NPC2022 • Complimentary Keynotes [August 19-21, 2022] - Online Only

Aug 18, 2022 ‐ Aug 20, 2022


Online Only access for:

  • 10th Annual Lindahl Lecture
  • 8th Annual Legacy Lecture
  • Pain & Long-COVID
  • Precision Medicine: The Next Great Medical Horizon

Products

What we need: Help, Hope, Learning

Preview Available

What we need: Help, Hope, Learning

Aug 20, 2022 7:45am ‐ Aug 20, 2022 8:30am

Outcomes

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

  • Empathize with the impact that pain has on the person with pain and their families
  • Counsel and educate patients
  • Develop patient care plans, tailored to the needs of the individual

Desirable Physician Attributes

  • Patient Care [ACGME/ABMS] Provide care that is compassionate, appropriate and effective for the treatment of health problems and the promotion of health
  • Provide Patient-centered Care [IOM] Identify, respect, and care about patients’ differences, values, preferences and expressed needs; listen to, clearly inform, communicate with, and educate patients; share decision making and management; and continuously advocate disease prevention, wellness, and promotion of healthy lifestyles, including a focus on population health
  • 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

Pain management domains and core competencies

  • 1. Multidimensional nature of pain: What is pain?
    • Describe the impact of pain on society
    • Explain 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 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
  • 3. Treatment: How is pain safely and effectively treated?
    • Empowers patients to recognize and apply health promotion and self-management strategies

Accreditation & Designation

Release date: This activity was released 8/20/2022.

Termination date: The content of this activity remains eligible for CME Credit until 8/19/2025, unless reviewed or amended prior to this date.

Claiming Credit: Watch the entire presentation and complete the Improvement Plan/Evaluation 

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 0.75 AMA PRA Category 1 Credits™. Physicians should claim only the credit commensurate with the extent of their participation in the activity.

California Required CME on Pain Management and the Appropriate Treatment of the Terminally Ill
AB487 requires physicians licensed in California to complete a one-time CME activity for 12 hours of credits that addresses both pain management and the appropriate care and treatment of the terminally ill. This activity contributes to achievement of requirements with AB487.

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

  • Payne, R., Anderson, E., Arnold, R., Duensing, L., Gilson, A., Green, C., ... & Shuler, N. (2010). A rose by any other name: pain contracts/agreements. The American Journal of Bioethics, 10(11), 5-12.
  • Dworkin, R. H., Turk, D. C., Farrar, J. T., Haythornthwaite, J. A., Jensen, M. P., Katz, N. P., ... & Carr, D. B. (2005). Core outcome measures for chronic pain clinical trials: IMMPACT recommendations. Pain, 113(1), 9-19.
  • Dworkin, R. H., Turk, D. C., Revicki, D. A., Harding, G., Coyne, K. S., Peirce-Sandner, S., ... & Farrar, J. T. (2009). Development and initial validation of an expanded and revised version of the Short-form McGill Pain Questionnaire (SF-MPQ-2). Pain, 144(1-2), 35-42.
  • Mackey, S. (2014). National pain strategy task force: the strategic plan for the IOM pain report. Pain Medicine, 15(7), 1070-1071
  • IOM (Institute of Medicine). 2011. Relieving Pain in America: A Blueprint for Transforming Prevention, Care, Education, and Research. Washington, DC: The National Academies Press.
  • Todd, K. H., Cowan, P., Kelly, N., & Homel, P. (2010). Chronic or recurrent pain in the emergency department: national telephone survey of patient experience. Western Journal of Emergency Medicine, 11(5), 408.
  • Henry, S. G., Paterniti, D. A., Feng, B., Iosif, A. M., Kravitz, R. L., Weinberg, G., ... & Verba, S. (2019). Patients’ experience with opioid tapering: A conceptual model with recommendations for clinicians. The Journal of Pain, 20(2), 181-191.
  • Elder, C. R., DeBar, L. L., Ritenbaugh, C., Rumptz, M. H., Patterson, C., Bonifay, A., ... & Deyo, R. A. (2017). Health care systems support to enhance patient-centered care: lessons from a primary care-based chronic pain management initiative. The Permanente Journal, 21.
  • Cowan, P. (2013). Support groups for chronic pain. In Handbook of Pain and Palliative Care (pp. 639-648). Springer, New York, NY.
  • IOM (Institute of Medicine). 2011. Patients charting the course: Citizen engagement and the learning health system: Workshop summary. Washington, DC: The National Academies Press

Speaker(s):
  • Penney Cowan, Founder & CEO, American Chronic Pain Association (ACPA)

Tags:

Patient Management Healthcare Policy Biopsychosocial Pain Medicine Patient Assessment Patient Resources
Neurological Consequences of COVID-19 & Post-Acute Sequelae of COVID (PASC)

