in Miami. This educational core naturally led to a residency in Physical Medicine and Rehabilitat... more in Miami. This educational core naturally led to a residency in Physical Medicine and Rehabilitation at the world-renowned Rehabilitation Institute of Chicago, a pain fellowship as the awardee of the J. Frankel Fellowship, and a career in Pain Medicine, a specialty that since Bonica has relied on the concept of using the training of mind and body together in healing programs dedicated to restoring people's lives after painful and sometimes devastating injuries. In retrospect, that he and the Institute chose each other for a career journey leading to his prominence in the field comes as no surprise. The Institute has been home to some of our field's important leaders, including two of AAPM's founders and past Presidents Robert Addison and Richard Blonsky, as well as Norman Harden, our Senior Associate Editor at Pain Medicine and a worldwide leader of complex regional pain syndrome research and advocacy who recently retired from his role as the Institute's Addison Chair of Pain Research.
Back and Neck Pain Back and neck pain are common complaints and are the main reasons for work-rel... more Back and Neck Pain Back and neck pain are common complaints and are the main reasons for work-related injury and disability claims, with a major economic affect in industrial countries. Many conditions cause back and neck pain (spinal, nonspinal, psychological). Back pain is treated with many specialties: family practice, orthopedic, chiropractic, neurological surgery and neurologists. MUSCLE SPRAIN Muscle sprain or strain is a common clinical scenario that occurs after minor trauma, causing shearing of muscle and fascia. It presents clinically with localized constant, deep pain, without radiation to the limb. There are no neurological symptoms. Treatment is symptomatic, and no diagnostic testing is necessary.
Disclosures: S. G. Chung, No Disclosures: I Have Nothing To Disclose. Objective: To test whether ... more Disclosures: S. G. Chung, No Disclosures: I Have Nothing To Disclose. Objective: To test whether the nucleus pulposus (NP) of the cervical intervertebral discs (IVD) migrates forward by cervical extension, so-called McKenzie, maneuver. Design: In vivo anatomical measurement before and after intervention. Setting: An MRI center in a university hospital. Participants: 10 young and healthy males (22.4 1.6 years old). Interventions: T2 midline sagittal MR images were obtained in supine position with the cervical spine in neutral and approximately 20 degree extended postures. Main Outcome Measures: The anterior and posterior IVD heights and the horizontal position of the posterior margin of NP were measured and compared between the neutral and extended postures in each IVD of the C3-4, C4-5, C5-6, C6-7 levels. Results or Clinical Course: Anterior IVD heights increased significantly in the C3-4 and C4-5 levels (5.77 0.71mm to 6.45 0.92mm and 6.30 0.85mm to 6.92 0.77mm, respectively, with p<.01) while slight increments were noticed in the lower levels. The posterior end of NP showed meaningful forwardly displacements in all of the levels (1.37 0.75mm, 1.41 1.45mm, 0.68 0.73mm, and 0.64 0.98 with p < .05). Conclusions: Cervical extension maneuver increases the height of anterior IVDs and moves NP forward, which may help to prevent or treat posterior annular tear or herniation of NP.
Abstract This chapter describes the physical medicine and rehabilitation approach to acute and ch... more Abstract This chapter describes the physical medicine and rehabilitation approach to acute and chronic painful musculoskeletal complaints. It highlights the importance of treating the whole patient with the goal of restoring maximal function through therapeutic exercise. The role of passive modalities, including cryotherapy, heat, and ultrasound, are discussed as adjunctive treatment to the active flexibility, strength, and cardiovascular exercise being performed by the patient under the supervision of physical therapists. Specific physical therapy approaches to low back pain including mechanical diagnosis and treatment and neurodynamic therapy are also discussed. Comprehensive interdisciplinary treatment programs can be helpful for those patients that develop more chronic musculoskeletal complaints.
Funding sources: The views expressed in this article are those of the authors and no official end... more Funding sources: The views expressed in this article are those of the authors and no official endorsement by the Food and Drug Administration (FDA) or the pharmaceutical and device companies that provided unrestricted grants to support the activities of the Analgesic, Anesthetic, and Addiction Clinical Trial Translations, Innovations, Opportunities, and Networks (ACTTION) public-private partnership should be inferred. Financial support for this project was provided by the ACTTION public-private partnership, which has received research contracts, grants, or other revenue from the FDA, multiple pharmaceutical and device companies, philanthropy, and other sources.
