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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.

Congratulations to Inaugural AAPM Early Investigator Research Grant Recipient, Ben Alter, MD PhD

June 17, 2020, CHICAGO –   The AAPM Early Investigator Research Grant was created in partnership with US WorldMeds to support preliminary or pilot research projects relevant to a comprehensive, multidisciplinary, patient-centered approach to pain management. AAPM members who are early stage investigators were invited to submit proposals for the opportunity to receive a $15,000 one-year grant.

AAPM is pleased to announce Ben Alter, MD PhD as the recipient of AAPM’s inaugural Early Investigator Research Grant. The grant will support Dr. Alter’s research entitled Brain biomarker of endogenous analgesia in patients with chronic knee pain. Dr. Alter is an Assistant Professor and the Director for Translational Pain Research in the Department of Anesthesiology and Perioperative Medicine, University of Pittsburgh. After studying medicine and neuroscience at Washington University, he completed training in anesthesiology at University of California, San Francisco and pain medicine at the University of Pittsburgh. 

Dr. Alter’s research explores how the brain modulates pain and how endogenous pain dampening systems can be systematically leveraged for novel pain therapies. The objective of his AAPM Research Grant-funded study is to assess whether functional near-infrared spectroscopy (fNIRS) can be used to detect changes in cortical activity during endogenous analgesia in patients with chronic knee pain from osteoarthritis. Using this alternative brain imaging technique will enable hemodynamic changes in the cerebral cortex to be measured by recording low-intensity infrared light absorption by hemoglobin over time. fNIRS is portable, scalable, can be collected in the ambulatory setting, and does not require supine positioning.

According to Dr. Alter, recent evidence suggests that endogenous analgesia is diminished in chronic pain states. Interestingly, the brain circuitry implicated in endogenous analgesia also appears to change in chronic pain states, as measured by functional magnetic resonance imaging (fMRI) techniques. As such, both psychophysical tests thought to reflect endogenous analgesia and fMRI measures are potential chronic pain biomarkers. However, the relative importance of these changes to the pathophysiology of chronic pain remains unknown, partly due to a lack of prospective studies in patients in relation to their course of chronic pain. Major barriers to these studies are the cost and patient tolerability of repeated fMRI sessions.

Research shows that mechanistically relevant biomarkers may allow for personalization of chronic pain management. It is hoped that Dr. Alter’s research will lead to the discovery of the brain biomarker of endogenous analgesia in patients with chronic knee pain.

“I am honored to be selected for this grant. This pilot grant will jump start promising research that I hope will improve pain care for patients dealing with chronic pain. It was truly made possible with the mentorship and support of my friends and colleagues at Pitt and beyond,” commented Dr. Alter. AAPM wishes him and his team the best as they utilize this early investigator grant.

About AAPM

The American Academy of Pain Medicine is the premier medical association for pain physicians and their treatment teams with some 2,000 members. Now in its 37th 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

Guidance for Pain Fellows’ Education and Research During COVID-19 Published in AAPM Journal

April 30, 2020, CHICAGO – The official journal of the American Academy of Pain Medicine (AAPM), Pain Medicine, has published an article written by Board Members of the Association of Pain Program Directors (AAPD) titled “Maintaining high quality multidisciplinary pain medicine fellowship programs: Part I: Innovations in pain fellows education, research, applicant selection process, wellness and ACGME implementation during the Covid-19 Pandemic”. The article provides guidance and recommendations for pain program directors to continue trainee education and research while ensuring trainee well-being.

“The COVID-19 pandemic and associated social distancing requirements are having a profound impact on the health care system, including on the clinical duties of pain fellows,” says AAPM President Ajay Wasan, MD MSc. “Pain fellows are the future of our specialty, and it’s critical that we provide them with the resources and guidance they need to effectively complete their training and launch their careers.”

In addition to detailing alterations to ACGME policies and fellow education, research, and well-being during the COVID-19 pandemic, the article also provides recommendations for how program directors can conduct interviews with future fellows while maintaining social distancing.

Given the urgent need for this information to be publicly available to program directors and fellows across the country as quickly as possible, the article has been published and is freely accessible as an Accepted Manuscript. The Accepted Manuscript is the final draft author manuscript, as accepted for publication by the journal, including modifications based on referees’ suggestions but before it has undergone copyediting, typesetting, or proof correction. Within a few weeks, the Accepted Manuscript will be replaced by a corrected proof, known as the Version of Record. Neither the Accepted Manuscript nor the Version of Record may be hosted by any organization or journal other than Pain Medicine, but anyone is welcome to link to the guideline.

A panel of article authors will discuss their recommendations during a live webinar on Friday, May 1, 6-7:15 pm CT. This live CME activity is free, and registration is required by logging into an existing AAPM account or creating a new account. Learn more and register. A recording of the webinar will be available following the live event.

About AAPM

The American Academy of Pain Medicine is the premier medical association for pain physicians and their treatment teams with some 2,000 members. Now in its 37th 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

COVID-19 Pain Management Practice Guidelines Published in AAPM Journal

April 7, 2020, CHICAGO – The official journal of the American Academy of Pain Medicine (AAPM), Pain Medicine, has published a practice guidelines article titled “Pain Management Best Practices from Multispecialty Organizations during the COVID-19 Pandemic and Public Health Crises” to assist pain medicine providers, health care leaders, and regulatory bodies as they respond to the COVID-19 crisis.

