAPM) efforts. The Foundation supports AAPM’s core purpose to optimize the health of patients in pain and eliminate the major health problem of pain by advancing the practice and the specialty of pain medicine. Information is available on the Foundation’s website at aapmfoundation.org.

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New Pain Medicine Journal Virtual Issue on Ketamine

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Pain Medicine, AAPM’s official journal, recently published a new virtual issue on ketamine. The issue is freely available and includes a collection of preliminary studies, surveys, pragmatic and systematic reviews, and consensus reports that have been published on the topic in the past several years in Pain Medicine.

An editorial titled “Ketamine Infusion: The Wild Wild West (and East)” authored by Pain Medicine Senior Associate Editor R. Norman Harden, MD introduces the issue.

“Low-dose ketamine produces analgesia and reportedly modulates central sensitization and hyperalgesia of various etiologies. There is weak to moderate evidence suggesting that ketamine may prove useful for certain chronic neuropathic pain conditions, particularly complex regional pain syndrome (CRPS),” says Dr. Harden in his editorial. “In the context of the opioid “crisis” and, unfortunately, in the absence of good evidence, ketamine is being used increasingly in infusion clinics to manage CRPS and other sorts of neuropathic pain. Understandably, this is driven by the desperation of both patients and clinicians searching for answers and relief in this terrible disease. There is some evidence for its effectiveness but no standard protocols, validated guidelines, or randomized controlled trials.”

This Pain Medicine virtual issue is intended to spur more and better research on ketamine by offering open access to past journal articles.

Members’ Update from AAPM President Ajay Wasan, MD MSc

Today AAPM President Ajay D. Wasan, MD MSc issued the following message to members.

Dear Colleagues,

I want to keep you apprised of how AAPM is responding to the extraordinary circumstances we are living in this year. This is due to the COVID-19 pandemic and among other things, the sustained call to end pervasive racial injustices in this country, which I believe should also include a push to end the disparities in pain care driven by race that are well-documented in our field (including in Pain Medicine!).

In my most recent message, I remarked on how pain specialists have risen to our new challenges in order to transform pain care through ingenuity, commitment, and grit. As your efforts and work continue in the face of COVID-19 and shared societal pain, know that AAPM is also continuing to develop new resources to help guide and support you.

Guidance for reopening pain practices amidst COVID-19

Last month AAPM leaders conducted an expert panel who delivered a free CME webinar that offered guidance on safely delivering patient care in light of the ongoing pandemic. A recording of this session is now accessible in the AAPM Education Center, and a summary of the recommendations is available. Learn more and access the course and summary >

This is the latest in a series of freely accessible CME resources AAPM has developed for pain medicine professionals in the past several months specific to the COVID crisis. View all of these resources and track the latest COVID-19 news and information that most closely affects our specialty at painmed.org/coronavirus. 

The show will go on: AAPM 2021 planning is underway

As I have mentioned, the pandemic further illustrates why multimodal approaches are crucial to the treatment of acute and chronic pain. No other medical specialty has as large a toolbox of these different modalities as we do. The 2021 AAPM Annual Meeting will focus on the theme Effective Pain Care is Multimodal. Thank you to everyone who participated in the call for educational sessions, and I invite you all to submit scientific poster abstracts. AAPM will accept abstract submissions through August 14, 2020, 5 pm CT. Learn more about AAPM 2021 and participate in the call for abstracts >

I hope that Phoenix will offer an additional respite for us this February following months of lock downs and social distancing. However, the AAPM 2021 Program Committee, chaired by Halena Gazelka, MD and Gagan Mahajan, MD, are preparing for any eventuality. For the first time this year, we anticipate offering virtual participation in the live AAPM Annual Meeting. If necessary, we are prepared to shift to a fully virtual experience should convening in-person not be feasible. No matter the delivery, we will use these dates of February 3-7, 2021 to gather members of the pain medicine community for our annual meeting and hope you will participate. We will keep you informed of these plans as they continue to evolve. 

Confronting disparities in pain management

Last month AAPM issued a statement condemning racism and acknowledging its heavy toll on public health as well as a need for action. Today I am following up to let you know the steps AAPM is taking to fulfill its commitment to eradicate disparities from pain treatment so that all health care professionals and persons seeking health care and pain care are safe, respected, and valued. 

