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14 Articles in Volume 19, Issue #1
Analgesics of the Future: NKTR-181
Antidote to CDC Guideline; Plantar Fasciitis; Patient Input
Assessing and Treating Migraine in Women and Men
Demystifying Opioid-Induced Hyperalgesia
Editorial: Have We Gone Too Far? Can We Get Back?
How to Compel Patients to Complete Home Exercises
Inflammation Targeted Nanomedicine
Intravenous Stem Cell Administration for Ileitis
Invasive Surgery: Effective in Relieving Chronic Pain?
Pain Catastrophizing: What Practitioners Need to Know
Pain Therapy Options for the Home
Regenerative Medicine
The Future of Pain Management: An Experts' Roundtable
Whole Body Vibration: Potential Benefits in the Management of Pain and Physical Function

The Future of Pain Management: An Experts' Roundtable

Industry leaders Jianguo Cheng, Stefan Evers, W. Clay Jackson, Lynn Kohan, William Maixner, Paula Marchetta, and more share their visions.
Pages 25-33
Page 1 of 6

For our first issue of the new year, PPM asked leading industry members and practicing clinicians, including some of our editorial board advisors, to share their visions of what the pain management landscape may look like in the next 5 to 10 years. For example, how might patient assessment evolve? What treatment approaches are likely to fade away or become more prominent? Which looming regulatory expectations will impact providers the most? How might patient communication and provider interaction change for the better? And, how might medical training and specialization adapt to the changing times? Here’s what your peers predict…

 

Jianguo Cheng, MD, PhD, FIPP 
President, American Academy of Pain Medicine

The landscape of pain management will continue to evolve in the coming 5 to 10 years based on three nationwide initiatives: the work of the HHS Pain Management Inter-Agency Task Force mandated by the US Congress; the implementation of the National Pain Strategy led by the NIH; and the National Academy of Medicine's Action Collaborative on Countering the US Opioid Epidemic. With these major national efforts, we can expect that best practice will be promoted, modeled, and adopted.

Some of the key components of best practice will include team-based care models that emphasize patient-centered, multidisciplinary, and coordinated care for patients with high impact pain. We can also expect that gaps and inconsistencies will be identified in pain management as well as in the prevention and treatment of substance use disorders. New and comprehensive strategies to address the gaps will be proposed and implemented to improve access to care, patient and provider education, and bench-to-bedside research. It is highly expected that a strong scientific and programmatic foundation will be laid, on which evidence-informed clinical practice can continuously improve the efficacy, safety, and cost-effectiveness of pain care.

Stefan Evers, MD, PhD 
Honorary Secretary, International Headache Society

Just last year, two major publications of disease classifications were updated: the third edition of the International Headache Society’s (IHS) International Classification of Headache Disorders (ICHD-3), creating a worldwide classification system for all headache disorders, and the World Health Organization’s updated manual of diseases (the ICD-11) featuring a new chapter dedicated to chronic pain disorders, including chronic migraine and other chronic headache disorders. ICD-11 will be presented to the World Health Assembly this May for adoption. Both sets of information will help to increase awareness of these disabling conditions going forward.

Another key event that took place in 2018 after two decades of research was the introduction of calcitonin gene-related peptide (receptor) antibodies for the prevention of migraine and certain headaches to the market. Looking ahead, patients may no longer have to take a daily tablet but instead may be able to administer a single injection once per month or quarter to prevent and reduce migraine attacks.

IHS is also hopeful about the improvements being made to stimulation techniques for the treatment of migraine as well. After several years of trial-and-error, the first devices are coming to market, including noninvasive vagus nerve stimulation or stimulation of the supraorbital nerve. The efficacy of the devices is not excellent, but they may be used to support or supplement other treatment strategies. In this context, the use of Botulinum toxin is also likely to become more routine in the treatment of chronic migraine.

As these advances are to be applauded, there is still much to do. Migraine is a heterogenous disease and its genetic implications are still largely unknown. Looking ahead, the medical community may once and for all be able to identify certain subtypes of migraine using genetic techniques, which could then serve to tailor treatment plans. So far, early genome-wide association studies have shown that migraine is not only heterogenous with respect to the clinical picture but also with regard to underlying genetic mechanisms.

Another reason migraine research still needs attention over the next 5 to 10 years is the disorder’s link with comorbidities. For example, there is an association between migraine and vascular disorders. Epidemiological research has suggested that migraine increases the risk for such disorders. If this proves true, a migraine treatment regimen may one day include the treatment of these risks as well. Could it be possible to minimize the risk for stroke or other vascular disorders increased by migraine, if we treat migraine properly? Or what about the comorbidity with depression? At least in some cases in the future, physicians should perhaps consider depression as a major objective of treatment in migraine patients. There are additional comorbidities, such as immunological disorders and restless legs syndrome, to be considered as well.

Overall, the future of migraine management will not exist unless we take time to educate our younger colleagues on how to diagnose and treat the disease, and how to perform effective, targeted research. At the moment, there is much enthusiasm among young medical students and researchers. If this excitement continues, we should not be anxious about the future of migraine and headache treatment.

W. Clay Jackson, MD, DipTh
President, Academy of Integrative Pain Medicine*

Patient assessment will evolve beyond the singular focus on the “pain score” to become more multimodal, with attention to qualitative and experiential domains. In addition, technologic advances will digitize the assessment process, extending the monitoring of patient experiences outside the brick-and-mortar locale of the clinic into the realm of digital biometric devices.

The pharmacocentric, opioiphilic, and allopathic-dominant model will be discredited, accompanied by a concomitant rise in integrative care, with attention to the biopsychosociospiritual components of the patient experience. Digital devices will allow for continuous feedback from the patient experience to the clinician’s counsel. Paternalistic models will yield to more collaborative care, as patients demand quality and choice in exchange for paying for a larger percentage of their care.

Last updated on: March 4, 2019
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