International Conference and Exhibition on Pain Medicine June 08-10, 2015 Chicago, USA

Biography:

Martin Grabois, is the 28th Presidentn of American Academy of Pain Medicine. Dr. Martin Grabois is a physiatrist in Houston, Texas and is affiliated with multiple hospitals in the area, including Houston Methodist Hospital and Michael E. DeBakey Veterans Affairs Medical Center. He received his medical degree from Temple University School of Medicine and has been in practice for 48 years.

Abstract:

This presentation will focus on two muscle pain syndromes, myofascial pain and fibromyalgia. It will focus on the etiology which is still in debate and the evaluation necessary to make the diagnosis. Both syndromes will be discussed from the point of view what these have in common and how they are dissimilar. The new ARA classification of fibromyalgia will be discussed. A significant amount of time will be spent on the evaluation of both history and physical exam which is necessary to make the diagnosis. Treatment will be presented that covers pharmaceutical, physical therapy, and psychological intervention necessary to manage these two syndromes. Emphasis will be placed on pain reduction and physical restoration. The presentation will conclude with a discussion on outcomes that can be expected.

Biography:

Lewis Terri has extensive experience in the development and administration of community programs and systems of care for persons with disabilities and chronic health impairments. Her work life represents broad community rehabilitation industry experience, having served as a special education teacher; the Director of an overseas embassy based mental health program in the People’s Republic of China; and collaborator with local, state, and federal agencies to create community mental healthand rehabilitation services for unserved and underserved persons with a wide variety of needs. She serves on the faculties of National Changhua University of Education in the Graduate Institute of Rehabilitation Counseling and Southern Illinois University Carbondale in the Rehabilitation Institute. She collaborates with vocational programs in the USA and Southeast Asia on the design of community based rehabilitation with special emphasis on Allied Health care coordination. She holds a BS in Special Education from Heidelberg College in Tiffin, OH; an MS in Special Education, Multi-handicapped from Montana State University in Billings, MT; and a PhD in Rehabilitation from SIU Carbondale. She has served as the volunteer patient navigator for consumers injured by the fungal meningitis outbreak of 2012 and has contributed hundreds of hours of patient education to families, legal teams, physicians, and the staff of the Senate HELP Committee. She has served on the Patient Safety work group that contributed to the Drug Quality and Safety Act. She is working on a book about this outbreak, examining the factors that led to the outbreak, the public health response, and implications for patient safety and consumer supports.

Abstract:

The presenter will offer the results of a national survey conducted across groups of consumers who have chronic and intractable pain syndromes. Researchers are now investigating the direct role that the physician-patient and pharmacist-patient relationship plays in the treatment and outcome of chronic and serious medical issues on chronic pain derived from a variety of medical conditions. Despite efforts to examine the relationship via factors, a conceptualization of the current working alliance between patients and treating providers has not been clearly articulated. This is particularly important in light of the influence exerted by the US Drug Enforcement Administration on physician autonomy, opioid access limitations imposed upon and by dispensing pharmacies, changes in state regulations, and the interplay with alternative forms of treatment. Understanding the impact of these issues on patients, their families and resources, and the interplay between patient factors and provider-patient trust and treatment is important. Additionally, faulty assumptions, cognitive biases, and gaps in services imposed by the medical model, distribution of treating providers, influence of payor source, and the failure to incorporate effective additional supports will be offered for feedback and discussion. Measures derived from the following measurements will be compared: Physician-Patient Working Alliance Scale, Perceived Utility Scale, Treatment Adherence Self-Efficacy Scale, Medical Outcome Study Adherence Scale, Physician Empathy Questionnaire, Physician Multicultural Competence Questionnaire, Medical Patient Satisfaction Questionnaire, and related collection instruments.

Biography:

Dr. Wahezi currently serves as Assistant Professor at Montefiore Medical Center in New York City and is the Program Director of the ACGME accredited Interventional Pain Fellowship. He has created a fellowship with an interventional focus and multidisciplinary foundation. His mission is to create an academic environment which fosters the growth of Interventional Pain through the investigation and development of new devices and techniques. Dr. Wahezi has authored more than thirty publications in peer reviewed pain journals, book chapters, abstracts, and posters, and has presented at national meetings. He is actively involved in several basic science and clinical studies in Interventional Pain management. His basic science interests include the development of animal models for pain and physiology of neuropathic pain. His clinical research interests include innovative percutaneous pain treatments.

Abstract:

Lumbar spinal stenosis (LSS) is primarily a disorder of the elderly and affects 1.2 million Americans and more than 5million people worldwide. The US prevalence of affected individuals is expected to double by 2024 due to an aging population. Surgery is the most common intervention performed for LSS and epidural injections are the most common non-surgical interventions. There is published clinical efficacy of both, but each has its own limitations. Epidurals are safe, display transient efficacy, but often need to be repeated, increasing the overall cost of treatment. Surgery is not commonly repeated, but surgical management of LSS is challenging due to the highly vulnerable geriatric patient population suffering from this condition. Medical comorbidities place them into high-risk stratification for open surgeries and general anesthesia. Percutaneous image guided lumbar decompression (PILD) is a new treatment which debulks hypertrophied ligamentum flavum ,which is observed in more than 90% of LSS cases. It reconciles the problems with epidurals and surgery, as it is a percutaneous procedure which modifies anatomy. PILD may be a solution to the treatment dilemma and emerges as a safe and effective option for LSS patients. Efficacy of pain and functional improvement of PILD has been demonstrated with statistically significant pain reduction and functional improvement. In this lecture I will discuss PILD patient selection, procedure performance, as well as past, present, and future research.

Biography:

Dr Aurel Neamtu has completed his MD followed by a PhD at the Iuliu Hatieganu University of Medicine and Pharmacy in Cluj-Napoca, Romania. Later he has completed an anesthesiology residency at the University of Louisville School of Medicine, and a pain fellowship at Washington University in St. Louis. Since 2004 he has served as faculty member in the Department of Anesthesiology at the University of Louisville SOM. His more recent interest is in ultrasound guided procedures, both for acute and chronic pain. Dr. Neamtu has published 12 peer reviewed papers and more than 30 abstracts and posters.

Abstract:

For the purpose of this presentation, the term “painful peripheral neuropathy” is used to mean the neuropathic pain conditions associated with most peripheral neuropathies, with the exception of trigeminal neuralgia, which is unique in terms of its clinical presentation and management. Over the past decade, diabetic polyneuropathy and postherpetic neuralgia have been the target of most treatment trials (1–3), with HIV sensory neuropathy, carpal-tunnel syndrome, and alcoholic polyneuropathy being less rigorously studied (4-6). The first comprehensive guidelines on pharmacological treatment of neuropathic pain published in 2006 (7) provide algorithms for medical management of most peripheral neuropathies. However, in this presentation the focus will be mostly on invasive management of painful peripheral neuropathies. Starting from a case presentation of a patient with posttraumatic saphenous peripheral neuropathy, the role of ultrasound guided procedures combined with older methods of neurolytic blocks will be discussed. Ultrasound guided procedures allow physicians to use real time images to deliver the local anesthetics, neurolytic substances, or perform radiofrequency ablations more accurately at the target of choice. In this way, potential complications that resulted in quasi abandonment of some older techniques could be reconsidered.

Biography:

Dr Narinder Kaur Multani has done Masters in Sports Medicine and Physiotherapy from Guru Nanak Dev University, Amritsar. She completed her PhD from Punjabi University. Patiala. She has more than 24 years of clinical, administrative & teaching experience and presently working as Professor in Department of Physiotherapy, Punjabi University, Patiala. Her thrust areas of research are Sports Physiotherapy, Osteoarthritis and Geriatric Physiotherapy. She has published more than 45 papers in reputed journals and has been serving as an editorial board member of repute. She has authored a book entitled “Principles of Geriatric Physiotherapy”. She was the Principal Investigator of a Major Research Project on Osteoporosis funded by University Grants Commission, India.

Abstract:

Knee Osteoarthritis is one of the leading causes of disability among older patients, affecting biomechanical loading, kinesiological factors and gait mechanics. A vast body of literature has shown the efficacy of conservative physical interventions focusing on alleviating pain and improving muscle strength. However, studies exhibiting effects of these interventions in terms of improving altered knee mechanics, joint space narrowing, altered gait and deformity are scant. Therefore, present study intends to concentrate on role of foot wear alteration and application of knee brace with that of the conventional physiotherapy on clinical outcome (pain & functional status), radiographic changes, static alignment (Q – angle, Genu Varum, Tibial Torsion), kinesiological factors (Quadriceps strength, Hamstring Strength, Hamstring Flexibility, Quadriceps Lag, Knee range of Motion), gait parameters (Step Length, Stride Length, Toe-out, Cadence, Gait velocity) and plantar pressure distribution (Anterior Mask, Posterior Mask, Medial Mask, Lateral Mask) in early medial knee osteoarthritis patients. Total 90 subjects (both males & females) with medial knee osteoarthritis (Grade 2 and 3) were included in the study, with 30 subjects in each interventional group: Control group (conventional physiotherapy), Experimental Group – I (Footwear alteration along with conventional physiotherapy) & Experimental Group – II (Footwear alteration & Knee Bracing along with conventional physiotherapy). Duration of these physical interventions for all the three groups was 6 months (3 sessions /week). The results of Analysis of Variance (ANOVA), using SPSS 17.0, showed that although Conventional physiotherapy was effective in reducing pain in addition to improving functional score, hamstring strength, cadence and gait velocity; it was discouraging to observe that radiographic joint space narrowing along with asymmetry in biomechanical loading was further increased. Conversely, interventions used in both the experimental groups were effective in improving clinical outcomes, radiographic joint space width, static alignment, kinesiological factors, gait parameters and plantar pressure distribution in patients of medial osteoarthritis knee. Nevertheless, comparison of both these experimental groups revealed that concurrent use of lateral wedge and valgus brace exhibited a greater improvement in genu varum (t = 2.92, p < 0.05), tibial torsion (t = 4.39, p < 0.00), quadriceps strength (t = 2.87, p < 0.05), quadriceps lag (t = 2.05, p < 0.05), hamstring strength (F = 9.84, p < 0.00) and toe out (t = 2.67, p < 0.01) than lateral wedge alone. Thus, it may be concluded that concurrent use of lateral wedge and valgus brace along with conventional physiotherapy should be an integral part in the rehabilitation of the patients with early medial OA knee.