Preview Available

Neurological Consequences of COVID-19 & Post-Acute Sequelae of COVID (PASC)

Aug 20, 2022 8:45am ‐ Aug 20, 2022 9:30am

Learning Objectives

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

  • Recognize the symptoms of post-acute COVID and how best to manage the symptoms
  • evaluate patients for post-COVID pain symptoms
  • make appropriate referrals to provide treatment for patients experiencing Post-Acute Sequelae of COVID (PASC)

Abstract

Among evaluated patients with long COVID, prolonged, often disabling, small-fiber neuropathy after mild SARS-CoV-2 was most common, beginning within 1 month of COVID-19 onset. Various evidence suggested infection-triggered immune dysregulation as a common mechanism. - Nath, 2022

Symptoms of long COVID are reported to be on-and-off, cyclic or multiphasic. A meta-analysis of pain-related symptoms reported for patients with long-term PASC determined that every one month of follow-up corresponded to a 45% increase in prevalence in patients who developed neuralgia after acute COVID-19 infection.

Weakness, often accompanied by myalgia and arthralgia, is a musculoskeletal manifestation of SARS-CoV-2 infection.

Central and peripheral nerve systems are one of the most susceptible targets for SARS-CoV-2 virus (neurotropism).

As well, a prolonged period of mechanical ventilation in the ICU may cause what is called “post intensive care syndrome” or “ICU-acquired weakness”, manifesting as cognitive dysfunction, muscle atrophy, sensory disruption and joint-related pain.

Residual effects from SARS-CoV-2 virus include fatigue, dyspnea, chest pain, persistent loss of taste and/or smell, cognitive changes, arthralgias, and decreased quality of life.

Accreditation & Designation

Release date: This activity was released 8/20/2022.

Termination date: The content of this activity remains eligible for CME Credit until 8/19/2025, unless reviewed or amended prior to this date.

Claiming Credit: Watch the entire presentation and complete the Improvement Plan/Evaluation.

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 0.75 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

