1:45 PM–2:45 PM Saturday, February 29

Emerging Applications for Peripheral Nerve Stimulation for Subacute and Chronic Pain Syndromes (309)

The emerging field of peripheral nerve stimulation (PNS) has captivated practitioners in novel treatment ideas for postsurgical and chronic neuropathic pain patients. This session will be a comprehensive review of evidence, techniques, and mechanisms for PNS treatments in the pain population.

Mechanisms of Peripheral Nerve Stimulation

Amitabh Gulati

Indications and Novel Techniques for the Application of PNS

Einar Ottestad

Evidence for PNS in Post-Surgical and Neuropathic Pain Syndromes

Vafi Salmasi

Learning Objectives:

  • Identify the physiology of PNS systems on neural transmissions and improvement in the perception of pain.
  • Recognize the importance of technique, including ultrasound guidance, in optimizing the efficacy of PNS for pain patients.
  • Review the evidence for PNS treatments for postsurgical and chronic neuropathic pain patients.
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Moderator:

Amitabh Gulati

Co-Presenters:

Einar Ottestad

Vafi Salmasi

11:15 AM–12:15 PM Saturday, February 29

The Promise and Reality of Regenerative Medicine in Pain Management (307)

Regenerative medicine (RM) in pain management provides new hope for not only reducing pain as a symptom but also for modifying the disease processes that underlie the mechanisms of pain, whether it is degenerative or neuropathic in nature. However, there are conspicuous gaps between the current clinical practice and the science/clinical evidence for the application of RM in pain management. This session specifically was designed by internationally recognized experts in basic science, translational science, and clinical practice of RM to bridge these gaps.

Emerging MSC Therapy to Combat Opioid Tolerance

Jianguo Cheng

The Science of MSCs and MSC Therapies

Arnold Caplan

The Pivotal Evidence or the Lack of it for Regenerative Medicine in Clinical Practice

Wenchun Qu

Learning Objectives:

  • Describe the scientific rationale of RM in pain management.
  • Describe the future direction of RM in pain management by presenting emerging and translational research.
  • Describe the pivotal evidence of RM for specific clinical indications in pain management in terms of metrics, data, and outcomes.
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Moderator:

Jianguo Cheng

Co-Presenters:

Arnold Caplan

Wenchun Qu

11:15 AM–12:15 PM Saturday, February 29

Neuromodulation Review 2 (305)

With the fact that chronic pain afflicts more than 100 million Americans and amid the current opioid crisis, there is great unmet need for innovative alternatives for the treatment of chronic pain.

This session will report on a multicenter, prospective, randomized, double-blind study of this novel SCS system and will also focus on the value of ECAP monitoring to understand the mechanism of action of SCS as well provide neurophysiologic monitoring of spinal cord function.

Advances in using SCS for the management of cancer-related pain with emphasis on recognizing and mitigating possible complications will also be addressed.

Outcomes of Clinical Trials of SCS using ECAPS to Provide Closed-Loop Control

Nagy Mekhail, MD PhD

ECAPS for Neuro-Monitoring

Steven Falowski, MD

Advances in the Use of Spinal Cord Stimulation in the Treatment of Cancer-Related Pain

Lisa Stearns, MD

Learning Objectives:

  • Review the shortfalls of the current ‘fixed output' spinal cord stimulation technology.
  • Appraise the value of measuring the Evoked Compound Action Potential ‘ECAP’ as indicator/monitor of spinal cord activation.
  • Discuss the value and long-term outcomes of spinal cord stimulation for cancer-related pain.
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9:15 AM–10:15 AM Saturday, February 29

Neuromodulation Review 1 (301)

In spite of significant advances in SCS technology, there is still a 20% failure rate in long term SCS therapy primarily due to loss of analgesic benefit. Participants will learn what physiological, pharmacological, and electromechanical factors may contribute to this failure rate and what steps can be implemented to improve long term SCS success.

