Podcasts about American Pain Society

Episode 194: Acute low back pain.  Future Dr. Ibrahim presents a clinical case to explain the essential points in the evaluation of back pain.  Future Dr. Redden adds information about differentiating between a back strain and more serious diseases such as cancer, and Dr. Arreaza shares information about returning to work after back strain.Written by Michael Ibrahim, MSIV. Editing and comments by Jordan Redden, MSIV, and Hector Arreaza, MD.You are listening to Rio Bravo qWeek Podcast, your weekly dose of knowledge brought to you by the Rio Bravo Family Medicine Residency Program from Bakersfield, California, a UCLA-affiliated program sponsored by Clinica Sierra Vista, Let Us Be Your Healthcare Home. This podcast was created for educational purposes only. Visit your primary care provider for additional medical advice.Dr. Arreaza:Welcome back, everyone. Today's topic is one that every primary care provider, emergency doctor, and even specialist sees routinely: low back pain. It's so common that studies estimate up to 80% of adults will experience it at some point in their lives. But despite how frequent it is, the challenge is to identify which cases are benign and which demand urgent attention.Jordan:Exactly. Low back pain is usually self-limiting and mechanical in nature, but we always need to keep an eye out for the rare but serious causes: things like infection, malignancy, or neurological compromise. That's why a good history and physical exam are our best tools right out of the gate.Michael:And to ground this in a real example, let me introduce a patient we saw recently. John is a 45-year-old warehouse worker who came in with two weeks of lower back pain that started after lifting a 50-lb box. He describes it as a dull, aching pain that radiates from his lower back down the posterior left thigh into the calf. He says it gets worse with bending or coughing, but he feels better when lying flat. He also mentioned some numbness in his left foot, but he denies any bowel or bladder issues. His vitals are completely normal. On exam, he had lumbar paraspinal tenderness, a positive straight leg-raise at 40 degrees on the left and decreased sensation in the L5 dermatome, though reflexes were still intact.Dr. Arreaza:That's a great case. Let's take a minute and talk about the straight leg raise test. This is a bedside tool we use to assess for lumbar nerve root irritation often caused by a herniated disc. ***Here's how it works: the patient lies supine, and you slowly raise their straight leg. If pain radiates below the knee between 30° and 70°, that suggests radiculopathy, especially involving the L5 or S1 nerve roots. Pain at higher angles is more likely due to hamstring tightness or mechanical strain.Michael:Right. So, stepping back: what do we mean by "low back pain"? Broadly, it's any pain localized to the lumbar spine, but it's often classified by type or cause:Mechanical (like muscle strain or degenerative disc disease), Radicular (nerve root involvement), Referred pain (like from pelvic or abdominal organs), Inflammatory (AS), and Systemic or serious causes like infection or malignancy. Jordan:In John's case, we're thinking radicular pain, most likely from a herniated disc compressing the L5 nerve root. That's supported by the dermatomal numbness, the leg pain, and that positive straight leg test.Dr. Arreaza:Good reasoning. Now, anytime we see back pain, our brains should run a checklist for red flags. These help us pick up more serious causes that require urgent attention. Let's run through the red flags.Michael:Sure. For fracture, we think about major trauma or even minor trauma in the elderly, especially those with osteoporosis or on chronic steroids. Also, anyone over 70 years old.Jordan:Then we have infections, which could include things like discitis, vertebral osteomyelitis, or epidural abscess. Red flags include fever, IV drug use, recent surgery, or immunosuppression.Michael:Malignancy is another critical one, especially if there's a history of breast, prostate, lung, kidney, or thyroid cancer. Clues include unexplained weight loss, night pain, or constant pain not relieved by rest.Jordan:And don't forget about inflammatory back pain, like ankylosing spondylitis, which is often seen in younger patients with morning stiffness that lasts more than 30 minutes and improves with activity.Dr. Arreaza:And of course, we always rule out cauda equina syndrome: a surgical emergency. That's urinary retention or incontinence, saddle anesthesia, bilateral leg weakness, or fecal incontinence. Missing this diagnosis can be catastrophic.Michael:Thankfully, in John's case, we don't see any red flags. His presentation is classic for uncomplicated lumbar radiculopathy. But we must stay vigilant, because sometimes patients don't offer up key symptoms unless we ask directly.Jordan:And that's where associated symptoms help guide us. For example:Radicular symptoms like numbness or weakness follow dermatomal patterns. Constitutional symptoms like fever or weight loss raise red flags. Bladder/bowel changes or saddle anesthesia raise alarms for cauda equina. Pain that wakes patients up at night might point to malignancy. Dr. Arreaza:So when do we order labs or imaging?Michael:Not right away. For most patients with acute low back pain, imaging is not needed unless they have red flags. If infection is suspected, we'd get CBC, ESR, and CRP. For cancer, maybe PSA or serum protein electrophoresis. And if inflammatory back disease is suspected, HLA-B27 can be helpful.Jordan:Yes, imaging should be delayed for at least six weeks unless red flags or significant neurologic deficits are present. When we do image, MRI is our go-to especially for suspected radiculopathy or cauda equina. X-rays can help if we're thinking about fractures, but they won't show soft tissue or nerve root issues.Michael:In the example from our case, since the patient doesn't have red flags, we'd go with conservative management: start NSAIDs and recommend activity modification. As this is the acute setting, physical therapy would not be recommended.Jordan:For the acute phase, research shows no serious difference between those with PT and those without in the long term. However, physical therapy is really the cornerstone of management for chronic back pain. It's not just movement: it's education, body mechanics, and teaching patients how to move safely. And PT can actually reduce opioid use, imaging, and injections down the line for patient struggling with long term back pain.Dr. Arreaza:Yes, and PT is not one-size-fits-all. PT might include McKenzie exercises, manual therapy, postural retraining, or even neuromuscular re-education. The goal is always to build core stability, promote healthy movement patterns, and reduce fear of motion.Jordan:Let's take a minute to talk about the McKenzie Method, a physical therapy approach used to treat lumbar disc herniation by identifying a specific movement, (often spinal extension) that reduces or centralizes pain. A common exercise is the prone press-up, (cobra pose for yoga fans) where the patient lies face down and pushes the upper body upward while keeping the hips on the floor to relieve pressure on the disc. These exercises should be done carefully, ideally under professional guidance, and discontinued if symptoms worsen.Michael:For our case patient, our working diagnosis is mechanical low back pain with L5 radiculopathy. No imaging needed now, no red flags. We'll treat conservatively and educate him about proper lifting, staying active, and recovery expectations.Jordan:We also emphasized to him that bed rest isn't helpful. In fact, bed rest can make things worse. Keeping active while avoiding heavy lifting for now is key.Dr. Arreaza:Return-to-work recommendations should be individualized. For example, an office worker, positioning while working, or work hours may be able to return to work promptly. However, those with physically demanding jobs may need light duty or be off work.Ice: no evidence of benefit. Heat: may reduce pain and disability in pain of less than 3 months, although the benefit was small and short.And we should always teach safe lifting techniques: bend at the knees, keep the load close, avoid twisting. It's basic knowledge, but it is very effective in preventing recurrence.Jordan:Now, if a patient fails to improve after 6 weeks of conservative therapy, or if they develop new neurologic deficits, that's when we think about referral to spine specialists or surgical consultation.Michael:And as previously mentioned: in cases where back pain becomes chronic (lasting more than 12 weeks) a multidisciplinary approach works best. That can include:Physical therapy, Cognitive behavioral therapy (CBT) And sometimes pain management interventions. Jordan:We can't forget the psychological toll either. Chronic back pain is associated with depression, anxiety, and opioid dependence. Increased risk factors include obesity, smoking, sedentary lifestyle, and previous back injuries.Dr. Arreaza:Well said. So, let's summarize. Michael?Michael:Sure! Low back pain is common, and most cases are benign. But we have to know the red flags that point to serious pathology. A focused history and physical exam are more powerful than many people realize. And the first step in treatment is almost always conservative, with a strong emphasis on maintaining physical activity.Jordan:And don't underestimate the value of patient education. Helping patients understand their pain, set realistic expectations, and stay active is often just as important as the medications or therapies we offer.Even without trying, every night you go to bed a little wiser. Thanks for listening to Rio Bravo qWeek Podcast. We want to hear from you, send us an email at RioBravoqWeek@clinicasierravista.org, or visit our website riobravofmrp.org/qweek. See you next week! _____________________References:Chou, R., Qaseem, A., Snow, V., Casey, D., Cross, J. T., Shekelle, P., & Owens, D. K. (2007). Diagnosis and treatment of low back pain: A joint clinical practice guideline from the American College of Physicians and the American Pain Society. Annals of Internal Medicine, 147(7), 478–491. https://doi.org/10.7326/0003-4819-147-7-200710020-00006Deyo, R. A., Mirza, S. K., Turner, J. A., & Martin, B. I. (2009). Overtreating chronic back pain: Time to back off? Journal of the American Board of Family Medicine, 22(1), 62–68. https://doi.org/10.3122/jabfm.2009.01.080102National Institute for Health and Care Excellence. (2020). Low back pain and sciatica in over 16s: Assessment and management (NICE Guideline No. NG59). https://www.nice.org.uk/guidance/ng59Qaseem, A., Wilt, T. J., McLean, R. M., & Forciea, M. A. (2017). Noninvasive treatments for acute, subacute, and chronic low back pain: A clinical practice guideline from the American College of Physicians. Annals of Internal Medicine, 166(7), 514–530. https://doi.org/10.7326/M16-2367UpToDate. (n.d.). Evaluation and treatment of low back pain in adults. Wolters Kluwer. https://www.uptodate.com (Access requires subscription)Theme song, Works All The Time by Dominik Schwarzer, YouTube ID: CUBDNERZU8HXUHBS, purchased from https://www.premiumbeat.com/. 

