Providing the Right Expectations: Understanding the Pathophysiology of Pain

Faculty

Mark S. Gold, MD
Adjunct Professor of Psychiatry, Washington University School of Medicine, St. Louis, MO
ASAM's Annual Lifetime Achievement John P. McGovern Award & Prize Winner
17th University of Florida Distinguished Alumni Professor, Gainesville, FL
Mark S. Gold, MD

Mark S. Gold, MD, is a teacher of the year, translational researcher, author, mentor, and inventor, best known for his work on the brain systems underlying the effects of opiate drugs, cocaine, and food. He has worked as an advisor to many White House Drug Czars, White House NIDA and NIMH directors over his career of 40+ years. He is an author and inventor who has published over 1,000 peer-reviewed scientific articles, texts, and practice guidelines. This pioneering work started with detoxification studies using clonidine and lofexidine as a non-opiate detox followed by oral naltrexone at Yale in the late 70s and continued at the University of Florida (UF). Dr. Gold translated opioid studies using mouse, rat, and non-human primate models before developing his opioid withdrawal hypothesis with his Yale colleagues. He then led the first studies to demonstrate non-opioid treatment efficacy for alpha-2 agonists. He also led rapid detoxification and clonidine to naltrexone studies in the late 70s and early 80s. Dr. Gold, trying to find patients who would take oral naltrexone, began his studies of Impaired Health Professionals and employees in health and safety occupations.

Dr. Gold has received a number of national awards for his research, including the Lifetime Achievement Award of the National Association of Addiction Treatment Professionals, Foundations Fund Prize (APA), PRIDE Lifetime Achievement Award, DEA 30 Years of Service Pin, the McGovern Award for Lifetime Achievement (ASAM-ABAM 2015), National Leadership Award (NAATP), DARE Lifetime Achievement Award, Public Relations Society’s Silver Anvil Award, and China Academy of Sciences and DARE awards for his career in research and prevention (2015). More recently, he received the PATH Foundations Lifetime Achievement Award (2016) as one of the “fathers” of addiction medicine, presented to him by President Obama’s White House Drug Czar Michael Botticelli. Dr. Gold was awarded Distinguished Alumni Awards at Yale University, University of Florida, and Washington University in St. Louis as well as the Wall of Fame at the UF College of Medicine.

Dr. Gold was a Professor, Eminent Scholar, Distinguished Professor, Distinguished Alumni Professor, Chairman, and Emeritus Eminent Scholar during his 25 years at the University of Florida. His work is widely cited by his peers. It includes citation classics in cocaine neurobiology, opioid addiction neurobiology and treatment, and food and process addictions. He proved that cocaine was misclassified as safe, or the champagne of drugs, leading to revision in the DSM 3 and diagnosis of addiction. He has been called a groundbreaking researcher, father of medication-assisted recovery, the first to translate rat experiments into theory and treatments for human addicts, and mentor of the next generation of addiction researchers and clinicians. Working closely with Bart Hoebel at Princeton University, Dr. Gold helped develop the food addiction theory he posited in the 80s. With Nicole Avena, he worked on sugar self-administration models for hedonic overeating and developed new treatments for overeating and obesity. Kelly Brownell and Dr. Gold’s Food and Addiction, published by Oxford University Press, has been widely recognized as groundbreaking. Although working on food and drug-like reinforcement systems has been an important part of his work for 30 years, he has also worked on dual disorders, anorexia and bulimia nervosa. Dr. Gold worked closely with Al Rhoton and Bill Luttge to establish the UF Brain Institute. He was an original member of the McKnight Brain Institute and Director working to develop programs in Psychiatry, Addiction, Neurology, and Neurosurgery.