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

  • Spudich, S., & Nath, A. (2022). Nervous system consequences of COVID-19. Science, 375(6578), 267-269.
  • Oaklander, A. L., Mills, A. J., Kelley, M., Toran, L. S., Smith, B., Dalakas, M. C., & Nath, A. (2022). Peripheral Neuropathy Evaluations of Patients With Prolonged Long COVID. Neurology-Neuroimmunology Neuroinflammation, 9(3).
  • Chrousos, G. P., & Kaltsas, G. (2005). Post‐SARS sickness syndrome manifestations and endocrinopathy: how, why, and so what?. Clinical Endocrinology, 63(4), 363.
  • Nath, A. (2020). Long-haul COVID. Neurology, 95(13), 559-560.
  • Shiers, S., Ray, P. R., Wangzhou, A., Sankaranarayanan, I., Tatsui, C. E., Rhines, L. D., ... & Price, T. J. (2020). ACE2 and SCARF expression in human DRG nociceptors: implications for SARS-CoV-2 virus neurological effects. Pain, 161(11), 2494.
  • Attal, N., Martinez, V., & Bouhassira, D. (2021). Potential for increased prevalence of neuropathic pain after the COVID-19 pandemic. Pain reports, 6(1).
  • Lancet, T. (2021). Understanding long COVID: a modern medical challenge. Lancet (London, England), 398(10302), 725.
  • Cascella, M., Del Gaudio, A., Vittori, A., Bimonte, S., Del Prete, P., Forte, C. A., ... & De Blasio, E. (2021). COVID-Pain: Acute and Late-Onset Painful Clinical Manifestations in COVID-19–Molecular Mechanisms and Research Perspectives. Journal of Pain Research, 14, 2403.
  • Dani, M., Dirksen, A., Taraborrelli, P., Torocastro, M., Panagopoulos, D., Sutton, R., & Lim, P. B. (2021). Autonomic dysfunction in ‘long COVID’: rationale, physiology and management strategies. Clinical Medicine, 21(1), e63.
  • Raveendran, A. V., Rajeev Jayadevan, and S. Sashidharan. "Long COVID: an overview." Diabetes & Metabolic Syndrome: Clinical Research & Reviews 15, no. 3 (2021): 869-875.
  • Nath, A., & Smith, B. (2021). Neurological issues during COVID-19: An overview. Neuroscience Letters, 742, 135533.
  • Goss, A. L., Samudralwar, R. D., Das, R. R., & Nath, A. (2021). ANA investigates: neurological complications of COVID‐19 vaccines. Annals of Neurology, 89(5), 856.
  • Bierle, D. M., Aakre, C. A., Grach, S. L., Salonen, B. R., Croghan, I. T., Hurt, R. T., & Ganesh, R. (2021). Central sensitization phenotypes in post acute sequelae of SARS-CoV-2 infection (PASC): defining the post COVID syndrome. Journal of Primary Care & Community Health, 12, 21501327211030826.
  • Groff, D., Sun, A., Ssentongo, A. E., Ba, D. M., Parsons, N., Poudel, G. R., ... & Chinchilli, V. M. (2021). Short-term and long-term rates of postacute sequelae of SARS-CoV-2 infection: a systematic review. JAMA Network Open, 4(10)
  • Hoshijima, H., Mihara, T., Seki, H., Hyuga, S., Kuratani, N., & Shiga, T. (2021). Incidence of Long-term Post-acute Sequelae of SARS-CoV-2 Infection Related to Pain and Other Symptoms: A Living Systematic Review and Meta-analysis. medRxiv.
  • Totura, A. L., & Bavari, S. (2019). Broad-spectrum coronavirus antiviral drug discovery. Expert opinion on drug discovery, 14(4), 397-412.
  • Berlin, D. A., Gulick, R. M., & Martinez, F. J. (2020). Severe COVID-19 [published online ahead of print May 15, 2020]. N Engl J Med, 10.
  • Abdalkader, M., Shaikh, S. P., Siegler, J. E., Cervantes-Arslanian, A. M., Tiu, C., Radu, R. A., ... & Jovin, T. G. (2021). Cerebral venous sinus thrombosis in COVID-19 patients: a multicenter study and review of literature. Journal of Stroke and Cerebrovascular Diseases, 30(6), 105733.
  • Ross Russell, A. L., Hardwick, M., Jeyanantham, A., White, L. M., Deb, S., Burnside, G., ... & Galea, I. (2021). Spectrum, risk factors and outcomes of neurological and psychiatric complications of COVID-19: a UK-wide cross-sectional surveillance study. Brain communications, 3(3), fcab168.
  • Zuo, Y., Estes, S. K., Ali, R. A., Gandhi, A. A., Yalavarthi, S., Shi, H., ... & Knight, J. S. (2020). Prothrombotic autoantibodies in serum from patients hospitalized with COVID-19. Science translational medicine, 12(570), eabd3876.
  • Novi, G., Rossi, T., Pedemonte, E., Saitta, L., Rolla, C., Roccatagliata, L., ... & Farinini, D. (2020). Acute disseminated encephalomyelitis after SARS-CoV-2 infection. Neurology-Neuroimmunology Neuroinflammation, 7(5).
  • Poyiadji, N., Shahin, G., Noujaim, D., Stone, M., Patel, S. C., & Griffith, B. (2020). COVID-19-associated acute hemorrhagic necrotizing encephalopathy: imaging features. Radiology, 296(2), 119.
  • LaRovere, K. L., Riggs, B. J., Poussaint, T. Y., Young, C. C., Newhams, M. M., Maamari, M., ... & Overcoming COVID-19 Investigators. (2021). Neurologic involvement in children and adolescents hospitalized in the United States for COVID-19 or multisystem inflammatory syndrome. JAMA neurology, 78(5), 536-547.
  • Abdel-Mannan, O., Eyre, M., Löbel, U., Bamford, A., Eltze, C., Hameed, B., ... & Hacohen, Y. (2020). Neurologic and radiographic findings associated with COVID-19 infection in children. JAMA neurology, 77(11), 1440-1445.