João Mendes. Joanne Alves e Ênio Simas conversam sobre 7 armadilhas na dor lombar. Vote no TdC no Prêmio Melhores Podcasts do Brasil. Estamos na categoria Ciência https://www.premiompb.com.br/ Referências: https://amdg.wa.gov/Files/AssessmentTools/5-Keele_STarT_Back9_item-7.pdf  Chou, Roger, and Paul Shekelle. “Will this patient develop persistent disabling low back pain?.” JAMA vol. 303,13 (2010): 1295-302. doi:10.1001/jama.2010.344 Stevans, Joel M et al. “Risk Factors Associated With Transition From Acute to Chronic Low Back Pain in US Patients Seeking Primary Care.” JAMA network open vol. 4,2 e2037371. 1 Feb. 2021, doi:10.1001/jamanetworkopen.2020.37371 Suri, Pradeep et al. “Predictive Validity of the STarT Back Tool for Risk of Persistent Disabling Back Pain in a U.S. Primary Care Setting.” Archives of physical medicine and rehabilitation vol. 99,8 (2018): 1533-1539.e2. doi:10.1016/j.apmr.2018.02.016 Samanta, Jo et al. “10-minute consultation: chronic low back pain.” BMJ (Clinical research ed.) vol. 326,7388 (2003): 535. doi:10.1136/bmj.326.7388.535 Gomes, Luís Antunes et al. “A Stratified Approach for Managing Patients With Low Back Pain in Primary Care (SPLIT Program): A Before-and-After Study.” Annals of family medicine vol. 22,3 (2024): 195-202. doi:10.1370/afm.3104 Richmond, Helen et al. “The Effectiveness of Cognitive Behavioural Treatment for Non-Specific Low Back Pain: A Systematic Review and Meta-Analysis.” PloS one vol. 10,8 e0134192. 5 Aug. 2015, doi:10.1371/journal.pone.0134192 Chou, Roger et al. “Nonpharmacologic therapies for acute and chronic low back pain: a review of the evidence for an American Pain Society/American College of Physicians clinical practice guideline.” Annals of internal medicine vol. 147,7 (2007): 492-504. doi:10.7326/0003-4819-147-7-200710020-00007 Qaseem, Amir et al. “Noninvasive Treatments for Acute, Subacute, and Chronic Low Back Pain: A Clinical Practice Guideline From the American College of Physicians.” Annals of internal medicine vol. 166,7 (2017): 514-530. doi:10.7326/M16-2367 Flynn, Diane M. “Chronic Musculoskeletal Pain: Nonpharmacologic, Noninvasive Treatments.” American family physician vol. 102,8 (2020): 465-477. Chou, Roger et al. “Diagnosis and treatment of low back pain: a joint clinical practice guideline from the American College of Physicians and the American Pain Society.” Annals of internal medicine vol. 147,7 (2007): 478-91. doi:10.7326/0003-4819-147-7-200710020-00006 Vitoula, Kristallia et al. “Behavioral Therapy Approaches for the Management of Low Back Pain: An Up-To-Date Systematic Review.” Pain and therapy vol. 7,1 (2018): 1-12. doi:10.1007/s40122-018-0099-4 Deyo, R A, and J N Weinstein. “Low back pain.” The New England journal of medicine vol. 344,5 (2001): 363-70. doi:10.1056/NEJM200102013440508 van Middelkoop, Marienke et al. “Exercise therapy for chronic nonspecific low-back pain.” Best practice & research. Clinical rheumatology vol. 24,2 (2010): 193-204. doi:10.1016/j.berh.2010.01.002

This episode is brought to you by Set for Life Insurance - a trusted partner in disability insurance for physicians.  With Dr. Diaz Ramirez, you'll discover the power of mastering the art of entrepreneurship in the medical field. With a focus on designing your physician life and overcoming mid-career crisis, she shares valuable insights on creating a vision, adjusting your mindset, prioritizing wellness, and much more. The conversation also delves into the six pillars of entrepreneurship that are essential for success in your medical career and personal life. Enjoy! Looking for something specific? Here you go! 00:08:08 Self-exploration is key to entrepreneurship.  00:11:15 Six pillars for entrepreneurial success.  00:17:59. Physicians can overcome mental barriers.  00:21:11 Take ownership of your life.  00:29:44 Masterminds help overcome imposter syndrome.  00:33:51 Embrace change in physician life. More on Dr. Myrdalis Díaz-Ramírez: Dr. Myrdalis Díaz-Ramírez is a mom of twins, wife, Board-Certified Interventional Pain Physician, public speaker, podcaster, and creator of the Physician Entrepreneur maxAllure Mastermind. Her podcast “Design Your Physician Life” tells the stories of successful entrepreneurs and provides the listener with specific tips to help their journey as an entrepreneur. She's also a clinical professor at Florida State University College of Medicine and has co-authored and edited multiple book chapters related to anesthesiology and pain medicine. Dr. Díaz-Ramírez created the exclusive physician entrepreneur maxAllure Mastermind. In this venture, she helps physicians who might feel overwhelmed, lost, in need of a change, or looking to increase momentum in their current businesses, to gain confidence, feel empowered, and develop specific plans to gain control over their personal and entrepreneurial lives in just six months. Dr. Díaz-Ramírez graduated from medical school and finished her Internship in Anesthesiology at the University of Puerto Rico, Medical Sciences Campus. Then, she completed her Residency in Anesthesiology and Pain Medicine Fellowship at Oregon Health and Science University, where she was Chief Resident and, later, faculty. She has led the design of multiple pain programs and worked as medical director of the Comprehensive Pain Program for Sarasota Memorial Hospital and her clinic, the Comprehensive Pain Center of Sarasota, which is now part of the Sarasota Pain Relief Centers. Dr. Díaz-Ramírez has focused her practice on a comprehensive approach to her patients' care and led her private clinic to receive the honor of Centers of Excellence from the American Pain Society. Did ya know…  You can also be a guest on our show? Please email me at brad@physiciansguidetodoctoring.com to connect or visit www.physiciansguidetodoctoring.com to learn more about the show! Socials: @physiciansguidetodoctoring on FB  @physicianguidetodoctoring on YouTube @physiciansguide on Instagram and Twitter