Biography:

Mark Versavel, MD, PhD, MBA is President and Founder of vZenium LLC, providing consulting services in clinical drug development in neurology and psychiatry, and Principal of akta Pharmaceutical Development. Mark is consulting CMO at Alzheon and responsible for clinical development of ALZ-801, a prodrug of tramiprosate, in Alzheimer’s Disease. He has 25 years of clinical development experience in multiple neurology and psychiatry indications across the areas of clinical pharmacology, early and late phase clinical trials and support of marketed products. Mark has worked for Pfizer from 1999 till 2003 in France as international clinical lead for pregabalin (Lyrica) in neuropathic pain and epilepsy, and from 2003 till 2008 in New London / Groton as local clinical lead for sumanirole in Parkinson’s disease and restless legs syndrome, and global clinical lead for ziprasidone (Geodon) in schizophrenia and bipolar disorder. Mark received his MD from the University of Antwerp in 1983, PhD in clinical pharmacology from the Humboldt University in Berlin in 2003 for the validation of a computerized cognition test system, and MBA from the University of Michigan in 2003.

Abstract:

CNV1014802 is a novel small molecule state-dependent sodium channel blocker that exhibits potency and selectivity against the Nav1.7 sodium channel. CNV1014802 was evaluated in two Phase 2 trials in neuropathic pain conditions. Efficacy and safety were evaluated in a randomized withdrawal Phase II clinical trial in subjects with trigeminal neuralgia (TGN). Following an initial 21 day open-label treatment period with CNV1014802 at a dose of 150 mg three times a day (tid), subjects who showed a successful response in the final week of the period, defined as a 30% or more reduction in number or severity of paroxysms relative to the run-in period, were then randomized to a 28 day double-blind treatment period with either CNV1014802 150 mg tid or placebo. All subjects entering the study had to have a pre-specified number of paroxysmal attacks of at least moderate severity. A total of 67 patients were recruited into the study and 69% of those patients completing the open label period were randomized as responders into the double-blind phase of the study. CNV1014802 was well tolerated and the study showed a consistent reduction of pain severity and number of paroxysms in all primary and secondary outcomes. In the primary endpoint of the study there was a treatment failure rate of 33% for CNV1014802 vs 65% for placebo and a favorable separation from placebo on the Kaplan Meier time to relapse. CNV1014802 showed a 2.3 unit decrease vs placebo in the NRS scale for pain intensity, 60% reduction in paroxysms vs. 12% on placebo, and 55% decrease in pain severity vs. 18% on placebo, by the end of the study. There were no serious adverse events related to the drug and the adverse event profile of the drug was similar to placebo in the double blind phase of the study. A second Phase 2 study was conducted in subjects with lumbosacral radiculopathy (LSR). This was a randomized, double-blind, placebo-controlled cross-over study designed to evaluate the efficacy and safety of orally administered CNV1014802 at a dose of 350 mg twice per day, in 81 subjects with pain associated with LSR. There was a statistically significant difference of -0.43 (p=0.0265) between CNV101802 and placebo in the primary endpoint, Pain Intensity-Numerical Rating Scale (PI-NRS) mean change from baseline to week 3. Additional exploratory analyses showed that for the subset treated by ‘802 alone, comprising 60% of patients randomized, there was an enhanced statistically significant reduction in pain (PI-NRS mean change at week 3, -0.72; p=0.0039). There were no serious adverse events related to the drug in this trial and CNV1014802 was very well tolerated. In conclusion, clinical proof of concept has been achieved with CNV1014802 in two Phase 2 trials and the compound was well tolerated without need for titration

Biography:

Balwinder Singh has done Masters in Mathematics and Master in Computer Applications from Guru Nanak Dev University, Amritsar. He has more than 22 years of teaching experience and presently working as Associate Professor Computer Science at Govt. College of Education, Patiala one of the premier institute of education in North India. His thrust areas of research are impact of ICT in teaching learning process. He has published more than 10 papers in reputed National Journals, one paper in the International Journal and presented more than 20 papers in National/ Regional level conferences/ seminars. He has authored a text book entitled “Computer Education” for B.Ed. and M.Ed. students.

Abstract:

The shift from manufacturing and resource-based jobs to the service industry has transformed the nature of work injuries and disability. The high rate of acute and fatal injuries observed in most countries at the beginning of the 20th century has been replaced by a sharp increase in the incidence of compensated musculoskeletal disorders such as back and neck pain. Neck pain is a major problem among computer users which causes considerable personal suffering due to pain, disability, and impaired quality of life, inducing great socioeconomic burden on both patients and society. Computer related health problems if ignored can prove debilitating. Therefore, there is a need to understand the dynamics of these problems and prevent it from assuming epidemic proportion. In this line of thought, the present study was done with an aim to find an appropriate physical intervention for management of neck pain among computer users. A total of 60 computer users with a history neck pain, who satisfied the inclusion criteria, were randomly assigned to three intervention groups; Group A ( Conventional physiotherapy), Group B (Muscle Energy Technique and conventional physiotherapy) and Group C (Microwave diathermy , Muscle Energy Technique and conventional physiotherapy). All the Interventions were given thrice a week for a period of 4 weeks. Clinical tests including VAS scale and Neck disability index (NDI) were used to assess the post intervention outcomes. Results of the within group analysis (paired t test) indicated significant improvement in all the three intervention groups for both the outcomes; VAS (t= 6.2, 14.12, 19.9 respectively for the Group A, B and C).), NDI (t=10.8, 10.7, 14.9 respectively in Group A, B and C) at p≤ 0.05. Findings of the inter group comparison (one way ANOVA) suggested a statistically significant difference among the three interventions groups with f= 29.46, 36.51 at p≤ 0.05 for VAS and NDI respectively. Further comparisons were done using Tukey’s Kramer post hoc test. The results indicated that intervention C (Microwave diathermy plus Muscle energy technique and conventional) was the most effective intervention amongst the three interventions for decreasing the neck disability (NDI). However in reference to pain (VAS), intervention B and C proved to be equally but significantly more effective than the intervention A (conventional physiotherapy). Thus it is concluded that Microwave diathermy and MET when added to the conventional physiotherapy programs may enhance the effectiveness of the protocol in reference to neck pain and disability. Keywords – Computer users, neck pain, muscle energy technique, Microwave diathermy.

Biography:

Hal S Blatman, MD, is the Founder and Medical Director of the Blatman Health and Wellness Center in Cincinnati, Ohio, a nationally recognized specialist in myofascial pain, and co-author of “The Art of Body Maintenance: Winners' Guide to Pain Relief”, a reference for treating myofascial pain, from migraine headaches to plantar fasciitis. He is credentialed in Pain Management, Occupational and Environmental Medicine, and Integrative Holistic Medicine. After receiving his medical degree from the Medical College of Pennsylvania (Drexel University) in 1980, he completed two years of training in orthopedic surgery. He later studied ergonomics and toxicology during his residency in Occupational and Environmental Medicine at the University of Cincinnati Hospital. In the early 1990’s, he studied with the late Janet Travell MD, pain physician to President Kennedy. He currently leads a team that specializes in the Holistic and Comprehensive rehabilitation and treatment of pain, ligament and tendon injury, fibromyalgia, and chronic fatigue syndrome. He is a past President of the American Holistic Medical Association.

Abstract:

Diet and nutrition have been shown to affect aging and the development or prevention of chronic illness. Nutrition also impacts chronic pain and fatigue. There are nutrients that speed healing and foods that increase pain. Sometimes a single exposure can cause weeks of pain. There are 3 main rules of nutrition for a longer and more pain free life. Following these rules will decrease pain and improve healing. Learning Objectives • Understand that food choices affect inflammation and pain • Learn nutrition rules that complement healing and getting out of pain

Biography:

Lewis Terri has extensive experience in the development and administration of community programs and systems of care for persons with disabilities and chronic health impairments. Her work life represents broad community rehabilitation industry experience, having served as a special education teacher; the Director of an overseas embassy based mental health program in the People’s Republic of China; and collaborator with local, state, and federal agencies to create community mental healthand rehabilitation services for unserved and underserved persons with a wide variety of needs. She serves on the faculties of National Changhua University of Education in the Graduate Institute of Rehabilitation Counseling and Southern Illinois University Carbondale in the Rehabilitation Institute. She collaborates with vocational programs in the USA and Southeast Asia on the design of community based rehabilitation with special emphasis on Allied Health care coordination. She holds a BS in Special Education from Heidelberg College in Tiffin, OH; an MS in Special Education, Multi-handicapped from Montana State University in Billings, MT; and a PhD in Rehabilitation from SIU Carbondale. She has served as the volunteer patient navigator for consumers injured by the fungal meningitis outbreak of 2012 and has contributed hundreds of hours of patient education to families, legal teams, physicians, and the staff of the Senate HELP Committee. She has served on the Patient Safety work group that contributed to the Drug Quality and Safety Act. She is working on a book about this outbreak, examining the factors that led to the outbreak, the public health response, and implications for patient safety and consumer supports.

Abstract:

In 2012, nearly 14,000 persons were exposed to contaminated pharmaceuticals produced and distributed by New England Compounding Company (NECC) in Framingham Massachusetts. The presenter has closely followed a group of nearly 400 sickened consumers and their families who were injured as the result of this outbreak. This session will elaborate on the natural history of this outbreak, the intersection with current pain management practices and compare it to both prior outbreaks and outbreaks that have occurred since. From the perspective of reducing future outbreaks and preventing patient harm, lessons and insights learned from the two years that have elapsed will be offered for review and discussion. This will focus on (1) What we can observe and measure; (2) Limitations of interim regulatory responses such as the passage of the Drug Quality and Safety Act and oversight mechanisms; (3) improving awareness and state and local response Opportunities for Research; and (4) opportunities for improved ethical decision making. A model for reducing future outbreaks and selecting interventional supports for specific consumer groups will be proposed derived from extracted patient experience. Among the topics to be discussed will be: (1) The history of outbreaks from 2000 and the context in which this outbreak occurred. (2) The role Public health and provider communications. (3) The limitations of the system of Federal, State, health practitioner Public health communications. (4) Consumer impact and the influence of systemic conflicts of interest. (5) Ethics treatment needs for patients who survived. (6) A model for reduction of patient harm and improved outcomes.

