30th Napa Pain Conference

Learning Objectives

As a result of participating in this activity, learners will be better able/better-able to:

• utilize strategies to optimize patient-provider interactions, in order to enhance patient outcomes
• mitigate commonly-reported care inequities associated with treatment of racial and ethnic minority populations

Desirable Physician Attributes

• Work in interdisciplinary Teams [IOM] Cooperate, collaborate, communicate, and integrate care in teams to ensure that care is continuous and reliable
• Interpersonal and Communication Skills [ACGME/ABMS] Effective information exchange and teaming with patients, their families, and other health professionals
• Professionalism [ACGME/ABMS] As manifested through a commitment to carrying out professional responsibilities, adherence to ethical principles, and sensitivity to a diverse patient population
• Patient Care [ACGME/ABMS] Provide care that is compassionate, appropriate and effective for the treatment of health problems and the promotion of health

Pain management domains and core competencies

4. Clinical conditions: How does context influence pain management?

1. Describe the unique pain assessment and management needs of special populations.
2. Explain how to assess and manage pain across settings and transitions of care.
3. Describe the role, scope of practice, and contribution of the different professions within a pain management care
   team.
4. Implement an individualized pain management plan that integrates the perspectives of patients, their social support
   systems, and health care providers in the context of available resources.
5. Describe the role of the clinician as an advocate in assisting patients to meet treatment goals.
   

Accreditation & Designation

Neurovations Education is accredited by the Accreditation Council for Continuing Medical Education (ACCME) to provide continuing medical education for physicians.

Neurovations Education designates this live activity for a maximum of 0.75 AMA PRA Category 1 Credits™. Physicians should claim only the credit commensurate with the extent of their participation in the activity.

Disclosure of Financial Relationships & Measures to Resolve of Conflicts of Interest

Presenter: Roger Fillingim discloses the following financial relationships within the past 24 months: Consulting: UCB

No other person with control of, or responsibility for, the planning, delivery, or evaluation of accredited continuing education has, or has had within the past 24 months, financial relationship(s) to disclose with ineligible companies whose primary business is producing, marketing, selling, re-selling, or distributing healthcare products used by or on patients.

All relevant financial relationships have been mitigated. Materials were reviewed in advance of the activity by person(s) that do not have conflicts of interest related to the content. In some cases, content may have been modified as part of the review and mitigation process. All clinical recommendations are evidence-based and free of commercial bias (e.g., peer-reviewed literature, adhering to evidence-based practice guidelines).

Learning Objectives

As a result of participating in this activity, learners will be better able to:

• Apply a greater understanding of the functioning of synaptic networks to anticipate therapeutic responses

Pain management domains and core competencies

What is pain? Multidimensional nature of pain:

• Demonstrates knowledge of the theories and science for understanding the physiology of pain and pain transmission

How is pain safely and effectively treated?

• Identifies appropriate multimodal pain treatment options as part of a comprehensive pain management plan
• Identifies and describes potential pharmacological and nonpharmacological treatment options
• Uses valid and reliable tools for measuring pain, function, and associated symptoms to assess and reassess related outcomes appropriate to the clinical context and population

Accreditation & Designation

Neurovations Education is accredited by the Accreditation Council for Continuing Medical Education (ACCME) to provide continuing medical education for physicians.

Neurovations Education designates this live activity for a maximum of 0.75 AMA PRA Category 1 Credits™. Physicians should claim only the credit commensurate with the extent of their participation in the activity.

Disclosure of Financial Relationships & Measures to Resolve of Conflicts of Interest

Presenter: Marom Bikson discloses the following financial relationships within the past 24 months: Stock: Soterix Medical; Grants, assigned inventions, and/or serves Scientific Advisory Board (Consulting): SafeToddles, Boston Scientific, GlaxoSmithKline, Biovisics, Mecta, Lumenis, Halo Neuroscience, Google-X, i-Lumen, Humm, Allergan (Abbvie), Apple

No other person with control of, or responsibility for, the planning, delivery, or evaluation of accredited continuing education has, or has had within the past 24 months, financial relationship(s) to disclose with ineligible companies whose primary business is producing, marketing, selling, re-selling, or distributing healthcare products used by or on patients.

