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28th Napa Pain Conference Sessions

Transforming Personalized Patient Care Through Neuromodulation




Credits: None available.

Standard: $29.95

Description

Transforming Personalized Patient Care Through Neuromodulation


Outline

An individualized, patient-centered approach for diagnosis and treatment of pain is essential to establishing a therapeutic alliance between patient and clinician. This patient-centered approach needs to focus on achieving improved function, activities of daily living (ADLs), and QOL as well as pain control. 

Solutions for improving management of chronic conditions are under the attention of healthcare systems, due to the increasing prevalence caused by demographic change and better survival, and the relevant impact on healthcare expenditures. Enhancing patients’ actual perception and encouraging self-management and self-awareness can result in a better lifestyle, and improved function for the individual.

As the field of neuromodulation matures, new models give way to better mechanistic understandings, which in turn inform new translational models. This bidirectional relationship between application and understanding leads to broader applications and an ability to tailor therapies to the needs of the individual. 

  • Uncovering which mechanisms are essential for treating specific pain conditions and/or patients
  • Closed-loop applications
  • Developing better translational models
  • The clinical value of a new approach to patient care monitoring of functional outcomes
  • Low-tech, accessible ways to collect data to drive clinical decision making

Learning Objectives

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

  • Work with my patients to collect new sources of information about their chronic condition to inform their treatment
  • Apply new sources of data to the personalization of care plans tailored to an individual patient's needs

At the Gereau Lab, Dr. Meacham utilizes a multidisciplinary approach, including behavioral studies, electrophysiology, optogenetics, in vivo imaging, molecular and genetic approaches to understand the signaling pathways involved in maladaptive plasticity in the nervous system that underlies pain sensitization.

Electrophysiological recording of neural activity in freely behaving animals, along with optogenetic and chemogenetic modulation of specific cell populations help to understand chronic pain as a disease of circuit dysfunction, and identify therapeutic strategies to normalize this dysfunction to reduce the intensity and impact of pain.


Desirable Physician Attributes

  • Patient Care [ACGME/ABMS & IOM] Provide care that is compassionate, appropriate and effective for the treatment of health problems and the promotion of health
  • Medical Knowledge [ACGME/ABMS] about established and evolving biomedical, clinical, and cognate (e.g. epidemiological and social-behavioral) sciences and the application of this knowledge to patient care
  • Employ Evidence-based Practice [IOM] Integrate best research with clinical expertise and patient values for optimum care and participate in learning and research activities to the extent feasible
  • Systems-based practice [ACGME] Awareness and responsiveness to larger context and system of health care, use of system resources

Pain management domains and core competencies

3. Treatment: How is pain safely and effectively treated?

  • Monitors the effects of pain management approaches to adjust the plan of care as needed with respect
    to functional outcomes
  • Empowers patients to recognize and apply health promotion and self-management strategies

4. Context: How does context affect pain?

  • Uses an individualized pain management plan (including risk mitigation) that integrates the perspectives of patients, family and social support systems, and clinicians in the context of available resources

Accreditation & Designation

Release date: This activity was released 8/28/2021.

Termination date: The content of this activity remains eligible for CME Credit until 8/27/2024, unless reviewed or amended prior to this date.

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

Neurovations Education designates this other activity (blended learning) for a maximum of 0.50 AMA PRA Category 1 Credit™. Physicians should claim only the credit commensurate with the extent of their participation in the activity.


Disclosure of Financial Relationships

Neither the presenter, reviewers nor any 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, any 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.