Biography:

Michelle Layton is full-time clinician working at Bethesda Physiocare and a senior instructor for the dry needling seminars through Myopain Seminars. She became certified in dry needling in 2009 and shortly after became involved with the courses as an examiner and lab instructor. She is also a board certified clinical specialist in orthopedics and a certified cervical and temporomandibular therapist. In 2013 she had a chapter published, Deep Dry Needling of the Trunk Muscles, In: Trigger Point Dry Needling: An Evidenced and Clinical-Based Approach and she is co-author of the dry needling seminar workbook for Myopain Seminars. She is a contributing co-author for a new quarterly review column for the Journal of Bodywork and Movement Therapies. She is involved in writing book reviews through the Orthopedic section of the APTA and Journal of Musculoskeletal Pain. She also serves as a manuscript reviewer for the Journal of Manual and Manipulative Therapy. Since 2006 she has been actively involved with the Federation State Boards of Physical Therapy as an item writer for the national physical therapy exam, the orthopedic practice review tool and other areas of need. She has also presented on the topic of dry needling at several conferences and to the Pennsylvania physical therapy board.

Abstract:

The use of trigger point dry needling (DN) is one technique that has a growing body of evidence demonstrating its usefulness in many pain conditions, including fibromyalgia, headaches, migraines, shoulder pain, pelvic pain, and plantar fasciitis. TrPs have been established as persistent sources of nociceptive input contributing to local and referred pain, and peripheral and central sensitization. TrPs can also contribute to restrictions in range of motion, loss of muscle strength, and altered movement activation patterns. Participants will learn the neuro-physiological basis for DN in the context of pain sciences and recognize how dry needling can be of benefit for many different patient populations with long-standing pain issues. While the focus will be on pain management and DN of myofascial trigger points (TrPs), DN can also be used to treat fascial adhesions, scar tissue, tendons, enthesopathies, and ligaments, among others.

Biography:

Dr. Feng Tao is an Associate Professor in the Department of Biomedical Sciences at Texas A&M University Baylor College of Dentistry. Dr. Tao received his RO1 award and Independent Scientist Award from NIH in 2012 and 2014, respectively. He has published more than 30 papers in peer-reviewed professional journals and he is serving as an editorial board member for some professional journals. Dr. Tao also served as an invited reviewer for Johns Hopkins ACCM Seed Grant, NSF-sponsored Pilot Funding at Louisiana State University, Arizona Biomedical Research Commission, Britain Israel Research and Academic Exchange Partnership Regenerative Medicine Initiative, Wings for Life−Spinal Cord Research Foundation in Austria, and NIH NRCS Study Section.

Abstract:

Chronic postsurgical pain is a serious issue in clinical practice. After surgery, patients experience ongoing pain or become sensitive to incident, normally nonpainful stimulation. The intensity and duration of postsurgical pain vary. However, it is unclear how chronic postsurgical pain develops. Here we showed that social defeat stress enhanced plantar incision-induced AMPA receptor GluA1 phosphorylation at the Ser831 site in the spinal cord and greatly prolonged plantar incision-induced pain. Interestingly, targeted mutation of the GluA1 phosphorylation site Ser831 significantly inhibited stress-induced prolongation of incisional pain. In addition, stress hormones enhanced GluA1 phosphorylation and AMPA receptor-mediated electrical activity in the spinal cord. Subthreshold stimulation induced spinal long-term potentiation in GluA1 phosphomimetic mutant mice, but not in wild-type mice. Therefore, spinal AMPA receptor phosphorylation contributes to the mechanisms underlying stress-induced pain chronification.

Biography:

Kailash Kothari is pioneer spine and pain consultant in India. He has completed his MBBS and MD from Pune University, Maharashtra, India. He is founder and director of Pain clinic of India Pvt. Ltd. (PCI) with 9 branches in Mumbai and Goa, India. He is practicing interventional pain management since 2000. He has travelled to many countries to treat patients and deliver lectures on pain management. He is a renowned teacher, conducts one of the most popular cadaveric pain training course called Comprehensive Interventional Pain Management (CIPM) for last 8 years and he is the director of pain fellowship at PCI. He is active member of many national and international pain societies. He is invited faculty for more than 100 national and international conferences in many countries. His interest is mainly in minimally invasive and endoscopic spine procedures.

Abstract:

Back pain due to Lumbar Disc Disease is a huge burden on healthcare system. The treatment options range from physiotherapy to fusion surgery. A number of minimally invasive procedures have also been developed in the recent past for its management. Disc-FX is a new minimally invasive technique that combines multiple mechanisms to treat this percutaneous discectomy, nuclear ablation and annular modification. Literature on its role in the management of lumbar disc pathology is limited. We have treated 30 consecutive patients with the Disc-FX discectomy for back pain due to lumbar disc pathology non-responsive to non-operative treatment. Based on Magnetic Resonance Imaging (MRI) we divided patients in 2 groups – those with degenerative disc disease (DDD) and those with a contained lumbar disc herniation (CLDH). The patients with diffuse disc prolapsed, extruded and migrated disc, facet pain were excluded. Patients were evaluated pre and post operative at various intervals. The surgical technique involves proper skin markings, under local anaesthesia and minimal sedation ipsilateral insertion of Disc-FX cannula in the dorsal part of the disc (from disc pathology and painful side), under fluoroscopy guidance provocative discogram, manual removal of disc material, nucleus ablation and annulus modulation performed Disc FX RF electrode. Significant improvement was seen in all outcome measures in most patients. Few patients needed further open operative procedures. Early results after the Disc-FX procedure suggest that it s a good treatment option for patients with back pain due to lumbar disc herniation and degeneration, especially for those with DDD & CDD where conservative treatment fails. This procedure is good for both low back and leg pain due to lumbar disc disease. This procedure involves combined 3 in1 approach to treat disc pathology. This treatment method looks very promising and in future larger, longer prospective studies will be needed to evaluate its efficacy.

Biography:

Weiya Ma completed her PhD from Dept of Pharmacology and Therapeutics at McGill University, Canada. After finishing two Postdoctoral Fellowships in Canada, she went to Wake Forest University in States to take a Faculty position in Dept of Anesthesiology. Then she moved back to Canada to continue her research at Douglas Mental Health University Institute. Now she is an Assistant Professor at Dept of Psychiatry, McGill University. She has published novel studies unraveling the role of neuropeptides in nociception, neuropathic pain and morphine tolerance. Her pioneer work exploring the role of inflammatory mediator PGE2 in the genesis of chronic pain has let her become a leader in this field. She was frequently invited to present her work at seminars, to contribute review articles and book chapters to introduce her research works.

Abstract:

Chronic pain is an unmet clinical need which severely deteriorates the quality of life of individuals and imposes heavy financial burden on the health care system. Its treatment is rather challenging due to the unclear underlying mechanism. Growing evidence indicates that peripheral (nociceptor) and central sensitization caused by inflammatory mediators plays an essential role in the genesis of chronic pain. Pain mediator prostaglandin E2 (PGE2) abundantly produced in inflamed tissues is known to sensitize dorsal root ganglion (DRG) neurons and potentiates sensitizing effects of other pain mediators such as capsaicin and its receptor, transient receptor potential vanilloid-1 (TRPV1). We hypothesized that facilitating the long-term synthesis, axonal and cell surface trafficking of PGE2/EP4 receptor and capsaicin/TRPV1 channel in DRG neuronsis involved in nociceptor sensitization and transition from acute to chronic pain. In cultured DRG neurons, PGE2 and EP4 agonist increased cell surface trafficking of EP4 receptor and TRPV1 channel, events mediated through PKA and PKC signaling transduction pathways and coupled with enhanced nociceptive activities of EP4 and TRPV1. In a model of transition from acute to chronic pain, pre-exposure to PGE2 prolonged mechanical allodynia evoked by subsequent PGE2 or capsaicin challenge. This event was blocked by pre-injection of EP4 antagonist. Intraplanar (i.pl.) injection of PGE2 increased the levels of EP4 and TRPV1 in DRG neurons, sciatic nerves and plantarskin, which was suppressed by co-injection of EP4 antagonist. In inflammatory pain models, i.pl.co-injection of COX2 inhibitor or EP4 antagonists with carrageenan or complete Freud’s adjuvant blocked or shortened mechanical allodynia evoked by subsequent PGE2 challenge. Inflammation-increased EP4 and TRPV1 in DRG neurons were reversed by COX2 inhibitor or EP4 antagonists. These data suggest facilitating synthesis, axonal trafficking and cell surface trafficking of EP4 and TRPV1 through PGE2/EP4 signaling contributes to nociceptor sensitization and potentiation as well as transition from acute to chronic pain.

Biography:

Ziad Elchami, Director of Pain & Headache Management Center at the International Medical Center (IMC), Jeddah, KSA, is a Pain & Headache Management Consultant, who specializes in chronic pain and neurology. His clinical interests include: clinical neurophysiology, neuromuscular disorders, and pain. He completed his medical degree at the University of Damascus. He then joined Kansas University Neurology Residency Program where he completed both his residency and fellowship programs in Clinical Neurophysiology and Neuromuscular Disorders. During this period, he served as Chief Residents and Chief Fellow, as well. He has a Pain & Headache Fellowship from Cleveland Clinic Foundation where he worked from 2003-2005. He deals with all cases related to chronic pain, chronic spine pain, and chronic migraine. He achieved many awards and is well-published in both major national and international journals. He also has presented more than 70 abstracts in various conferences and seminars world-wide.

