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Full Schedule

Full Schedule

  • Tuesday, September 7, 2021
  • 7:30am – 8:20am
    Casting a Wider Net: Using Focused Acceptance & Commitment Therapy in Primary Care
    Frontline practitioners are called upon to provide psychosocial counseling in conjunction with traditional medical care, often without adequate training, experience, or resources. Healthcare systems are addressing this call to action by casting a wider net and aiming to optimize care. Focused acceptance and commitment therapy (FACT) may be the alternative tool to treat chronic pain. Research has shown that integrating behavioral health interventions into primary care leads to better patient outcomes by reducing provider burden, lowering healthcare costs, and mitigating stigma associated with mental health services. FACT is an abridged version of ACT, acceptance and commitment therapy, which uses experiential exercises, mindfulness practice, and values clarification to promote psychological flexibility and overall health. FACT distills the core methods of ACT into a protocol that is delivered in 4 sessions: Finding Leverage, Promoting Awareness, Promoting Openness, and Promoting Engagement. FACT shows promise for treating the biopsychosocial symptoms of chronic pain in an overburdened healthcare system.
  • 7:30am – 8:20am
    Prime Time or Too Soon? – Pharmacogenetics in Pain Management
    Variability in drug response can be related to a person’s genetic make-up. Is it time to test everyone or not quite yet? This session will focus on the role of pharmacogenetics in pain management including relevant variants and management strategies.
  • 7:30am – 8:20am
    Treatment Algorithm for Managing Chronic Back Pain in the Elderly Population
    In this presentation, we will identify conditions that attribute to chronic back pain for the elderly population and how to assess and identify best methods for treatment of chronic back pain. Evidence suggests that the prevalence of severe and chronic lower back pain increases as people age. This population is more susceptible to developing certain lower back pain conditions (eg, tumors, lumbar spinal stenosis, and vertebral fractures caused by osteoporosis), as well as be adversely affected by age-related changes (such as those that are physical, psychological, or mental in origin). Additionally, we will examine barriers and challenges faced by healthcare professionals in treating elderly patients suffering from chronic back pain. We will discuss evidence based treatment algorithms for managing chronic pain in elderly patients and overcoming challenges associated with comorbid conditions.
  • 8:00am – 5:00pm
    Industry Supported Satellite Event
  • 8:30am – 9:30am
    Breakfast Product Theater, Disease Awareness, Medical Information (PDM) Program
  • 9:40am – 10:30am
    Calming the Storm: Adding PTSD Treatment to Your Pain Practice
    As many as half of patients with chronic pain may also experience trauma symptoms. The presence of active trauma symptoms—mood swings, nightmares, social avoidance, etc—can not only impact a patient’s pain experience, but can limit the effectiveness of pain treatments or therapies if not specifically addressed and treated. There is an inherent need for pain practitioners to develop strategies to both assess for active trauma symptoms or the presence of PTSD and to provide effective avenues for treatment. The recent COVID-19 pandemic seems to have increased the prevalence of mental health disorders, creating an even greater need to adequately assess and treat trauma symptoms. This course will present screening tools and review typical signs and symptoms of PTSD to help with assessment. We’ll review the treatments to diminish the presence of active trauma symptoms, including how to use resources in the community and potentially build them within an existing pain practice. The remainder of this course will review the structure and outcomes of a novel interdisciplinary program created by my practice to specifically treat PTSD.
  • 9:40am – 10:30am
    Interventional Options for Refractory Migraine and Cervicogenic Headaches
    Migraines constitute a complex disorder with a strong genetic component, characterized by episodes of moderate-to-severe headaches that may unfold over hours to days. The presentation is most often unilateral and generally associated with nausea and increased sensitivity to light and sound. Migraines are a highly prevalent condition, affecting 12% of the population, up to 17% of women, and 6% of men each year. Cervicogenic headaches are chronic and recurrent headaches that present as unilateral pain starting in the neck, accompanied by reduced range of motion. Prevalence of cervicogenic headaches among patients with headaches is 1% to 4%. These headaches manifest as referred pain arising from irritation caused by cervical structures innervated by C1-3 spinal nerves. Physical therapy is considered the first line of treatment. Spinal manipulative therapy and therapeutic exercise regimens are effective in treating headache. Some forms of headaches remain intractable to conservative therapies, for instance, due to resistance to common regimens, intolerance to pharmaceutical agents, or comorbid factors that cause interactions with their therapies. We will discuss interventional pain modalities, such as peripheral nerve stimulation, third occipital nerve block, lesser occipital nerve block, greater occipital nerve block, sphenopalatine block, radiofrequency ablation, and cervical epidural steroid injections. Various approaches to cervicogenic headaches will be reviewed, including lateral atlantoaxial joint intra-articular injections and C2 nerve root coblation.