  • Khedr, E. M., Abo-Elfetoh, N., Deaf, E., Hassan, H. M., Amin, M. T., Soliman, R. K., ... & Saber, M. (2021). Surveillance study of acute neurological manifestations among 439 Egyptian patients with COVID-19 in Assiut and Aswan University Hospitals. Neuroepidemiology, 55(2), 109-118.
  • Ward, H., Atchison, C., Whitaker, M., Ainslie, K. E., Elliott, J., Okell, L., ... & Elliott, P. (2021). SARS-CoV-2 antibody prevalence in England following the first peak of the pandemic. Nature communications, 12(1), 1-8.
  • Elliott, J., Whitaker, M., Bodinier, B., Eales, O., Riley, S., Ward, H., ... & Elliott, P. (2021). Predictive symptoms for COVID-19 in the community: REACT-1 study of over 1 million people. PLoS medicine, 18(9), e1003777.
  • Balcom, E. F., Nath, A., & Power, C. (2021). Acute and chronic neurological disorders in COVID-19: potential mechanisms of disease. Brain, 144(12), 3576-3588.
  • Christensen, P. A., Olsen, R. J., Long, S. W., Subedi, S., Davis, J. J., Hodjat, P., ... & Musser, J. M. (2021). Delta variants of SARS-CoV-2 cause significantly increased vaccine breakthrough COVID-19 cases in Houston, Texas. MedRxiv.
  • Hosp, J. A., Dressing, A., Blazhenets, G., Bormann, T., Rau, A., Schwabenland, M., ... & Meyer, P. T. (2021). Cognitive impairment and altered cerebral glucose metabolism in the subacute stage of COVID-19. Brain, 144(4), 1263-1276.
  • Guedj, E., Campion, J. Y., Dudouet, P., Kaphan, E., Bregeon, F., Tissot-Dupont, H., ... & Eldin, C. (2021). 18F-FDG brain PET hypometabolism in patients with long COVID. European journal of nuclear medicine and molecular imaging, 48(9), 2823-2833.
  • Douaud, G., Lee, S., Alfaro-Almagro, F., Arthofer, C., Wang, C., McCarthy, P., ... & Smith, S. M. (2022). SARS-CoV-2 is associated with changes in brain structure in UK Biobank. Nature, 604(7907), 697-707.
  • Brann, D. H., Tsukahara, T., Weinreb, C., Lipovsek, M., Van den Berge, K., Gong, B., ... & Datta, S. R. (2020). Non-neuronal expression of SARS-CoV-2 entry genes in the olfactory system suggests mechanisms underlying COVID-19-associated anosmia. Science advances, 6(31), eabc5801.
  • Evangelho, V. G. O., Bello, M. L., Castro, H. C., & Amorim, M. R. (2022). Down syndrome: the aggravation of COVID-19 may be partially justified by the expression of TMPRSS2. Neurological Sciences, 43(2), 789-790.
  • Lee, M. H., Perl, D. P., Nair, G., Li, W., Maric, D., Murray, H., ... & Nath, A. (2021). Microvascular injury in the brains of patients with Covid-19. New England Journal of Medicine, 384(5), 481-483.
  • Chertow, D., Stein, S., Ramelli, S., Grazioli, A., Chung, J. Y., Singh, M., ... & Kleiner, D. (2021). SARS-CoV-2 infection and persistence throughout the human body and brain.
  • Jolobe, O. M. (2022). Post-COVID-19 diabetes in the context of long COVID. The American Journal of Emergency Medicine.
  • Noval Rivas, M., Porritt, R. A., Cheng, M. H., Bahar, I., & Arditi, M. (2022). Multisystem Inflammatory Syndrome in Children and Long COVID: The SARS-CoV-2 Viral Superantigen Hypothesis. Frontiers in Immunology, 3480.
  • Geers, D., Sablerolles, R., van Baarle, D., Kootstra, N., Rietdijk, W., Schmitz, K., ... & de Vries, R. D. (2022). Ad26. COV2. S priming provides a solid immunological base for mRNA-based COVID-19 booster vaccination. medRxiv.
  • Heming, M., Li, X., Räuber, S., Mausberg, A. K., Börsch, A. L., Hartlehnert, M., ... & Zu Hörste, G. M. (2021). Neurological manifestations of COVID-19 feature T cell exhaustion and dedifferentiated monocytes in cerebrospinal fluid. Immunity, 54(1), 164-175.
  • Hosaka, T., Tsuji, H., & Kwak, S. (2021). RNA editing: A new therapeutic target in amyotrophic lateral sclerosis and other neurological diseases. International Journal of Molecular Sciences, 22(20), 10958.
  • Johansson, M., Ståhlberg, M., Runold, M., Nygren-Bonnier, M., Nilsson, J., Olshansky, B., ... & Fedorowski, A. (2021). Long-haul post–COVID-19 symptoms presenting as a variant of postural orthostatic tachycardia syndrome: the Swedish experience. Case Reports, 3(4), 573-580.
  • Oaklander, A. L., Mills, A. J., Kelley, M., Toran, L. S., Smith, B., Dalakas, M. C., & Nath, A. (2022). Peripheral neuropathy evaluations of patients with prolonged long COVID. Neurology-Neuroimmunology Neuroinflammation, 9(3).
  • Novak, P., Mukerji, S. S., Alabsi, H. S., Systrom, D., Marciano, S. P., Felsenstein, D., ... & Pilgrim, D. M. (2022). Multisystem Involvement in Post‐Acute Sequelae of Coronavirus Disease 19. Annals of neurology, 91(3), 367-379.
  • Shiers, S., Ray, P. R., Wangzhou, A., Sankaranarayanan, I., Tatsui, C. E., Rhines, L. D., ... & Price, T. J. (2020). ACE2 and SCARF expression in human DRG nociceptors: implications for SARS-CoV-2 virus neurological effects. Pain, 161(11), 2494.
  • Ballering, A. V., van Zon, S. K., Olde Hartman, T. C., Rosmalen, J. G., & Lifelines Corona Research Initiative. (2022). Persistence of somatic symptoms after COVID-19 in the Netherlands: an observational cohort study. The Lancet, 400(10350), 452-461.
  • Moutal, A., Martin, L. F., Boinon, L., Gomez, K., Ran, D., Zhou, Y., ... & Khanna, R. (2021). SARS-CoV-2 spike protein co-opts VEGF-A/neuropilin-1 receptor signaling to induce analgesia. Pain, 162(1), 243.