Abstract:

Introduction: Fibromyalgia is a disorder characterized by widespread musculoskeletal pain accompanied by fatigue, sleep, memory and mood issues. Researchers believe that fibromyalgia amplifies painful sensations by affecting the way your brain processes pain signals. 

Objective: The objective is to discuss the effectiveness of Extracorporeal Shockwave (ESWT), by applying either 9 or 12 sessions, for the treatment of fibromyalgia.

Aim: The aim is to establish the efficacy of ESWT in the management of fibromyalgia.

Methods: 50 female patients were evaluated; with generalized muscle pain with tenderness, over the fibromyalgia trigger points, randomly allocated to receive either 9 or 12 sessions of ESWT (trial was conducted for a period of 4 years in Pain & Headache Center, IMC, KSA). ESWT applied to the affected trigger points and radiating triggered muscles. Inclusive criteria: Group A: age: 25-70; mean age = 48 (for patients who had 9 sessions); Group B: age: 35-80; mean age = 57 (for patients who had 12 sessions). Exclusive criteria: Pediatric patients, anyone with pacemaker and has a history of bleeding tendencies and as per the other exclusive criteria of ESWT.

Results: Average improvement of 70% was appreciated in patients approaching 9 sessions of treatment (A). ESWT was applied to the trigger point and up to 80% approaching 12 sessions attained after one month and sustained up to 9 months in group A and at least 12 months in group B.

Conclusions: ESWT therapy was proven to improve fibromyalgia pain, other trigger points and radiating pain patients without the need for further medication or PT treatments.

Biography:

Kailash Kothari is pioneer spine and pain consultant in India. He has completed his MBBS and MD from Pune University, Maharashtra, India. He is founder and director of Pain clinic of India Pvt. Ltd. (PCI) with 9 branches in Mumbai and Goa, India. He is practicing interventional pain management since 2000. He has travelled to many countries to treat patients and deliver lectures on pain management. He is a renowned teacher, conducts one of the most popular cadaveric pain training course called Comprehensive Interventional Pain Management (CIPM) for last 8 years and he is the director of pain fellowship at PCI. He is active member of many national and international pain societies. He is invited faculty for more than 100 national and international conferences in many countries. His interest is mainly in minimally invasive and endoscopic spine procedures.

Abstract:

Chronic neck and arm pain or cervicobrachialgia commonly occurs with the degeneration of cervical spine. Cervical medial branch block is commonly done pain management procedure for relieving this pain. We will discuss the application of radiofrequency (RF) neurotomies of cervical medial branches in patients with cervicobrachialgia and the factors which can influence the treatment outcome. Surgeon’s understanding of fluoroscopic anatomy is very important in placement of the RF needle, and in turn achieving better results. Demographic data, types of pain distribution, responses of double controlled blocks, and long term relief of pain after one or two diagnostic blocks, electrical stimulation parameters, numbers and levels of neurotomies, and surgical outcomes at 6 months are important parameters to discuss. It is recommended to do a good sensory and motor stimulation before ablation to improve the long term results. It is important to ablate a level above and below the suspected painful level to achieve good results. Cervical medial branch neurotomy is considered useful therapeutic modality for the management of cervicobrachialgia in selected patients, using good clinical and diagnostic pain management techniques in patients with degenerative zygapophyseal disorders.

Biography:

Boaz G Samolky Dekel works at the University of Bologna Teaching Hospital, Italy, where he is responsible of the hospital chronic and acute pain center. As an Assistant Professor of Anesthesiology, Intensive care and pain Medicine of the University of Bologna, Italy, he does research and teaches Anesthesiology, Intensive care and Pain Medicine at the Bologna’s University Medical School. He graduated cum laude from the University of Bologna school of Medicine and from its post-graduate school of Anesthesia and Intensive care. His main research interests are Post-operative pain control; cancer pain, chronic non-cancer pain; invasive and non invasive analgesia techniques, and public pain medicine evaluation. His research work is nationally and internationally published.

Abstract:

In patients with chronic pain, Breakthrough pain (BTP) is a transient exacerbation of pain that occurs either spontaneously or in relation to a specific predictable or unpredictable trigger despite relative stable and adequately controlled background pain; BTP is usually related to background pain and is typically of rapid onset, severe in intensity and generally self limiting with a mean duration of 30 minutes and has traditionally been managed by the administration of supplemental analgesia at a dose proportional to the total background opioid dose. BTP shows variable prevalence in different clinical contexts both among cancer and non-cancer patients. While the considerable clinical burden of BTP is generally recognized, available common pain assessment tools are insufficient for its identification and diagnostic tools for BTP with demonstrated formal validation and prognostic capability are lacking. An innovated approach for BTP diagnosis may come from its prognosis features. Prognosis refers to the risk of future health outcomes in people with a given health condition. Prognosis research seeks to recognize and ameliorate future outcomes in patients with a given health condition and it provides crucial evidence for translating findings from clinical research to clinical practice. A useful prognostic model provides accurate predictions that inform stakeholders, supports clinical research, and allows for informed decisions to ameliorate patient outcomes. We have developed and validated a simple prognostic/diagnostic tool which may easily predict the likelihood of the presence of BTP in patients with potential clinical features of BTP. This has an important impact on therapeutic decisions.

Biography:

George Grant, who is known as The Caring Doctor, is considered the Canadian authority in integrative medicine and a wellness ambassador. He is an expert in biofeedback, stress, anti-aging and natural pain management. He is the founder & CEO of the Academy Of Wellness. He enjoys a stellar academic and a fascinating career in research. He is a Scientist, Professor, Chemist, Toxicologist, Nutritionist, Biofeedback, Stress management and a Pain specialist. He worked as a Senior Consultant for Health Canada, FDA and CDC as well as in private practice. He has helped 6000 clients naturally worldwide including clients at Sunnybrook hospital in Toronto to recover naturally from clogged arteries within few months. He has helped fortune 500 companies, nonprofit organizations and Olympic athletes along with 5000 clients worldwide. He has over 100 published articles, conference presentations, book reviews and 10 bestselling books/ DVDs.

Abstract:

Dr. George Grant discusses the results of a case study to evaluate the efficacy of IPM transdermal cream made with hyaluronic acid along with natural herbal ingredients in the reduction of prostate inflammation over 3 months for 12 male subjects ranging from mid-forties to mid-seventies. After using the natural IPM transdermal cream for 3 months by 12 volunteer subjects, the improvement in the reduction of frequent urination during the day and at night was over 12.5% using both biofeedback and PSA testing. Using natural herbal formula to reduce BPH instead of using prescription medications with unpredictable and sometimes serious side effect is an innovative approach with promising successful management of BPH among men.

Biography:

Douglas J Spiel, MD, a Board Certified Radiologist, was the first radiologist in the country to become a Diplomat of the American Board of Interventional Pain Physicians. He currently serves on the executive board of ABBIP and also holds certification as a fellow of Interventional Pain Practice (FIPP). As a member of the editorial board of Pain Physician, he frequently reviews publications prior to submission in this international peer reviewed journal. His practice covers the continuum of interventional pain – including simple procedures utilizing needles, probes, and catheters and more complex surgeries utilizing endoscopes, lasers, burrs and fusion materials. For five years he was the team physician for a professional baseball team and continues to see professional athletes in his private practice. He credits his unique background and medical-cross training as the keys to his “out of the box” practice of pain medicine.

Abstract:

Chronic Pelvic Pain (CPP) affects 15% of women between the ages of 18 and 50. From bladder symptoms of frequency, urgency and dysuria to gynecologic complaints of dyspareunia and vulvodynia, multiple organ systems can frequently be involved. The associations with prior conditions are myriad and many practitioners have been left “chasing their tails “treating anatomic bases that don’t pan out. Only by understanding the neurobiology of chronic pain, can we hope to effectively treat what amounts to be upwards of 20 million women (in the US alone). In stepwise progression, Dr. Spiel walks the listener through the associated diagnoses, important facts, key hypotheses, requisite neurobiology and the mechanisms of chronic pain so that the attendees can visualize what goes on within the body and the nervous system. With numerous audiovisual aids and diagrams, Dr. Spiel lays the groundwork necessary to understand the algorithmic approach he utilizes. By comparing CPP with another well known chronic pain entity, his theories are substantiated by similar treatment protocols accepted the world over. Case studies of treated patients are introduced to emphasize and elucidate many of the key points. Finally, a novel product is demonstrated allowing prolonged neural blockade which could not be successfully performed without it. The lecture will offer doctors and other professionals hope, while offering patients an opportunity to regain their lives. An eye-opening, sentinel presentation which will change the way CPP is managed from now on.

Biography:

Enrique Latorre Marques, MD,Com. Spanish Royal Navy (exc.), completed his studies in Universities Complutense of Madrid, Zaragoza and Barcelona. He was in the Naval Academy and Underse as School of Spanish Royal Navy, Air-Space Medicine Center of Air Force, National Health Service School, Madrid. He was the Head of Health Services in Submarine Base, Anesthesiology in the Air-Naval Fleet, Bosnia and Kosovo O.Z., and actually Consultant 3 Dept. of Anesthesiology, Trauma Center “Miguel Servet” Hospital & School of Medicine,University of Zaragoza. He is the Chair of Newsletter Committee,SIG onNeuromodulation, International Association for Study of Pain. He received many Awards: Spanish Royal Navy, Army, Dept of Defense, NATO, United Nations, Spanish Prime Minister, Spanish NHS and International Red Cross. Currently, he is working as the Director of Pain Clinic “Montpellier Clinic”, Zaragoza.