Additional Reading

  • Anderson, G. F. (2010). Chronic care: making the case for ongoing care. Robert Wood Johnson Foundation.
  • Lasorsa, I., D’Antrassi, P., Ajčević, M., Stellato, K., Di Lenarda, A., Marceglia, S., & Accardo, A. (2016). Personalized support for chronic conditions. Applied clinical informatics, 7(03), 633-645.
  • Boccia, S., Pastorino, R., Ricciardi, W., Ádány, R., Barnhoorn, F., Boffetta, P., ... & Ma’n, H. Z. (2019). How to integrate personalized medicine into prevention? Recommendations from the Personalized pREvention of Chronic Diseases (PRECeDI) consortium. Public Health Genomics, 22(5-6), 208-214.
  • Mickle, A. D., Won, S. M., Noh, K. N., Yoon, J., Meacham, K. W., Xue, Y., ... & Rogers, J. A. (2019). A wireless closed-loop system for optogenetic peripheral neuromodulation. Nature, 565(7739), 361-365.
  • Meacham, K., Shepherd, A., Mohapatra, D. P., & Haroutounian, S. (2017). Neuropathic pain: central vs. peripheral mechanisms. Current Pain and Headache Reports, 21(6), 28.
  • Anderson, G., & Horvath, J. (2004). The growing burden of chronic disease in America. Public health reports, 119(3), 263-270.
  • Zhang, H., Gutruf, P., Meacham, K., Montana, M. C., Zhao, X., Chiarelli, A. M., ... & Rogers, J. A. (2019). Wireless, battery-free optoelectronic systems as subdermal implants for local tissue oximetry. Science Advances, 5(3), eaaw0873.
  • Guo, L., Meacham, K. W., Hochman, S., & DeWeerth, S. P. (2010). A PDMS-based conical-well microelectrode array for surface stimulation and recording of neural tissues. IEEE Transactions on Biomedical Engineering, 57(10), 2485-2494.
  • Ridding, M. C., Brouwer, B., Miles, T. S., Pitcher, J. B., & Thompson, P. D. (2000). Changes in muscle responses to stimulation of the motor cortex induced by peripheral nerve stimulation in human subjects. Experimental Brain Research, 131(1), 135-143.
  • Russo, M., Cousins, M. J., Brooker, C., Taylor, N., Boesel, T., Sullivan, R., ... & Parker, J. (2018). Effective relief of pain and associated symptoms with closed‐loop spinal cord stimulation system: preliminary results of the Avalon study. Neuromodulation: Technology at the Neural Interface, 21(1), 38-47.
  • Meacham, K. W., Guo, L., DeWeerth, S. P., & Hochman, S. (2011). Selective stimulation of the spinal cord surface using a stretchable microelectrode array. Frontiers in Neuroengineering, 4, 5.
  • Linderoth, B., & Meyerson, B. A. (2010). Spinal cord stimulation: exploration of the physiological basis of a widely used therapy. The Journal of the American Society of Anesthesiologists, 113(6), 1265-1267.
  • Sdrulla, A. D., Guan, Y., & Raja, S. N. (2018). Spinal cord stimulation: clinical efficacy and potential mechanisms. Pain Practice, 18(8), 1048-1067.
  • Shechter, R., Yang, F., Xu, Q., Cheong, Y. K., He, S. Q., Sdrulla, A., ... & Guan, Y. (2013). Conventional and kilohertz-frequency spinal cord stimulation produces intensity-and frequency-dependent inhibition of mechanical hypersensitivity in a rat model of neuropathic pain. Anesthesiology, 119(2), 422-432.
  • Lempka, S. F., McIntyre, C. C., Kilgore, K. L., & Machado, A. G. (2015). Computational analysis of kilohertz frequency spinal cord stimulation for chronic pain management. Anesthesiology, 122(6), 1362-1376.
  • Hunter, C. W., Yang, A., & Davis, T. (2017). Selective radiofrequency stimulation of the dorsal root ganglion (DRG) as a method for predicting targets for neuromodulation in patients with post amputation pain: A case series. Neuromodulation: Technology at the Neural Interface, 20(7), 708-718.
  • Makin, T. R., & Flor, H. (2020). Brain (re)organisation following amputation: Implications for phantom limb pain. NeuroImage, 218, 116943.