Year Zero is a reader-supported publication. To receive new posts and support my work, consider becoming a free or paid subscriber.Leor Sapir is a scholar at the Manhattan Institute who has become a leading figure in the ongoing effort to bring accountability to a medical field that has run off the rails. In this episode of the Year Zero podcast, which was recorded in July, we discuss the fast evolving state of the legislative bans on child sex trait modification procedures and the wider project to bring an ongoing medical scandal to heel. Excerpts:Parallels between the opioid epidemic and pediatric gender medicine“There are really interesting parallels between the opioid epidemic and the gender medicine issue. In both cases, for example, it started with medical authority, citing very, very low quality studies, claiming that the use of opioids in cancer patients could be scaled at large, and that the same type of risk benefit ratio would would apply to other types of patients — patients who are not, for example, terminally ill, or even patients with a history of addictions and patterns of addictive behavior. And that, of course, turned out not to be the case. The medical associations got involved and also fueled the opioid epidemic, sometimes for good intentions, sometimes, as in the case of the American Pain Society, because they were influenced by Big pharma money. So there, I think in the case of the opioid epidemic, there was just a clear villain, and the villain was Purdue Pharma. And it was a villain that the American Left loves to hate. Big corporate interests that make money off of health care. Here, I wouldn't want to argue that there aren't kind of pharma interests involved in general medicine, of course, there are, it's a big business, and it's growing too. And we have some evidence that clinics and hospitals that do the procedures as opposed to the psychotherapy get a net benefit from them. And they also, of course, boost their scores on the Corporate Equality Index, and, you know, ESG, and all that stuff. So there's definitely a lot of institutional self interest in doing so called gender affirming care. But I wouldn't argue that the financial motives are primary here. I think that they they definitely play a role. But I would say that the ideology is by far and away the most important factor. But in any case, there are strong parallels to the opioid epidemic. And, you know, this is another example of how we don't learn our lessons.On the capture of American policymaking by the NGO Borg “The ACLU never has to face voters. It's accountable only to its own funders. And those funders are increasingly a small number of deep pocketed foundations, individuals or corporations that give money. And often these people either don't know what's going on or they are themselves highly ideological and out of tune with what what most Americans agree on. And so the first problem is that with the ACLU, there's no mechanism of accountability between these interest groups and the general public in a way that there is with political parties in the general public. The second problem is that these interest groups almost by definition, are going to get more and more extreme over time, right? Because they usually they're founded for a certain purpose, they have a strong sense of mission. And that sense of mission tends to attract people who are ideologically aligned with that mission. So if it's the ACLU — first of all civil liberties, then it was civil rights, now it's what you might call — what you have called “Successor Ideology.” If it's environmentalism, who's gonna go work at the Environmental Defense Fund, who is going to go work at at the UN — all these organizations: environmentalists, people who are very, very gung ho about environmentalism, and importantly, people who are willing to impose very costly policies on the public, because the kind of trade offs that they're willing to accept are much more extreme than the kind of trade offs that the average citizen would accept. So these groups, the ACLU, for example, will attract young, very ideological, very woke lawyers — people like Chase Strangio to its ranks and promote them. And so gradually, over time, these groups tend to become more and more extreme in their positions. And because of the way in which the American political system gives them so much power and so much leverage over the policy process, we end up with the politics of radical policymaking. So it's not that other countries don't have similar problems. But here in the United States, because of how our system of government works, these problems tend to be much more extreme and much more intractable.”Thank you for reading Year Zero. This post is public so feel free to share it. This is a public episode. If you'd like to discuss this with other subscribers or get access to bonus episodes, visit wesleyyang.substack.com/subscribe

In the latest episode of The Flip N' Shift Podcast, my guest is Dr. Tawny Kross. Dr. Tawny Kross, Pain Specialist of Kross Centered Care. Dr. Kross is a Doctor of Physical Therapy and a Pain Specialist. She has nearly a decade of experience at a Veteran's hospital in North Carolina working with patients that have some of the most complex chronic pain cases. Dr. Kross  believes passionately in our brain and body's innate ability to heal. She is SO excited to be able to share her knowledge with you now as a Pain and Wellness Coach.  Website:  https://www.drtawnykross.com Facebook: https://www.facebook.com/tawny.kross Instagram:  https://www.instagram.com/dr.tawny.kross Link Tree:  https://journals.lww.com/pain/Abstract/2022/02000 https://uspainfoundation.org/news/the-financial-and-emotional-cost-of-chronic-pain https://pubmed.ncbi.nlm.nih.gov/16896359 https://www.nytimes.com/2017/06/23/science/john-sarno-dead-healing-back-pain-doctor.html   Article and Publication Cite Sourcing: eyo RA, Weinstein JN. Low back pain. N Engl J Med. 2001;344(5):363-370. doi:10.1056/NEJM200102013440508; Chou R, Qaseem A, Snow V, et al. Diagnosis and treatment of low back pain: a joint clinical practice guideline from the American College of Physicians and the American Pain Society [published correction appears in Ann Intern Med. 2008 Feb 5;148(3):247-8]. Ann Intern Med. 2007;147(7):478-491. doi:10.7326/0003-4819-147-7-200710020-00006; Webster BS, Bauer AZ, Choi Y, Cifuentes M, Pransky GS. Iatrogenic consequences of early magnetic resonance imaging in acute, work-related, disabling low back pain. Spine (Phila Pa 1976). 2013;38(22):1939-1946. doi:10.1097/BRS.0b013e3182a42eb6 Koes BW, Van Tulder MW. Clinical Review, Diagnosis and treatment of low back pain.  Stewart M, Loftus S. Sticks and Stones: The Impact of Language in Musculoskeletal Rehabilitation. J Orthop Sports Phys Ther. 2018;48(7):519-522. doi:10.2519/jospt.2018.0610 Major NM, Helms CA. MR imaging of the knee: findings in asymptomatic collegiate basketball players. AJR Am J Roentgenol. 2002;179(3):641-644. doi:10.2214/ajr.179.3.1790641   Please subscribe to the Flip N' Shift Podcast Channels. Connect with us through The Flip N Shift website.   The Flip N Shift Self Healing Podcast is Now Available on ALL Podcast Platforms.   All audio formatted episodes will have corresponding visual/kinesthetic aides, tools and techniques available for download in our website.  (click on the link below)   https://www.flipnshift.com   The Instatie link will connect you to all of our social media platforms and podcast platforms.   https://www.instatie.com/FlipnShift-Podcast    