  • 9:40am – 10:30am
    Neurogenic Thoracic Outlet Syndrome
    If you see patients with pain from the neck/shoulder, radiating down the arm and into the fingers, they may have neurogenic thoracic outlet syndrome, or NTOS. Occipital headaches, arm weakness, and chest wall pain often co-exist. This syndrome targets women and can occur after motor vehicle accidents. This is a complex spectrum disorder that provokes controversy. In fact, it may be the most controversial diagnosis in medicine. Yet, the evidence demonstrates that if left untreated, quality of life is impaired as much as having chronic heart failure. We will talk about common symptoms, etiology, diagnosis, and current treatment options including Botox® therapy.
  • 9:40am – 10:30am
    Taming of the Spew! Managing Opioid-Induced Nausea and Vomiting
    Opioid-induced nausea and vomiting is a distressing symptom affecting the quality of life of patients and complicating the management of their pain. With initiation of opioid therapy, nausea with or without vomiting is not uncommon. While some patients may experience this side effect only transiently, for others it may be persistent. This presentation will explore the risk factors predictive of opioid-induced nausea in patients with chronic cancer and noncancer pain. The audience will be introduced to the 4 interrelated neural pathways that mediate nausea and vomiting, and also where anti-emetic therapies act in these pathways, particularly as it relates to opioid-induced nausea and vomiting. Although not completely known, the suspected 3 part pathogenesis of opioid-induced nausea and vomiting will be explored. Finally, this presentation will address strategies for managing opioid-induced nausea such as anti-emetic use, opioid rotation/reduction, and changing the route of administration. With greater recognition and understanding, we can tame the opioid-induced spew!
  • 10:30am – 11:00am
    Break
  • 11:00am – 11:50am
    “Doctor, I Have a Pain Between L4 and L5”: Dealing with False Positives and Google Dx
    Musculoskeletal pain is among the most common encountered by any clinician in an ambulatory care practice, including urgent care. This presentation will illustrate directed history taking and basic exams when patients present with common neuromusculoskeletal pain complaints, emphasizing the importance of the clinical evaluation as opposed to imaging tests. We will discuss the importance of knowing the limitations and pitfalls of imaging tests in the evaluation of spinal pain conditions, particularly in the setting of chronic spinal pain and potential secondary gains/disability. The relevant literature will be discussed in detail, using clinical scenarios and illustrative cases. Other common complaints such as joint pain (shoulder, hip, knee) will also be presented. A case will be made about the importance of regaining patient trust by improving face-to-face communication to deter belief in online sources rather than healthcare providers.
  • 11:00am – 11:50am
    Pink Elephant: Is Alcohol a Pain Panacea or a Problem?
    Chronic pain and alcohol consumption are both very common in the general population, and alcohol is often used to numb both physical and emotional pain. This relationship is especially salient as estimates of alcohol consumption have increased during the COVID-19 pandemic. In this course, the epidemiology of co-occurring pain and alcohol use will be discussed, and recent figures related to alcohol sales will be reviewed. This session will also provide information on the latest evidence surrounding the interaction between alcohol consumption and pain. For example, moderate alcohol use has been associated with improved pain-related outcomes for certain pain conditions; however, both excessive binge drinking and alcohol use disorder are associated with worsened pain outcomes. The interaction of alcohol with pharmacologic treatments for pain will be reviewed. Furthermore, the presence of pain may serve as a trigger for some to increase alcohol consumption as a maladaptive coping strategy. Behavioral approaches to address this process, to treat co-occurring alcohol use disorder and chronic pain, and to reduce problem drinking will be presented.
  • 11:00am – 11:50am
    See, Be, Deceived…or Relieved? Evaluating CBD for Pain Management
    How many times a week (or a day) does a patient ask you about cannabidiol (CBD)? This session will take a deeper dive into CBD and learn how it compares to cannabis and what evidence there is (if any) to support its use in pain management. What considerations should you make when co-prescribing for a patient using CBD? In this session, we’ll compare and contrast the mechanism of action of THC and CBD and how each affects the nervous system and examine the published evidence on the use of CBD in pain management, including studied dosage forms and pain indications. Finally, we’ll review the potential implications of prescribing or recommending CBD for pain management.