Background: Tanezumab, a monoclonal antibody against nerve growth factor, is in development for t... more Background: Tanezumab, a monoclonal antibody against nerve growth factor, is in development for the treatment of the signs and symptoms of osteoarthritis (OA). Objectives: To assess the improvement in physical function following treatment with subcutaneous (SC) tanezumab in three Phase 3 OA studies. Methods: All three randomized, double-blind, controlled studies enrolled patients (pts) with radiographically-confirmed OA of the hip or knee, who had inadequate response or could not tolerate standard of care analgesics. Study 1 was a dose-titration study (NCT02697773), where pts received two SC doses of: placebo at baseline/week (wk) 8; tanezumab 2.5 mg at baseline/wk 8; or tanezumab 2.5 mg at baseline/5 mg at wk 8 1. In Study 2 (NCT02709486), pts received three SC doses of placebo, tanezumab 2.5 mg, or 5 mg (at baseline/wk 8/wk 16). In Study 3 (NCT02528188), pts received a stable dose of nonsteroidal anti-inflammatory drugs (NSAIDs) before randomization to double-dummy tanezumab 2.5 m...
Long-term opioid therapy has the potential for serious adverse outcomes and is often used in a vu... more Long-term opioid therapy has the potential for serious adverse outcomes and is often used in a vulnerable population. Because adverse effects or failure to maintain benefits is common with long-term use, opioid taper or discontinuation may be indicated in certain patients. Concerns about the adverse individual and population effects of opioids have led to numerous strategies aimed at reductions in prescribing. Although opioid reduction efforts have had generally beneficial effects, there have been unintended consequences. Abrupt reduction or discontinuation has been associated with harms that include serious withdrawal symptoms, psychological distress, self-medicating with illicit substances, uncontrolled pain, and suicide. Key questions remain about when and how to safely reduce or discontinue opioids in different patient populations. Thus, health care professionals who reduce or discontinue long-term opioid therapy require a clear understanding of the associated benefits and risks as well as guidance on the best practices for safe and effective opioid reduction. An interdisciplinary panel of pain clinicians and one patient advocate formulated recommendations on tapering methods and ongoing pain management in primary care with emphasis on patient-centered, integrated, comprehensive treatment models employing a biopsychosocial perspective.
The findings and scientific conclusions in this report are those of the authors and do not reflec... more The findings and scientific conclusions in this report are those of the authors and do not reflect the position of any funding source or its representatives, who were not present during panel discussions related to these findings and who had no input in the design, analysis, interpretation of results, or preparation of this article and any and all products of this venture. For those authors holding positions with the US Department of Veterans Affairs, the present statement reflects their personal views and does not represent the views or positions of the Department of Veterans Affairs or any other agency of the US federal government. Disclosures and conflicts of interest: D.P. Alford is a course director for safe opioid prescribing continuing medical education programs, funded by an unrestricted educational grant awarded to the Boston University School of Medicine CME office by the Risk Evaluation and Mitigation Strategy (REMS) Program Companies as part of the US Food and Drug Administration (FDA) extended-release and long-acting (ER/LA) Opioid REMS program. He did not receive any direct compensation from industry for this activity. C. Argoff has served as a consultant for BioDelivery Sciences, Collegium, Daiichi Sankyo, Egalet, Grü nenthal, Kaleo, US WorldMeds, Pfizer, Eli Lilly, Novartis, Scilex, Teva, and Regeneron and has received honoraria for speaking from Allergan, Daiichi Sankyo, Amgen, Teva, Eli Lilly, and Jazz Pharmaceuticals. B. Canlas has no relevant financial relationships to disclose. E. Covington has served as a consultant for Inspirion, Endo Pharmaceuticals, AcelRx Pharmaceuticals, Intellipharmaceutics, Indivior, Braeburn Pharmaceuticals, Trevena, and Franklin Bioscience. K.J. Haake has served as a consultant to Medtronic and Pfizer and currently serves as a consultant to the Centene Corporation. S.G. Kertesz attests to ownership of stock in Abbott Pharmaceuticals and Merck, amounting for less than 3% of his assets, sold in 2017. He has no other current or past consultancies, honoraria, or industry relationships to disclose. S.P. Stanos is a course director for safe opioid prescribing continuing medical education programs funded by unrestricted educational grants awarded to Miller Medical Communications by the REMS Program Companies as part of the US Food and Drug Administration ER/LA Opioid REMS program. He did not receive any direct compensation from industry for these activities. He served as an invited consultant to
Headlines: "President Trumpov announces Governor Christie to lead charge to fight the opioid epidem... more Headlines: "President Trumpov announces Governor Christie to lead charge to fight the opioid epidemic." Reporter: "A comment from the AAPM, please." AAPM President: "The President's decision to appoint the task force gives us an opportunity to respond to a serious crisis and help the public and stakeholders understand the breadth of 'pain management.'"