Speaker(s):
  • Dr. Avindra Nath, MD, Chief, Section for Infections of the Nervous System; Clinical Director, Translational Neuroscience Center, NIH - National Institute of Neurological Disorders and Stroke (NINDS)

Tags:

Pain Management Healthcare Disparities COVID-19 Pathology Neurology Immunology Neuropathic Pain Public Health
Long-COVID: Managing Pain Symptoms & Recovery

Preview Available

Long-COVID: Managing Pain Symptoms & Recovery

Aug 20, 2022 9:30am ‐ Aug 20, 2022 10:42am

Learning Objectives

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

  • Recognize the symptoms of long COVID
  • Identify influencing factors in the structures and systems of care that contribute to iatrogenic harm for persons with PASC
  • Evaluate and treat pain in these patients
  • Implement strategies to help improve long term COVID over time
  • Assess for MCAS in post-acute COVID patients

PASC Fatigue Treatment Recommendations: "The Four Ps"

  • Pacing
    • Avoiding the push and crash cycle that is common in post-COVID recovery
  • Prioritizing
    • Encourages a patient to focus and decide on which activities need to get done and which activities can be postponed to avoid overexertion and crashing
  • Positioning
    • Modifying activities to make them easier to perform
  • Planning
    • Encourages the patient to plan the day or week to avoid overexertion and to recognize energy windows

Accreditation & Designation

Release date: This activity was released 8/20/2022.

Termination date: The content of this activity remains eligible for CME Credit until 8/19/2025, unless reviewed or amended prior to this date.

Claiming Credit: Watch the entire presentation and complete the Improvement Plan/Evaluation.

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 1.25 AMA PRA Category 1 Credit™. Physicians should claim only the credit commensurate with the extent of their participation in the activity.

California Required CME on Pain Management and the Appropriate Treatment of the Terminally Ill
AB487 requires physicians licensed in California to complete a one-time CME activity for 12 hours of credits that addresses both pain management and the appropriate care and treatment of the terminally ill. This activity contributes to achievement of requirements with AB487.

ABA MOCA
This activity contributes to the patient safety CME requirement for Part II: Lifelong Learning and SelfAssessment of the American Board of Anesthesiology’s (ABA) redesigned Maintenance of Certification in Anesthesiology Program® (MOCA®), known as MOCA 2.0®. Please consult the ABA website, www.theaba.org, for a list of all MOCA 2.0 requirements

Maintenance of Certification in Anesthesiology® and MOCA® are registered certification marks of the American Board of Anesthesiology®

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

[Presenter] Monica Verduzco-Gutierrez discloses the following financial relationships within the past 24 months: Research: Ipsen; Consulting: Allergan, Merz, Ipsen; Speaking: Allergan, Merz, Ipsen, Piramal, Medtronic