Excited to chat with Dr. Díaz-Ramírez about entrepreneurship, burnout, and creating Masterminding in the maxAllure Mastermind. Dr. Díaz-Ramírez talks about why successful entrepreneurs don't go it alone. Dr. Myrdalis Díaz-Ramírez is a mom of twins, wife, Board-Certified Interventional Pain Physician, public speaker, podcaster, and creator of the Physician Entrepreneur maxAllure Mastermind. Her podcast “Design Your Physician Life” tells the stories of successful entrepreneurs and provides the listener with specific tips to help their journey as an entrepreneur. She's also a clinical professor at Florida State University College of Medicine and has co-authored and edited multiple book chapters related to anesthesiology and pain medicine. Dr. Díaz-Ramírez created the exclusive physician entrepreneur maxAllure Mastermind. In this venture, she helps physicians who might feel overwhelmed, lost, in need of a change, or looking to increase momentum in their current businesses, to gain confidence, feel empowered, and develop specific plans to gain control over their personal and entrepreneurial lives in just six months. Dr. Díaz-Ramírez graduated from medical school and finished her Internship in Anesthesiology at the University of Puerto Rico, Medical Sciences Campus. Then, she completed her Residency in Anesthesiology and Pain Medicine Fellowship at Oregon Health and Science University, where she was Chief Resident and, later, faculty. She has led the design of multiple pain programs and worked as medical director of the Comprehensive Pain Program for Sarasota Memorial Hospital and her clinic, the Comprehensive Pain Center of Sarasota, which is now part of the Sarasota Pain Relief Centers. Dr. Díaz-Ramírez has focused her practice on a comprehensive approach to her patients' care and led her private clinic to receive the honor of Centers of Excellence from the American Pain Society.

In this episode, we were discussing how to build a Stepped Care Model for the treatment and intervention of chronic pain. The Stepped Care Model for chronic pain originated in the VA health system and has been used in a number of other places. This model prioritizes the role of primary care providers in optimizing pharmacological management as well as the timely and equitable access to patient-centered evidence-based non-pharmacologic approaches. Joining us to discuss this model is Dr. Matthew Bair. His principal research focuses on chronic pain, psychological comorbidity, and developing strategies to improve pain management in the primary care setting. He has a strong background in conducting clinical trials, developing and testing interventions that combine pharmacologic and non-pharmacologic treatments, and his funded work often contrasts pharmacological and behavioral approaches for pain management. He has served on several national Veterans Affairs committees related to improving pain management as well as the Clinical Practice Guideline Committee at the American Pain Society. He serves as an Editorial Board Member for Pain Medicine and the Journal of General Internal Medicine. In this episode, you will learn all about a Stepped Care Model for Chronic Pain, the effectiveness of a Stepped Care Model, and the impact of chronic pain amongst veteran populations. Without further ado, let's begin and let's meet Dr. Matthew Bair and learn about a Stepped Care Model for Chronic Pain.   Love the show? Subscribe, rate, review, and share! Here's How » Join the Healing Pain Podcast Community today: integrativepainscienceinstitute.com Healing Pain Podcast Facebook Healing Pain Podcast Twitter Healing Pain Podcast YouTube Healing Pain Podcast LinkedIn Healing Pain Podcast Instagram

Pediatric pain has been left on the back burner for decades now-- where many clinicians 30 years ago thought that infants did not feel pain. With the progress made, both in pain management and technology, it's about time that we call institutions to shift the culture, so we can work towards making pain visible-- so we can provide comfort to children patients that they desire and deserve.   In this episode, I've brought back Dr. Neil Schechter, to discuss his endeavor, ChildKind International. This passion project of his aims to have an open-access library to serve as a clearinghouse for information on pediatric pain research, and can serve as a reference to improve children's pain management.   ChildKind offers a certification for hospitals based on their commitment to and availability of certain measures to address pediatric pain and comfort adequately. Being certified, fosters trust from parents, promoting a positive experience for both patient and parent. In addition, with a pain management system throughout the institution contributes to higher staff retention and lower healthcare provider burnout.   With this huge step forward in creating accessible pain care, it's up to us as clinicians to offer the same amount of care for our patients regardless of where they present for their care -- because it is not only the pain team or service's responsibility. It is all our responsibility.    Takeaways In This Episode The current practices of handling pediatric pain What Childkind International is and what led to its creation How to enact change within the institution ChildKind's mission and 5 Principles ChildKind's role in promoting change and its benefits The importance of change from the top-down and bottom-up Pediatric pain is everyone's responsibility  Dr. Schechter's hopes for ChildKind and all healthcare institutions   Links Neil Schechter MD ChildKind International Connect with ChildKind International: Facebook  Instagram LinkedIn Pedia Pain Focus Epi # 53. Are you making the most of your "Golden Half-Hour" with your pain patients? Proactive Pain Solutions Physicians Academy Clinicians' Pain Evaluation Toolkit Proactive Pain Solutions   About the Guest    Neil Schechter, MD He is the President and CEO of ChildKind, an international organization dedicated to improving the quality of pediatric care. Currently, he directs the Chronic Pain Program at Boston Children's Hospital and is an Associate Professor of Anesthesia at Harvard Medical School. Dr. Schechter graduated with a medical degree and completed pediatric training at the University of Connecticut. He also did his fellowships at Children's Hospital and Harvard University in Boston. His research initially focused on documenting the under-treatment of pain in children and issues of pain that are associated with chronic disease. His research, later on, shifted to the common pains connected to pediatric practice and to create procedures to improve pain-related practice patterns in health care providers and institutions. Dr. Schechter is a passionate advocate for the betterment of pediatric pain care which allowed him to serve as a member of editorial boards and experts committees including the World Health Organization Committee and Palliative Care and the Task Force on Chronic Pain in Children of American Pain Society. He has also been the recipient of the Jeffrey Lawson Award for Advocacy in Children's Pain Relief from the American Pain Society.

