26th Napa Pain Conference

Aug 16, 2019 ‐ Aug 18, 2019


The 26th Napa Pain Conference

August 26-29, 2019 | Napa, CA


Professional Evolution

In 1990, Dr. Eric Grigsby founded the Napa Pain Conference (NPC) to support the burgeoning specialty of pain medicine, with an eye towards growth and innovation. That spirit is in the DNA of the conference, inspiring the education you’ll receive in the coming days.

No other conference works harder to cultivate such an amazing, multidisciplinary faculty of clinicians, researchers, industry leaders and policy makers. It is our honor and privilege to collaborate with each of them. If a lecture changes the way you’ll practice, take a moment to tell them - we’re sure they’d like to hear it; they’ve all work so hard on their presentations.

While many meetings have been shrinking, NPC is growing year over year. Thank you for being a part of this community. We hope you feel at home at the conference, reuniting with old friends or forging new connections.

Welcome to the Napa Pain Conference.
We made this for you, and we hope that you love it.

Sincerely,
The team at Neurovations Education


Sessions

Break iconBreak

Preview Available

Break

Aug 16, 2019 9:45am ‐ Aug 16, 2019 10:00am

Identification: NPC26-F-Break1

Breaks are not accredited for continuing education.


Breakout 1 iconBreakout 1

Preview Available

Breakout 1

Aug 16, 2019 1:30pm ‐ Aug 16, 2019 3:30pm

Identification: NPC26-F6


Break & Poster Viewing iconBreak & Poster Viewing

Preview Available

Break & Poster Viewing

Aug 16, 2019 3:30pm ‐ Aug 16, 2019 3:45pm

Identification: NPC26-F-Break2

Breaks are not accredited for continuing education.


Breakout  2 iconBreakout 2

Preview Available

Breakout 2

Aug 16, 2019 3:45pm ‐ Aug 16, 2019 5:30pm

Identification: NPC26-F7


Treating the Hip, Knee & Sacroiliac Joint

Aug 16, 2019 3:45pm ‐ Aug 16, 2019 5:30pm

Identification: NPC26-F7-A


Interventional Pain Management

Treating the Hip, Knee & Sacroiliac Joint


Target Audience: Interventional pain physicians, advanced practice providers, and members of the
clinical care team


Learning Objectives

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

  • Select appropriate interventional therapies to treat pain in the lower extremities

Presentations

SI -Joint

Daniel Choi, MD, MBA

Hip

Avinash Ramchandani, MD, MBA

Knee

Maxim S. Eckmann, MD


Description

Pain of the trunk and lower extremities is often debilitating, reducing function and limiting daily tasks such as walking or standing for prolonged periods of time. Satisfactory control of pain in the lower extremities is important for patient self care and well being.


Additional Reading

  • Dreyfuss, P., Snyder, B. D., Park, K., Willard, F., Carreiro, J., & Bogduk, N. (2008). The ability of single site, single depth sacral lateral branch block s to anesthetize the sacroiliac joint complex. Pain Medicine, 9(7), 844-850.
  • Szadek , K. M., van der Wurff, P., van Tulder, M. W., Zuurmond, W. W., & Perez, R. S. (2009). Diagnostic validity of criteria for sacroiliac joint pain: a systematic review. The Journal of Pain, 10(4), 354-368.
  • Simopoulos, T. T., Manc hikanti, L., Gupta, S., Aydin, S. M., Kim, C. H., Solank i, D., ... & Hirsch, J. A. (2015). Systematic review of the diagnostic accuracy and therapeutic effectiveness of sacroiliac joint interventions. Pain Physician, 18(5), E713-56.
  • Vane lderen , P., Szadek , K., Cohen , S. P., De Witte, J., Lataster, A., Patijn , J., ... & Van
    Zundert, J. (2010). 13. Sacroiliac joint pain. Pain Practice, 10(5), 470-478.