Determinants of SCS Failures: Opioids, Lack of Sustained Analgesia, and SCS Tolerance/Adaptation

Peter Staats, MBA MD

Advances in SCS Pharmacology

Magdalena Anitescu, MD PhD

Programming Approaches to Solve Failure of SCS Analgesia

Lawrence Poree, MD MPH PhD

Learning Objectives:

  • Discuss physiological, pharmacological, and electromechanical factors that may contribute to a failure rate in long term SCS therapy.
  • Identify strategies to improve long-term SCS success.
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11:00 AM-12:00 PM Sunday, March 1

Neuromodulation and Mitigating the Risk of Infection (411)

Neuromodulation increasingly is seen as an alternative opioid-sparing treatment option. Given its increased use, it is vitally important that implanters understand how to identify patients at increased risk of infection, mitigate infection, and manage infection. Attendees will leave this session feeling more confident in how to decrease and manage infections.

Protocols for Infection Prevention

Samer Narouze

When the Redness Doesn’t Resolve: Infection Identification and Management

Stephanie Neuman

Case Experiences: Bugs and Beyond

Susan Moeschler

Learning Objectives:

  • Discuss the incidence and impact of spinal cord stimulator infections along with identified surgical site infection risk factors.
  • Diagnose and discuss types of spinal cord stimulator infections.
  • Identify best practices for infection prevention as well as treatment approaches based on infection type.
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9:45–10:45 AM Sunday, March 1

Neuropathic Pain: Pharmacological Trends and Interventional Techniques in Challenging Patients (405)

Patients with intractable neuropathic pain are challenging. This session will discuss the evidence-based use of current pharmacotherpeutic agents that target underlying pain mechanisms. We will also review the evidence-based uses of regional and interventional techniques including neural blockade, neuromodulation (spinal cord stimulation and peripheral stimulation), and targeted drug delivery and guidelines for use of some of these modalities.

Update on Pharmacotherapy

Andrea Nicol

Regional and Interventional Techniques

May Chin

Neurostimulation and Targeted Drug Delivery

Eellan Sivansen

Learning Objectives:

  • Review current evidence-based uses of pharmacological agents that target neuropathic pain.
  • Discuss evidence-based uses of interventional techniques in patients with severe neuropathic pain refractory to conventional treatment.
  • Review current guidelines and concepts in neuromodulation (spinal cord stimulation, peripheral stimulation) and targeted drug delivery for intractable neuropathic pain.
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Moderator:

May Chin

Co-Presenters:

Andrea Nicol

Eellan Sivansen

8:30–9:30 AM Sunday, March 1

Brain Imaging (404)

This session will describe the advances and utility of neuroimaging for pain. Specifically, it will provide a contemporary overview of neuroimaging of the brain, brainstem and spinal cord. It will outline how neuroimaging has advanced the understanding of acute and chronic pain, as well as how cognitive and emotional factors contribute to the magnification and persistence of pain. The neuroscience of placebo and expectations and how this knowledge can translate into better understanding of our patient’s response to treatment will also be discussed. Finally, current efforts and results in development of objective brain/spinal cord biomarkers to (1) predict treatment responses; (2) prognose course of pain; (3) identify those susceptible to the development of chronic pain after injury will be discussed. The session will conclude with an interactive Q&A session to address the current and future uses of neuroimaging in pain.

Neuroimaging of Pain: Overview and Impressions

Katherine Martucci, PhD

Placebos and Painkillers: Is Mind as Real as Matter

Luana Collaca, PhD

Brain-Based Biomarkers of Pain: Advancing the Goal of Precision Pain Medicine

Sean Mackey, MD PhD

Learning Objectives

  • Discuss the role of neuroimaging in elucidating the central mechanisms involved in pain processing, perception and plasticity.
  • Recognize the cognitive and emotional factors that modulate our experience of pain, our individual differences in pain perception and analgesia, and the central neural correlates of these phenomena.
  • Discuss the neuroimaging results that have advanced our understanding of placebo and nocebo in the experience and treatment of pain.
  • Describe the role of brain neuroimaging in the detection and classification of acute and chronic pain
  • Review the validity requirements for a neuroimaging based measurement of pain to be clinically useful as a tool for precision pain medicine.
  • Review the ethical, privacy, and legal implications of a brain imaging-based objective measure of pain.

 

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