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.