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Saturday, October 21, 2017
Practical QiGong for Your Daily Life and Practice
How qi (“energy”) movements can release and relieve pain
QiGong, one of the most widely practiced and researched energy medicine traditions in the world, is scientifically documented to relieve pain and stress, reverse aging and paralysis, boost your immune system, your energy, sense of well-being, and more. Start your day in a fun energizing way, and experience for yourself the meditative breathing and stretching exercises of “miracle healing” QiGong. Learn practical Qi tools you can apply immediately to your daily life and practice; and discover for yourself how QiGong can empower you, your staff, your patients, and your loved ones toward greater freedom from pain. Be sure to wear comfortable clothing.
Learning Objectives: After completing this educational activity, participants will be better able to: 1) Discuss three ways to activate your Qi; 2) Demonstrate proper meditative QiGong abdominal breathing and posture and discuss its importance; 3) Identify three principles and practices of QiGong “PMA,” positive mental attitude, and discuss their importance; 4) Demonstrate and discuss how to balance and harmonize you and your client’s Qi for release and relief of pain.
Faculty: Nadia Linda Hole, MD
Keynote: The Science, Politics, and Medicine of Medical Cannabis for Chronic Pain
The clinical evidence – and challenges – for treating pain with medical cannabis.
The presentation will cover the science, politics, and medicine for the successful integration of medical cannabis into clinical practice for treating chronic pain. A summary of the evidence for using medical cannabis to treat chronic pain will also be discussed.
Learning Objectives: After completing this educational activity, participants will be better able to: 1) Discuss the controversy and regulatory issues surrounding medical cannabis; 2) Discuss opioid/cannabinoid interactions; 3) Discuss the abuse potential of the cannabinoids; 4) Review the basic mechanisms and pharmacology of the cannabinoids; 5) Review the clinical evidence for pain relief.
Faculty: Mark Wallace, MD
Noninvasive Treatments for Low Back Pain and ACP Guidelines
Current management practices for low back pain have largely failed to stem rising costs or improve clinical outcomes. Incremental solutions, such as eliminating fraud and conflicts of interest, prior authorization for services, care coordination, and electronic health records, have similarly not improved results. This presentation will explore the 2017 American College of Physicians (ACP) Clinical Practice Guidelines on noninvasive treatments for acute, subacute, and chronic low back pain and how the guidelines can be pragmatically incorporated into patient care. Practical solutions to implement such approaches will be illustrated as well as barriers to care.
Learning Objectives: After completing this educational activity, participants will be better able to: 1) Assess the current state of low back pain management in the United States; 2) Summarize the recommendations of the 2017 ACP clinical guidelines for noninvasive treatments for low back pain; 3) Explain how noninvasive and integrative options can be incorporated in a practical manner consistent with the ACP guidelines.
Faculty: Robb Russell, DC
The Three E’s of Patient Communication: Empathy, Education, and Engagement to Improve Outcomes
Improving clinical outcomes through clinician-patient communications
This course will discuss a variety of evidence-based ideas surrounding best practices for communicating with patients who have chronic pain. These ideas will include the physician as an intervention with the use of empathy in the patient encounter, patient education, and the role that understanding the cause of pain can have on improving outcomes, motivational interviewing, improving patient self-efficacy and empowerment to guide their own treatment. The presentation will be a combination of didactic material presentation, case-based discussion, and small group exercises to generate audience engagement.
Learning Objectives: After completing this educational activity, participants will be better able to: 1) Discuss the role of empathy and compassion in the patient encounter with an emphasis on using these techniques regardless of what treatment strategy is being chosen or offered; 2) Describe the role patient education can play and how being able to communicate the pathophysiology of patient’s pain condition can decrease anxiety and improve outcomes; 3) Illustrate the role that motivational interviewing can play in the encounter around chronic pain and why the use of it can improve self-efficacy.
Faculty: Jill Schneiderhan, MD, ABIHM, and Russell Lemmon, DO
A Common Condition You Haven’t Heard Of: Small Fiber Polyneuropathy
This session will provide an update on a not-so-rare condition associated with chronic pain, small fiber polyneuropathy. In addition to describing the condition, methods of assessment and treatment will be discussed.
Learning Objectives: After completing this educational activity, participants will be better able to: 1) Define small fiber polyneuropathy; 2) Describe methods to make the diagnosis of small fiber polyneuropathy; 3) Describe current treatment approaches for small fiber polyneuropathy.
Faculty: Charles E. Argoff, MD
11:40 AM-12:10 PM
Team-based Care for Low Back Pain: A Panel Discussion
Current management practices for low back pain, irrespective of the approach taken, have largely failed to control costs or improve clinical outcomes. In the U.S., the prevalence and costs of back pain treatment are high and increasing —but clinical outcomes are not improving. This panel session will explore how restructuring the delivery of spine care, including team-based care, is necessary. Changing spine care delivery can help improve patient satisfaction and clinical outcomes and reduce costs. The panel will review and discuss real-world case scenarios.