Since his retirement as a Director of the McKnight Brain Institute, Chairman, Distinguished Professor, and a full-time academic in 2014, Dr. Gold has continued his teaching, mentoring, research, and writing. He finished his 5-year State Department grant on opium smokers and the effects of second- and third-hand opium on children in Afghanistan. He has worked on de novo clinical addiction programs at the Medical College of Georgia, Northwestern, UF, and Tulane Lakeview Health. Dr. Gold regularly lectures at national and international meetings, medical societies, grand rounds around the United States, and international and national scientific meetings on his career, bench-to-bedside science in eating disorders, obesity, and addictions. Recently, he gave a keynote speech at the National Opioid Summit and Florida Opioid Summit as well as for the DEA-DOJ. He speaks regularly at medical schools across the United States, recently at Yale University, Mayo Clinic, Tulane, Washington University in St. Louis, Stanford, University of Connecticut (UConn), UCSF, Emory, Harvard-McLean-Borden Cottage, and UNC. He has given recent keynote addresses at American College of Psychiatrists, CADCA, ASAM, NAATP, APA, and Biological Psychiatry as well as a many states, medical, and psychiatric associations, dealing with the opioid epidemic.

Dr. Gold is an Adjunct Professor in the Department of Psychiatry at Washington University and an active member of the Clinical Council at the Washington University School of Medicine’s Public Health Institute. He has Wash University mentees and works with them regularly. He is the Director of Research for the DEA Educational Association, working closely with DEA and moderating their quarterly educational events broadcast from DEA Headquarters around the world.

Steven P. Stanos, DO
Executive Medical Director, Rehabilitation and Performance Medicine
Swedish Pain Services, Swedish Health System, Seattle, WA
Steven P. Stanos, DO

Steven P. Stanos, DO currently serves as Executive Medical Director of Rehabilitation and Performance Medicine, Swedish Pain Services at the Swedish Health System in Seattle, Washington. Aside from directing pain management services for the hospital system, he also leads Swedish’s pain rehabilitation center, Functional Restoration, an integral part of the pain medicine continuum of care. In addition to his work with Swedish Health System, he is active with committees work at Providence St. Joseph Health related to the system integration of pain management including primary and specialty care. Prior to joining Swedish and Providence, he served as medical director of the Center for Pain Management at the Rehabilitation Institute of Chicago (RIC) Northwestern University Medical School from 2002-2014, and served as an Assistant Professor at Northwestern University Feinberg School of Medicine and program-co chair of the multidisciplinary pain fellowship.

Dr. Stanos is board certified in physical medicine and rehabilitation and pain medicine by the American Board of Pain Medicine and by the American Board of Anesthesia.

Dr. Stanos is a Past President of the American Academy of Pain Medicine and serves on the Board of Directors of the American Board of Pain Medicine. He served as a panel member on the Service Delivery and Reimbursement work group for the National Pain Strategy, an invited consultant to the CDC for the CDC Opioid Guideline for Prescribing Opioids for Chronic Pain, and as a work group member for Healthy People 2020 and Healthy People 2030. He is active with the American Academy of Physical Medicine and Rehabilitation and has served as the co- chair of education for the Pain and Neuromuscular Council.

Dr. Stanos’s work also includes ongoing educational initiatives for primary care, pain medicine, and physical medicine specialists around the United States and abroad. Dr. Stanos has published numerous scientific articles and book chapters related to pain management. He has been involved in the development and publication of treatment guidelines related to rehabilitation approaches for chronic pain and low back pain conditions. He also serves on the editorial board for the journal Pain Medicine and as a reviewer for other pain and rehabilitation journals.

A Mayday Foundation Advocacy fellow in 2013, Dr. Stanos’s advocacy has continued to focus on increasing awareness and access for inter-disciplinary biopsychosocially-based pain care for patients suffering with chronic pain. In 2014, the University of Washington Department of Pain Medicine awarded Dr. Stanos with the John J. Bonica, MD lecture. He has appeared on CNN, National Public Radio, Fox News, regional print, and television news covering various topics related to pain medicine and pain rehabilitation.

Statement of Need

It can be difficult and daunting to evaluate patients with chronic pain, as the nervous system is complex and knowing which type of pain the patient is experiencing – neuropathic, nociceptive, or nociplastic – is the best guide for where clinicians should focus their treatment choices; the fact that there is no clinical way to diagnose sensitization only adds to the difficulty. It’s important for clinicians to think of what the actual mechanisms of a medication are and how to use them in a rational way to help decrease pain.