Abstract:

Low back pain is one of the most prevalent diseases and generates great amounts of health costs. During the last 30 years different efforts from National Health Services around the world have been intended to minimize overuse of health resources and obtain better results not only in symptoms and functional status but finally in the quality of life. Clinical Guidelines pretend this goals from 30 years ago, however new techniques e.g. Neuromodulation have reached in the last ten years high levels of efficacy in the treatment when others have failed. IASP (International Association for Study of Pain) created two years ago the special Interest group on Neuromodulation whit interdisciplinary basis integrated for scientist and professionals interested in this area. Goals are not only investigation but clinical application. On another hand The European Union created in 2000 the COST projects (Co-Directorate from European Commission) that pretends around a panel of experts obtain better results in the most prevalent areas of health. One of this was “The COST B 13 project for Low back Pain Management” that launched from 2001 to 2005 “The Clinical Guidelines for its Management”. The Spanish Working Group adapted, completed and also included the Neuromodulation in their clinical guideline of management based on scientific evidence. Today we have an interesting focus of discussion around National Health Systems (in Europe is universal and public, it differs for example to USA that it is private) about high cost of Neuromodulation and scenary of economic crisis. We need investigate and generate studies that obtain results in outcomes, cost-effectiveness and put the Neuromodulation in the right place. For this reason, IASP SIG on Neuromodulation include between their goals create The Scientific Based Guideline for Management of Neuromodulation in Chronic and Failed Back Pain because it is one of the emergent areas.

Biography:

Rômulo José Soares Bezerra is graduated in Pharmacy from the University Estacio de Sá – Rio de Janeiro - Brazil (2004), Master in cell and molecular biology by FIOCRUZ (2008) and PhD in cell and molecular biology by FIOCRUZ (2012). He is the invited member of the American Chemical Society (ACS), participating as a reviewer of the journal “Journal of Biomolecular”. He has experience in the biochemistry and pharmacology area in the following topics: Leishmania amazonensis, nitric oxide, arginase, anti-Leishmania experimental chemotherapy, and biochemistry of trypanosomatids. Actually, his research is focusing in the context of High Throughput Screening of natural products to find an active molecule, which could be useful in the future to treat some diseases related to the purinergic receptors.

Abstract:

The search for new medicines with less side effects and more efficacy to treat the pain states and inflammatory diseases continues to be a challenge difficult to solve. In this context, the search of new molecules with antagonistic action on the P2X7 receptor (P2X7R), which is a purinergic receptor that is physiologically activated by ATP released from apoptotic or necrotic cells during an inflammatory process, emerge as a promising therapy. Since its activation promotes the release of pro-inflammatory and pro-nociceptive cytokines, i.e. IL-1β and other inflammatory mediators as NO and ROS. Our group has been focusing in the context of the High Throughput Screening of Natural Products to find a possible new analgesic and anti-inflammatory compound with antagonistic profile on the P2X7R. Actually, we found three compounds with such in vitro and in vivo activities.

Biography:

Ziad Elchami, Director of Pain & Headache Management Center at the International Medical Center (IMC), Jeddah, KSA, is a Pain & Headache Management Consultant, who specializes in chronic pain and neurology. His clinical interests include: clinical neurophysiology, neuromuscular disorders, and pain. He completed his medical degree at the University of Damascus. He then joined Kansas University Neurology Residency Program where he completed both his residency and fellowship programs in Clinical Neurophysiology and Neuromuscular Disorders. During this period, he served as Chief Residents and Chief Fellow, as well. He has a Pain & Headache Fellowship from Cleveland Clinic Foundation where he worked from 2003-2005. He deals with all cases related to chronic pain, chronic spine pain, and chronic migraine. He achieved many awards and is well-published in both major national and international journals. He also has presented more than 70 abstracts in various conferences and seminars world-wide.

Abstract:

Introduction: Allodynia is believed to be a hypersensitive reaction that may result from central sensitization that could be associated with entities such as fibromyalgia, traumas, neuropathic conditions and others. The pain signals originate with specialized nerves, called nociceptors, that sense information about things like temperature and painful stimuli right from the skin.

Objective: The objective is to manage allodynic pain and to attain better functionality and lifestyle for the patients.

Aim: The aim is to establish the efficacy of managing allodynia with combination treatment of Botox Injection and Cymbalta.

Methods: 20 patients with chronic allodynia pain affecting either upper or lower extremity were evaluated in Pain & Headache Center, KSA. Diagnosed clinically and by imaging as chronic pain, all received localized injection of 100 units, applied to the affected region, each trigger point was injected with 5-10 units, followed by starting patients on Cymbalta taper up to 60mg daily and sustain patients for 6 months.

Inclusive criteria: 12 males, 8 females, ages ranging from 40-70; mean age = 55. Exclusive criteria: Pregnant women, children, anyone who is allergic to any of the medication ingredients, and patients who have liver and kidney disease and contraindicated for Botox injection or Cymbalta.

Results: Average improvement of 85% was appreciated, as per numeric pain scale, within 4-6 weeks and sustained for at least 12 months, with no evidence of major side

Biography:

George Grant, who is known as The Caring Doctor, is considered the Canadian authority in integrative medicine and a wellness ambassador. He is an expert in biofeedback, stress, anti-aging and natural pain management. He is the founder & CEO of the Academy Of Wellness. He enjoys a stellar academic and a fascinating career in research. He is a Scientist, Professor, Chemist, Toxicologist, Nutritionist, Biofeedback, Stress management and a Pain specialist. He worked as a Senior Consultant for Health Canada, FDA and CDC as well as in private practice. He has helped 6000 clients naturally worldwide including clients at Sunnybrook hospital in Toronto to recover naturally from clogged arteries within few months. He has helped fortune 500 companies, nonprofit organizations and Olympic athletes along with 5000 clients worldwide. He has over 100 published articles, conference presentations, book reviews and 10 bestselling books/ DVDs.

Abstract:

The amethyst bio belt was used by 12 subjects for one hour three times per week as well as using the amethyst Bio Mat during sleep daily over 3 months period. We used two different biofeedback devices to measure pain reduction, BMI [body mass index] to measure fat reduction and blood cortisol levels to measure stress reduction. The Bio belt and the Far Infra-Red/Negative Ions Amethyst Bio Mat reduced pain by 18% and reduced BMI by 10% and reduced Stress by 82% of 12 subjects in 3 months as validated by Pre and Post Biofeedback Brain Scans as well as fasting blood test to measure the stress hormone cortisol. Thermotherapy was enhanced when the bio belt was combined with the bio mat use during sleep to reduce stress, pain and abdominal fat. The bio-belt made from the amethyst is a small bio mat wrapped around the abdomen to reduce abdominal fat and around the back to reduce pain and stress. The Bio Mat technology is a combination of far infrared rays, negative ion effects and the conductive properties of amethyst channels. These three powerful health stimulators are combined in a single, easy-to-use product with remarkable healing properties. The Bio Mat delivers soothing, deep-penetrating heat while stimulating the regeneration of damaged cells in the body. It’s a safe and natural way to achieve optimal health now and maintain a stronger, more resilient body in the future. The combination of the bio-belt and the bio mat is a highly effective thermotherapy available to medical professionals and home consumers who want to reduce pain, stress and abdominal fat. The Bio Mat is an approved medical device by FDA.

Biography:

Arun Aggarwal, MBBS, FRACP, FAFRM (RACP), FAFPM (ANZCA), received his PhD in 2004 from the University of Sydney. He is currently working as a VisitingNeurologist at Concord Hospital, a Chronic Pain Specialist at the RPAH Pain Clinic and a Rehabilitation Specialist at Balmain Hospital. He is a member of the Royal Australasian College of Physicians, Australasian Faculty of Rehabilitation Medicine and the Australasian Faculty of Pain Medicine. His research has included Electrophysiological Studies in Familial Amyotrophic Lateral Sclerosis with his primary paper, “Detection of pre-clinical motor neurone loss in SOD1 mutation carriers using motor unit number estimation” being widely cited in the international literature. He was awarded the Australian Association of Neurologists Young Investigator Award for his presentation of this paper in 1999 and was nominated for the Delsys Prize in 2012. He has written 3 book chapters on this subject and has also published widely on a number of different topics. He currently has a number of research projects in the areas of Chronic Pain andParkinson’s disease. He is on the Editorial board of the Journal of Clinical Trials. He is the current Chairman of Australian & NZ Association of Neurologists Neuro-Rehabilitation Sub-Committee and on the Medical Advisory Board of Trigeminal Neuralgia Association (Australia).

Abstract:

Ketamine is a non-competitive antagonist of N-Methyl-D- Aspertate (NMDA) receptors. It reduces NMDA-mediated nociceptive responses in dorsal horn neurons by binding to the phencyclidine (PCP) site of the NMDA receptor-gated ion channel. Chronic noxious input to the dorsal horn cells (mediated mainly by C-fibres) results in the removal of magnesium from the NDMA receptors and their activation by glutamate. This causes prolonged depolarization spinal neurons, which leads to central desensitization that may result in hyperalgesia (an excessive response to a painful stimulus and allodynia (a painful response to a normally non-painful stimulus). Ketamine helps to minimise excessively painful responses. Studies have also proven that antagonizing these receptors improves opioid receptors sensitivity, reduces opioid tolerance and suppresses opioid-induced hyperalgesia. Currently, there is no evidence on the long-term effectiveness of ketamine infusions in the setting of chronic pain. Methodology We performed a prospective study on 100 patients in the RPAH Pain Management Centre, to evaluate the long-term effect of a 3-7 day sub-anaesthetic ketamine infusion with refractory chronic, non-cancer between 2007 and 2012. A proportion of patients who responded to the infusion were commenced on lozenges to see if the improvement could be maintained. The assessment was based on the evaluation of a standardized questionnaire performed over a telephone conversation. We sought to determine whether ketamine provides long-term benefit to:  Reduce pain levels  Reduce opioid requirements Results Our study showed that there was a significant reduction in pain intensity measured by VAS reducing from a mean of 6.38 before ketamine to 4.60 after ketamine infusion (p<0.005). There was also a significant reduction in opioid use from a mean morphine equivalent dose of 216mg/day before ketamine to 89mg/day after ketamine infusion (p<0.005). Current preliminary data suggests that around 35% of patients are able to maintain these opioid dose reductions with similar or reduced VAS scores, when placed on ketamine lozenges. This study answers several unresolved issues regarding the ketamine infusion. The most clinically important is whether it will be possible to maintain the ketamine induced pain relief for long-term, what is the percentage of relapse and what is the response to ketamine lozenges after a ketamine inpatient infusion. Conclusion The preliminary results of this prospective study suggest that a sub-anesthetic inpatient infusion of ketamine may offer a promising therapeutic option for long-term relief of chronic refractory non-cancer pain. The study also establishes the safety and efficacy of this novel approach and strongly supports ketamine being a useful and safe long-term analgesic option.

