Day 2 :
Keynote Forum
Traci Patterson
Advanced Pathways Hypnosis, USA
Keynote: The effectiveness of using Hynposis Combined Therapy (HCT) for the treatment of chronic pain (CRPS, fibromyalgia, neuropathic pain, etc.)
Time : 10:30-11:00
Biography:
Traci A Patterson, Owner and Founder of Advanced Pathways Hypnosis, Irvine, CA, is an Instructor and Clinical Hypnotherapist, who specialized in chronic pain and PTSD. Her interests include: Complex Regional Pain Syndrome (CRPS), Fibromyalgia, neuropathic pain, cancer patients and PTSD. She holds her hypnosis/hypnotherapy credentials through National Guild of Hypnotists and is internationally credentialed. She also holds a Doctorate degree from University California, Irvine. She comes to the field from a perspective that few others have, as she was formerly diagnosed herself with CRPS, and spent the better part of the next seven years traveling the world, both literally and figuratively, in search of solutions for a disease which traditional medicine says has no cure.
Abstract:
Introduction: Chronic pain is currently affecting more than 100 million people in the US alone, and the figures continue to grow exponentially. Chronic pain conditions can include CRPS, Fibromyalgia, neuropathic pain, and chronic migraines. Researchers have shown that chronic pain affects the way your brain processes pain signals through the limbic system.
Objective: The objective is to discuss the effectiveness of Hypnosis Combined Therapy (HCT), by having chronic pain patients complete a week long intensive.
Aim: The aim is to establish the efficacy of HCT in the treatment of chronic pain.
Case Studies: A) 51 year old female diagnosed with Fibromyalgia for 30 years. When she arrived her average pain level was 9/10 (10 being worst pain imaginable), sleep quality 9/10 (10 being worst) and quality of life 8/10 (10 being worst). She completed a week long intensive with HCT. At the conclusion of the week her pain levels were 0/10, sleep quality was 0/10 (10 being worst) and quality of life 1/10 (10 being worst). B) 27 year old female diagnosed with CRPS type 1. When she arrived her average pain level was 9/10 (10 being worst), sleep quality 7/10 (10 being worst) and quality of life 7/10 (10 being worst). At the conclusion of the week her pain levels were 0/10 (10 being worst), sleep quality 0/10 (10 being worst) and quality of life 1/10 (10 being worst).
Conclusion: HCT has proven to significantly decrease pain levels and improve the lives of chronic pain patients without the need for invasive procedures or medications.
Keynote Forum
Rose Berkun
Jacobs School of Medicine and Biomedical Sciences, USA
Keynote: Opioid Addiction and Treatment
Time : 11:00-11:30
Biography:
Rose Berkun is an Assistant Professor of Anesthesiology at Jacobs School of Medicine and Biomedical Sciences in Buffalo, New York. She is a President Elect for New York State Society of Anesthesiologists. She is an owner and President of Northeast Ambulatory Anesthesia, PLLC, a company specializing in Office Based Anesthesia services. She is a graduate of SUNY at Buffalo School of Medicine as well as SUNY at Buffalo Anesthesiology Residency program. She is a Medical Director of Anesthesia services for several medical groups in Buffalo, including Aesthetic Associates Center, Dent Neurologic Institute and Buffalo Cancer Center. She is actively involved in several societies, including the American Medical Association, American Society of Anesthesiology and New York State Society of Anesthesiologists.