There is rarely a medication that will decrease pain completely, but patients should at least experience positive effects on their level of function and quality of life. Dr. Steven Stanos discusses the importance of providing the right expectations for patients, “You have to set the right expectation for the patient. If the patient has a poor understanding of their pain condition, there is this thought that is not accurate – that we can give a medicine for everything. There is rarely a medicine that is going to decrease their pain completely. It’s important to tie the pain score to functional outcomes – what can they now be doing?”

In this free CME Snack, Dr. Gold and Dr. Stanos focus on the pathophysiology of pain and the underlying mechanisms to assessment and appropriate management and share insights on ways to properly educate patients about their pain to optimize safe and effective multimodal treatment plans.

Learning Objectives

At the end of this CME/CE activity, participants should be able to:

  • Apply knowledge of acute and chronic pain pathways and underlying mechanisms to clinical assessment and appropriate management of pain.
  • Educate patients about their pain to optimize safe and effective, multimodal treatment plans.

The following learning objectives pertain only to those requesting CNE or CPE credit:

  • Explain acute and chronic pain pathways and underlying mechanisms and how they relate to clinical assessment and appropriate management of pain.
  • Educate patients about their pain to optimize safe and effective, multimodal treatment plans.

Financial Support

Supported by an educational grant from Johnson & Johnson.

Target Audience

Physicians, physician assistants, nurse practitioners, nurses, and pharmacists.

Credit Information

Physicians (ACCME) 0.25

CME Outfitters, LLC, is accredited by the Accreditation Council for Continuing Medical Education (ACCME) to provide continuing medical education for physicians. CME Outfitters, LLC, designates this enduring activity for a maximum of 0.25 AMA PRA Category 1 Credit(s)™. Physicians should claim only the credit commensurate with the extent of their participation in the activity.

Pharmacists/Pharmacy Tech (ACPE) 0.25

This application-based activity is approved for 0.25 contact hour (0.025 CEUs) of continuing pharmacy credit.
UAN: JA0007185-0000-21-132-H08-P

ABIM MOC 0.25

Successful completion of this CME activity, which includes participation in the evaluation component, enables the participant to earn up to 0.25 medical knowledge MOC points in the American Board of Internal Medicine's (ABIM) Maintenance of Certification (MOC) program. Participants will earn MOC points equivalent to the amount of CME credits claimed for the activity. It is the CME activity provider's responsibility to submit participant completion information to ACCME for the purpose of granting ABIM MOC credit.

MIPS Improvement Activity

Completion of this accredited CME activity meets the expectations of an Accredited Safety or Quality Improvement Program (IA_PSPA_28) for the Merit-based Incentive Payment Program (MIPS). Clinicians should submit their improvement activities by attestation via the CMS Quality Payment Program website.

Disclosure Declaration

It is the policy of CME Outfitters, LLC, to ensure independence, balance, objectivity, and scientific rigor and integrity in all of their CE activities. Faculty must disclose to the participants any relationships with commercial companies whose products or devices may be mentioned in faculty presentations, or with the commercial supporter of this CE activity. CME Outfitters, LLC, has evaluated, identified, and mitigated any potential conflicts of interest through a rigorous content validation procedure, use of evidence-based data/research, and a multidisciplinary peer review process.


Dr. Gold has no disclosures to report.


Dr. Stanos reports that he receives research support from Grunenthal and is a consultant for SCILEX Pharmaceuticals, Inc.


Disclosures were obtained from the CME Outfitters, LLC staff: No disclosures to report.

  • Mae Ochoa, RPh (peer reviewer)
  • Jan Perez (planning committee)
  • Sharon Tordoff (planning committee)

Faculty of this CE activity may include discussions of products or devices that are not currently labeled for use by the FDA. The faculty have been informed of their responsibility to disclose to the audience if they will be discussing off-label or investigational uses (any uses not approved by the FDA) of products or devices.

Obtaining Credits

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Questions about this activity?

Call us at (877) CME-PROS or (877) 263-7767.

SN-097-030119-57

 

Providing the Right Expectations: Understanding the Pathophysiology of Pain
Event Date: 03/01/2019