Biography:

Folaju Olusegun Oyebola is the Head of Pain and Palliative Medicine at the Federal Medical Centre Abeokuta, Nigeria. He pioneered hospital based Pain and Palliative care services in the Country by integrating pain and supportive care services into acute care tertiary health Institutions in Nigeria. He completed his MPhil degree in Palliative Medicine at the University of Cape Town and subsequently had some clinical placements in palliative medicine across Africa, North America, Europe and India. In 2009 got ESMO Fellowship Award in Palliative care to Belgium and Switzerland. He obtained Diploma in International Palliative Care Leadership Development Initiative of the SanDiego Institute of Palliative Medicine California. In April - November 2011 he attended the Palliative Care Education and Practice (PCEP) of the Harvard Medical School in Boston Massachusetts, USA. He was a Scholar recipient of the American Academy of Hospice and Palliative Medicine (AAHPM) in 2015 and had presented papers at several local and international conferences.

Abstract:

Introduction: About 60-70% of Cancer cases in Nigeria present in advance stage. At least 30% of such cases experience one or more types of pain, which is almost pathognomic of the disease state. The Federal Medical Center Abeokuta, Nigeria since 2001 provides an integrated hospital based pain and palliative care services to cancer and other chronic non-cancer pains. This facility adds value to and aims at improving the quality of life of patients and families suffering from cancer pain. Method of Study: A retrospective study of the case notes of cancer patients referred to the Pain and Palliative Medicine department over the last 3 years were reviewed. The types of cancer, nature of pain presentations, pain management modality and their responses were recorded and evaluated. Results: Most of the patients presented with moderate to severe nociceptic or neuropathic or mixed pains. In all cases, the primary physician or surgeon had previously intervened with some analgesics without any improvement before referral. Opioid phobia and lack of skills and experience of appropriate Opioids prescriptions among doctors are common phenomenon. Many of the patients suffered from physical, social, emotional, financial and spiritual distress culminating to pain, which are often underestimated. The multimodal nature of the pain presentations required holistic and multidisciplinary team care approach management. Opioids and adjuvants medications with supportive care provide relief in more than 70% of the patients. Lesson learnt: Cancer pain management goes beyond WHO analgesic ladder. The use of oral morphine, acetaminophen, non-steroidal anti-inflammatory, adjuvants and compassionate supportive care in limited resource settings greatly improve cancer pain management. There is need for concerted efforts to train and empower all health care professionals with the basic skills and knowledge of pain management in developing countries in order to cope with these challenges.

Biography:

Preeti Doshi is one of the pioneering pain physicians in the city of Mumbai, working as a Consultant In-Charge of Pain clinic at the Jaslok hospital and Research Centre, Mumbai, India. She started this clinic 14 years ago after extensive training at various centres in UK and Australia. She also offers her services as an expert in pain management at some prestigious tertiary care referral centres in South Mumbai area. First lady in India to obtain the WIP certification by passing Fellow In Interventional Pain Practice [FIPP] in March 2009.She is regularly invited as a faculty for many international conferences to represent India. Her areas of special interest are Advanced pain therapies and Neuromodulation. She organized an international symposium and live workshop on Advanced Pain Therapies in collaboration with Weil Cornell Medical College, New York called “Comprehensive Review of Interventional Pain Therapies” at Jaslok hospital, Mumbai in November 2007. She has authored chapters on pain management in textbooks; national and international journals.

Abstract:

Trigeminal Neuralgia is a unique condition in which patient suffers severe distressing paroxysms of lancinating pain along the distribution of one or multiple divisions of the trigeminal pain occurring spontaneously or triggered by trivial daily routine activities like brushing, chewing, shaving etc. It can be of a classic [idiopathic] variety or secondary resulting from an organic pathology in the central nervous system. Pharmacotherapy is the mainstay of treatment in majority of patients as the first line of management with reasonably good results. There is however a small percentage who will not be adequately controlled with medications, where invasive options need to be considered. In the minimally invasive options for patients who are not fit or willing for surgery Radiofrequency Ablation of trigeminal ganglion emerges as the safest and the most efficacious option. This is due to the evidence in the literature which reveals 97-100% success rate with ability for selective lesioning of one or more divisions with some acceptable side-effect profile again with lower incidence as compared to other techniques. At our centre we have performed 600 such procedures over the past 14 years. In this video I have demonstrated the practical technique followed at our centre which yields excellent result.

Biography:

Kalia specializes in interventional pain management, cancer pain rehabilitation and interventional spine procedures. He earned his Master degree in Public Health from Western Kentucky University in Bowling Green and his medical degree from the Mahatma Gandhi Memorial Medical College in Indore, India. He interned in General Surgery at St. Josephs Mercy Hospital in Pontiac, Michigan and did residencies at the University of Rochester in both Physical Medicineand Rehabilitation and Preventive Medicine and Public Health. He completed a Fellowship in Pain Medicine in the Department of Anesthesiology at the University of Rochester as well. He is certified by the American Board of Physical Medicine & Rehabilitation and the American Board of Pain Medicine. He belongs to the American Academy of Physical Medicine and Rehabilitation, American Academy of Physiatrists, American College of Preventive Medicine, American Pain Society, American Society of Interventional Pain Physicians, American Academy of Pain Medicine and American Society of Regional Anesthesia & Pain Medicine. He won the Leadership Education in Neurodevelopmental Disorders (LEND) Fellowship Award from the Department of Pediatrics at the University of Rochester for the 2007 – 08 school year and was the chief resident in Physical Medicine and Rehabilitation for the 2011 – 12 school year. He also received the Young Investigator Travel Award from the University of Rochester in 2013. His publications include topics such as cancer pain management and interventional spine care.

Abstract:

Cancer Pain is quite complex and challenging to manage. Over the years we have made exemplary advancements in treatment of cancer but we are still struggling in providing a comprehensive holistic care to patients with intractable cancer related pain and their appropriate rehabilitation of cancer related impairments. We have made an earnest attempt to combine the tenets of cancer rehabilitation and cancer pain management under the same roof. It’s a unique model to providing comprehensive pain management and rehabilitation services within a self-sustainable fiscally responsible service line in a large community based health system.

Biography:

Abstract:

Background: Methionine-enkephalin-Arg-Phe (MERF) is a known endogenous amphiactive analgesic peptide. Neuropeptide FF (NPFF) is reported for long lasting analgesia, role in opioid modulation and tolerance development. Based on these reports a dualsteric chimeric peptide NPYFa (YGGFMKKKPQRFamide) was designed, having Met-enkephalin (opioid) and PQRF sequence of NPFF at C-terminal which can target both opioids and NPFF receptors. The aim of the present study was to determine opioid induced analgesia upon acute treatment and its tolerance development upon chronic exposure. Results: NPYFa demonstrated early onset, dose dependent and prolonged anti-nociception. Antagonists (μ, κ and δ receptor) pretreatment studies alone or together and with NPFF receptors antagonist demonstrated κ-opioid receptors mediated anti-nociception. RF9, NPFF receptor antagonist exhibited additive effect to NPYFa acute analgesia, suggesting participation of NPFF receptors. In addition both Eu-GTP-γS binding assay and FACS analysis further corroborated the observed acute analgesia showing significant binding with KOR and NPFF2 receptors suggesting its multiple binding nature. Further chronic (6 days) treatment effect of NPYFa showed up-regulation of protein expression of these receptorssuggesting no tolerance development to the NPYFa acute analgesia. Conclusions: Thus, NPYFa demonstrated potent, long lasting anti-nociception without tolerance development. Hence NPYFa may prove to be a potent analgesic probe with less tolerance development.

Biography:

Hal S Blatman, MD, is the Founder and Medical Director of the Blatman Health and Wellness Center in Cincinnati, Ohio, a nationally recognized specialist in myofascial pain, and co-author of “The Art of Body Maintenance: Winners' Guide to Pain Relief”, a reference for treating myofascial pain, from migraine headaches to plantar fasciitis. He is credentialed in Pain Management, Occupational and Environmental Medicine, and Integrative Holistic Medicine. After receiving his medical degree from the Medical College of Pennsylvania (Drexel University) in 1980, he completed two years of training in orthopedic surgery. He later studied ergonomics and toxicology during his residency in Occupational and Environmental Medicine at the University of Cincinnati Hospital. In the early 1990’s, he studied with the late Janet Travell MD, pain physician to President Kennedy. He currently leads a team that specializes in the Holistic and Comprehensive rehabilitation and treatment of pain, ligament and tendon injury, fibromyalgia, and chronic fatigue syndrome. He is a past President of the American Holistic Medical Association.

Abstract:

Fascia is the level of body work that embodies massage, PT, acupuncture, psychology, medication, diet, inflammation, mind body, and energy healing. There is no pain, memory of trauma, nutritional impropriety, anxiety, or environmental stress anywhere inthe body, that does not impact fascia....and the repercussions are multisystemic and body wide. Every practitioner touches this network in some way....part of why so many different models work for healing in any one individual. Classic medical teaching has promoted the idea of 9 body systems. These include musculoskeletal, nervous, endocrine, cardiovascular, immune, respiratory, urinary, digestive, and reproductive systems. Fasciology refers to all cells, tissues, and organs as they are wrapped and segmented by the supporting-storing system. Fascial anatomy differs from regional anatomy by emphasizing relationships between structure, function, and transformation over time. Our cells and organs maintain through interaction between the supporting system and the functional system. Under the regulation of the nervous and immune systems, the fascia network regulates the functional and living status of cells, and provides a stable environment for cellular function and survival. Our work as healers communicates to other healers through the fascia response of ourpatients.This presentation will stimulate the imagination and creativity of all practitioners as we realize how our work integrates and contributes to each person’s healing through the fascia system that connects all body systems and treatment modalities.