All relevant financial relationships have been mitigated. Materials were reviewed in advance of the activity by person(s) that do not have conflicts of interest related to the content. In some cases, content may have been modified as part of the review and mitigation process. All clinical recommendations are evidence-based and free of commercial bias (e.g., peer-reviewed literature, adhering to evidence-based practice guidelines).

Additional Reading

1.Peterchev, AV, Wagner, TA, Miranda, PC, Nitsche, MA, Paulus, W, Lisanby, SH, Pascual-Leone, A, Bikson, M (2012). Fundamentals of transcranial electric and magnetic stimulation dose: Definition, selection, and reporting practices. Brain Stim, 5(4), 435-453

2.Melzack, R, Wall, PD (1965) Pain mechanisms: a new theory. Science;150(3699):971-9.

3.Sharma, M, Bhaskar, V, Yang, L, FallahRad, M, Gebodh, N, Zhang, T, Esteller, R, Martin, J, Bikson, M. (2023). Novel Evoked Synaptic Activity Potentials (ESAPs) Elicited by Spinal Cord Stimulation. eNeuro, 10(5)

Learning Objectives

As a result of participating in this activity, learners will be better able to:

• Mitigate conflicting influences that could adversely effect patient care
• Avoid/manage clinician burnout
• Use a biopsychosocial-spiritual model to evaluate persons with pain
• Use and model language that destigmatizes pain, reflects a whole-person perspective, builds a therapeutic alliance, and promotes behavior change

Desirable Physician Attributes

• Work in interdisciplinary Teams [IOM] Cooperate, collaborate, communicate, and integrate care in teams to ensure that care is continuous and reliable
• Interpersonal and Communication Skills [ACGME/ABMS] Effective information exchange and teaming with patients, their families, and other health professionals
• Professionalism [ACGME/ABMS] As manifested through a commitment to carrying out professional responsibilities, adherence to ethical principles, and sensitivity to a diverse patient population
• Patient Care [ACGME/ABMS] Provide care that is compassionate, appropriate and effective for the treatment of health problems and the promotion of health

Pain management domains and core competencies

• 1. Multidimensional nature of pain: What is Pain?
  • Describes how cultural, institutional, societal, and regulatory influences affect assessment and management of pain
• 2. Pain assessment and measurement: How is pain recognized?
  • Assess patient preferences and values to determine pain-related goals and priorities
  • Uses a biopsychosocial-spiritual model to evaluate persons with pain
  • Uses and models language that destigmatizes pain, reflects a whole-person perspective, builds a therapeutic alliance, and promotes behavior change
  • Demonstrates empathic, compassionate, and professional communication during pain assessment
  • Describes patient, clinician, and system factors that can facilitate or interfere with effective pain assessment and management
  • Recognizes patient preferences and values to determine pain-related goals and priorities, including quality of life
  • Uses and models language that destigmatizes pain, reflects a whole-person perspective, builds a therapeutic alliance, and promotes behavior change

Accreditation & Designation

Neurovations Education is accredited by the Accreditation Council for Continuing Medical Education (ACCME) to provide continuing medical education for physicians.

Neurovations Education designates this live activity for a maximum of 1.0 AMA PRA Category 1 Credits™. Physicians should claim only the credit commensurate with the extent of their participation in the activity.

Disclosure of Financial Relationships & Measures to Resolve of Conflicts of Interest

Presenter: Eric Grigsby discloses the following financial relationships within the past 24 months: Research: Centrexion, Eli Lilly, KTG- Kolon Tissue Gene, Xalud, Medtronic, Novartis, NatureCell, Sollis Tx

No other person with control of, or responsibility for, the planning, delivery, or evaluation of accredited continuing education has, or has had within the past 24 months, financial relationship(s) to disclose with ineligible companies whose primary business is producing, marketing, selling, re-selling, or distributing healthcare products used by or on patients.

