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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.

AAPM Responds to CDC Call for Comments on Management of Acute and Chronic Pain

Comments submitted by the American Academy of Pain Medicine to the Centers for Disease Control and Prevention Docket No. CDC-2020-0029 on June 15, 2020. View full comments including references.

The American Academy of Pain Medicine appreciates the opportunity to respond to the Centers for Disease Control and Prevention (CDC) Request for Comment on Management of Acute and Chronic Pain and offer the following pain care priorities:

Opioids for chronic non-cancer pain; appropriate and safe opioid analgesic prescribing for chronic pain

  • Acknowledge and emphasize the importance of individualized patient care. Preservation of physician autonomy in clinical decision-making is paramount to the delivery of patient-centered care.
  • Reduce regulatory barriers to appropriate opioid prescribing when medically indicated.
  • Promote safe prescribing practices including utilization of opioids with lower risk profiles (e.g. buprenorphine).
  • Conduct regular opioid use screening and monitoring.
  • Implement standardized monitoring and best practices.
  • Measure appropriate functional outcomes (e.g. pain disability, pain interference, etc.)
  • Highlight conditions treated ineffectively with chronic opioid therapy and where opioids are not recommended (e.g. primary headache disorders, fibromyalgia).

Opioids for acute, post-surgical pain; risks of prolonged opioid prescribing

  • Promote evidence-based guidelines and prescribing strategies (lowest amount for shortest duration, co-prescribe naloxone, screen for SUD or risk, PDMP, etc.); maximize non-opioid and non-pharmacologic strategies.
  • Promote patient education regarding risks and side effects including withdrawal, dependency and addiction.

Opioid taper indications/strategies

  • Utilize and individualize guidelines on how and when to taper opioids.
  • Acknowledge heightened patient risk of death from overdose or suicide after stopping opioid treatment.
  • Emphasize the importance of concurrent behavioral health and/or opioid or substance use disorder treatment during opioid tapering.
  • Recognize the potential harms of forced opioid tapering.

Interdisciplinary pain management best practices 

  • Facilitate access to appropriate multidisciplinary and interdisciplinary pain care strategies. Multimodal pain care is required for optimal outcomes. Integrating behavioral pain management strategies into acute and chronic pain care is a national imperative.
  • Implement the National Pain Strategy.
  • Facilitate national systems for broad integration of multidimensional assessment and multimodal pain care that engages patients as active participants in symptom self-management.
  • Individualize pain care (emphasize the imperative of patient-centered care).
  • Reduce access barriers and financial barriers to interdisciplinary pain rehabilitation programs that utilize a biopsychosocial model of care. Such programs have demonstrated efficacy in reducing pain, improving function, improving mood, and teaching patients self-management skills. Interdisciplinary programs have clearly demonstrated a successful model for tapering and/or discontinuing opioids, independent of dose and duration of treatment, while improving pain, function, and quality of life for patients.

Barriers for multidisciplinary chronic pain management

  • Address, as a priority, the lack of or insufficient insurance reimbursement/coverage versus inadequate access to non-pharmacologic strategies (e.g. acupuncture, chiropractor, nutrition consultation, exercise programs, physical therapy, mental health support, integrative medicine, etc.).
  • Prioritize compassionate, effective pain care to decrease wide-spread suffering and provider-driven stigma.
  • Recognize social determinants of health and barriers to pain care access.
  • Prioritize solutions for additional insurance-based barriers to evidence-based nonpharmacologic pain management interventions: 1) payers and benefit plans continue to lack consistent coverage; 2) prior authorization processes impede access; 3) out-of-pocket expenses can be prohibitive for patients. A number of payers remain focused at times on opioid prescribing limits versus improving access for non-pharmacologic therapies.

Pain management education

  • Integrate interprofessional pain management competencies as well as substance use disorder prevention, screening, and treatment competencies into medical, nursing, dental, etc., pre-licensure and continuing medical education.
  • Transform psychology education and training to include and emphasize pain management.

Pain care measurement and monitoring strategies 

  • Utilize appropriate measures to adequately monitor patient function, pain interference, quality of life, disability, etc.
  • Promote responsible use of and interpretation of urine drug screen monitoring.

Substance use disorder (SUD) screening, prevention and treatment; co-managing pain and SUD

  • Normalize substance use disorders as a treatable / preventable disease.
  • Prioritize substance use disorder treatment and prevention as a public health priority.
  • Reduce the stigmatization of substance use disorder treatment.
  • Understand the role of buprenorphine in treating pain and opioid use disorder (OUD).
  • Individualize acute pain treatment plans in patients with OUD.

Mental health care access 

  • Ensure adequate access to mental health providers and behavioral medicine for patients with chronic pain.
  • Prioritize mental health care modalities that are low-cost and low-burden to improve access and compliance to mental health care.
  • Emphasize brief and effective behavioral health modalities, such as single-session pain classes.
  • Expand access to patient education that highlights the effectiveness of both brief and long-term access to behavioral pain treatment.

