Notes from the American Pain Society, 27th Annual Scientific Meeting
An Interview with Kevin Zacharoff, MD
| Kevin Zacharoff, MD, the Director of Medical Affairs of PainEDU.org, attended the American Pain Society Annual Scientific Meeting in Tampa, Florida, May 8-10, 2008, and reports back on what he found to be the "highlights" for PainEDU users, in this "Spotlight" interview. |
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Questions
1: Tell us about the conference sessions that you found most interesting at APS this year.
 2: What other sessions did you find interesting?
3: Is there anything else you would like to comment on for PainEDU users?
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-------------------------------------------------------------------------------------------------------------------------- Evelyn Corsini:
Tell us about the conference sessions that you found most interesting at APS this year. Kevin Zacharoff, MD: I think one of the most important sessions at the APS was the symposium "Clinical Guideline on Chronic Opioid Therapy in Chronic Noncancer Pain: Process and Progress Report." This session presented a draft version of the result of a unique collaboration between the American Pain Society and the American Academy of Pain Medicine to develop evidence-based guidelines for opioid therapy in the management of chronic noncancer pain. A large multidisciplinary group worked together for almost one year doing an extensive review of the literature to cull out "the best of the best". The intention is to provide guidance for both expert and primary care practitioners on the issues surrounding use of opioids in treating noncancer pain. This meeting was the first public presentation of the Guidelines, which are now going out for peer review. The goal is to ratify the Guidelines in the fall and publish them in the Journal of Pain.
The faculty for this symposium was Gil Fanciullo, MD, MS, moderator (substituting for Perry Fine, MD, who was unable to make the meeting), Christine Miaskowski, PhD, RN, FAAN, and Roger Chou, MD. The Guidelines will be very comprehensive, covering everything from screening and assessment, to exit strategies. 
EC: What other sessions did you find interesting? KZ: There were a number of discussions about dilemmas raised by the use of opioid medications, especially when treating chronic pain. One was the workshop, "Promoting Safe and Effective Chronic Opioid Therapy: An Integration of Scientific Evidence and Practice Considerations". In this workshop Scott Fishman, MD, talked about legal aspects of treatment, and Kenneth Berkowitz, MD, FCCP, gave a compelling and interesting discussion on the ethics of pain management, and the responsibilities that physicians have to patients suffering from pain. Dr. Fishman stressed the idea of balancing the risks and benefits of prescribing opioids much in the same way that any other clinical decision would be made, whether the patient is opioid naïve or a substance abuser. There was discussion by the other faculty members about the need for more long-term studies of the people who receive chronic opioid treatment.
Another presentation discussed new approaches to risk management with regard to opioid medications, both currently available, and "in the pipeline", in a symposium titled "State-of-the-Science: Abuse-Deterrent Opioid Formulations", presented by Nathaniel R. Katz, MD, MS, Lynn R. Webster, MD, and Steven D. Passik, Ph.D. This discussion included identification of the goal for these medications. For some, it is to make them "abuse deterrent", that is to make it harder to extract the active ingredient from the drug. For others, the goal is to actually make a drug "abuse resistant", by combining an opioid with an opioid antagonist, so that the more drug the user takes, the less the effect. Dr. Katz’s presentation also included a valuable standardization of terminology surrounding misuse, abuse, and addiction
EC: Is there anything else you would like to comment on for PainEDU users? KZ: Yes, I was interested to hear a lot of discussion about the controversial use of methadone as a chronic pain treatment. There is controversy because of the increasing numbers of deaths reported that are associated with methadone. Clearly, more research is needed to identify the appropriate patient population for the use of this drug that has both economic and therapeutic benefits, but which needs to be fit into a "safe place".
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