Abstract:
Addiction is a chronic disease, just like hypertension and diabetes. Since 1999, the rate of overdose deaths involving opioids (including prescription opioid pain relievers and heroin) nearly quadrupled. 78 Americans die every day from an opioid overdose. Deaths from prescription opioids-drugs like oxycodone, hydrocodone, and methadone—have also quadrupled since 1999 and now account for the number one cause of accidental death, surpassing motor vehicle accidents. In 1996, the American Pain Society (APS) introduced the phrase “pain as the 5th vital sign". In 2001, the Joint Commission rolled out its Pain Management Standards, which helped grow the idea of pain as a "fifth vital sign." It required healthcare providers to ask every patient about their pain, given the perception at the time was that pain was undertreated. On December 12, 1995, the Food and Drug Administration approved the opioid analgesic OxyContin. It was advertized as a safer, less addictive opiate analgesic because of its longer half life. It hit the market in 1996. In its first year, OxyContin accounted for $45 million in sales reaching $3.1 billion by 2010. Since that time, the U.S. has experienced a surge in opioid prescriptions -- and, subsequently, an increase in overdoses and deaths tied to these painkillers. Because of this crisis and a shortage of addiction specialists, ABMS approved a new Addiction Medicine multi-specialty subspecialty for Preventive Medicine and a certificate exam open to 24 medical specialties. American Medical Association vowed to advocate for a removal of "pain as the fifth vital sign" from all patient assessments and surveys. States are working at local levels to help physicians treat opioid addicted patients in their own practices.
- Chronic Pain Medication
Location: Mississippi Amph
Chair
Amit Mirchandani
Texas Cell Institute, USA
Co-Chair
Salaheldin Halasa
Nitromedicine, USA
Session Introduction
Pernilla Qvarfordh
Rigshospitalet Glostrup, Denmark
Title: Should patients walk from the postanesthesia care unit to the general ward after a lumbar discectomy? A randomized study
Time : 11:50-12:15
Biography:
Not Available
Abstract:
Background: Postoperative immobilization is associated with a higher risk of heart and lung complications, loss of muscle mass and prolonged stay in hospital. To reduce these risks, the fast track surgery concept has been introduced. It is well documented that early mobilization after surgery, as well as an increased time out of bed each day, reduce the patient's risk of postoperative complications and improves their well-being. However, early mobilization may be a challenge to the patient. Symptoms such as nausea, vomiting, pain, dizziness, and fainting may hinder early mobilization. In many hospitals patients are mobilized postoperatively only after several hours in the general ward.
Aim: The aim of this randomized pilot study was to investigate whether it was feasible and safe to mobilize patients shortly after lumbar disc surgery with the objective of reducing postoperative complications and allowing shorter hospitalization.
Methods: The patients were randomized into two groups. Those in the intervention group used a walking frame to walk, with a porter and a nurse, from the post-anesthesia care unit to the general ward. Patients in the control group were transported in their beds. The Bournemouth Questionnaire was used to define the well-being of the patients. 22 patients were included, 11 in each group. Due to the limited number of patients statistical comparisons were not performed. However, patients in the walking group were mobilized earlier than the controls and needed fewer painkillers and less oxygen supplement during the first postoperative day.
Results: The length of stay and the number of postoperative complications were similar in the two groups as tested during the three weeks after surgery.
Conclusion: In conclusion we found that it might be feasible and safe to mobilize patients shortly after lumbar disc surgery. The need for opioid consumption and oxygen supplementation was reduced, and might improve the patient´s well-being. There were no indications of an increased number of postoperative complications.
Sahil Patel
Pain Management, Gujarat, India
Title: The ultimate solution of joint pain us-fda approved joint pain relieving harbal “churna†for osteoarthitis, rheumatoid arthritis, spondilytis and other joint pain
Time : 12:15-12:40
Biography:
Abstract:
Aim : To find the effectiveness of the "Churna" as an alternative treatment to any invasion in joints for the Pain relief of Osteoarthritis, Rheumatoid arthritis and / or any kind of Joint Pain.
Methodology : A study was carried out where 889 patients of Osteoarthritis, Rheumatoid Arthritis, Ankylosing Spodylosis, Chronic Spodylitis & Frozen Shoulder of age group between 29 to 94 yrs were given 10gms of sachets of the "Churna" two times a day for 12-15 month period.