in Miami. This educational core naturally led to a residency in Physical Medicine and Rehabilitat... more in Miami. This educational core naturally led to a residency in Physical Medicine and Rehabilitation at the world-renowned Rehabilitation Institute of Chicago, a pain fellowship as the awardee of the J. Frankel Fellowship, and a career in Pain Medicine, a specialty that since Bonica has relied on the concept of using the training of mind and body together in healing programs dedicated to restoring people's lives after painful and sometimes devastating injuries. In retrospect, that he and the Institute chose each other for a career journey leading to his prominence in the field comes as no surprise. The Institute has been home to some of our field's important leaders, including two of AAPM's founders and past Presidents Robert Addison and Richard Blonsky, as well as Norman Harden, our Senior Associate Editor at Pain Medicine and a worldwide leader of complex regional pain syndrome research and advocacy who recently retired from his role as the Institute's Addison Chair of Pain Research.
Back and Neck Pain Back and neck pain are common complaints and are the main reasons for work-rel... more Back and Neck Pain Back and neck pain are common complaints and are the main reasons for work-related injury and disability claims, with a major economic affect in industrial countries. Many conditions cause back and neck pain (spinal, nonspinal, psychological). Back pain is treated with many specialties: family practice, orthopedic, chiropractic, neurological surgery and neurologists. MUSCLE SPRAIN Muscle sprain or strain is a common clinical scenario that occurs after minor trauma, causing shearing of muscle and fascia. It presents clinically with localized constant, deep pain, without radiation to the limb. There are no neurological symptoms. Treatment is symptomatic, and no diagnostic testing is necessary.
Disclosures: S. G. Chung, No Disclosures: I Have Nothing To Disclose. Objective: To test whether ... more Disclosures: S. G. Chung, No Disclosures: I Have Nothing To Disclose. Objective: To test whether the nucleus pulposus (NP) of the cervical intervertebral discs (IVD) migrates forward by cervical extension, so-called McKenzie, maneuver. Design: In vivo anatomical measurement before and after intervention. Setting: An MRI center in a university hospital. Participants: 10 young and healthy males (22.4 1.6 years old). Interventions: T2 midline sagittal MR images were obtained in supine position with the cervical spine in neutral and approximately 20 degree extended postures. Main Outcome Measures: The anterior and posterior IVD heights and the horizontal position of the posterior margin of NP were measured and compared between the neutral and extended postures in each IVD of the C3-4, C4-5, C5-6, C6-7 levels. Results or Clinical Course: Anterior IVD heights increased significantly in the C3-4 and C4-5 levels (5.77 0.71mm to 6.45 0.92mm and 6.30 0.85mm to 6.92 0.77mm, respectively, with p<.01) while slight increments were noticed in the lower levels. The posterior end of NP showed meaningful forwardly displacements in all of the levels (1.37 0.75mm, 1.41 1.45mm, 0.68 0.73mm, and 0.64 0.98 with p < .05). Conclusions: Cervical extension maneuver increases the height of anterior IVDs and moves NP forward, which may help to prevent or treat posterior annular tear or herniation of NP.
Abstract This chapter describes the physical medicine and rehabilitation approach to acute and ch... more Abstract This chapter describes the physical medicine and rehabilitation approach to acute and chronic painful musculoskeletal complaints. It highlights the importance of treating the whole patient with the goal of restoring maximal function through therapeutic exercise. The role of passive modalities, including cryotherapy, heat, and ultrasound, are discussed as adjunctive treatment to the active flexibility, strength, and cardiovascular exercise being performed by the patient under the supervision of physical therapists. Specific physical therapy approaches to low back pain including mechanical diagnosis and treatment and neurodynamic therapy are also discussed. Comprehensive interdisciplinary treatment programs can be helpful for those patients that develop more chronic musculoskeletal complaints.
Funding sources: The views expressed in this article are those of the authors and no official end... more Funding sources: The views expressed in this article are those of the authors and no official endorsement by the Food and Drug Administration (FDA) or the pharmaceutical and device companies that provided unrestricted grants to support the activities of the Analgesic, Anesthetic, and Addiction Clinical Trial Translations, Innovations, Opportunities, and Networks (ACTTION) public-private partnership should be inferred. Financial support for this project was provided by the ACTTION public-private partnership, which has received research contracts, grants, or other revenue from the FDA, multiple pharmaceutical and device companies, philanthropy, and other sources.