  • D’Arcy, R. C., Greene, T., Greene, D., Frehlick, Z., Fickling, S. D., Campbell, N., ... & Lakhani, B. (2020). Portable neuromodulation induces neuroplasticity to re-activate motor function recovery from brain injury: a high-density MEG case study. Journal of Neuroengineering and Rehabilitation, 17(1), 1-12.
  • Knotkova, H., Hamani, C., Sivanesan, E., Le Beuffe, M. F. E., Moon, J. Y., Cohen, S. P., & Huntoon, M. A. (2021). Neuromodulation for chronic pain. The Lancet, 397(10289), 2111-2124.
  • Ting, W. K. C., Fadul, F. A. R., Fecteau, S., & Ethier, C. (2021). Neurostimulation for Stroke Rehabilitation. Frontiers in Neuroscience, 15, 583.
  • Caylor, J., Reddy, R., Yin, S., Cui, C., Huang, M., Huang, C., ... & Lerman, I. (2019). Spinal cord stimulation in chronic pain: evidence and theory for mechanisms of action. Bioelectronic Medicine, 5(1), 1-41.
  • Sun, G., Wen, Z., Ok, D., Doan, L., Wang, J., & Chen, Z. S. (2021). Detecting acute pain signals from human EEG. Journal of Neuroscience Methods, 347, 108964.
  • Van Dieën, J. H., Reeves, N. P., Kawchuk, G., Van Dillen, L. R., & Hodges, P. W. (2019). Analysis of motor control in patients with low back pain: A key to personalized care?. Journal of orthopaedic & sports physical therapy, 49(6), 380-388.
  • Simmons, L. A., Drake, C. D., Gaudet, T. W., & Snyderman, R. (2016). Personalized health planning in primary care settings. Federal Practitioner, 33(1), 27.
  • Yang, Y., Wu, M., Vázquez-Guardado, A., Wegener, A. J., Grajales-Reyes, J. G., Deng, Y., ... & Rogers, J. A. (2021). Wireless multilateral devices for optogenetic studies of individual and social behaviors (pp. 1-11). Nature Publishing Group.
  • Song, E., Xie, Z., Bai, W., Luan, H., Ji, B., Ning, X., ... & Rogers, J. A. (2021). Miniaturized electromechanical devices for the characterization of the biomechanics of deep tissue. Nature Biomedical Engineering, 1-13.
  • Guo, H., D'Andrea, D., Zhao, J., Xu, Y., Qiao, Z., Janes, L. E., ... & Rogers, J. A. (2021). Advanced Materials in Wireless, Implantable Electrical Stimulators that Offer Rapid Rates of Bioresorption for Peripheral Axon Regeneration. Advanced Functional Materials, 2102724.
  • O’Brien, M. K., Botonis, O. K., Larkin, E., Carpenter, J., Martin-Harris, B., Maronati, R., ... & Jayaraman, A. (2021). Advanced Machine Learning Tools to Monitor Biomarkers of Dysphagia: A Wearable Sensor Proof-of-Concept Study. Digital Biomarkers, 5(2), 167-175.
  • Park, Y., Chung, T. S., & Rogers, J. A. (2021). Three dimensional bioelectronic interfaces to small-scale biological systems. Current Opinion in Biotechnology, 72, 1-7.
  • Mickle, A. D., Won, S. M., Noh, K. N., Yoon, J., Meacham, K. W., Xue, Y., ... & Park, S. Il, Gereau, RW, Rogers, JA, 2019. Nature, 565, 361-365.
  • Massimino, M. (2017). Spaceman: An Astronaut's Unlikely Journey to Unlock the Secrets of the Universe. Crown Publishing Group (NY).
  • K. Meacham, K. Gurba, S. Haroutounian, R. Bijlani, K. Shenouda,S. Babcock, L. Crock, M. Bottros. High Resolution Trajectory Mapping of Post-Discharge Knee Replacement Patients Shows an Excess of Prescribed Opioids: Results of the TRIPP (Trajectories in Postoperative Pain) Study. Abstract accepted for poster presentation at the 17th World Congress on Pain, International Association for the Study of Pain, Boston, September 2018.

Speaker(s):

  • Dr. Kathleen W. Meacham, MD, PhD, Assistant Professor, Division of Pain Management, Washington University School of Medicine

Credits

  • 0.50 - Physician
  • 0.50 - Non-Physician

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