Mechanism of Action: This "Churna" containing 9 natural phytonutrients exerting synergistic activities on body, reducing inflammation and pain by inhibiting prostaglandin synthesis, suppressing cyclooxygenase-1, cyclooxygenase 2, 5-lipoxygenase and cytokines and neutralizing leukocyte elastase and free radicals by inhibiting lipid peroxidation and raising levels of Vitamin C. This "Chuma" promotes healing of joints by stimulating peripheral and collateral circulation, inhibiting platelets aggregation, reducing synovial fluid leucocyte count and lowering elevated serum transarninase levels and erythrocyte sedimentation rates, and supplying lysine to help maintain nitrogen balance in body.
Results : Eleven out of 889 patients had partial pain relief around 30-50% with the "Churna" as they left the treatment in the middle of treatment period. Total 98.76 percentage of the patient who completed stydy period of 12-15 months exhibited complete pain relief on use of the "Churna" without any noticeable side effects.
Conclusion: For painful joint treatments, Ozone treatment, LAHC injections, Prolotherapy requires invasion of joint, and long term NSAID use has known systemic side effects. Here, simple oral intake of the "Churna" to relieve joint pain without any kind of joint invasion or visible systemic side effects was achieved successfully in 878 out of 889 patients proving its effectiveness.
- Pain Medication
Location: Mississippi Amph
Chair
Amit Mirchandani
Texas Cell Institute, USA
Co-Chair
Salaheldin Halasa
Nitromedicine, USA
Session Introduction
Blanca de la Cruz
University of Seville, Spain
Title: Therapeutic physical exercise for lower limb overpronation in young athletes
Biography:
De la Cruz has completed her PhD from University Pablo de Olavide, Seville, Spain. She has a Masters in Physical Activity and Sport Sciences from University of Granada (Spain) and a Bachelor in Physical Therapy from University of Seville (Spain). She has published more than 10 papers in reputed journals and has been serving as a reviewer of reputed journals. She is coordinator of Sport Physiotherapy Group of SAMEDE.
Abstract:
Introduction: There is a growing prevalence of biomechanical alterations in the lower limbs in school-age children. The aim of this study was to assess the effectiveness of a therapeutic exercise program (TEP) in child athletes with lower limb overpronation during gait.
Method: Relevant databases (PubMed and SCOPUS) were used. A total of 123 young athletes (aged 9–12 years) were evaluated, of which 20 had lower limb overpronation (n=40 lowers extremities). All subjects underwent biomechanical analysis including all relevant angles, as follows: the Helbing angle, the tibiofemoral angle, and the Fick angle in both limbs. The sample was randomly allocated to: a control group (CG=10 subjets) whose no had treatment for three months; and an experimental group (EG10 subjects) whose the children participated in a TEP intervention program for three further months.
Results: At the beginning, a CG had tibiofemoral angle169.34±0.87º, helbing angle 10.08±4.02º and fick angle 6.93±3.00º; and EG had tibiofemoral angle168.80±1.98º, helbing angle 10.65±4.17º and fick angle 5.35±3.00º. After the intervention, a CG had tibiofemoral angle 168.92±1.73º, helbing angle 9.25±3.16º and fick angle 8.95±3.49º; and EG had tibiofemoral angle 172.75±2.45º, helbing angle 5.05±1.36º and fick angle 11.58±1.50º. In EC, all biomechanical parameters significantly improved (p<0.001 for three angles), and all subjects in the case group adopted a nearly normal gait pattern.
Conclusions: Our three-month TEP-based intervention was efficient in making young athletes with a pathological gait pattern adopt a normal gait pattern.
Agnieszka Tymecka-Woszczerowicz
Medical University of Warsaw, Poland
Title: Indirect costs of back pain internationally
Biography:
Agnieszka Tymecka-Woszczerowicz obtained Master of Pharmacy Degree at the Medical University of Gdansk, Poland. Her researches were carried in collaboration with Universita Degli Studi di Perugia, Italy. She has finished Ph.D. studies at Pharmacoeconomics Department, Faculty of Pharmacy, Medical University of Warsaw, Poland. She works as Clinical Research Coordinator in Clinical Research Trials in Neurology.