Ensuring that persons experiencing pain have continued access to pain management services throughout this global pandemic is crucial. The Pain Medicine guidelines, which are supported by the medical societies and organizations listed below, addresses how pain medicine specialists can continue to offer vital pain care while also implementing strategies designed to keep themselves, their clinical staff members, and their patients safe.

“The need for providers and patients to responsibly address the COVID crisis must be balanced with the public health benefits inherent in the treatment of pain, as well as with the welfare of healthcare providers. Walking this ‘fine balance’ is critically important for pain specialists right now,” says AAPM President, Ajay Wasan, MD MSc, who co-authored the guidelines. “The purpose of this article is to offer guidance to help pain providers mitigate procedure risks, establish plans that protect clinicians and patients, implement telemedicine options, and triage procedures and clinical visits during the COVID-19 outbreak appropriately.”

Given the urgent need for this information to be publicly available as quickly as possible, the Pain Medicine guidelines article has been published and is freely accessible as an Accepted Manuscript. The Accepted Manuscript is the final draft author manuscript, as accepted for publication by the journal, including modifications based on referees’ suggestions but before it has undergone copyediting, typesetting, or proof correction. Within a few weeks, the Accepted Manuscript will be replaced by a corrected proof, known as the Version of Record. Neither the Accepted Manuscript nor the Version of Record may be hosted by any organization or journal other than Pain Medicine, but anyone is welcome to link to the guideline.

AAPM member and Director-at-Large Steven P. Cohen, MD spearheaded efforts to create this guideline and is its lead author. Dr. Cohen worked with representatives from the following associations to gather input and support for recommendations included in the article:

  • American Academy of Pain Medicine (AAPM)
  • American Academy of Physical Medicine and Rehabilitation (AAPMR)  
  • American Society of Anesthesiologists (ASA)
  • American Society of Regional Anesthesia and Pain Medicine (ASRA)
  • North American Neuromodulation Society (NANS)
  • Spine Intervention Society (SIS)
  • United States Military
  • Veteran Health Administration
  • World Institute of Pain (WIP)
A panel of guideline authors representing the multispecialty organizations that assisted in developing these recommendations will present a live webinar on Monday, April 13, 6-7:15 pm CT. This live CME activity is free, and registration is required by logging into an existing AAPM account or creating a new account. Learn more and register. A recording of the webinar will be available following the live event.

View a video conversation with two of the guidelines’ authors, ​Stephen P. Cohen, MD ​and ​Friedhelm Sandbrink, MD​. 

About AAPM

The American Academy of Pain Medicine is the premier medical association for pain physicians and their treatment teams with some 2,000 members. Now in its 37th 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

U.S. Surgeon General Vice Admiral Jerome M. Adams, MD MPH, to Discuss Pain Management and the Opioid Crisis During AAPM 2020

January 29, 2020, CHICAGO – The American Academy of Pain Medicine Program Committee is excited to announce that U.S. Surgeon General Vice Admiral Jerome M. Adams, MD MPH, will deliver a keynote address about the importance of pain management in combating the opioid crisis during AAPM 2020, the 36th Annual Meeting of the Academy, on Friday, February 28, 9:15 am, at the Gaylord National Resort & Convention Center in National Harbor, MD.

Dr. Adams is the 20th Surgeon General of the United States. His mission as the “Nation’s Doctor,” is to advance the health of the American people.

“Dr. Adams is an inspirational speaker with first-hand knowledge of the intersection of pain, opioid use, and addiction,” says Program Committee Co-Chair Steven P. Cohen, MD. “If there is one meeting you should attend in 2020, this is it!”

During his tenure as Surgeon General, Dr. Adams has created several initiatives to tackle our nation’s most pressing health issues, including the opioid epidemic. Dr. Adams issued the first Surgeon General’s Advisory in thirteen years, urging more Americas to carry naloxone, an FDA-approved medication that can reverse the effects of an opioid overdose. Dr. Adams also released Facing Addiction in America: The Surgeon General’s Spotlight on Opioids, and a digital postcard calling for a cultural shift in the way Americans think about, talk about, and respond to the opioid crisis. His Surgeon General’s postcard recommends actions that can prevent and treat opioid misuse, and promote recovery.

Dr. Adams joins a slate of renowned AAPM 2020 speakers that includes Eric Schoomaker, MD PhD, the 43rd U.S. Army Surgeon General; Brian Hainline, MD, Chief Medical Officer for the NCAA; Francis J. Keefe, PhD, Editor-in-Chief of PAIN; James C. Eisenach, MD, immediate past Editor-in-Chief of Anesthesiology; Mark E. Epstein, DVM CVPP, Chairperson of the Pain Management Guidelines for Dogs and Cats; and many others. For full details about this meeting, including instructions on how to register, visit annualmeeting.painmed.org.

Members of the press interested in attending the meeting should contact Megan Drumm, AAPM Director of Marketing & Communications, at [email protected].

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