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:

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.