Abstract:
Back pain is a major health problem affecting performance at work and general well-being worldwide. It generates work absenteeism and disablement and leads to a high economic burden to society. The Global Burden of Disease (GBD) Study 2010 showed that out of 291 conditions evaluated, low back pain ranked highest in terms of years lived with disability and sixth in disability-adjusted life years (DALYS). The most common method to estimate the burden of a specific disease on a society is a cost-of-illness (COI) study. Cost-of–illness studies aim to identify and measure all the costs of a disease: direct, indirect and intangible costs. Many studies focus only on direct costs of an illness and payers perspective, like e.g. costs of hospital services, physician services, medical devices, rehabilitation, drugs, and diagnostic tests. Indirect costs represent the other portion of estimated costs as a result of broader perspective – social perspective. These include mortality costs, morbidity costs due to absenteeism and presenteeism, informal care costs. For many diseases, indirect costs are substantial and can be significantly greater than the direct costs. International literature on studies which included indirect costs of back pain has been reviewed to determine the amount of indirect costs among total costs. The data in reviewed studies referred to USA, Netherlands, Sweden, Australia, Germany, UK and Switzerland. Results showed that indirect costs compose a significant part of the total costs of back pain (from 27.4% to 95%) and should be taken into consideration in cost-of-illness analysis. Differences in obtained results are caused by various methodology used to assess the indirect costs which means there is a need to elaborate uniform and generally accepted methodology for indirect costs assessment. With expanding and aging populations in many countries, the enormous burden from back pain will grow significantly over coming decades. To prioritize prevention efforts appropriately world-wide, information on the burden caused by back pain would be useful.
- Pain Management Nursing
Location: Mississippi Amph
Chair
Amit Mirchandani
Texas Cell Institute, USA
Co-Chair
Salaheldin Halasa
Nitromedicine, USA
Session Introduction
Pilar Montesó Curto
Rovira i Virgili University, Spain
Title: Clinical trial in patients with fibromyalgia: Infiltration versus group therapy resolution problems
Biography:
Abstract:
Biography:
Not available.
Abstract:
Nitromedicine is a new medical specialty, focused on modulating Nitro-Redox Sensitive Biochemical Pathways to managing Oxidative Stress Related Diseases (OSRDs) and enhance Stem Cell Therapy. It has been known since the discovery of the biological role of NO in the 1980s, that supplying NO donors such can have many beneficial effects in different conditions by stimulating stem cells and modulating the immune response, however, there also exists a substantial risk of side-effects with long-term use. Excess NO can inhibit mitochondrial metabolism by binding to cytochrome c oxidase (CCO) and can also produce reactive nitrogen species (Peroxynitrite) by interacting with reactive oxygen species (ROS). To avoid these potential damaging side-effects we propose to combine the use of NO donors with four additional components. Initially, we believe that the addition of antioxidants such as Thiols, Polyphenols and Vitamins can neutralize ROS and RNS. Secondly, we believe that application of appropriate wavelengths and dosages of light (blue, red or near infrared depending on the exact condition being treated) will dissociate NO from CCO (and other storage sites) thus restoring mitochondrial ATP production and stimulating healing in many situations. Thirdly, we think detoxification will remove the pathological free radical generators and increases the nitric oxide bioavailability. Lastly, by delivering electrons to the body through electrotherapy, we might help to saturate the free radicals with electrons, thus eliminating underlying oxidative stress, stabilizing mitochondria, preventing further formation of pathological free radicals and increasing the nitric oxide bioavailability. This combination therapy may be applied to treat and prevent large variety of oxidative stressed related diseases such as degenerative diseases, immunological diseases, chronic infectious diseases, cancers and a broad range of unmet medical needs involving chronic inflammation with an emphasis on pain management.