All relevant financial relationships have been mitigated. Materials were reviewed in advance of the activity by person(s) that do not have conflicts of interest related to the content. In some cases, content may have been modified as part of the review and mitigation process. All clinical recommendations are evidence-based and free of commercial bias (e.g., peer-reviewed literature, adhering to evidence-based practice guidelines).

Learning Objectives

As a result of participating in this activity, learners will be better able/better-able to:

• identify patients with refractory painful diabetic neuropathy who are likely to benefit from FDA-approved interventional procedures

Accreditation & Designation

Neurovations Education is accredited by the Accreditation Council for Continuing Medical Education (ACCME) to provide continuing medical education for physicians.

Neurovations Education designates this live activity for a maximum of 0.75 AMA PRA Category 1 Credits™. Physicians should claim only the credit commensurate with the extent of their participation in the activity.

This activity includes discussions of unlabeled or investigational uses of commercial and/or developmental products.

This activity includes discussions and explorations of new and evolving topics. Such inclusion includes adequate justifications of statements based upon current science, evidence and clinical reasoning.

Disclosure of Financial Relationships & Measures to Resolve of Conflicts of Interest

Presenter: Taissa Cherry discloses the following financial relationships: Research: Nevro [relationship has ended over 24 months ago], Boston Scientific [relationship has ended over 24 months ago]

No other person with control of, or responsibility for, the planning, delivery, or evaluation of accredited continuing education has, or has had within the past 24 months, financial relationship(s) to disclose with ineligible companies whose primary business is producing, marketing, selling, re-selling, or distributing healthcare products used by or on patients.

All relevant financial relationships have been mitigated. Materials were reviewed in advance of the activity by person(s) that do not have conflicts of interest related to the content. In some cases, content may have been modified as part of the review and mitigation process. All clinical recommendations are evidence-based and free of commercial bias (e.g., peer-reviewed literature, adhering to evidence-based practice guidelines).