Pain management research and funding

  • Prioritize adequate funding and support pain management studies and research for new pharmacologic and non- pharmacologic pain care targets and strategies.

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.

Approved by the AAPM Executive Committee on June 15, 2020

AAPM Statement on Racism in Health Care

The American Academy of Pain Medicine condemns racism and acknowledges its heavy toll on public health. Racial and ethnic disparities in pain treatment and pain treatment outcomes have been widely documented. AAPM is committed to working with its members and the health care community at large to eradicate these disparities, so that all health care professionals and persons seeking health care and pain care are safe, respected, and valued. 

AAPM Past President Steven Stanos, DO Discusses COVID-19’s Impact on the Opioid Epidemic with AMA

This morning AAPM Past President Steven Stanos, DO participated in an AMA COVID-19 UPDATE podcast to discuss how the pandemic has impacted the nation’s opioid epidemic. Dr. Stanos also serves as AAPM’s representative on the AMA Opioid Task Force.

Dr. Stanos describes a three-prong approach that his hospital system, Swedish Pain Services, has implemented in order to respond to the pandemic: risk mitigation for patients, increased access for virtual visits, and taking care of staff and hospital team members.

Panelists discussed ways to increase access and eliminate treatment barriers for patients suffering from pain as well as those with opioid use disorder. View the full video.

2021 Annual Meeting

AAPM 2021: Effective Pain Care is Multimodal

The AAPM Annual Meeting is the must-attend meeting of the year for the entire pain care team. It brings together specialists of varying modalities and disciplines to address evidence-based, innovative best practices that treat the whole patient through multimodal and multidisciplinary approaches. AAPM 2021 will provide attendees with the skills and knowledge necessary to more fully incorporate multimodal pain care efficiently and effectively into their practices.

2020 has been an unprecedented year, with the COVID-19 pandemic impacting every aspect of our professional and personal lives. For us in the pain medicine field – this public health crisis came as we continue to combat the persisting public health problems of chronic pain and the opioid epidemic. 

I am proud of our specialty for rising to meet these challenges in order to continue delivering care through ingenuity, commitment, and grit. The pandemic has shown an even brighter light on why multimodal approaches are crucial to the treatment of acute and chronic pain, and no other medical specialty has as much command of these modalities as we do.

AAPM 2021 will offer us the much-needed opportunity to convene and share what we have learned and experienced this past year as we continue to reshape the delivery of pain care in a post-COVID-19 world.

-AAPM President, Ajay Wasan, MD MSc

AAPM 2021 will be held, this spring, in a virtual format, on dates still to be determined.

The meeting will highlight critical components of multidisciplinary care, including:

  • Academic and research
  • Acute pain/preventing transition to chronic pain
  • Basic & translational science
  • Cancer pain
  • Diagnostics and imaging sciences
  • Integrative and transdisciplinary care
  • Pain treatment for special patient populations
  • Pharmacotherapies
  • Physical and behavioral therapies
  • Practice management
  • Pro/con debate
  • Procedural and surgical interventions

Make sure you receive the most up-to-date information about the meeting. Join the AAPM 2021 mailing list >

AAPM members receive special meeting perks, including significantly discounted rates. Check your member status or join now >

Re-opening and Revitalizing Your Practice During the COVID-19 Pandemic Free Live CME Webinar May 21, 6 pm CT

The COVID-19 pandemic is causing substantial disruptions to daily life around the world and pain practitioners across the globe are affected by these disruptions while care for their patients with chronic pain. Slowly social distancing regulations are beginning to lift throughout the country, and providers are navigating how to re-open and adapt their practices.

AAPM will present a free live CME webinar on Thursday, May 21, 6-7:15 pm CT, titled Re-opening and Revitalizing Your Practice During the COVID-19 Pandemic. Attendees will hear from an expert panel comprised of both academic as well as private practice practitioners who will share strategies to safely and successfully provide patient care in this new environment.

Make sure your most pressing questions and concerns are addressed by participating in a brief 5-question Re-Opening Your Pain Practice Amidst COVID-19 Survey. Responses are anonymous and will be incorporated into the May 21 webinar and interactive Q & A portion of the activity.

Presenters for this live activity include Vitaly Gordin, MD, Tim Lamer, MD, Tobias Moeller-Bertram, MD PhD MAS, Gregory Polston, MD, ToNhu Vu, MD, and Ajay Wasan, MD MSc.​

Participation in AAPM COVID-19 educational activities is free. Registration is required by logging into your AAPM account or creating a new account. 

The capacity for the May 21 webinar is 200 live participants, and we anticipate the webinar will sell out. Please only register if you are able to attend the live activity. A recording will be freely available in the AAPM Education Center following the live event. Contact AAPM Member Services for assistance at in[email protected] or 847-375-4731.

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