Biography:

Babak Babakhani has completed his MD followed by residency in Anesthesiology and Intensive Care at Tehran University of Medical Science-Iran (TUMS) with national board certification in Anesthesiology. Then he participated in a joint program of Clinical Neuroscience PhD by International Neuroscience Institute Hannover-Germany and TUMS. He trained as a fellow of Neuro-anesthesiology and Neuro-intensive care at Academic Teaching Hospital Nordstadt Hannover-Germany. He has an experience of 2 years directorship of interdisciplinary pain clinic. He has lectured and presented in numerous national and international meetings at Iran, Germany, Austria, Spain and USA.

Abstract:

The definition of pain by IASP is “an unpleasant sensory and emotional experience associated with actual or potential tissue damage, or described in terms of such damage”. Physical pain is a complaint associated with disparate cognitive costs and socioeconomic outgo, but is not easy to ascertain. Pretty much most of the clinical studies of acute and chronic painful conditions, recruit self-report measures, as an assessment tool in predicting therapeutic efficacy. The competency of such measures is limited by factors such as age, cognition disorders and impaired consciousness. Validation the interplay between peripheral and central influences, and ascertaining pathological vs emotional or cognitive influences could aid decisions regarding the best modality of treatments. This is where imaging might provide contribution in diagnosis and management of chronic pain. Functional MRI (fMRI) is a functional neuroimaging technique using MRI that measures brain activity using regional changes in cerebral blood flow. Coupling of cerebral blood flow and neuronal activation is the basis of fMRI (Activity drives metabolism and metabolism drives perfusion). Although the most research and clinical uses of this modality have tendencious toward minimizing surgical complications in patients undergoing surgery of brain tumors, there is growing interests toward using of fMRI in diagnosis, classification and follow up of non-malignant pathologies of CNS. In a study of fMRI based neurologic signature of physical pain, Wager et al., showed that it is possible to use fMRI to assess pain elicited by noxious heat in healthy persons. We use fMRI to see how neuroplasticity can affect the anatomic location of eloquent area in affected patients. Central neuroplasticity possess prognostic value in patients suffering from chronic pain syndromes. fMRI also enable us tracking down central effects of medications which cross blood brain barrier.

Biography:

Louis S Premkumar is a Cellular and Molecular Neurobiologist and a Professor of Pharmacology at SIU School of Medicine, Springfield, IL. He obtained his doctoral degree in Neuroscience from John Curtin School of Medical Research, Australian National University, Canberra. He is an expert on TRP channels and has extensively studied TRPV1 ion channel on which the active ingredient of hot chili pepper, capsaicin binds and brings about the actions. Increased expression of TRPV1 is implicated in certain modalities of pain and an ultrapotent TRPV1 agonist, resiniferatoxin is undergoing clinical trials for the treatment of debilitating chronic pain conditions. He has published more than sixty peer-reviewed articles and has contributed chapters in five books.

Abstract:

Transient Receptor Potential Vanilloid 1 (TRPV1) is a nociceptive ion channel activated by capsaicin, an ingredient in hot chili pepper. TRPV1 has been shown to be sensitized and over-expressed in the sensory neurons in chronic pain conditions. Therefore, TRPV1 is considered to be a potential target for developing analgesics. Several TRPV1 antagonists have been developed and proven to be effective in alleviating certain modalities of pain. Unfortunately, antagonism of TRPV1 in humans induces hyperthermia. Resiniferatoxin (RTX), a potent agonist of TRPV1 exhibits unique properties that can be utilized to treat chronic pain conditions. Intrathecal administration of RTX potently and selectively activates TRPV1 causing a depolarization block of the central nerve terminals in the short-term, and ablating TRPV1 containing central nerve terminals of the sensory neuron in the long-term at the level of the spinal cord. Finally, preventing nociceptive transmission at the level of the spinal cord using RTX will be a useful strategy in chronic, debilitating and intractable pain arising from large and inaccessible areas, such as malignancies of internal organs and bone.

Biography:

Abstract:

Introduction:

Minimally-invasive treatments of degenerative disc disease are becoming more popular. Various intradiscal procedures have been introduced since many years ago, with variable and inconsistent outcome. Chemical neucleolysis has been performed using multiple chemical substances including Chymopapain and alcohol with limited success. Discogel, a new similar substance composed of ethanol mixed with ethyl cellulose and radiopaque material, has been recently introduced with promising results. In this study, we try to present our initial experience with intradiscal injection of Discogel in Iranian patients, to evaluate its efficacy and safety.

Methods: From August until December, we have started our experience with Discogel in five centers in Tehran, Iran. Seventy-four patients with symptomatic lumbar or cervical disc herniation, who failed conservative non-surgical treatment, were included into the study. Protruded and extruded herniated disc without sequestration, with disc height more than 50% of the initial height, Pfirrman grading of III or IV, with radicular symptoms more prominent than axial symptoms. 0.5 to 0.6 milliliters of Discogel in cervical discs and 0.8 to 1.6 milliliters in lumbar discs was injected under controlled fluoroscopic/ CT scan guidance using standardized techniques.

Results: Seventy-four patients were injected, aged 20-78 (mean=44.4±9.7). There were 52 lumbar and 22 cervical operations. This was the first intervention for all patients except for 3 of them that had a history of previous operation at other levels. The procedure lasted from 15 to 90 minutes depending on the number of levels, and the whole admission took from 3 to 24 hours. Median VAS score was 10 before injection, which dropped to 5 at 1 week post-injection, and 0 at 1 month post-injection. Only 3 patient reported significant remaining pain at 1 month of follow-up that underwent operation. No complications were noted.

Conclusion: Initial results were promising, indicating more than 95% of good and very good results. This preliminary study shows efficacy and safety of Discogel intradiscal injection in selected cases. Further long-term follow-up is needed to evaluate the results.

Biography:

Michael J Iadarola completed his PhD in Pharmacology from Georgetown University Medical School in 1980. He has been involved in research on epilepsy, antipsychotics, and for the past 25 years, the neurobiology of pain and pain control systems with an emphasis on molecular, translational and clinical studies. His current research focuses interventional approaches to analgesic treatment and understanding the complete gene expression repertoire of primary sensory neurons using next-generation RNA sequencing. In 2014, he received the Fredrick W.L. Kerr award in basic science from the American Pain Society in recognition of “Total career achievements that have made outstanding contributions to the field of pain research.”

Abstract:

Dysfunctions of pain neural systems can lead to chronic pain conditions that are frequently resistant to treatment and can severely degrade quality of life. The ability to effectively treat pain is critically dependent on a detailed, quantitative, and comprehensive analysis of the molecular properties of nociceptive sensory neurons. These neurons occupy the beginning of the pain pathway and their cell bodies in dorsal root (DRG) or trigeminal ganglia connect the body to the central nervous system. Upon injury or pathophysiological insults such as diabetic neuropathy, they become “peripheral generators” which drive sensitization processes at higher level of the neuraxis. Important peripheral generators are DRG neurons that express the TRPV1 vanilloid-ligand-gated ion channel. These neurons transduce sensations of painful heat and inflammation, and play a fundamental role in clinical pain from cancer and arthritis. We have used the ultrapotent TRPV1 agonist resiniferatoxin (RTX) in animal and human clinical trials to produce a highly selective chemoaxotomy of pain-sensing neurons. Loss of the TRPV1-dependent peripheral generators produced a potent pain reduction in both cancer and arthritis in canine clinical pain and we are evaluating this in human cancer pain. These results prompted us to elucidate the complete transcriptome of TRPV1-expressing DRG neurons using next-generation RNA-Seq. We also performed transcriptome analysis of the non-TRPV1 neuro-glial ganglionic and selective genetic and chemical ablation. The transcriptomic data define distinct molecular signatures within a clinically important neuronal population and provide an overall framework for understanding the pain processes at the molecular level.

Biography:

Ziad Elchami, Director of Pain & Headache Management Center at the International Medical Center (IMC), Jeddah, KSA, is a Pain & Headache Management Consultant, who specializes in chronic pain and neurology. His clinical interests include: clinical neurophysiology, neuromuscular disorders, and pain. He completed his medical degree at the University of Damascus. He then joined Kansas University Neurology Residency Program where he completed both his residency and fellowship programs in Clinical Neurophysiology and Neuromuscular Disorders. During this period, he served as Chief Residents and Chief Fellow, as well. He has a Pain & Headache Fellowship from Cleveland Clinic Foundation where he worked from 2003-2005. He deals with all cases related to chronic pain, chronic spine pain, and chronic migraine. He achieved many awards and is well-published in both major national and international journals. He also has presented more than 70 abstracts in various conferences and seminars world-wide.

Abstract:

I. What is Chronic Pain II. What is Allodynia and its Impact on Muscles and Nerves III. What is Centralized Pain IV. What is Botulinum Toxin and its Mechanism of Action in Pain Management V. Indications of Botulinum Toxin in Pain Management and Current Indications and Previous Experiences and Data

Biography:

Alen J Salerian is the medical director of Salerian Center and the President of Doctors for Equal Rights for Mental and Physical pain. He is a psycho pharmacologist who currently divides his energy between research and advocacy for people with chronic and mental pain. He has practiced in Washington DC for four decades, taught at George Washington University medical Center, served as the FBI's medical director of Mobile Psychiatric Emergency Response Team and is the medical director of Salerian Center for Neuroscience and Pain. He has published numerous articles in peer-reviewed journals including Lancet, Psychiatric Research, CNS Spectrum, Medical hypotheses, Journal of Psychology and Clinical Psychiatry contributed to Washington Post LA Times. He also appeared on CBS 60 minutes, Panorama (BBC). He has published two books, Viagra for your brain and Honest Moments with Dr. Shrink (cartoons). His forensic study of JFKs assassination JFK images will soon to be released.