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

  • Oaklander, A. L., Mills, A. J., Kelley, M., Toran, L. S., Smith, B., Dalakas, M. C., & Nath, A. (2022). Peripheral Neuropathy Evaluations of Patients With Prolonged Long COVID. Neurology-Neuroimmunology Neuroinflammation, 9(3).
  • Chrousos, G. P., & Kaltsas, G. (2005). Post‐SARS sickness syndrome manifestations and endocrinopathy: how, why, and so what?. Clinical Endocrinology, 63(4), 363.
  • Nath, A. (2020). Long-haul COVID. Neurology, 95(13), 559-560.
  • Shiers, S., Ray, P. R., Wangzhou, A., Sankaranarayanan, I., Tatsui, C. E., Rhines, L. D., ... & Price, T. J. (2020). ACE2 and SCARF expression in human DRG nociceptors: implications for SARS-CoV-2 virus neurological effects. Pain, 161(11), 2494.
  • Moldofsky, H., & Patcai, J. (2011). Chronic widespread musculoskeletal pain, fatigue, depression and disordered sleep in chronic post-SARS syndrome; a case-controlled study. BMC neurology, 11(1), 1-7.
  • Attal, N., Martinez, V., & Bouhassira, D. (2021). Potential for increased prevalence of neuropathic pain after the COVID-19 pandemic. Pain reports, 6(1).
  • Chrousos, G. P., & Kaltsas, G. (2005). Post‐SARS sickness syndrome manifestations and endocrinopathy: how, why, and so what?. Clinical endocrinology, 63(4), 363.
  • Liu, Y., Sawalha, A. H., & Lu, Q. (2021). COVID-19 and autoimmune diseases. Current Opinion in Rheumatology, 33(2), 155.
  • Faye, A. S., Lee, K. E., Laszkowska, M., Kim, J., Blackett, J. W., McKenney, A. S., ... & Lebwohl, B. (2021). Risk of adverse outcomes in hospitalized patients with autoimmune disease and COVID-19: a matched cohort study from New York City. The Journal of Rheumatology, 48(3), 454-462.
  • Hong, N., & Du, X. K. (2004). Avascular necrosis of bone in severe acute respiratory syndrome. Clinical Radiology, 59(7), 602-608.
  • Zhang, S., Wang, C., Shi, L., & Xue, Q. (2021). Beware of Steroid-Induced Avascular Necrosis of the Femoral Head in the Treatment of COVID-19—Experience and Lessons from the SARS Epidemic. Drug Design, Development and Therapy, 15, 983.
  • Michelen, M., Manoharan, L., Elkheir, N., Cheng, V., Dagens, A., Hastie, C., ... & Stavropoulou, C. (2021). Characterising long COVID: a living systematic review. BMJ global health, 6(9), e005427.
  • Lancet, T. (2021). Understanding long COVID: a modern medical challenge. Lancet (London, England), 398(10302), 725.
  • Cascella, M., Del Gaudio, A., Vittori, A., Bimonte, S., Del Prete, P., Forte, C. A., ... & De Blasio, E. (2021). COVID-Pain: Acute and Late-Onset Painful Clinical Manifestations in COVID-19–Molecular Mechanisms and Research Perspectives. Journal of Pain Research, 14, 2403.
  • Dani, M., Dirksen, A., Taraborrelli, P., Torocastro, M., Panagopoulos, D., Sutton, R., & Lim, P. B. (2021). Autonomic dysfunction in ‘long COVID’: rationale, physiology and management strategies. Clinical Medicine, 21(1), e63.
  • de Araújo, A. L., da Silva Duarte, A. J., Levin, A. S., Guedes, B. F., Kallas, E. G., Pinna, F. R., ... & HCFMUSP PASC Initiative. (2021). Post-acute sequelae of SARS-CoV-2 infection (PASC): a protocol for a multidisciplinary prospective observational evaluation of a cohort of patients surviving hospitalisation in Sao Paulo, Brazil. BMJ Open, 11(6), e051706.
  • Raveendran, A. V., Rajeev Jayadevan, and S. Sashidharan. "Long COVID: an overview." Diabetes & Metabolic Syndrome: Clinical Research & Reviews 15, no. 3 (2021): 869-875.
  • Nath, A., & Smith, B. (2021). Neurological issues during COVID-19: An overview. Neuroscience Letters, 742, 135533.
  • Goss, A. L., Samudralwar, R. D., Das, R. R., & Nath, A. (2021). ANA investigates: neurological complications of COVID‐19 vaccines. Annals of Neurology, 89(5), 856.
  • Bierle, D. M., Aakre, C. A., Grach, S. L., Salonen, B. R., Croghan, I. T., Hurt, R. T., & Ganesh, R. (2021). Central sensitization phenotypes in post acute sequelae of SARS-CoV-2 infection (PASC): defining the post COVID syndrome. Journal of Primary Care & Community Health, 12, 21501327211030826.
  • Groff, D., Sun, A., Ssentongo, A. E., Ba, D. M., Parsons, N., Poudel, G. R., ... & Chinchilli, V. M. (2021). Short-term and long-term rates of postacute sequelae of SARS-CoV-2 infection: a systematic review. JAMA Network Open, 4(10)
  • Hoshijima, H., Mihara, T., Seki, H., Hyuga, S., Kuratani, N., & Shiga, T. (2021). Incidence of Long-term Post-acute Sequelae of SARS-CoV-2 Infection Related to Pain and Other Symptoms: A Living Systematic Review and Meta-analysis. medRxiv.


Speaker(s):

Tags:

Healthcare Disparities Interventional Pain Management COVID-19 Cytokine Headache Vagus Nerve Inflammation Neuropathic Pain Chronic Pain Physical Medicine & Rehabilitation Public Health Disability Joint Pain
Precision Medicine: The Next Great Medical Horizon

Preview Available

Precision Medicine: The Next Great Medical Horizon

Aug 21, 2022 7:45am ‐ Aug 21, 2022 8:23am

Learning Objectives

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

  • provide care that is compassionate, appropriate and effective
  • personalize care to meet patient goals

Desirable Physician Attributes

  • Systems-based Practice [ACGME/ABMS] Awareness and responsiveness to larger context and system of health care, use of system resources
  • 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

Accreditation & Designation

Release date: This activity was released 8/21/2022.