Speaker(s):

Intraspinal Drug Delivery Safety & Standardization

Aug 16, 2019 3:45pm ‐ Aug 16, 2019 5:30pm

Identification: NPC26-F7-B


Intraspinal Drug Delivery

Safety & Standardization


Target Audience: Clinicians supervising or providing direct care for patients with intrathecal drug delivery systems, and providers considering the use of IIDs


Learning Objectives

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

  • Implement strategies to prevent the two clinician-related factors that contribute to the most serious adverse events
  • Triage inflammatory catheter tip granulomas

Presentations

Pharmacodynamics & Pharmacokinetics of Approved & Off-label IDDS Medications

Michael Saulino, MD, PhD

A Standardized Refill Protocol for Intrathecal Drug Delivery Systems

Lawrence Poree, MD, PhD, MPH



Description

Intraspinal drug delivery (IDD) is a safe and efficacious method used to deliver medications for the treatment of chronic neurological disease that requires periodic reservoir refills that can place patients at risk for a rare, accidental but potentially life-threatening pocket fill. After clinicians have been refilling pump reservoirs for 5 years, 18% report at least one of these serious adverse events.


Additional Reading

  • Mcglothlen G & Rodriguez L. Training for the intraspinal drug delivery system reservoir refill procedure highly variable: A nationwide survey of health care professionals. Neuromodulation. 2017; 20(7):727-732.
  • Fitzgibbon, D. R., Stephens, L. S., Posner, K. L., Michna, E., Rathmell, J. P., Pollak, K. A., & Domino, K. B. (2016). Injury and liability associated with implantable devices for chronic pain. The Journal of the American Society of Anesthesiologists, 124(6), 1384-1393.
  • Deer, T. R., Pope, J. E., Hayek, S. M., Lamer, T. J., Veizi, I. E., Erdek, M., ... & Rosen, S. M. (2017). The Polyanalgesic Consensus Conference (PACC): recommendations for intrathecal drug delivery: guidance for improving safety and mitigating risks. Neuromodulation: Technology at the Neural Interface, 20(2), 155-176.
  • Deer, T. R., Pope, J. E., Hayek, S. M., Bux, A., Buchser, E., Eldabe, S., ... & Doleys, D. M. (2017). The polyanalgesic consensus conference (pacc): recommendations on intrathecal drug infusion systems best practices and guidelines. Neuromodulation: Technology at the Neural Interface, 20(2), 96-132.
  • McGlothlen, Gail, “Intraspinal Drug Delivery Reservoir Refill Procedure by Non-Physician Clinicians: A Nation-Wide Survey of Training, Pocket Fill Experience, and Life-Long Learning Behaviors” (2016). Doctoral Projects. 39.
  • American Society of Health-System Pharmacists Guidelines on Preventing Medication Errors in Hospitals
  • Pharmaceutical Compounding—Sterile Preparations (general information chapter 797). In: The United States Pharmacopeia, 36th rev., and the National Formulary, 31 ed. Rockville, MD: The United States Pharmacopeial Convention; 2013: 361–98
  • Adler, J. A., & Lotz, N. M. (2017). Intrathecal pain management: a team-based approach. Journal of Pain Research, 10, 2565.
  • McGivern, J. G. (2007). Ziconotide: a review of its pharmacology and use in the treatment of pain. Neuropsychiatric disease and treatment, 3(1), 69.
  • Hanna, M. H., Peat, S. J., Woodham, M., Knibb, A., & Fung, C. (1990). Analgesic efficacy and CSF pharmacokinetics of intrathecal morphine-6-glucuronide: comparison with morphine. British Journal of Anaesthesia, 64(5), 547-550.

Speaker(s):
  • Dr. Michael Saulino, MD, PhD, Clinical Director, Intrathecal Therapy Services, MossRehab
  • Dr. Lawrence Poree, MD, PhD. MPH, Clinical Professor, Department of Anesthesia, University of California at San Francisco (UCSF)

5th Annual Legacy Lecture: How Expectations Shape Pain

Aug 17, 2019 8:00am ‐ Aug 17, 2019 8:45am

Identification: NPC26-Sa1

5th Annual Legacy Lecture

How Expectations Shape Pain

Honoring the Legacy of our Leaders

Howard L. Fields, MD, PhD
Founder, UCSF Pain Management Center
Director, Wheeler Center for the Neurobiology of Addiction, University of California, San Francisco
Professor Emeritus of Neurology and Physiology, UCSF Center for Integrative Neuroscience


Target Audience: Clinicians & researchers addressing acute or chronic pain


Howard Fields, MD, PhD founded the University of California, San Francisco Pain Management Center and made major contributions to the understanding and treatment of neuropathic pain, and the understanding of mechanisms of pain modulation and placebo analgesia.

