We had a lovely meeting at the Omni  Champions Gate in Orlando. Our theme was integrative pain care in the 21st century. We had a new and exciting format this year where we had a live patient who agreed to be interviewed, examined and an active participant in an abbreviated treatment process. It was a smashing success and our reviews from our attendees were very positive! We utilized an interdisciplinary panel including pain medicine, functional medicine, prolotherapy, psychology,  physical therapy and psychiatry. There was a lot of interaction from the audience and we felt that this really encompassed the spirit of the Southern Pain Society's mission statement of multidisciplinary treatment of pain.  It was really fascinating to observe each specialty's conceptualization of the patient unfold. I strongly feel that we could benefit from more of these type presentations in the future!

The meeting progressed highlighting pain treatment innovations including a presentation on laser therapies, energy medicine and restorative injection therapies.

On Sunday, one of our favorite speakers, David Vaughan an attorney from Louisiana, gave a compelling presentation on compliance. Other presentation highlights included what the ICD means for pain medicine, pain regulations from a DEA perspective. Dr. Marla Golden's presentation on self management programs for chronic pain patients was the closing talk for our conference this year, and it was very fitting. Dr. Golden highlighted the ways in which we can help patients empower themselves. This also stimulated some really good discussion among our attendees.

As we move our attention to plans for the new year, our planning is already underway for our New Orleans meeting in September 2016. We are very excited to be returning to New Orleans as this is one of our favorite cities to host a meeting in. We have some very exciting speakers on our roster. One of the faculty that I am extremely excited about is Dr. David Hanscom, who is an orthopedic surgeon who also emphasizes a mind-body approach to managing pain. His book Back in Control: A Spine Surgeon's Roadmap Out of Chronic Pain is an excellent study in the mind body pain experience. Dr. Hanscom will be speaking about his book as well as other developments in the treatment of chronic pain.

We will have many other exciting speakers as well and will continue to update you via email updates and news alerts. We are also already beginning planning on our 2017 meeting and are excited that we will be able to host this meeting in New Orleans as well. Stay tuned for more updates on both 2016 and 2017. As always if you have suggestions for topics, speakers, or just a general question do not hesitate to contact me through our website. Always happy to answer questions and welcome dialogue from our membership! Happy New Year!

Geralyn Datz, PhD
Clinical Health Psychologist
President, Southern Pain Society

Our 2016 Conference Committee has been hard at work putting together an excellent program for the 2016 conference in New Orleans. To be held from September 30th to October 2nd, the conference theme is "Pain Management - Are we doing anything right?" We have an outstanding line-up of presenters who will assuredly show that pain management specialists are carrying out lots of "right" treatments for our patients - even in patients with difficult to treat painful complaints.

However, recent medical publications demonstrate that the robust & public complaints about pain management practices - especially practices involving medication management - are still clearly valid. We continue to have a long way to go in making effective pain medications available to legitimate patients who need them while minimizing the risks of diversion, overdose, or death. In short, we have a long way to go in making pain management treatment "right" for our patients.

On August 19th, Dr. Bill McCarberg, President of the American Academy of Pain Medicine, published his President's Message in the journal Pain Medicine concerning Washington State's Opioid Prescribing Guidelines [1]. Starting his column with "These are difficult times for the pain practitioner", Dr. McCarberg shows that many of our beliefs about the effectiveness of a diversity of pain management treatments is being challenges by outcomes studies. When it comes to medications, not just opiate / opioid medications are having problems but also antidepressants, anticonvulsants, and anti-inflammatories show only modest benefit - when they show any benefit at all - over the long-term of treatment for chronic pain. Physical modalities such as physical therapy, chiropractic, massage, and pool / aqua therapy similarly reveal only slight patient improvements over the long-term (if they show any improvement at all). Reimbursement for these physical modalities is scant but even that level of reimbursement is more generous than what is available for the "gold standard" of pain management treatment; interdisciplinary pain rehabilitation. The insurance / financial and geographic barriers for patients aspiring to receive interdisciplinary pain rehabilitation are so great that patients face Powerball-type odds of getting into one.