Disparities in Pain Management SIG launched

Thank you to AAPM members Juliet Gaisey, MD; James Khan, MD MSc; Sean Mackey, MD PhD; Fabienne Saint-Preux, MD; Natacha Telusca, MD MPH; Charonn D. Woods, MD who are co-chairing the Academy’s newest shared interest group, the Disparities in Pain Management SIG. The AAPM Disparities in Pain Management SIG seeks to equalize access to treatment for chronic pain in racial and ethnic minorities and people living in poverty by:

  • Creating a forum for sharing knowledge and expanding awareness of existing disparities in pain care
  • Promoting and participating in research efforts and programs to help improve access to pain treatment in the United States and globally
  • Creating opportunities for mentorship and partnership to improve medical education in pain management

All members interested in contributing to this group can join the SIG by visiting their My Account page and adjusting their SIG preferences, or you can contact AAPM Member Services at [email protected] or 847-375-4731 to be added.

​Upcoming diversity, equity, and inclusion resources

In addition to the formation of this new SIG, AAPM leadership are actively identifying additional opportunities to enact positive change and engage in diversity, equity, and inclusion activities. AAPM 2021 will feature content about pain care disparities and the need for greater diversity in the workforce of pain specialists.

Help keep AAPM strong

During these difficult times, I personally have relied on the camaraderie and expertise available through AAPM and my fellow members more than ever. I hope you too have found support, knowledge, and guidance from the Academy and our amplified voice of nearly 2,000 members.

When the time comes for you to renew, we hope you will choose to do so. Your membership fuels AAPM. If you have friends or colleagues that you think may be interested in joining us, I hope you’ll consider logging into your AAPM account to make a referral.

Thank you for your continuing efforts on behalf of our patients. I am proud to stand by each of you as one of your colleagues.

Ajay D. Wasan, MD MSc
President AAPM 

Guidance for Reopening Pain Practices Amidst COVID-19

The COVID-19 pandemic has resulted in unprecedented challenges to healthcare in general and to pain management practices in particular. Chronic pain patients being one of the most vulnerable patient populations under normal circumstances, have been affected particularly hard during the pandemic when pain management practices were closed and most treatment modalities, including medical management, physical therapy, psychological interventions, and interventional procedures were not available. Additionally, loss of revenue from not rendering services put a tremendous financial strain on pain practices. 

As pain practices work to continue treating patients and reopen more widely during the ongoing COVID-19 pandemic, AAPM has established recommendations to guide pain providers. While local conditions vary quite a bit from region to region, recommendations can be tailored to individual practices and local regulations, as well as the current state of the pandemic in their region.

AAPM recently featured this guidance on reopening pain practices amidst COVID-19 during a live webinar originally presented on June 2, 2020. A recording of this webinar is now freely available as a CME course in the AAPM Education Center. Reopening topics covered by the expert faculty panel during the course include: 

  • Patient care in light of the ongoing pandemic
  • Safety measures when reopening a pain clinic in order to protect both healthcare workers and patients
  • Risk stratification of pain management procedures based on urgency vs. the increased risk of contracting COVID-19
  • The important role of telemedicine
  • The financial impact of the pandemic and available resources, and 
  • How to prevent the physicians burnout during pandemic and beyond.
The presenters also created a summary of the guidance that is available for download.
AAPM is regularly updating its COVID-19 practice resources and creating adding new content at painmed.org/coronavirus.

New Clinical Practice Guidelines on Management of Pain in Sickle Cell Disease Co-Authored by AAPM Board Member, Rob Hurley, MD PhD

AAPM Director-at-Large Robert W. Hurley, MD PhD co-authored new clinical practice guidelines on management of pain in sickle cell disease (SCD) published in the American Society of Hematology (ASH) journal, Blood Advances.

Pain is the most common complication of SCD and it significantly decreases daily quality of life. Severe pain is the leading cause of emergency department visits and hospitalizations for people with SCD. Individuals with pain from SCD often don’t get the care they need because comprehensive information about medications and therapies had not been readily available. This guideline address clinical challenges by providing the first evidence-based recommendations to help individuals with SCD and their providers make the most informed decisions for personalized care.

Read the guidelines.

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