Abstract:

Salerian Center for Neuroscience and Pain is a private institution in Washington DC with a dual mission of Hippocratic medicine and science. This presentation reviews endorphins and endorphin agonists in treatment of chronic pain, addiction, depression chronic pain with depression and psychosis with endorphins as the common crucial variable. There is compelling evidence that endorphins and endorphin agonists are of vital importance in the genesis and treatment of chronic pain, addiction, depression, chronic pain with depression and psychosis. This presentation reviews biology of regional brain dysfunction, neurotransmitters, mechanism of action of antidepressant strategies, preclinical data over antidepressant effects of endorphins, clinical data of antidepressant effects of endorphins, common pathways of pain and depression and addresses common challenges associated with therapeutic interventions with endorphin like substances. The engineering of slow-release endorphins agonists have enabled possible effective treatments for diverse neuropsychiatric conditions with relatively low risk of overuse or adverse events. Further double-blind studies will be helpful to validate these findings.

Biography:

James D Adams received a PhD degree in Pharmacology from the University of California San Francisco in 1981. He has been a faculty member at the University of Southern California, School of Pharmacy since 1987. He has over 230 publications and has done research on several pain medications. He received training from a California Indian Healer and is an expert on plant medicines. He will discuss his work on a pain liniment made from California sagebrush that is effective even in severe pain such as broken bones. Several hundred patients have used the liniment. He will discuss the chemistry and pharmacology of the liniment and will discuss safety issues of the liniment in comparison to opioids and NSAIDs.

Abstract:

A pain cycle exists in the body that can begin in skin sensory neurons, continues to the spinal cord and the brain, and then returns to the spinal cord and the skin. Analgesia can occur at any of these neurons to break the pain cycle. Upon initiation of the pain cycle in chronic pain, several changes occur including cyclooxygenase 2 induction in the skin. Cyclooxygenase 2 is the major source of PGE2 that enhances pain at transient receptor potential cation channels in the skin. A traditional California plant medicine, made from Artemisia Californica, was found to be an effective treatment of severe and chronic pain including broken bones, cancer pain, back pain, fibromyalgia, diabetic neuropathy and more. The liniment contains monoterpenoids and sesquiterpenes. Transient receptor potential cation channels are the major pain receptors in the skin and can be inhibited by monoterpenes such as camphor, menthol and eucalyptol. These monoterpenes cross the skin and provide pain relief for several hours. Sesquiterpenes can cross the skin and inhibit cyclooxygenase 2. The combination of monoterpenes and sesquiterpenes in the liniment provides several hours of pain relief.

Biography:

Vahid Mohabbati got his primary medical degree (MD) from Shiraz University of Medical sciences in 1997. Then he was trained as an Emergency Physician and worked as chief emergency physician in different parts of Iran for 8 years. He then moved to Australia and continued practicing in Emergency Medicine as locum in rural and remote hospitals and general practices for 2-3 years. He commenced postgraduate training in pain medicine in Brisbane and then moved to Sydney to complete his fellowship. Immediately after that he started training in palliative medicine and completed his fellowship in Sydney. Currently he is a staff specialist in Palliative Medicine at Royal Prince Alfred Hospital and a Visiting Pain Specialist at Liverpool hospital. He is a clinical lecturer at the University of Sydney.

Abstract:

Pain and palliative medicine are underdeveloped in most of the world, and outside North America, Europe, and Australia; access to quality pain and palliative care is very rare. Pain and palliative medicine are expanding in the developed world, but it is only the beginning to be available in the developing world where it is presently needed the most in terms of population access. Collaborative effort is essential to position pain medicine and palliative care higher in global and national health agendas. Significant barriers exist, in the lack of clear policies establishing pain and palliative medicine, the lack of educational programs to teach, the lack of essential medications needed to deliver pain and palliative medicine, and the lack of organized service delivery programs in both fields. Existing resources are available that can be adapted to individual countries and to fill existing needs. Lack of recognition, however, hinders progress in addressing services to alleviate suffering for those in needs and who are amongst the most vulnerable in a society. We conducted a population base study on prevalence of chronic pain in Shiraz, Iran (not published yet). In our study, 6.95% of the 1050 respondents who were willing to participate in the study had suffered from chronic pain (CP) for ≥6 months. According to the results, 54% of the participants with CP used analgesics, mostly NSAIDs and narcotic analgesics. Besides these, 37% of the patients used other pain relief methods, such as traditional medicine and acupuncture. The results also showed an acceptable rate of satisfaction with treatments. Larger population base studies at a national and regional level are needed to gain more accurate data on chronic pain (cancer and non-cancer) and also to explore other aspects of chronic pain including cancer treatment-related chronic pain, neuropathic pain, health related costs, disease burden, barriers to development of pain and palliative services in Middle Eastern communities.

Biography:

In 2004 I founded a medical centre for pain management and outpatient surgery center. ( called “Zentrum SchmerzLOS” that’s a german word for painfree and for the fate of painpatients synonymious). Since that time I could establish the pain centre in a large part of Austria as a centre for interventional pain therapy: in Vienna with the centre in Baden/Vienna and Upper Austria with the centre in Linz. At now we are a team of 16 ambitious doctors and nurses specialized for anaesthesia and pain therapy and we trat about 3500 patients a year. Our treatment with fluoroscopy guided interventions is strictly following the ISIS guidelines. Large priority of SchmerzLOS is set on scientific research, on the one hand for quality improvement, on the other hand for improvement of interventional pain therapy.

Abstract:

Background Facet joints and the sacroiliac joint (SIJ) complex have been identified as a common source of chronic low back pain. Low back pain is a commom problem. The prevalence of facet joint (FJ) mediated low back pain is 31% i - 45%ii, the prevalence for the SI Joint as a source of chronic axial low back pain is reported between 18% and 30%iii. Radiofrequency (RF) neurotomy has been investigated in recent years as a minimally invasive treatment option for FJ –and SIJ-mediated low back pain. The use of atestblock as a predictive factor is well documented. Predective co-factors like BMI, gender, and comorbidities for successful and long term pain decrease have not been well established. Objective This retrospective study was designed to illustrate the general outcome after radiofrequency neurotomy of lumbar medial branches and rami posterior of the SI Joint in patients with low back pain 1, 6 and 12 months after treatment. Outcomes were stratified by BMI, gender and age to determine their effect on the reduction of opioids and NSAIDS. Study Design. The records of 164 patients with chronic low back pain who underwent treatment with RF medial branch Neurotomy (parallel needle technique) and/or cooled RF LBN in case of SI Joint mediated low back pain were identified. Subjects were selected for treatment based on physical examination and positive response (>50% pain relief) to an lumbar medial branch block/Ramus dorsalis L5 block or intraarticular SIJ block. Lumbar medial branches L3 and L4 and the ramus dorsalis L5 were lesioned in „ISIS“ parallel needle technique (N=36), Cooled RF LBN involved lesioning the L5 dorsal ramus and lateral to the S1, S2, and S3 posterior sacral foraminal apertures (N=87). Visual analog scale (VAS) pain scores, quality of life, BMI, medication usage, and satisfaction were asked before the procedure, at 1 month postprocedure (N = 164), and again after 6 (N= 75) and 12 months (N=89) postprocedure. Results A VAS decrease in the total group was seen from 8 to 4 after 6 months and 4.5 after 12 months, and lower medication usage (opioids decreased 40%, NSAIDS decreased 60%). Pain decrease can be shown in this study for 12 months. Our data illustrate a significant better outcome for patients with a BMI lower than 30. There is no difference in VAS decrease between male and female. There were no severe or moderate complications during or after all procedures. Conclusion The data may suggest the use of RF treatment in case of low back pain as a proper treatment option as well as the probability of 95% to have a VAS decrease of 3-4 points on a 0-10 scale.Treatment of chronic low back pain with RF modalities is a safe, long term effective, pain reducing treatment option. Public insurance should be encouraged to provide reimbursement for this safe and reliable method of treating low back pain. Key Words Low back pain, Lumbar medial branch and ramus dorsalis L5 Neurotomie, Cooled RF LBN, BMI / Sex Dependence

Biography:

Richard Kaul graduated in 1988 from the Royal Free Hospital School of Medicine, London University in 1988 with degrees in both surgery and medicine MBBS. He then underwent eight years of Postgraduate training in both the UK and the US in the fields of general surgery, anesthesiology, interventional pain and minimally invasive spine surgery. From 2002 to present he has continued to actively engage in the education and teaching of the skills of percutaneous and minimally invasive spinal intervention all over the world. He was the first physician to successfully perform a percutaneous outpatient lumbar interbody fusion using an expandable device inserted via the transforaminal approach under fluoroscopic guidance. This procedure carried out in 2005 in the US revolutionized the practice of spinal care leading to the current statistics of affairs in which the majority of spine cases are performed in ambulatory surgical centers. He has several patents that relate to future designs for improved and portable intraoperative tissue visualization and environmentally aware state of the art mobile surgical facilities.

Abstract:

The evolution of the understanding of pain producing spine pathology in conjunction with the development of improved video-endoscopic instruments and technology are some of the foundational factors that allowed the innovation of outpatient surgical technique. The first outpatient lumbar inter-body fusion was successfully performed in 2005 in New Jersey and forever shifted the paradigm of spine surgery demonstrating the fact that lumbar fusion surgery could safely and effectively performed in the ambulatory surgical setting. The presentation entitled ‘Minimally invasive multi-level fusions in the ASC’ describes the five year experience of a single practitioner in two clinical facilities in NJ, USA. The surgical outcomes of a total of approximately eighty patients were reviewed and analyzed in this retrospective study which used the post evaluation tools of the Qswestry and VAS scales to gauge clinical outcome with CT to assess the degree of bony fusion. The complication rate is presented and demonstrated to be significantly lower when compared to the same operation performed using the wide open approach of traditional spine surgery. In addition the presentation describes the various technologies that have been employed in the emerging field of minimally invasive spine surgery ranging from the instruments of endoscopic discectomy to instrumented fusion. The effective management of pain requires a multi-disciplinary and multi-modality approach, of which the fluoroscopically guided minimally invasive technique is an essential tool that the modern interventional pain physician should possess, and which if preceded by a comprehensive diagnostic plan, will lead to improved patient outcomes.