Dr. Fields’ major interests are in nervous system mechanisms of pain and substance abuse with a focus on how endogenous opioids contribute to these mechanisms. His group was the first to demonstrate the clinical effectiveness of opioids for neuropathic pain and of topical lidocaine for post-herpetic neuralgia. In laboratory studies he discovered and elucidated a pain modulating neural circuit that is required for opioids to produce analgesia. He also discovered that placebo analgesia is blocked by an opioid antagonist.

His recent work has centered on the problem of addiction, and he has begun to delineate the molecular and cellular circuitry of drug reward. His laboratory discovered nerve cells in the striatum that selectively encode the magnitude of a reward. They have also shown how the neurotransmitter dopamine contributes to motivation and reward based choice. His latest work focused on the neurobiology of opioid reward.


Learning Objectives

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

  • Apply an understanding of the roles that conditioning and expectations play in modulating the pain experience to the care of persons with chronic pain

Additional Reading

  • Cormier, S., Lavigne, G. L., Choinière, M., & Rainville, P. (2016). Expectations predict chronic pain treatment outcomes. Pain, 157(2), 329-338.
  • Keltner, J. R., Furst, A., Fan, C., Redfern, R., Inglis, B., & Fields, H. L. (2006). Isolating the modulatory effect of expectation on pain transmission: a functional magnetic resonance imaging study. Journal of Neuroscience, 26(16), 4437-4443.
  • Fields, H. (2004). State-dependent opioid control of pain. Nature Reviews Neuroscience, 5(7), 565.
  • Dum, J., & Herz, A. (1984). Endorphinergic modulation of neural reward systems indicated by behavioral changes. Pharmacology Biochemistry and Behavior, 21(2), 259-266.
  • Lord, J. A., Waterfield, A. A., Hughes, J., & Kosterlitz, H. W. (1977). Endogenous opioid peptides: multiple agonists and receptors. Nature, 267(5611), 495.
  • Knutson, B., Adams, C. M., Fong, G. W., & Hommer, D. (2001). Anticipation of increasing monetary reward selectively recruits nucleus accumbens. Journal of Neuroscience, 21(16), RC159-RC159.
  • Eippert, F., Finsterbusch, J., Bingel, U., & Büchel, C. (2009). Direct evidence for spinal cord involvement in placebo analgesia. Science, 326(5951), 404-404.
  • Johansen, J. P., Fields, H. L., & Manning, B. H. (2001). The affective component of pain in rodents: direct evidence for a contribution of the anterior cingulate cortex. Proceedings of the National Academy of Sciences, 98(14), 8077-8082

Speaker(s):

fMRI-based Biomarkers for Pain: From Models to Interventions

Aug 17, 2019 8:45am ‐ Aug 17, 2019 9:45am

Identification: NPC26-Sa2


fMRI-based Biomarkers for Pain

Interventional Pain Management


Target Audience: Clinicians & researchers addressing acute or chronic pain


Learning Objectives

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

  • Utilize diagnostic biomarkers when formulating a diagnosis or treatment plan

Description

Translational neuroscience is a field at the intersection of basic neuroscience and clinical applications. The ‘Neurologic Pain Signature’ is a sensitive neurobiologic model specific to pain in individuals, involving brain regions that receive nociceptive afferents, and showing little effect of expectation or self-regulation in tests. Another model, the ‘Stimulus Intensity-Independent Pain Signature’, explains substantial additional variation in trial-to-trial pain reports.