Learning Objectives: After completing this educational activity, participants will be better able to: 1) Address how fragmentation and misdirected care, inappropriate incentives, and inefficient communication lead to poor outcomes for low back pain; 2) Explain how team-based, relationship-centered care can refine the approach to low back pain to produce optimal patient outcomes; 3) Explain how integrative care options can be pragmatically incorporated in a care plan.
Faculty: Robb Russell, DC, Melissa Nagare, DC, LAc, Clifford Lee, LAc
The Moral Debate: Do What’s Right – Or What’s Allowed?
This interactive presentation will discuss the impact of moral distress upon pain management specialists/clinicians. Additionally, participants will identify strategies to mitigate their moral distress. Facilitated discussion with open forum pre-prepared discussion questions to elicit learner reply/answers. Case examples will be included in the presentation. Information obtained will be de-identified to ensure confidentiality.
Learning Objectives: After completing this educational activity, participants will be better able to: 1) Define moral distress; 2) Identify root causes of moral distress; 3) Discuss strategies to mitigate moral distress in one’s practice.
Faculty: Phyllis Whitehead, PhD, APRN/CNS, ACHPN, RN-BC
Case Study Session: Small Fiber Polyneuropathy
A case study designed to highlight the diagnosis and treatment of small fiber polyneuropathy will be presented. Attendees will participate in the diagnosis and treatment options of this condition that is being recognized as a major cause of painful burning sensations in the feet.
Learning Objectives: After completing this educational activity, participants will be better able to: 1) Identify key symptoms of small fiber polyneuropathy; 2) Discuss key causes and conditions associated with small fiber polyneuropathy.
Faculty: Charles Argoff, MD
Luncheon Keynote: How Healing Works: and What it Means for Health Care (Non-CME)
We now know that most of health—possibly up to 80%—comes from factors outside of what we usually do in the clinic or hospital. The primary determinants of health involve social, environmental, lifestyle, and complementary medicine factors that few clinicians learn to deliver. How can we integrate these health determinants into our routine practice? In this course, Wayne Jonas, MD, will describe a simple, systematic approach called a HOPE (Healing Oriented Practices and Environments) visit that helps patients tap into their inherent healing capacity. Drawing on the most rigorous scientific evidence available, he will show that by adding some simple questions and tools to your office practice, you can quickly move toward more patient-centered, integrative health care and enhance your patients healing for any chronic disease.
Learning Objectives: After completing this educational activity, participants will be better able to: 1) Understand where health comes from and how medical care can access it; 2) Identify the three dimensions of integrative health used in chronic disease; 3) Learn about the HOPE note and how to apply it to enhance healing; 4) Name one activity that will expand your delivery of healing in practice.
Faculty: Wayne Jonas, MD
Keynote: Wounded Healers: Preventing Clinician Suicide
Clinician suicide, tragic as it is, is not random or rare. Rather, it is the culmination of predictable risk factors, which differ in a key way from risk factors for suicide in the general population. We will examine these clinician-specific risk factors, explore ways to minimize risks, and discuss a shift in culture that leads to a healthier, more balanced model of caregiving.
Learning Objectives: After completing this educational activity, participants will be better able to: 1) Name the annual reported rate of physician suicide, and discuss its likely accuracy; 2) Name the risk factors specific to clinician suicide, and discuss how they differ from risk factors that accrue to the general population; 3) Discuss the concept of the “wounded healer” and how personal vulnerability may contribute to clinician effectiveness, but leave risk factors for reduced personal health.
Faculty: W. Clay Jackson, MD, DipTh
Conference Assembly: Realities of Insurance Coverage for Integrative Pain Care
How a patient’s mindset affects outcomes, and the role of clinicians in managing expectations
Pain is a biopsychosocial condition that requires an integrative, comprehensive approach to treatment. It is essential that the toolbox of evidence-informed treatments provided by the full scope of licensed and certified health care providers are not limited by coverage constraints. In July 2017, the National Academies of Science, Engineering, and Medicine released a report on Pain Management and the Opioid Epidemic with a recommendation that public and private payers develop reimbursement models that support evidence-based and cost-effective comprehensive pain management encompassing both pharmacologic and nonpharmacologic treatment modalities. We will hear from the Centers for Medicare and Medicaid Services and a private payer about the process by which they make determinations for coverage. Through discussion and audience participation, we will look for future opportunities and different ways to think about the current evidence.
Learning Objectives: After completing this educational activity, participants will be better able to: 1) Demonstrate understanding of constraints and opportunities to improve coverage for the range of evidence-based integrative, comprehensive pain care; 2) Utilize available data and information about the effectiveness of integrative therapies for pain as a means of improving coverage for these therapies; 3) Demonstrate knowledge of the efforts both federally and on the state level to improve payer policies for pain, and how they can work with these partners to further this effort.