Termination date: The content of this activity remains eligible for CME Credit until 8/20/2025, unless reviewed or amended prior to this date.

Claiming Credit: Watch the entire presentation and complete the Improvement Plan/Evaluation.

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 0.75 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

  • Koenig, I. R., Fuchs, O., Hansen, G., von Mutius, E., & Kopp, M. V. (2017). What is precision medicine?. European respiratory journal, 50(4).
  • Ginsburg, G. S., & Phillips, K. A. (2018). Precision medicine: from science to value. Health Affairs, 37(5), 694-701.
  • Zhang, X. D. (2015). Precision medicine. Personalized medicine, omics and big data: concepts and relationships. J Pharmacogenomics Pharmacoproteomics, 6(1), 1000e144.

Speaker(s):
  • Prof. Sten Lindahl, MD, PhD, FRCA, Chair Emeritus, Nobel Committee in Physiology or Medicine

Tags:

Healthcare Disparities
Post Dural Puncture Headache After Removal of Spinal Cord Stimulator Leads: A Case Report

Preview Available

Post Dural Puncture Headache After Removal of Spinal Cord Stimulator Leads: A Case Report

Aug 21, 2022 3:00pm ‐ Aug 21, 2022 3:00pm

Synopsis

Post dural puncture headaches are, more recently, being documented as a complication related to spinal cord stimulator placement. Dural compromise are usually appreciated prior to this condition's onset. A viable treatment for post dural headaches is epidural blood patches. Less reported in literature still, is the presence of post dural headache after leads removal from a trail spinal cord stimulator, when initial placement of the spinal cord stimulator was without noted dural compromise and tolerated by the patient well prior to its removal.  

Disclosures

Nothing to Disclose by any Author

Speaker(s):

Tags:

Migraine Headache Musculoskeletal Pain
A self-anchoring injectable helical wire rope structure electrode (Injectrode) enables ease of placement and clear imaging

Preview Available

A self-anchoring injectable helical wire rope structure electrode (Injectrode) enables ease of placement and clear imaging

Aug 21, 2022 3:00pm ‐ Aug 21, 2022 3:00pm

Synopsis

In order to overcome barriers to adoption of neurostimulation technologies by patients and clinicians, we present here a minimally invasive needle placeable and fully implanted neurostimulator that is suitable for clinical imaging (U/S, X-Ray, MRI). The structural design and placement procedure of the injectable helical wire structure electrode (Injectrode) renders the device self anchoring and deliverable using a minimal number of components. Demonstrated are placements by clinicians on various nerve targets in animal and human models.


Disclosures

  • Stephan Nieuwoudt is employed by and owns equity in Neuronoff, Inc. 
  • Amelia Howe is employed by and owns equity in Neuronoff, Inc. 
  • Johanna Pearson is employed by Neuronoff, Inc. 
  • Emily Szabo is employed by and owns equity in Neuronoff, Inc. 
  • Morgan McGaughey is employed by and owns equity in Neuronoff, Inc. 
  • Derrick Liu is employed by and owns equity in Neuronoff, Inc. 
  • Shaher Ahmad is employed by and owns equity in Neuronoff, Inc. 
  • Kip A. Ludwig is receiving funds from and owns equity in Neuronoff, Inc.
  • Hesham Elsharkawy owns equity in Neuronoff, Inc. 
  • Amol Soin owns equity in Neuronoff, Inc. 
  • Alaa Abd-Elsayed owns equity in Neuronoff, Inc. 
  • Manfred Franke is employed by and owns equity in Neuronoff, Inc. 
  • Andrew J. Shoffstall is receiving funds from and owns equity in Neuronoff, Inc.
  • This project is supported by Neuronoff Inc., NIH 1U18EB029251-01 Grant, and the DARPA EEI program. Opinions, interpretations, conclusions and recommendations are those of the author and are not necessarily endorsed by the Department of Defense or the National Institutes of Health.