Additional Reading

  • Pizzo, P. A., Clark, N. M., & Carter-Pokras, O. (2011). Relieving pain in America: A blueprint for transforming prevention, care, education, and research. IOM (Institute of Medicine).
  • Brinjikji, W., Luetmer, P. H., Comstock, B., Bresnahan, B. W., Chen, L. E., Deyo, R. A., ... & Wald, J. T. (2015). Systematic literature review of imaging features of spinal degeneration in asymptomatic populations. American Journal of Neuroradiology, 36(4), 811-816.
  • Neugebauer, V., & Li, W. (2003). Differential sensitization of amygdala neurons to afferent inputs in a model of arthritic pain. Journal of Neurophysiology, 89(2), 716-727.
  • Carrasquillo, Y., & Gereau, R. W. (2007). Activation of the extracellular signal-regulated kinase in the amygdala modulates pain perception. Journal of Neuroscience, 27(7), 1543-1551.
  • Robinson, L. F., Atlas, L. Y., & Wager, T. D. (2015). Dynamic functional connectivity using state-based dynamic community structure: Method and application to opioid analgesia. NeuroImage, 108, 274-291.
  • Wager, T. D., & Atlas, L. Y. (2015). The neuroscience of placebo effects: connecting context, learning and health. Nature Reviews Neuroscience, 16(7), 403.
  • Woo, C. W., Chang, L. J., Lindquist, M. A., & Wager, T. D. (2017). Building better biomarkers: brain models in translational neuroimaging. Nature Neuroscience, 20(3), 365.
  • Kross, E., Berman, M. G., Mischel, W., Smith, E. E., & Wager, T. D. (2011). Social rejection shares somatosensory representations with physical pain. Proceedings of the National Academy of Sciences, 108(15), 6270-6275.
  • Wager, T. D., Rilling, J. K., Smith, E. E., Sokolik, A., Casey, K. L., Davidson, R. J., ... & Cohen, J. D. (2004). Placebo-induced changes in FMRI in the anticipation and experience of pain. Science, 303(5661), 1162-1167.
  • Wager, T. D., Atlas, L. Y., Botvinick, M. M., Chang, L. J., Coghill, R. C., Davis, K. D., ... & Yarkoni, T. (2016). Pain in the ACC?. Proceedings of the National Academy of Sciences, 113(18), E2474-E2475.
  • Wager, T. D., Atlas, L. Y., Lindquist, M. A., Roy, M., Woo, C. W., & Kross, E. (2013). An fMRI-based neurologic signature of physical pain. New England Journal of Medicine, 368(15), 1388-1397.
  • Reddan, M. C., & Wager, T. D. (2018). Modeling pain using fMRI: from regions to biomarkers. Neuroscience Bulletin, 34(1), 208-215.

Speaker(s):
  • Tor Wager, PhD, Diana L. Taylor Distinguished Professor in Neuroscience, Dartmouth College

Moving from Bench to Bedside: Promising Treatments on the Horizon and the Barriers of Moving from Clinical Trials to Clinical Practice

Aug 17, 2019 9:45am ‐ Aug 17, 2019 10:45am

Identification: NPC26-Sa3


Moving from Bench to Bedside

Promising Treatments on the Horizon and the Barriers of Moving from Clinical Trials to Clinical Practice


Target Audience: Clinicians & researchers addressing acute or chronic pain


Learning Objectives

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

  • Understand and be able to contribute to the biomedical research translation continuum

Description

“The gap between what we know and what we do in public health is lethal to Americans, if not the world.”
- David Satcher, MD, PhD, Former U.S. Surgeon General

Only 25% of highly promising biomedical discoveries result in a published randomized clinical trial, and less than 10% are established in clinical practice within 20 years. In 2001, the Institute of Medicine (IOM) identified the importance and difficulty of translating basic science knowledge to patient care. In 2003, the National Institutes of Health (NIH) Roadmap identified translational research as a critical component of health care improvement.

In 2016, the 21st Century Cures Act made changes to the FDA Drug Approval process, and in 2018 the FDA announced plans to overhaul the 510(k) device approval process.

Accelerated approval pathways and the acceptance of new standards of evidence create opportunities for new therapies, but require prudence from researchers and regulators.


Additional Reading

  • Drolet, B. C., & Lorenzi, N. M. (2011). Translational research: understanding the continuum from bench to bedside. Translational Research, 157(1), 1-5.