- Orofacial pain
Location: Mississippi Amph
Chair
Amit Mirchandani
Texas Cell Institute, USA
Co-Chair
Salaheldin Halasa
Nitromedicine, USA
Session Introduction
Kalpesh Vakharia,
University of Maryland, USA
Title: Bell’s palsy: Medical and surgical treatment
Biography:
Kalpesh Vakharia is an Assistant Professor of Facial Plastic and Reconstructive Surgery in the Department of Otorhinolaryngology – Head and Neck Surgery at the University of Maryland, School of Medicine. He is double boarded in Otolaryngology – Head and Neck Surgery as well as in Facial Plastic and Reconstructive Surgery. He received his Medical degree from University of California, San Francisco. He completed a five year residency in Otolaryngology- Head and Neck Surgery at Harvard Medical School followed by an AAFPRS Facial Plastic and Reconstructive Surgery Fellowship at the Cleveland Clinic Foundation. He is an accomplished clinician, teacher and researcher. He has several publications in the field of Facial Plastic and Reconstructive Surgery and has presented his research at many national meetings. His clinical interests include treating facial nerve disorders, facial reconstruction and reanimation, as well as aging face rejuvenation.
Abstract:
Bell's palsy is unilateral, acute onset facial paralysis that is a common condition. One in every 65 people experiences Bell's palsy in the course of their lifetime. The majority of patients afflicted with this idiopathic disorder recover facial function. Initial treatment involves oral corticosteroids, possible antiviral drugs, and protection of the eye from desiccation. A small subset of patients may be left with incomplete recovery, synkinesis, facial contracture, or hemifacial spasm. A combination of medical and surgical treatment options exist to treat the long-term sequelae of Bell's palsy. Bell’s palsy is a clinical diagnosis and is largely one of exclusion. Patients present with a sudden onset of facial weakness that tends to be unilateral and rapidly progressive. The facial weakness tends to reach its peak within 72 hours. Patients may also have accompanied hyperacusis, change in facial sensation, neck or periauricular pain, or dysgeusia.
Samina Ismail
Aga Khan University, Pakistan
Title: Postoperative analgesia for caesarean section patients
Biography:
Samina Ismail holds the position of a Professor at the Department of Anesthesiology and Intensive Care, Aga Khan University, Karachi. Her main research interests are obstetric anesthesia, regional anesthesia and pain management. She has contributed number of scientific publication and book chapters. She is a reviewer of number of national and international journals and had served as the Editor of the journal ‘Anesthesia, Pain and Intensive Care”. She is the Director of Anesthesia Obstetric Services at her University. She has started obstetric anesthesia fellowship program at Aga Khan University and is the Director of the fellowship program. She is also Director of Anesthesia Research Cell at her university and heading the research activity in her department.
Abstract:
Caesarean section (CS) commonly induces moderate to severe pain for 48 hrs. The aims of postoperative pain treatment are to provide subjective comfort, inhibit nociceptive impulses and blunt the neuro-endocrine response to pain thus enhancing the restoration of function. Opioids are used both by systemic and neuraxial route for postoperative analgesia. Patient controlled intravenous analgesia (IV-PCA) has shown to be superior to conventional IM opioids for women having had a caesarean Pain, pruritus, nausea/vomiting, sedation and respiratory depression are concerning issues that complicate postoperative opioid usage. These limitations have led to the introduction of multimodal analgesia in the form of co-analgesic/ adjuvant drugs and nerve block and wound infilteration. The NICE guidelines for cesarean sections suggest that wound infiltration and/or ilioinguinal nerve block are viable alternatives to systemic analgesia. TAP block can be a better option for patients not receiving long acting neuraxial opioids. Women having CS presents a unique set of problems to the anesthetist and requires optimal pain management. We need to explore the possibility to establish standard pain relief methods, the choice should be determined by drug availability, resource limitations and financial consideration.