On December 18th, the Centers for Disease Control and Prevention published their latest in a series of studies documenting the precipitous rise of opiate / opioid overdose deaths throughout the United States [2]. This article was the latest in a long series of publications in Morbidity and Mortality Weekly Report by Dr. Leonard J. Paulozzi, MD, and his colleagues at the CDC's National Center for Injury Prevention and Control. Beginning in the 1990's, each article in the series showed an alarming and steep rise in overdose deaths attributed to opiate-containing pain medications [3]. Furthermore, the rate of increase also closely mirrored the rate of sales of these medications. Indeed, it is the deep concern about this marked increase in deaths that led to the rapid adoption of Risk Evaluation and Mitigation Strategies (REMS) for these medications as well as the rapid proliferation of urine drug testing kits and prescription monitoring software.

The latest update continues to demonstrate this grim trend. The rate of opioid overdose deaths increased by 14% from 2013 to 2014. More persons died from drug overdoses in the United States in 2014 than during any previous year on record. Opioids are the main drugs associated with overdose deaths. In 2014, opioids were involved in 28,647 deaths, or 61% of all drug overdose deaths. Overall, the rate of opioid overdoses has tripled since 2000.

Then, on January 5th of this year, medical researchers at Harvard University and Boston University published their review of nearly three thousand non-fatal opioid overdose admissions to affiliated hospitals in the Annals of Internal Medicine [4]. All patients in this study were receiving their opiates through prescriptions to treat chronic non-malignant pain from 2000 to 2012. Their analysis was striking - nearly 91% of these patients were prescribed opiate-containing pain medications again well within one year of their treatment admission! Furthermore, nearly 70% of the prescribers were the same prescriber of opiate-containing medication that caused the first overdose!! Further analysis showed 7% of these patients were admitted within a year for treatment of another opiate overdose. When looking at patients prescribed the highest dosages, the rate of readmission for an opiate overdose by two years was 17%.

These articles - both the one from the CDC as well as the one from Harvard & Boston University are exactly the type of studies that Dr. McCarberg is talking about in his President's Message.

This leads to a question discussed by Dr. McCarberg, as well as by an editorial written by Dr. Jessica Gregg in the Annals of Internal Medicine [5]. Are the physicians writing these repeated opiate prescriptions lazy, cavalier, or willfully blind to the jeopardy of their patients from these medications? Or is it closer to the truth that these prescribers are listening to their patients who often strenuously state that opiate-containing pain medications have relieved their intolerable physical suffering better than any of the other myriad of treatments they have tried in the past? This is not merely an academic argument for the answers that help to solve this question are clearly part of the key in making safe and effective - as well as reasonably affordable and convenient - pain management treatments available to our patients.

I hope that you will join me in New Orleans as we explore this topic and find ways to do "right" for more of our patients.

References

[1] Bill McCarberg. AMERICAN ACADEMY OF PAIN MEDICINE PRESIDENT'S MESSAGE. Washington State Opioid Prescribing Guidelines . Pain Medicine , 16: 1455-1456. doi: 10.1111/pme.12851

[2] Rose A. Rudd, et al. Increases in Drug and Opioid Overdose Deaths - United States, 2000-2014. Morbidity and Mortality Weekly Report, Volume 18, Pages 1-5; Published December 18th, 2015. Available at URL  http://www.cdc.gov/mmwr/preview/mmwrhtml/mm6450a3.htm?s_cid=mm6450a3_w

[3] Paulozzi LJ, Ryan GW. Opioid analgesics and rates of fatal drug poisoning in the United States. American Journal of Preventive Medicine 31:506-511; 2006.

[4] Marc R. Larochelle, et al. Opioid Prescribing After Nonfatal Overdose and Association With Repeated Overdose: A Cohort Study. Annals of Internal Medicine 164 (1): 1-9. Published January 5th, 2016

[5] Jessica Gregg. Follow-up to Nonfatal Opioid Overdoses: More of the Same or an Opportunity for Change? Annals of Internal Medicine 164(1): 62-63. Published January 5th, 2016.