Speaker(s):
  • Dr. Jianguo Cheng, MD, PhD, FIPP, Professor of Anesthesiology, Cleveland Clinic, Learner Research Institute & Case Western Reserve University

Best Practices for Prescribing Opioids

Aug 17, 2019 11:00am ‐ Aug 17, 2019 12:30pm

Identification: NPC26-Sa4-A


Best Practices for Prescribing Opioids


Target Audience: All clinical providers


Learning Objectives

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

  • Improve charting and record keeping in preparation for a medical board review
  • Implement strategies, when appropriate, to taper patients to the lowest effective dose
  • Recognize patients who are at high risk for misuse and/or suspected of seeking inappropriate opioid prescriptions
  • Act on a nuanced understanding of what the 2016 CDC guidelines do, and do not, include

Presentations

When (do?) “Guidelines” Diverge from “Best Practices”

Mark Schumacher, MD, PhD

Proper Charting & Documentation

Samir Sheth, MD

When Should You Taper (or Not Taper)?

Samir Sheth, MD

Pharmacology & Use of Buprenorphine, Naloxone & Low Dose Naltrexone (LDN)

Avinash Ramchandani, MD, MBA


Description

Almost every patient that we care for will receive some opioid. Opioids represent the mainstay of perioperative analgesic therapy.

Do opioid prescribing guidelines have to be a “no-win” scenario?


Additional Reading

  • Olsen, Y. (2016). The CDC guideline on opioid prescribing: rising to the challenge. JAMA, 315(15), 1577-1579.
  • Davis, M. P. (2012). Twelve reasons for considering buprenorphine as a frontline analgesic in the management of pain. J. Support Oncol, 10(6), 209-219.
  • Darnall, B. D., Juurlink, D., Kerns, R. D., Mackey, S., Van Dorsten, B., Humphreys, K., ... & Hoffman, D. E. (2018). International stakeholder community of pain experts and leaders call for an urgent action on forced opioid tapering. Pain Medicine, 20(3), 429-433.
  • Corder, G., Tawfik, V. L., Wang, D., Sypek, E. I., Low, S. A., Dickinson, J. R., ... & Scherrer, G. (2017). Loss of μ opioid receptor signaling in nociceptors, but not microglia, abrogates morphine tolerance without disrupting analgesia. Nature Medicine, 23(2), 164.
  • Von Korff, M., Saunders, K., Ray, G. T., Boudreau, D., Campbell, C., Merrill, J., ... & Weisner, C. (2008). Defacto long-term opioid therapy for non-cancer pain. The Clinical Journal of Pain, 24(6), 521.
  • Campbell, C. I., Weisner, C., LeResche, L., Ray, G. T., Saunders, K., Sullivan, M. D., ... & Satre, D. D. (2010). Age and gender trends in long-term opioid analgesic use for noncancer pain. American Journal of Public Health, 100(12), 2541-2547.
  • Kroenke, K., Alford, D. P., Argoff, C., Canlas, B., Covington, E., Frank, J. W., ... & Kravitz, R. L. (2019). Challenges with implementing the centers for disease control and prevention opioid guideline: a consensus panel report. Pain Medicine, 20(4), 724-735.
  • Safavi-Hemami, H., Brogan, S. E., & Olivera, B. M. (2019). Pain therapeutics from cone snail venoms: From Ziconotide to novel non-opioid pathways. Journal of Proteomics, 190, 12-20.
  • Younger, J., & Mackey, S. (2009). Fibromyalgia symptoms are reduced by low-dose naltrexone: a pilot study. Pain Medicine, 10(4), 663-672.
    Fields, H. (2004). State-dependent opioid control of pain. Nature Reviews Neuroscience, 5(7), 565.
  • Toljan, K., & Vrooman, B. (2018). Low-Dose Naltrexone (LDN)—Review of Therapeutic Utilization. Medical Sciences, 6(4), 82.
  • Younger, J., Parkitny, L., & McLain, D. (2014). The use of low-dose naltrexone (LDN) as a novel anti-inflammatory treatment for chronic pain. Clinical Rheumatology, 33(4), 451-459.
  • Cornish, J. W., Metzger, D., Woody, G. E., Wilson, D., McLellan, A. T., Vandergrift, B., & O’Brien, C. P. (1997). Naltrexone pharmacotherapy for opioid dependent federal probationers. Journal of Substance Abuse Treatment, 14(6), 529-534.

Speaker(s):