Every child inevitably would experience pain in the course of their life, but if not addresses appropriately, these experiences can have long-lasting and detrimental effects which carry into adulthood. What's even more remarkable is that healthcare experiences including what we do  as part of healthcare as professionals is often a significant part of what causes pain and anxiety  for children.  Efforts to minimize distress, discomfort, pain and related anxiety  should be a priority in healthcare. What can healthcare professionals do to prevent, minimize, and ease a child’s fear, anxiety and pain over the medical procedures that they need to undergo as part of their treatment and care?   Join me in this episode as I talk about the prevention and treatment of pain caused by procedures within the hospital and healthcare settings with Stefan Friedrichsdorf, MD, medical director of the Center of Pain, Palliative and Integrative Medicine at the UCSF Benioff Children’s Hospitals in Oakland and San Francisco!   Dr. Stefan Friedrichsdorf, MD, FAAP is a Professor of Pediatrics at the University of California at San Francisco (UCSF).    Find out about his "Comfort Promise" and 4 simple steps that every healthcare professional should ensure to relieve or decrease pain and anxiety among kids who are undergoing treatment and minor or major procedures.  Dr Friedrichsdorf shares his experiences, findings, outcomes, implementation plan and even some of the common barriers as well as ways to address them often overlooked   Takeaways In This Episode: How Dr. Stefan got involved in pediatric pain Dr. Stefan talks about the prevention and treatment of pain caused by procedures in our hospital, and the staffs Situations where children in hospitalized settings are experiencing pain and anxiety from their treatment procedures The prevention and treatment of pain and anxiety caused by needles What is the “comfort promise”? The four steps to decrease pain and anxiety caused by vaccinations? How to get past the barrier of having our colleagues recognize that this issue of fear and anxiety brought about by treatment procedures is an important issue?   Links  Stefan Friedrichsdorf, MD FAAP LinkedIn Twitter His paper Clinicians Pain Evaluation Toolkit Proactive Pain Solutions   About the guest: Stefan Friedrichsdorf, MD FAAP   Stefan Friedrichsdorf is the medical director of the Center of Pain Medicine, Palliative Care and Integrative Medicine at the UCSF Benioff Children’s Hospitals in Oakland and San Francisco. He's a Professor of Pediatric at the UCSF.     Dr. Friedrichsdorf received the 2016 “Elizabeth Narcessian Award for Outstanding Educational Achievements in the Field of Pain” by the American Pain Society and the 2011 “Hastings Center Cunniff-Dixon Physician Award”. He was the medical director of the department of pain medicine, palliative care & integrative medicine at Children’s Minnesota from 2005-2020 and under his leadership the department grew into one of the largest and most comprehensive in the country. It received the “Circle of Life Award” by the American Hospital Association in 2008 and was the 2013 recipient of the “Clinical Centers of Excellence in Pain Management Award” by the American Pain Society and in 2018 the Albert Bandura Influencer Award from VitalSmarts.   He was the associate editor of the Journal of Pain and Symptom Management until 2020, the principal investigator of a National Institutes of Health (NIH) / National Cancer Institute (NCI) multisite study on the creation, implementation and evaluation of the Pediatric Palliative Care Curriculum “Education in Palliative and End-of-Life Care (EPEC)-Pediatrics”. In 2008 he founded and since then directs the annual Pediatric Pain Master Class, a unique week-long intensive course for interdisciplinary health professionals.   Dr. Friedrichsdorf has presented more than 750 lectures about pediatric pain medicine, palliative care and integrative medicine and has a track record of research and publications in the field, including more than 60 peer-reviewed articles and contributions to more than 25 books on the subject. He is president-elect of the Special Interest Group on Pain in Childhood of the International Association for the Study of Pain (IASP).   Dr. Friedrichsdorf received his MD degree from the Medical University of Lübeck, Germany, completed his pediatric residency at the University of Witten/Herdecke, Germany (Children’s Hospital Datteln), and undertook his fellowship in Pediatric Pain Medicine and Palliative Care at the University of Sydney, Australia (Children's Hospital at Westmead). He is double boarded in Pediatrics in Germany and the United States, a Diplomate of the American Board of Pediatrics, and trained in pediatric clinical hypnosis.  

Dr. Jennifer Rabbitts, MD a Board certified pediatric anesthesiologist and prolific pain researcher studies pain and health outcomes including the influence of sleep and other factors on pain outcomes in the short and long term. Sleep and pain have a bidirectional relationship, but it appears that sleep has the upper hand determining the sensitivity, intensity and duration of pain. Sleep as an important pillar of health, exerts its influence in many domains and many ways. In this episode she discusses her findings on the salient ways in which sleep influences pain and other health outcomes of children undergoing surgery, both in the immediate peri-operative and post-operative period.   Takeaways in This Episode How Dr. Rabbitts became interested in children's pain management Why it is important to be studying the relationship between sleep and pain Host of factors in the hospital which influence the quantity and quality of sleep during the peri-operative period The American Academy of Sleep Medicine recommendations on the optimal amount of sleep for children and adolescents and whether it should be altered around surgery Duration and stages of the impact of sleep disruptions after surgery Whether and how sleep may play a role in development of persistent and chronic pain How much reduction in sleep is needed for impacting the pain outcomes after surgery A surprising finding that completely surprised me about sleep disruption and opioids in adolescents  Recommendations for change in clinical practice around sleep and surgery Differences in the peri-operative outcomes of children with sleep disordered breathing/sleep apnea and children with acute sleep disruptions Dr Rabbitts' recommendations for clinicians around sleep in the peri-operative period   Links Jennifer Rabbitts, MD Contact Dr. Rabbitts : Email, twitter  American Academy of Sleep Medicine Clinicians Pain Evaluation Toolkit Proactive Pain Solutions   About the Guest Jennifer Rabbitts, MD Jennifer Rabbitts, MD is a board certified pediatric anesthesiologist and pediatric pain researcher at Seattle Children’s Hospital. She’s an Associate Professor of Anesthesiology at the University of Washington. Dr. Rabbits completed her medical school in South Africa and her residency and fellowship training at the Mayo clinic. Her work is focused on prevention and management of acute postoperative pain in children. Studying risk factors that predict which children will develop severe and longer lasting postoperative pain and investigating ways to modify them. Her research has earned her several awards even from her residency days and she’s also been the recipient of the young investigator award, the future leaders in Pain research award from the American Pain Society.

Meiltä on toivottu jaksoa opiodikriisistä ja tässä se tulee! Mielikuvat “hillbilly”-addiktista elävät vahvoina, mutta opioidien väärinkäyttö ja niistä johtuvat yliannostukset ovat koko Yhdysvaltojen ongelma. Vuonna 2019 amerikkalainen kuoli todennäköisemmin opioidiyliannostukseen kuin liikenneonnettomuuteen. Opioidit ovat vieneet myös monen tunnetun taiteilijan hengen (Tom Petty, Prince, Heath Ledger...RIP). Miten tähän pisteeseen on tultu? Miksi opioidit koukuttavat niin helposti? Miksi amerikkalaisten kivusta ja pahasta olosta on tullut kannattavaa bisnestä? Miksi Oxycontinia markkinoitiin aggressiivisesti amerikkalaisille vuosien ajan? Tätä(kin) aihetta käsittelemme tyylillemme uskollisina taustoittamalla ilmiön historiaa, nimeämällä valtaa väärin käyttävät tahot (tässä tapauksessa erityisesti Purdue Pharma, American Pain Society ja Joint Commission - kerromme näistä kaikista jaksossa lisää) sekä pohtimalla sanojen ja mielikuvien merkitystä (aggressiivisin tarinankertoja voittaa usein Yhdysvalloissa). Keskustelemme myös sairaalamaailmasta ja siitä, miltä opioidikriisi on näyttänyt sairaanhoitajalle. Laura jakaa läheltä piti-tilanteen lenkkipolulla alligaattorin kanssa ja kertoo miten Skam-sarja on pelastanut koko viikon. Ensi viikolla vietämme kevätlomaa, palataan siis muutaman viikon päästä :)