  • 12:30pm – 1:30pm
    Lunch Product Theater, Disease Awareness, Medical Information (PDM) Program
  • 1:40pm – 2:30pm
    Post-Surgical Neuralgia: Diagnosis and Treatment
    This will be a comprehensive presentation on surgical neuralgia, and we will discuss risk factors that can increase the incidence of the condition. We also discuss mechanisms, why the condition may develop, and appropriate measures taken preemptively to reduce the incidence. We will present in detail the symptoms and signs providers should look for to make the diagnosis and order the appropriate investigations to aid in confirming the diagnosis. Modalities for treating the condition starting with conservative management will be discussed along with potentially progressing to invasive interventions. 
  • 1:40pm – 2:30pm
    Tales of Pain Self-Management Workshop: The Who, What, Why, and How!
    The Chronic Pain Self-Management Program (CPSMP) is an evidence-based program developed by Dr. Sandra LeFort and later modified at the Stanford Patient Education Research Center. Through a grant, we received training to offer a 6 week online course to patients suffering with chronic pain. In this presentation, we will share our experiences with the program as well as the key principles that form the foundation for a pain self-management workshop. We hope to offer participants insight into the value of such a program while also sharing practical tips for teaching and engaging patients in self-management strategies for their chronic pain.
  • 1:40pm – 2:30pm
    The Dog Ate My Homework: A Guide to Avoiding Relapse and Maintaining Adherence
    According to the World Health Organization (WHO), approximately 125,000 people in the US with treatable diseases die each year because they do not take their medication as prescribed. The WHO also reports that 10% to 25% of hospital and nursing home admissions result from patient noncompliance. Adherence rates for behavioral change related to obesity, substance abuse, smoking cessation, and chronic pain have shown similar relapse rates following completion of treatment. Providers can formulate specific procedures for improving patient participation, such as anticipating nonadherence, considering the prescribed self-care curative measures from the patient's perspective, improving the patient-provider relationship, customizing treatment, enlisting family support, and making use of other healthcare providers. This presentation will define compliance, adherence, and relapse, and will offer providers evidence-based strategies, such as building the therapeutic relationship, motivational interviewing, and health coaching interventions, to help maintain long term gains in their pain management care.
  • 2:40pm – 3:30pm
    Apocalypse Now…or Later? Chronic Pain After COVID-19
    As we better understand the acute challenges of managing the COVID-19 pandemic, it is the lingering effects on COVID-19 survivors that healthcare providers are increasingly beginning to treat. Initially viewed as a respiratory disease, it is now clearer that many organ systems are affected due to a systemic inflammatory response. Many COVID-19 survivors have sustained prolonged periods of sedation and immobilization, putting them at increased risk of myopathy and polyneuropathy. Emerging reports of neurological sequelae include nerve pain, confusion, headache, anosmia, and chronic fatigue. This course will shed light on some of these emerging symptoms and potential treatment solutions.
  • 2:40pm – 3:30pm
    Implementing a New Pain Coach Education Service in an Academic Medical Center During the COVID Pandemic
    Amid the US opioid epidemic, providers and patients with acute and chronic pain are desperately searching for non-opioid or nonpharmacologic management options. A pilot pain coaching and education consultation service was developed by the Pain Assessment and Management Initiative (PAMI) at the University of Florida College of Medicine – Jacksonville and officially launched December 2020. This program is accompanied by a pain discharge tool cart filled with integrative pain management options. In this course, we will explain how the team navigated electronic medical record (EMR) charting and patient notification processes, developed a data collection system, educated multiple staff disciplines and specialties, and brought this coaching service to patients and providers in an urban academic medical center. We will share lessons learned and steps required to implement a program in an ED, trauma center, or hospital. Topics include developing a job description, hiring the right person, training and shadowing, working with IT analysts to develop a model EMR consult note template, communication and champion development with stakeholders, clinicians and administrators, tips for identifying patients, refining the coaching script and approach, development of patient education materials and toolkits, and formulation of a quality improvement program and data collection plan.
  • 2:40pm – 3:30pm
    Updates on Complex Regional Pain Syndrome
    Complex regional pain syndrome (CRPS) often causes serious impairments in activities of daily living and the ability to function. It can lead to a tremendous burden to patients and their families. There continues to be clinical confusion and misunderstanding about the syndrome due to its dramatic nature, limited knowledge of its mechanisms, and frequent lack of response to interventions. Research into CRPS has grown although our understanding remains incomplete. We will summarize our knowledge about CRPS, including epidemiology, pathophysiology, diagnosis, natural course, treatment, and prevention.
  • 3:40pm – 4:30pm
    Afternoon Break Product Theater, Disease Awareness, Medical Information (PDM) Program. Refreshments Served.