Additional Reading

1. Centers for Disease Control and Prevention. National Diabetes Fact Sheet, 2011. 2011.
2. Whiting DR, Guariguata L, Weil C, Shaw J. IDF diabetes atlas: global estimates of the prevalence of diabetes for 2011 and 2030. Diabetes Res Clin Pract. 2011; 94:311–321. [PubMed: 22079683]
3. Barrett AM, Lucero MA, Le T, Robinson RL, Dworkin RH, et al. Epidemiology, public health burden, and treatment of diabetic peripheral neuropathic pain: a review. Pain Med. 2007; 8:S50–62. [PubMed: 17714116]
4. Tesfaye S, Selvarajah D. Advances in the epidemiology, pathogenesis and management of diabetic peripheral neuropathy. Diabetes Metab Res Rev. 2012; 28:8–14. [PubMed: 22271716]
5. •5. Morales-Vidal S, Morgan C, McCoyd M, Hornik A. Diabetic peripheral neuropathy and the management of diabetic peripheral neuropathic pain. Postgrad Med. 2012; 124:145–153. [PubMed: 22913903]
6. Bansal V, Kalita J, Misra UK. Diabetic neuropathy. Postgrad Med J. 2006; 82:95–100. [PubMed: 16461471]
7. Abbott CA, Malik RA, van Ross ER, Kulkarni J, Boulton AJ. Prevalence and characteristics of painful diabetic neuropathy in a large community-based diabetic population in the U.K. Diabetes Care. 2011; 34:2220–2224. [PubMed: 21852677]
8. Davies M, Brophy S, Williams R, Taylor A. The prevalence, severity, and impact of painful diabetic peripheral neuropathy in type 2 diabetes. Diabetes Care. 2006; 29:1518–1522. [PubMed: 16801572]
9. Hartemann A, Attal N, Bouhassira D, Dumont I, Gin H, et al. Painful diabetic neuropathy: diagnosis and management. Diabetes Metab. 2011; 37:377–388. [PubMed: 21820345]
10. Ziegler D. Painful diabetic neuropathy: advantage of novel drugs over old drugs? Diabetes Care. 2009; 32:S414–419. [PubMed: 19875591]
11. Kluding PM, Pasnoor M, Singh R, Jernigan S, Farmer K, et al. The effect of exercise on neuropathic symptoms, nerve function, and cutaneous innervation in people with diabetic peripheral neuropathy. J Diabetes Complications. 2012; 26:424–429. [PubMed: 22717465]
12. Mendell JR, Sahenk Z. Clinical practice. Painful sensory neuropathy. N Engl J Med. 2003; 348:1243–1255. [PubMed: 12660389]
13. Hovaguimian A, Gibbons CH. Clinical Approach to the Treatment of Painful Diabetic Neuropathy. Ther Adv Endocrinol Metab. 2011; 2:27–38. [PubMed: 21709806]
14. Cheng, J., & Rosenquist, R. W. (Eds.). (2018). Fundamentals of Pain Medicine. Springer International Publishing.
15. Cheng, J. (2021). Is It Time to Redefine Neuropathic Pain?. Pain Medicine, 22(12), 2801-2802.
16. Mekhail, N. A., Cheng, J., Narouze, S., Kapural, L., Mekhail, M. N., & Deer, T. (2010). Clinical applications of neurostimulation: forty years later. Pain Practice, 10(2), 103-112.
17. Mekhail, N. A., Mathews, M., Nageeb, F., Guirguis, M., Mekhail, M. N., & Cheng, J. (2011). Retrospective review of 707 cases of spinal cord stimulation: indications and complications. Pain practice, 11(2), 148-153.
18. Xu, J., Liu, A., & Cheng, J. (2017). New advancements in spinal cord stimulation for chronic pain management. Current Opinion in Anaesthesiology, 30(6), 710-717.
19. Xu, L., Sun, Z., Casserly, E., Nasr, C., Cheng, J., & Xu, J. (2022). Advances in interventional therapies for painful diabetic neuropathy: a systematic review. Anesthesia & Analgesia, 134(6), 1215-1228.
20. Kapural, L., Gupta, M., Paicius, R., Strodtbeck, W., Vorenkamp, K. E., Gilmore, C., ... & Province-Azalde, R. (2020). Treatment of chronic abdominal pain with 10-kHz spinal cord stimulation: safety and efficacy results from a 12-month prospective, multicenter, feasibility study. Clinical and translational gastroenterology, 11(2).

Learning Objectives

As a result of participating in this activity, learners will be better able/better-able to:

• apply an improved understanding of the pathophysiology of pelvic pain to make an accurate diagnosis
• identify patients who may benefit from interventional pain management techniques
• mitigate adverse events associated with interventional pain management procedures for pelvic pain

Accreditation & Designation

Neurovations Education is accredited by the Accreditation Council for Continuing Medical Education (ACCME) to provide continuing medical education for physicians.

Neurovations Education designates this live activity for a maximum of 0.75 AMA PRA Category 1 Credits™. Physicians should claim only the credit commensurate with the extent of their participation in the activity.

Disclosure of Financial Relationships & Measures to Resolve of Conflicts of Interest

Presenter: Shalini Shah discloses the following financial relationships within the past 24 months: Consulting: SPR Therapeutics, Masimo Corporation, Allergan

No other person with control of, or responsibility for, the planning, delivery, or evaluation of accredited continuing education has, or has had within the past 24 months, financial relationship(s) to disclose with ineligible companies whose primary business is producing, marketing, selling, re-selling, or distributing healthcare products used by or on patients.

All relevant financial relationships have been mitigated. Materials were reviewed in advance of the activity by person(s) that do not have conflicts of interest related to the content. In some cases, content may have been modified as part of the review and mitigation process. All clinical recommendations are evidence-based and free of commercial bias (e.g., peer-reviewed literature, adhering to evidence-based practice guidelines).