Join us this week with Dr. Forrest Tennant, a pioneer in the management of neuro-inflammatory disorders of the spine, and specifically adhesive arachnoiditis. Previously thought to be a hopeless diagnosis, Dr. Tennant has created several novel protocols which have provided hope and relief to thousands of patients suffering from these diseases of the spine.Forest Tennant, MD, DrPH, is an internist and addictionologist who has spent his medical career researching and treating intractable pain. He managed the Veract Intractable Pain Clinics in West Covina, California, from 1975 (originally focused on cancer pain and post-polio disease) to 2018. Dr. Tennant served as the editor-in-chief of Practical Pain Management from 2007 through 2017 and continues to hold an Emeritus honor with the journal. Today, he leads the Tennant Foundation and its Arachnoiditis Research and Education Project.Dr. Tennant is a member of the American Academy of Pain Medicine, the Academy of Integrative Pain Management, the American Pain Society, and the American Society of Addiction Medicine. He has authored over 300 scientific articles and books. He formerly served as a Medical Officer in the US Army and US Public Health Service, and was a consultant to the FDA, National Institute on Drug Abuse, and Drug Enforcement Administration, as well as to the LA Dodgers, National Football League, and NASCAR.Connect with us:- Bobby's LinkedIn - https://www.linkedin.com/in/bobby-koneru-md-6873198- Bobby's Twitter - https://twitter.com/konerumd- Deepti's LinkedIn - https://www.linkedin.com/in/deepti-agarwal

Dr. Neil Schechter, MD, shares what the patients and families report as the most important and helpful elements during their pain care visit and what they desire from clinicians. Additionally, he shares the practical tips to engage patients and families and how to effectively provide feedback during a pain evaluation even for the most complex patients. Takeaways in This Episode Dr. Neil Schechter's journey from developmental pediatrics to pediatric pain management. What parents of children with chronic pain report as the most important  and helpful elements in their pain care visits Why these elements are felt to be equally if not more important than any medications, procedure or treatments modalities Providing context of pain and its nuances for parents and healthcare professionals. The impact of what healthcare professionals say to patients and families. Importance of feedback during a pediatric pain care visits 3 Key components of feedback for patients and families during a pediatric pain care evaluation Ways to create a lasting impact from your feedback Keys to professional longevity with particular tips for pediatric pain professionals. Dr Schechter's advice for healthcare professionals caring for children's pain Links Neil Schechter, MD Pedia Pain Focus Episode #8. What Patients Want More Than Any Scripts or Tests The Golden Half Hour in Chronic Pediatric Pain-Feedback as the First Intervention ChildKind International Chronic Pain & Illness Workbook for Teens When Your Child Hurts Clinicians' Pain Evaluation Toolkit Proactive Pain Solutions   About the Guest Speaker Neil Schechter, MD Neil Schechter, MD is the Director of Chronic Pain Clinic; Senior Associate in Pain Medicine, in the Department of Anesthesiology, Critical Care and Pain Medicine at Boston Children's Hospital. He's an Associate Professor of Anesthesia at Harvard Medical School. Dr. Schechter received his medical degree from the University of Connecticut. He completed pediatric training at the University of Connecticut and fellowships in psychosomatic pediatrics and developmental pediatrics at Children’s Hospital and Harvard University in Boston. He has authored over 120 articles and is the senior editor of Pain in Infants, Children, and Adolescents, the major multi-disciplinary textbook in the area of pediatric pain. He has served on a number of editorial boards and expert committees in the area of pediatric pain including the World Health Organization Expert Committee on Pediatric Pain and Palliative Care, the Task Force on Chronic Pain in Children of the American Pain Society, and the Rome IV Committee on Pediatric Functional Gastrointestinal Disorders. He has given numerous named lectureships and received the Jeffrey Lawson Award for Advocacy in Children’s Pain Relief from the American Pain Society. Dr. Schechter’s initial research focus was on documenting the under-treatment of pain in children and attempting to understand its origin. He then became involved in issues of pain associated with chronic disease where his research focused on sickle cell disease and on painful procedures in children with chronic disease. Most recently, he has become interested in the more common pains associated with pediatric practice such as injection pain and functional pain syndromes as well as developing strategies to alter pain-related practice patterns in health care providers and institutions. He is the President & CEO of ChildKind, a global initiative to reduce pain in children’s healthcare institutions.

Since the COVID-19 pandemic, use of digital technology in healthcare has become commonplace, but Dr. Tonya Palermo, PhD has spent more than 2 decades researching and developing digital interventions for management of children's pain. In this episode she discusses the origin and development of her free app for self management of pediatric pain, WebMAP, its components, who its applicable for and how healthcare professionals can use it in their clinical practice to empower and equip their patients and families with self management strategies.      Takeaways in This Episode How serendipity got Dr. Palermo on the path to becoming the most prolific researcher in pediatric pain Dr. Palermo's first foray into digital interventions for accurate measurement of pediatric pain using a palm pilot, for patterns of pain and patterns of activity limitation. Use of website to collect data and offer simple interventions for kids and families living in remote areas. Surprising finding she saw in relation to acceptance and outcomes from these interventions The platform to deliver interventions designed to improve pain care and lifestyle interventions that promote wellness and change in behaviors (Hint: Psychology based interventions). Precursor to the WebMAP program and its progression What WebMAP is, who it is for, and how HCPs can integrate it in clinical care. (Tips Sheet included in the links link) What they did to ensure and drive patient/parent engagement Uniques feature and opportunities for improvement of WebMAP Challenges  associated with use of m-health and digital interventions in healthcare Whats working and what she’s focused on now and in future How she manages to do it all and what advice she has for the aspiring professionals Links Tonya Palermo, PhD Contact Dr. Tonya Palermo Pediatric Pain and Sleep Innovations Lab WebMAP Mobile App Tip Sheet for Healthcare Professionals Solutions for Kids in Pain (SKIP) Proactive Pain Solutions Physicians Academy Cognitive Behavioral Therapy for Chronic Pain In Children and Adolescents Managing your Child's Chronic Pain About the Speaker Tonya Palermo, PhD Dr. Tonya Palermo is a professor of anesthesiology, pediatrics and psychiatry at the University of Washington School of Medicine. She serves as associate director for the Center for Child Health, Behavior and Development. Palermo’s longstanding NIH-funded research program has focused on assessment and treatment of chronic pain in children and adolescents. She is specifically interested in cognitive-behavioral interventions; delivery of psychological treatment via eHealth and mHealth interventions; sleep disturbances; and parent/family factors as they relate to pain treatment. Through her work as program director for the University of Washington Anesthesiology T32 program and for the Psychology Postdoctoral Fellowship Program in Pain Research, Palermo is active in training clinician–scientists at the postdoctoral and junior faculty level. Palermo serves on the executive boards of the Society of Pediatric Psychology and the American Pain Society, serves as editor of the Journal of Pediatric Psychology and has been elected a fellow of the American Psychological Association. She also serves as a member of the advisory council for the Center for Scientific Review at NIH.

Overcome chronic pain with Dr. Paul Christo. Dr. Christo is one of the world's leading pain specialists and author of Aches and Gains, A Comprehensive Guide to Overcoming Your Pain. He’s an Associate Professor in the Division of Pain Medicine at the Johns Hopkins University School of Medicine. He served as Director of the Multidisciplinary Pain Fellowship Program for 8 years, and the Blaustein Pain Treatment Center for 5 years at the Johns Hopkins Hospital. He hosts an award-winning, nationally syndicated SIRIUS XM radio talk show on overcoming pain called, Aches and Gains. Naomi Judd, Joe Montana, and Maya Angelou have all been guests. His show has earned him the John and Emma Bonica Public Service Award from the American Pain Society, recognizing distinguished contributions to the field of pain medicine through public education, dissemination of information, and public service. Dr. Christo was selected as a Mayday Pain and Society Fellow and named a “Hero” by The Pain Community, a patient advocacy association for his work on Aches and Gains. He was also honored by the American Society of Pain Educators as Pain Educator of the Year for his transformational work on public education through the media. Today we talk with Dr. Paul to ask the question, are you ready to overcome chronic pain?