  • 4:40pm – 5:30pm
    Night & Day: The Disabling Power of Sympathy/The Enabling Power of Empathy
    Those with chronic pain often elicit considerable sympathy. Unknowingly, most sympathizers come from a place of judgment and pity, contributing to helplessness and immobilization in the person with pain. Empathy, on the other hand, is climbing into the pit with the broken and being there with them. Not trying to fix them or give them solutions, but instead actively listening to understand their perspective. Pain management coaching seeks to actively empathize with those with pain, giving the patient unconditional positive regard, which leads to increased confidence, autonomy, and empowerment. Pain management coaching pioneer Becky Curtis will share how pain management coaching will support pain patients as they make lasting behavior changes.
  • 4:40pm – 5:30pm
    Osteoarthritic Joint Pain: Advances in Diagnosis and Treatment
    Joint pain is an unfortunate fundamental problem in patient care and pain management. For example, knee pain is so prevalent that, by 2020, more than 1 million patients had undergone knee replacement surgery. However, there are several different medications and treatments that are options before undergoing surgery, which may not be readily apparent. And what if your patient is not a surgical candidate, or if the pain persists even after joint replacement surgery? In this course, we review the relevant clinical exam findings for diagnosis as well as treatment options for cervical/lumbar facet joint pain through peripheral joints such as the shoulder, hip, and knee.
  • 4:40pm – 5:30pm
    What's Psych Got to Do with Perioperative Pain Management?
    The transition from acute to chronic pain has created an enormous burden on the healthcare system. This has led to a shift away from opioid therapy and to treating patients with a multimodal therapeutic approach. The focus has been to better identify the risk factors that contribute to the development of persistent pain. Psychological factors such as anxiety, depression, pain catastrophizing, and pain self-efficacy have been found to contribute substantially to surgical outcomes. A well-timed multimodal approach including a combination of pharmacological, regional, and nonpharmacological therapies is crucial to optimize postoperative pain management and to prevent transition to chronic pain states. Evidence based psychological therapies, such as cognitive behavioral therapy, mindfulness based cognitive therapy, and acceptance and commitment therapy have utility in managing pain within the perioperative setting and complement traditional medical treatments. Often, pain coping skills cannot be learned, internalized, and enacted within a perioperative timeframe. A comprehensive and coordinated effort in the pre- and postoperative phases could have the greatest positive effect on outcomes and will be discussed during this presentation.
  • 5:40pm – 6:30pm
    All in the Family: Their Role and Impact on Pain Management
    About 43% of households have at least 1 person with chronic pain, and that pain affects all members of the family, plus caregivers and/or significant others. It can demoralize and depress both patient and family, especially when there is no effective pain control and no hope for relief. Family can have a role in maintaining the pain, and should be included in pain assessment and treatment of pain. Family members must not only recognize and overcome obstacles that may occur when communicating with chronic pain patients, but also must deal with their own pain and stress. Addressing emotions with support groups, family therapy, or individual therapy can strengthen the family and the individual, as well as reduce the suffering of all involved. It is important for frontline practitioners to consider not only the person who is suffering in front of them, but the people behind the patient.
  • 5:40pm – 6:30pm
    Everything's Coming Up Roses: How Pain Management Coaching Impacts Pain Outcomes
    Perhaps the single most failure-producing aspect of chronic pain is its inherent isolation. Add the medical hopelessness faced by many patients, and a perfect storm is created for chronic pain patients to fall permanently out of the workforce and fail to thrive. Pain management coaching provides the bridge between medical care and the patient's innate will to survive. Pain management coaching pioneer Becky Curtis will share how the latest research on the brain and pain relate to pain management and patient re-learning. Attendees will gain understanding of the role pain management coaching plays in reshaping the learned phenomena of chronic pain, and how clients acquire knowledge and implement effective pain management strategies with the guidance of a coach.
  • 5:40pm – 6:30pm
    Painful Conditions of the Upper Limb: Arm
    This course will explore painful neuromusculoskeletal conditions affecting the upper limb. It will review the most common neuromusculoskeletal conditions seen in an outpatient setting, providing primary care and specialists alike a solid foundation of practical knowledge to evaluate and manage these common complaints, including cervical radiculopathy, focal entrapment syndromes, and soft-tissue pathology of the shoulder, elbow, wrist, and hand. Using clinical scenarios and illustrative cases, we’ll review the key components of the history and physical exam and relevant anatomy along with recommended diagnostic testing. Alternative diagnoses and clinical pearls will also be discussed, emphasizing important diagnostic tests necessary to differentiate conditions. Cases will be followed by practical, up-to-date, evidence-based management recommendations.