Faculty: R. Douglas Metz, DC, Denee Choice, MD, Bob Twillman, PhD, Mary Greene, MD, MPH, MBA
Update on the Evaluation of Osteoarthritis
The program will start with evaluation techniques for Osteoarthritis (OA) including special imaging views. Dr. Achar will discuss the cost of management, special physical exam techniques and focus on management including discussing role of exercise, the question of running and jumping with specific focus on the knee.
Learning Objectives: After completing this educational activity, participants will be better able to: 1) Discuss why patients with OA should be counseled on exercise; 2) Explain the use of opioids in the management of OA.
Faculty: Suraj A. Achar, MD, FAAFP
Enhanced Recovery After Surgery (ERAS) – An Integrative Approach
This session will expand upon the protocols of ERAS put forth by the University of California San Francisco with using the approach of Integrative Medicine modalities of acupuncture, massage therapy, and osteopathic manual treatments. The faculty will also review the evidence for ERAS as well as the additional uses of integrative modalities for decreasing time spent in hospital, improving pain control, and patient satisfaction.
Learning Objectives: After completing this educational activity, participants will be better able to: 1) Explain the ERAS protocol; 2) Demonstrate evidence for integrative medicine post surgical cases; 3) Discuss how ERAS protocols improve patient outcomes.
Faculty: Michael Kurisu, DO
The Evidence for Chronic Opioid Therapy for Chronic Pain
This session will provide an update on the current evidence for chronic opioid therapy for chronic pain.
Learning Objectives: After completing this educational activity, participants will be better able to: 1) Define chronic opioid therapy; 2) Describe current evidence for the use of chronic opioid therapy for chronic pain; 3) Describe current strategies to optimize treatment outcomes for chronic opioid therapy for chronic pain.
Faculty: Charles E. Argoff, MD
Evidenced-based Approach to Osteoarthritis Management
The session will focus on the evidenced based approach to osteoarthritis management discussing, topical therapy, weight loss, exercise, bracing and whether opioids should be used at all. We will also evaluate the evidence for intra-articular injections and medications to address pain catastrophizing. Finally Dr. Achar will review the data for surgical procedures.
Learning Objectives: After completing this educational activity, participants will be better able to: 1) Discuss the role of topical therapy; 2) Review the data on intra-articular injection and surgery.
Faculty: Suraj A. Achar, MD, FAAFP
Frontline Clinical Use of Evidence-based Integrative Medicine for Chronic Pain
This presentation summarizes chronic pain treatment trends highlighting the increasing interest in incorporating integrative medicine approaches on the frontlines of clinical care. Examples drawn from federally funded research projects will illustrate opportunities and challenges of incoporating such approaches into everyday practice settings: patients’ and clinicians’ experience coordinating acupuncture and chiropractic care for chronic musculoskeletal pain with conventional health care services; a yoga-based adapted movement program embedded within an interdisciplinary primary-care based program for patients receiving long-term opioid therapy; and a statewide Medicaid policy shifting reimbursable treatment for back pain designed to enhance access to integrative medical modalities for qualifying patients.
Learning Objectives: After completing this educational activity, participants will be better able to: 1) Describe changes in the availability of chronic pain-related treatment in the U.S. and its congruence with research data supporting such care; 2) Identify research-supported complementary health approaches for the treatment of chronic pain; 3) Provide examples of ways in which complementary health approaches have and can be integrated into integrated approaches to chronic pain treatment and evaluated.
Faculty: Lynn DeBar, PhD, MPH
An Evidence-Based Need: Urine Drug Monitoring
This session will provide an update on the current evidence for urine drug monitoring for chronic pain.
Learning Objectives: After completing this educational activity, participants will be better able to: 1) Define urine drug monitoring; 2) Describe current evidence for the use of urine drug monitoring for chronic pain; 3) Describe current strategies to optimize urine drug monitoring for chronic pain.
Faculty: Charles E. Argoff, MD
Keynote: Changing Mindsets to Enhance Pain Treatment Effectiveness
How a patient’s mindset affects outcomes, and the role of clinicians in managing expectations.
Patient expectations shape the experience of pain, pain treatment needs, and powerfully influence treatment response. Acquiring a positive mindset is critical to extinguishing nocebo responses and optimizing outcomes. Evidence shows that structure and function of the brain is changed by reducing a negative mindset in chronic pain. However, barriers exist for current “gold-standard” psychological treatment. Brief, low-cost treatments that target mindset as a psychological saboteur of pain and outcomes may be scaled to efficiently and economically address a key aspect of the pain crisis in the U.S. This session will review the evidence, current studies, and future directions that hold promise for harnessing the mind-body connection for pain relief.
Learning Objectives: After completing this educational activity, participants will be better able to: 1) Discuss how negative and positive expectations influence pain intensity; 2) Discuss how negative expectations influence opioid analgesia; 3) Define pain catastrophizing and discuss its impact on pain outcomes; 4) Discuss how brief, targeted interventions may help shift mindset and address the unmet needs of patients who cannot access psychological treatment for pain.
Faculty: Beth D. Darnall, PhD
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