Prasad Shirvalkar, MD, PhD, Assistant Professor, UCSF School of Medicine Dr. Prasad Shirvalkar is a neurologist and interventional pain medicine specialist who provides the full spectrum of care for chronic pain conditions. This includes conservative, nonsurgical treatments such as medications and nerve blocks (anesthetic injections near nerves that are sending pain signals). He also treats patients with advanced neuromodulation therapy by implanting peripheral and spinal cord stimulators, which are devices that relieve pain by sending electrical signals to the spine. Shirvalkar cares for hospitalized patients and provides telemedicine visits for established patients. He coordinates with other providers for each patient, collaborating to treat any pain condition. Shirvalkar's research aims to develop new therapies for hard-to-treat pain disorders, such as post-stroke pain and phantom limb pain, by harnessing technologies such as brain and spinal cord stimulation. He is conducting a study using electrodes implanted in the brain to understand how individuals interpret pain signals, with the goal of personalizing brain stimulation therapies. He is also interested in how sudden, severe pain episodes can progress to become chronic and in whether early intervention can prevent chronic pain. Shirvalkar earned his doctoral and medical degrees at Icahn School of Medicine at Mount Sinai. He then completed a residency in neurology at Weill Cornell Medicine and Memorial Sloan Kettering Cancer Center, where he served as chief resident. He completed a fellowship in pain management at UCSF. Shirvalkar belongs to the American Academy of Neurology, American Pain Association, American Pain Society, American Society of Anesthesiologists, International Neuromodulation Society and North American Neuromodulation Society, where he serves on the scientific program committee. In addition to medicine and science, Shirvalkar has a passion for percussion. He plays jazz drums in his free time and used to play with the Oakland Raiders' band.

Have you heard about it before? Right now you are going to learn about one of the most important associations when it comes to chronic pain management. Today, Penney Cowan, founder and CEO of the American Chronic Pain Association, joins us to talk about the reasons why she decided to found it, what are its present projects, and what is really important if a person is dealing with chronic pain. Penney Cowan is the founder and CEO of the American Chronic Pain Association (ACPA), which provides peer support and education in pain management skills to people with pain and their families; and works to build awareness about chronic pain among professionals, decision-makers, and the general public. Ms. Cowan is a recognized speaker advocating a multidisciplinary approach to pain management. Most recently she is a Co-founder and Board Member of the World Patients Alliance. She has been an advocate and consumer representative for pain issues and received numerous awards from organizations, such as the Institute for Public Service, American Pain Society, and American Academy of Pain Medicine.

Have you heard about it before? Right now you are going to learn about one of the most important associations when it comes to chronic pain management. Today, Penney Cowan, founder and CEO of the American Chronic Pain Association, joins us to talk about the reasons why she decided to found it, what are its present projects, and what is really important if a person is dealing with chronic pain. ABOUT TODAY'S GUEST - PENNY COWAN Penney Cowan is the founder and CEO of the American Chronic Pain Association (ACPA), which provides peer support and education in pain management skills to people with pain and their families; and works to build awareness about chronic pain among professionals, decision-makers, and the general public. Ms. Cowan is a recognized speaker advocating a multidisciplinary approach to pain management. Most recently she is a Co-founder and Board Member of the World Patients Alliance. She has been an advocate and consumer representative for pain issues and received numerous awards from organizations, such as the Institute for Public Service, American Pain Society, and American Academy of Pain Medicine.

Donald Murphy, author of Clinical Reasoning In Spine Pain, was the guest today. We cover how he was able to successfully integrate high quality spine care into a hospital setting and his mission to develop an army of high quality professional called the Primary Spine Practitioner (PSP). Check out the PSP Program at the University of Pittsburgh here. CRISP Education and Research site Dr. Donald Murphy DC Bio: Dr. Murphy is a chiropractic physician with over 30 years of experience in practicing, teaching and consulting in Primary Spine Care. Dr. Murphy is Clinical Assistant Professor in the Department of Family Medicine at Alpert Medical School of Brown University and Adjunct Assistant Professor, Department of Physical Therapy, University of Pittsburgh. His other faculty appointments include Professor, Part-Time University Faculty at Southern California University of Health Sciences and Adjunct Associate Professor of Research at New York Chiropractic College. Dr. Murphy has been admitted as a Fellow of the Royal College of Chiropractors in the United Kingdom. He has also served on the Expert Panel for several spine care guidelines, including those of the American College of Environmental and Occupational Medicine, American College of Physicians and American Pain Society. Dr. Murphy has nearly 100 publications in peer-reviewed scientific journals and book chapters. He teaches in the certification course for Primary Spine Practitioners offered by the University of Pittsburgh. His recent books, Clinical Reasoning in Spine Pain, Volume I and Volume II serve as the required texts for that course for Primary Spine Practitioners offered by the University of Pittsburgh. His recent books, Clinical Reasoning in Spine Pain, Volume I and Volume II serve as the required texts for that course. His consulting activities include assisting hospitals, healthcare systems and insurers implement high-value spine care services through Spine Care Partners, LLC and providing consulting services for existing and aspiring Primary Spine Practitioners through the Primary Spine Practitioner Network . He also provides Primary Spine Practitioner training services to chiropractic and physical therapy institutions to assist them in developing a course leading to PSP Certification as well as Expert Witness and other medicolegal services.

The Knee Bone’s Connected to the... Musculoskeletal (MSK) pain conditions are the leading cause of disability worldwide, and this year’s American Pain Society track will explore the latest evidence addressing measurement, mechanisms, and management of MSK pain conditions. Among the most prevalent MSK pain conditions is knee osteoarthritis (OA), which is the leading cause of pain and disability among older adults. A brief overview of peripheral mechanisms and treatments, along with the epidemiology and clinical characteristics of knee OA, will be discussed in this course. Knee OA has historically been viewed as a regional pain condition driven by peripheral input due to arthritis changes in the knee joint. Accordingly, treatments have primarily focused on targeting peripheral changes. However, burgeoning evidence suggests that central pain processing is substantively altered among knee OA sufferers, raising the possibility that peripherally focused treatments may be ineffective for some proportion of these patients. Findings from studies using quantitative sensory testing and neuroimaging to examine central mechanisms related to knee OA will be presented. Because knee OA appears to disproportionately affect specific population groups, with African Americans at increased risk for OA related pain and disability, findings regarding ethnic group differences in OA pain and associated contributing factors will be discussed. The session will conclude with a summary of findings and recommendations to adopt a biopsychosocial approach to assessment and treatment of knee OA. (Recorded at PAINWeek 2018)