Speaker(s):
  • Stephan Nieuwoudt, PhD, Director of Research and Development, Neuronoff, Inc
  • Amelia Howe, Research Scientist, Neuronoff, Inc.
  • Johanna Pearson, Research Intern, Neuronoff, Inc.
  • Elizabeth Ingram, MRI Technologist, Department of Radiology, University of Alabama at Birmingham
  • Emily Szabo, Technical Writer, Manufacturing Engineer, Neuronoff, Inc.
  • Derrick Liu, MS, Sr. Research Scientist, Neuronoff, Inc.
  • Morgan McGaughey, Jr. Clinical & Development Scientist, Neuronoff, Inc.
  • Shaher Ahmad, COO, Neuronoff, Inc.
  • Mark Bolding, Associate Professor, Department of Radiology, University of Alabama at Birmingham
  • Kip Ludwig, PhD, Co-Director, Wisconsin Institute for Translational Neuroengineering (WITNe)
  • Hesham Elsharkawy, Director of Transitional Pain Service, MetroHealth
  • Amol Soin, Director, Ohio Pain Clinic
  • Alaa Abd-Elsayed, Medical Director, Pain Clinic, Anesthesiology Department and Pain Medicine, University of Wisconsin School of Medicine and Public Health
  • Manfred Franke, PhD, CEO, Neuronoff, Inc
  • Andrew J. Shoffstall, Assistant Professor, Dept. of Biomedical Engineering, Case Western Reserve University
Multimodal Imaging Analysis of Fibromyalgia Syndrome Reveals Structural and Functional Abnormalities in Cortico-Thalamic Loops

Multimodal Imaging Analysis of Fibromyalgia Syndrome Reveals Structural and Functional Abnormalities in Cortico-Thalamic Loops

Aug 21, 2022 3:00pm ‐ Aug 21, 2022 3:00pm

Synopsis

Here we propose a characterization of Fibromyalgia pathophysiology in gray matter (GM) tissue using a multimodal neuroimaging approach (volumetric, diffusion-weighted, and resting-state functional connectivity).

Disclosures

Nothing to Disclose by any Author

Speaker(s):
Mechanistic Insights into Anterolateral System Modulation with Conventional and Burst Stimulation

Mechanistic Insights into Anterolateral System Modulation with Conventional and Burst Stimulation

Aug 21, 2022 3:00pm ‐ Aug 21, 2022 3:00pm

Synopsis

Evoked compound action potentials (ECAPs) from both the dorsal columns and the anterolateral system (ALS) in sheep were used to quantify neural activation with burst and conventional spinal cord stimulation (SCS). When dosed equivalently, no statistically significant difference in neural activation was noted between both stimulation modalities. Sub-threshold SCS resulted in no change in neural activation, while supra-threshold SCS potentiated ALS excitability in an equivalent manner for both modalities. We postulate that differences noted previously between burst and conventional SCS results from non-equivalent dosing between these stimulation modalities.

Disclosures

  • Authors Dinsmoor and Usoro are employees of Medtronic plc. 
  • Author Poree has stock options in Nalu, and has received research funding from Abbott, Nalu, and Saluda; he is a consultant for Nalu, Saluda, and Medtronic. 
  • This work was funded by Medtronic plc.

Speaker(s):
  • David Dinsmoor, MS, Distinguished Engineer, Medtronic
  • Dr. Lawrence Poree, MD, PhD. MPH, Clinical Professor, Department of Anesthesia, University of California at San Francisco (UCSF)
  • Joshua Usoro, Senior Biomedical Engineer, Medtronic
Human Transcription Error Assessment within a Simulated Electronic Health Record System

Human Transcription Error Assessment within a Simulated Electronic Health Record System

Aug 21, 2022 3:00pm ‐ Aug 21, 2022 3:00pm

Synopsis

Medical practices and hospitals have adopted Electronic Health Record (EHR) systems that streamline patient information and relevant clinical data. Access to an EHR system with effective exchange of electronic health information is critical in maintaining data consistency and reliability. Human errors that occur during the transcription of data from one field to another, or from a paper to an electronic record, can negatively impact patient care and reduce efficiency. Human transcription errors can occur as early as the scheduling process, with these errors compounding as more individuals touch and re-transcribe the data. Though previous literature have touched upon error rates, they have not addressed the complexity of patient data involved with scheduling.

Disclosures

Nothing to Disclose by any Author

Speaker(s):
Atypical Presentation of Post-Dural Puncture Headache from Cervical Spinal Cord Stimulator Lead Placement

Atypical Presentation of Post-Dural Puncture Headache from Cervical Spinal Cord Stimulator Lead Placement

Aug 21, 2022 3:00pm ‐ Aug 21, 2022 3:00pm

Synopsis

The incidence of Post Dural Puncture Headaches (PDPH) is less than 1% with the use of fluoroscopy. PDPH typically occurs due to accidental dural puncture during initial epidural needle placement. We present a case of a 44 year-old male with history of aplastic anemia who presented with bilateral hand and lower extremity paresthesia with severe allodynia refractory to treatment. The patient experienced significant relief of symptoms after dual thoracic and single cervical SCS lead placement He presented with slow-onset headache after three days from cervical lead tip puncture. To date, there is a paucity of papers describing such an occurrence.

Disclosures

Nothing to disclose by any author

Speaker(s):