Background: Tanezumab, a monoclonal antibody against nerve growth factor, is in development for t... more Background: Tanezumab, a monoclonal antibody against nerve growth factor, is in development for the treatment of the signs and symptoms of osteoarthritis (OA). Objectives: To assess the improvement in physical function following treatment with subcutaneous (SC) tanezumab in three Phase 3 OA studies. Methods: All three randomized, double-blind, controlled studies enrolled patients (pts) with radiographically-confirmed OA of the hip or knee, who had inadequate response or could not tolerate standard of care analgesics. Study 1 was a dose-titration study (NCT02697773), where pts received two SC doses of: placebo at baseline/week (wk) 8; tanezumab 2.5 mg at baseline/wk 8; or tanezumab 2.5 mg at baseline/5 mg at wk 8 1. In Study 2 (NCT02709486), pts received three SC doses of placebo, tanezumab 2.5 mg, or 5 mg (at baseline/wk 8/wk 16). In Study 3 (NCT02528188), pts received a stable dose of nonsteroidal anti-inflammatory drugs (NSAIDs) before randomization to double-dummy tanezumab 2.5 m...
Long-term opioid therapy has the potential for serious adverse outcomes and is often used in a vu... more Long-term opioid therapy has the potential for serious adverse outcomes and is often used in a vulnerable population. Because adverse effects or failure to maintain benefits is common with long-term use, opioid taper or discontinuation may be indicated in certain patients. Concerns about the adverse individual and population effects of opioids have led to numerous strategies aimed at reductions in prescribing. Although opioid reduction efforts have had generally beneficial effects, there have been unintended consequences. Abrupt reduction or discontinuation has been associated with harms that include serious withdrawal symptoms, psychological distress, self-medicating with illicit substances, uncontrolled pain, and suicide. Key questions remain about when and how to safely reduce or discontinue opioids in different patient populations. Thus, health care professionals who reduce or discontinue long-term opioid therapy require a clear understanding of the associated benefits and risks as well as guidance on the best practices for safe and effective opioid reduction. An interdisciplinary panel of pain clinicians and one patient advocate formulated recommendations on tapering methods and ongoing pain management in primary care with emphasis on patient-centered, integrated, comprehensive treatment models employing a biopsychosocial perspective.
The findings and scientific conclusions in this report are those of the authors and do not reflec... more The findings and scientific conclusions in this report are those of the authors and do not reflect the position of any funding source or its representatives, who were not present during panel discussions related to these findings and who had no input in the design, analysis, interpretation of results, or preparation of this article and any and all products of this venture. For those authors holding positions with the US Department of Veterans Affairs, the present statement reflects their personal views and does not represent the views or positions of the Department of Veterans Affairs or any other agency of the US federal government. Disclosures and conflicts of interest: D.P. Alford is a course director for safe opioid prescribing continuing medical education programs, funded by an unrestricted educational grant awarded to the Boston University School of Medicine CME office by the Risk Evaluation and Mitigation Strategy (REMS) Program Companies as part of the US Food and Drug Administration (FDA) extended-release and long-acting (ER/LA) Opioid REMS program. He did not receive any direct compensation from industry for this activity. C. Argoff has served as a consultant for BioDelivery Sciences, Collegium, Daiichi Sankyo, Egalet, Grü nenthal, Kaleo, US WorldMeds, Pfizer, Eli Lilly, Novartis, Scilex, Teva, and Regeneron and has received honoraria for speaking from Allergan, Daiichi Sankyo, Amgen, Teva, Eli Lilly, and Jazz Pharmaceuticals. B. Canlas has no relevant financial relationships to disclose. E. Covington has served as a consultant for Inspirion, Endo Pharmaceuticals, AcelRx Pharmaceuticals, Intellipharmaceutics, Indivior, Braeburn Pharmaceuticals, Trevena, and Franklin Bioscience. K.J. Haake has served as a consultant to Medtronic and Pfizer and currently serves as a consultant to the Centene Corporation. S.G. Kertesz attests to ownership of stock in Abbott Pharmaceuticals and Merck, amounting for less than 3% of his assets, sold in 2017. He has no other current or past consultancies, honoraria, or industry relationships to disclose. S.P. Stanos is a course director for safe opioid prescribing continuing medical education programs funded by unrestricted educational grants awarded to Miller Medical Communications by the REMS Program Companies as part of the US Food and Drug Administration ER/LA Opioid REMS program. He did not receive any direct compensation from industry for these activities. He served as an invited consultant to
Headlines: "President Trumpov announces Governor Christie to lead charge to fight the opioid epidem... more Headlines: "President Trumpov announces Governor Christie to lead charge to fight the opioid epidemic." Reporter: "A comment from the AAPM, please." AAPM President: "The President's decision to appoint the task force gives us an opportunity to respond to a serious crisis and help the public and stakeholders understand the breadth of 'pain management.'"
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