Tim and Jeff are joined by Dr. Roger Chou on this week's episode of Pain Reframed! A professor and physician at Oregon Health & Science University (OHSU), Dr. Chou was part of the team that developed the CDC's Guideline for Prescribing Opioids for Chronic Pain in 2016. More recently, he co-published an editorial in the New England Journal of Medicine, examining the current state of opioid prescribing in the United States. Tim, Jeff, and Dr. Chou discuss the impact of both of these works and the steps we can take in our clinics to make sure we're always putting the patient first.  Dr. Roger Chou is a Professor in the Departments of Medicine, and Medical Informatics & Clinical Epidemiology at Oregon Health & Science University (OHSU) School of Medicine, and Staff Physician in the Internal Medicine Clinic at OHSU. He has served as Director of the Pacific Northwest Evidence-based Practice Center since 2012. He has conducted systematic reviews in a number of areas, including chronic pain and musculoskeletal conditions, screening and prevention, diagnostic testing, and prognosis. He has served as Director of the American Pain Society clinical guidelines program, the GRADE methodologist for the World Health Organization’s Division of Reproductive Health, is a member of the Cochrane Back Review Editorial Board, and co-chair of the National Quality Forum Musculoskeletal Standing Committee. Dr. Chou is on several journal editorial boards and is an author on numerous scientific articles published in peer-reviewed journals. LINKS: Twitter - @ISPITeam No Shortcuts to Safer Opioid Prescribing (New England Journal of Medicine) Learn more about the roles that physical therapists and physical therapy assistants can play in reducing the opioid epidemic

Whether you are a practitioner or a patient interested in learning more about psychological informed care, you will benefit a lot from Dr. Beverly E. Thorn’s research which focuses on investigating the important components of cognitive behavioral therapy for chronic pain. Beverly is Professor Emerita of psychology at the University of Alabama. She is the recipient of the 2018 Wilbert E Fordyce Clinical Investigator Award from the American Pain Society. She explains why the cognitive model is important in the treatment of chronic pain care, what should be included in cognitive treatment for chronic pain, and how many sessions are required to see meaningful change. She also touches on the importance of motivational enhancement and assertiveness, why treatments designed for those with pain should be simple and accessible, as well as some of the mechanisms, the similarities, and the differences between cognitive behavioral therapy and mindfulness approaches for chronic pain. Sign up for the latest episode at www.drjoetatta.com/podcasts.   Love the show? Subscribe, rate, review, and share! Here’s How » Join the Healing Pain Podcast Community today: drjoetatta.com Healing Pain Podcast Facebook Healing Pain Podcast Twitter Healing Pain Podcast YouTube Healing Pain Podcast LinkedIn

Dr. Greg Dussor is an Associate Professor in the School of Behavioral and Brain Sciences at the University of Texas, Dallas. He is also a neuroscientist with the startup company Ted’s Brain Science Products which develops non-opioid pain management products. His research focuses on identifying the mechanisms of chronic headache pain and identifying potential therapeutic targets. Greg’s interests outside the lab include wine and coffee. He enjoys trying different kinds of wine and has gotten into the habit of experimenting with espresso each morning. Greg received his B.S. in biochemistry from the University of Alabama and his PhD in Pharmacology from the University of Texas Health Science Center, San Antonio. Greg conducted postdoctoral research at the Vollum Institute of Oregon Health and Science University. He worked as a faculty member at the University of Arizona College of Medicine before coming to Dallas. Greg is the recipient of the University of Texas Health Science Center, San Antonio Department of Pharmacology Award for Academic Excellence, the Future Leaders in Pain Research Award from the American Pain Society, and the Vernon and Virginia Furrow Award for Excellence in Graduate Student Education from the University of Arizona. Greg is here to chat with us about his experiences in science and life in general.

This Month in AJN – January 2018 monthly highlights January 2018 Editor-in-Chief Shawn Kennedy and Clinical Editor Betsy Todd present the highlights of the January issue of AJN. The authors of our first CE, “Oral Care for Head and Neck Cancer Symptom Management,” describe an evidence-based practice change at a radiation oncology center designed to reduce the severity of oral mucositis in adults receiving radiation treatment for head and neck cancer. Our second CE, “Managing Postoperative Pain,” reviews the recommendations of the American Pain Society's postoperative pain management guideline, and discusses its historical context and the current events that may affect its implementation in clinical practice. Our next article, “Original Research: Increasing the Connectivity and Autonomy of RNs with Low-Risk Obstetric Patients,” describes a study that explored the perspectives of patients, RNs, certified nurse midwives, and other providers regarding a new prenatal connected care model aimed at reducing in-office visits and creating virtual patient–RN connections. “Professional Development: Predatory Journals: Alerting Nurses to Potentially Unreliable Content” provides information for nurses on predatory journals and their harmful practices, plus online search strategies for identifying and avoiding the content published in these journals. In addition, there's News, Reflections, Drug Watch, Art of Nursing, and more.

This Month in AJN – January 2018 monthly highlights January 2018 Editor-in-Chief Shawn Kennedy and Clinical Editor Betsy Todd present the highlights of the January issue of AJN. The authors of our first CE, “Oral Care for Head and Neck Cancer Symptom Management,” describe an evidence-based practice change at a radiation oncology center designed to reduce the severity of oral mucositis in adults receiving radiation treatment for head and neck cancer. Our second CE, “Managing Postoperative Pain,” reviews the recommendations of the American Pain Society’s postoperative pain management guideline, and discusses its historical context and the current events that may affect its implementation in clinical practice. Our next article, “Original Research: Increasing the Connectivity and Autonomy of RNs with Low-Risk Obstetric Patients,” describes a study that explored the perspectives of patients, RNs, certified nurse midwives, and other providers regarding a new prenatal connected care model aimed at reducing in-office visits and creating virtual patient–RN connections. “Professional Development: Predatory Journals: Alerting Nurses to Potentially Unreliable Content” provides information for nurses on predatory journals and their harmful practices, plus online search strategies for identifying and avoiding the content published in these journals. In addition, there’s News, Reflections, Drug Watch, Art of Nursing, and more.

Episode 7 The one with Dr. Antonio Rozier Today we talk health and wellness with Dr. Antonio Rozier! Because of Dr. Rozier’s outstanding work in the healthcare industry, he serves as a diplomat of the American Board of Physical Medicine and Rehabilitation. Apart from that, he is an active member of the American Academy of Physical Medicine and Rehabilitation, International Spine Intervention Society, and American Pain Society. He lectures frequently throughout the DFW Metroplex on musculoskeletal pain, osteoporosis, and physical fitness. Apart from his educational and professional feats, Dr. Rozier practices mixed martial arts and is a health coach. Finally, Dr. Rozier is the founder of the Zen Interventional Pain and Wellness Center.  You can find him through his website: http://www.roziermd.com  He’s a great guy and we really enjoyed our conversation! Our intro music is provided by Lish and titled “One of those Days” You can find more of their awesome work on through their facebook page: https://www.facebook.com/lishmusic/ Our feature tracks are provided by Desert Dwellers. Today’s feature is titled “Wings of Waves (Liquid Stranger Remix)” You can find them through their website: http://desertdwellers.org/ As always please check us out at http://ascendedminds.net to connect and join our Tribe! We rely on your generous support to help us grow and continue our journey. You can donate through our website and Patreon or you can support us by connecting, sharing, and reviewing what we’re doing! Thank you for all your support regardless of the form it takes! We’re blessed and grateful for each of you! Blessed Be!

Methadone is a very useful opioid that indisputably requires careful attention to dosing and monitoring. In this fast paced presentation, participants will learn about the American Pain Society guidelines for the safe and effective use of methadone and how those guidelines should be applied for patients with an advanced illness. Using a case based approach, participants will explore methadone dosing in opioid naïve and opioid tolerant patients, how to adjust a calculated dose based on patient related variables (eg, comorbid conditions, concurrent drug therapy), and how to use methadone in an adjunctive role. As if that weren't controversial enough, participants will also learn about medical cannabis, including its proposed indications, mechanism of action, adverse effects, and role in management of patients with chronic noncancer pain or an advanced illness. Methadone and marijuana--all you need now is potato chips!