Evidence-based nonpharmacologic pain medicine as culture

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Evidence-based nonpharmacologic pain medicine as culture

Transcript Of Evidence-based nonpharmacologic pain medicine as culture

5/13/2019
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Evidence-based nonpharmacologic pain medicine as culture change in practice, education and policy: How do we get there from here? Heather Tick, MD
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Overview
• Pain crisis in US – Burden of pain including economic impact
• Opioid epidemic – Adverse effects and addiction liability – Continued inadequate pain care
• Evidence-based nonpharmacologic options – Acute pain inpatient setting – Acute pain outpatient setting – Cancer pain – Chronic pain

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Burden of pain including economic impact
• $560-635 billion annual cost of pain care – Exceeds annual expenditures for heart disease, cancer, diabetes combined
• 11-47% of US population have chronic pain – Low back, neck, OA, headache most common – Leading cause of disability globally – Expected to rise with increase in diabetes, obesity and surgeries
• 17.8% GDP spent on healthcare; significant portion on pain • $78.5 billion annual opioid overdose, abuse, dependency
– 2015 private insurers and employer self-funded plans pain $16,000 more per patient w/dx opioid abuse or dependence than for any other diagnosis
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Pain Task Force White Paper Accessed by 5000+ colleagues
• www.nonpharmpaincare.org • Researchgate • Including DoD, VA, CMS, NIH, multiple professional
organizations and researchers around the world
Tick H, Nielsen A, Pelletier KR, Bonakdar R, Simmons S, Glick R, Ratner E, Lemmon RL, Wayne PM, Zador V. Evidence-based Nonpharmacologic Strategies for Comprehensive Pain Care: The Consortium Pain Task Force White
Paper. Explore (NY). 2018.

ACUTE

CHRONIC

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ACUTE PAIN
• A DANGER alert system • A signal of potential life threatening injury • A brain process (no brain no pain) • A need for urgent action • Subject to modification by the CNS
NON-LIFE T H R E AT E N I N G
PAIN • A brain process modifies our
sense of urgency • Inhibitory central and peripheral
pathways • No need for urgent
action

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WHAT IS CHRONIC PAIN?

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• Possibly ongoing nociception • A change in brain processes • The failure of descending inhibitory
pathways • A chronic disease • An urgent need for drugs?

W H AT FA C I L I TAT E S CHRONIC PAIN

• Peripheral and central sensitization (Mense) Ongoing nociception sensitizes (Mense)
• Descending inhibitory pathways augment pain-microglia
• Adaptive movement disorderssomatsensory cortex (Barbe)
• Chronic stress, PTSD, adrenal activation
• Adverse childhood events • Opioids • Chronic inflammation
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WHAT IS PAIN
• A sensation • A signal of injury • A chronic disease • A brain process • A need for drugs

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CHRONIC DISEASE
• Chronic diseases cause 7 in every 10 deaths each year in the United States.
• About 133 million Americans—nearly 1 in 2 adults—live with at least one chronic illness.
• More than 75% of health care costs are due to chronic conditions.
http://www.cdc.gov/chronicdisease/resources/publications/aa g/chronic.htm (accessed 9.15.13))
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Medicine is like a game of connect the dots
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Tree
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Medicine is like a game of connect the dots What about the connectors?
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THE KEY TO HEALTH:

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FASCIA
• Body-wide force signaling system
• More of a connector than a tissue demarcation
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PainDiabetesMenseGameBrain Process