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The inaugural Treating & Preventing Chronic Pain Conference held in Arlington, Virginia, on October 8-10, 2015, was successful in bringing an innovative approach to merging health professionals with patients in an educational environment that offered a respectful exchange of questions and answers between the two groups. The TAP Conference was presented by the National Fibromyalgia & Chronic Pain Association in partnership with the International Myopain Society. The outstanding and varied array of speakers and their presentations allowed people with fibromyalgia and chronic pain to learn more about their conditions. Scientific research and information about helpful resources and treatment modalities that can be accessed through the Internet and local practitioners broadened participants’ practical tools.
This CME event educated clinicians and researchers about a variety of treatment options and approaches that will ultimately help them provide better service to patients with these conditions.
At the opening reception on Thursday evening, presenters, patients and members of the Chronic Pain Round Table Forum co-mingled. Earlier that afternoon, 28 stakeholders from industry, government agencies (FDA, NIAMS, NCCIH and PCORI), researchers and clinicians, along with patient advocates, shared information concerning research funding, new research possibilities, better access to care for patients and a variety of other issues that transcended each of the groups. The intent is for this venue of stakeholders to meet on an annual basis to discuss updates and positive movements toward rectifying and addressing some of the agenda items discussed at the forum.
The TAP Conference was attended by over 300 participants. The international streaming video audience spanned 25 countries including the USA, Canada, UK, Israel, Denmark, Japan, Saudi, Ukraine, Mexico, Czech Republic, New Zealand, France, Spain, Belgium, Portugal, Finland, Thailand, Moldova, Slovakia, Iraq, Italy, Germany, Argentina and Qatar. All participants (in person and virtually) were able to ask questions of the speakers, exchange chats and Tweets with friends and other online audience members. Volunteer Leaders AGainst Pain from across the U.S. attended and assisted on many levels for the TAP Conference to run smoothly. The IMS and NFMCPA leadership were very appreciative of their support.
On Friday morning the keynote address was given by world renowned fibromyalgia and chronic pain expert and researcher Dr. Daniel Clauw (University of Michigan), who discussed centralized pain and its role in chronic pain conditions. Dr, Lynn Webster, a well-known pain specialist, gave a report on the NFMCPA survey “Hydrocodone Rescheduling: The First 100 Days” and the benefits of marijuana in the treatment of pain.
As the morning progressed audience members learned about a variety of fibromyalgia and chronic pain instigators and resources that might help control relevant symptoms. Sleep; cervical spine conditions; myofascial pain; exercise; integrative medicine techniques including mindfulness and CBT; self-management including yoga and mindful movement; occupational therapy techniques; and myofascial pain self-management were all covered. Each presentation segment was followed by a question-and-answer period. It was a full day of sharing and learning valuable information. Dr. Lynn Webster was the featured Friday dinner guest speaker, sharing highlights about his new book, The Painful Truth, followed by a documentary movie trailer by the same name. In December, Dr. Webster initiatied an international chronic pain campaign to educate the public, medical communities and others about the impact that chronic pain has on the lives of people affected by its unrelenting assault. His moving presentation brought people in the room closer together and was a wonderful ending to a successful day.
On Saturday morning, the conference took a little different approach. Scientific researcher Dr. Frank Rice presented his information about small fiber neuropathy in fibromyalgia. Neurologist Dr. Mike Sorrell discussed myofascial medicine. German doctor and researcher Dr. Wolfgang Bauermeister followed with his presentation about novel imaging of trigger points, which he feels is the major cause of musculoskeletal pain. Dr. James Fricton, president of the International Myopain Society, rounded out the morning presentations by talking about preventing chronic pain both in the future and in the present for people who are already affected.
The variety of Saturday afternoon workshops included Dr. Andrew Holman, a Seattle area rheumatologist, who presented information from his study looking at fibromyalgia and PC3 positional cervical cord compression diagnostic MRI information. A physical therapy approach to PC3 treatment was taught by Sue Horton, PT. Dr. Cory Kingston, a chiropractor, discussed a technique that helps reduce stretch and pressure on the spinal cord in the neck and works to correct lordosis (curvature of the neck).
Dr. Bauermeister delivered a two-hour workshop on identifying trigger points with ultrasound elastography and the benefits of different approaches to treatment. A variety of additional concurrent workshops provided a wide breadth of treatment options. Drs. Kim Jones and Kathleen Holton instructed about exercise and nutrition to reduce chronic pain. Dr. William Collinge unveiled his AwareHealth System, an online Personal Health Informatics program to reduce FM and chronic pain symptoms. The workshop by Barbara Kornblau, JD, OT about Reasonable Accommodation – based on ADA Regulations empowered people to know their rights.
Additional workshops: Physical therapist Mary Biancalana taught Myofascial pain self-management techniques. Professional make-up artist Rachel Perrin gave a demonstration on beauty care and “liking who you see in the mirror.” Popular children’s author and blogger Elizabeth Christy spoke about her book, Why Does Mommy Hurt? Dr. Jim Fricton conducted a workshop on his on-line Preventing Chronic Pain Campaign and explained to audience members how to access and use this information.
Throughout two days of presentations and workshops, resources and information were provided that could be incorporated into each participant’s symptom management program. The post-conference streaming videos of the presentations and workshops are available for $15 at paintap.org/buy-live-stream.
Click here to review the entire TAP Chronic Pain program including bios for each speaker.
On Saturday morning, October 10, at the Treating and Preventing Chronic Pain Conference, Dr. Wolfgang Bauermeister gave a presentation on a novel approach to identifying and treating TrPs (Trigger Points) and referred pain. That afternoon Dr. Bauermeister offered a two-hour workshop to teach health professionals and patients about myofascial pain identification and treatment.
Wolfgang Bauermeister MD PhD is a physiatrist specializing in Sports and Pain Medicine. He received a German medical degree and PhD from the University of Hamburg Medical School and a second medical degree in the USA.
In the U.S. he gained experience in pain clinics where he took care of athletes and chronic pain patients. After a residency at Tufts New England Medical Center – Tufts University Boston USA – in the specialty of Physical Medicine and Rehabilitation he received certification by the American Board of Physical Medicine and Rehabilitation.
Upon his return to Germany in 1988, Dr. Bauermeister became familiar with shock wave lithotripsy. Shockwave is an acoustic wave which carries high energy characterized by a sudden increase in pressure with a high positive and a low negative amplitude. High energy shockwaves destroy kidney stones whereas lower energies promote healing, regeneration and reparative processes of the soft tissue including pain relief. He found that some patients, who had suffered from low back pain and sciatica, were pain free after lithotripsy. They had severe bruising at the site of entrance of the shock waves, which coincided with typical trigger point areas responsible for low back pain and sciatica. Through his observations the idea was born that shock waves could remove myofascial TrPs.
Driven by the need to make TrPs visible, he subsequently started working with Ultrasound Elastography in 2000, which at the time was used for the diagnosis of prostate tumors. He found that by using this technology, myofascial TrPs could be visualized. After searching for several years, he obtained a suitable device which would enable him to acquire high definition elastography images of myofascial TrPs. Now the technology is generally available and is well suited not only to diagnose TrPs but to monitor the effects of any therapeutic approach.
With most musculoskeletal pain problems, including fibromyalgia, hard knots are found in the muscle accompanied by hardening of collagen fibers in the fascia. These muscle knots can be extremely small, but they can develop into large knots which are easy to palpate in superficial but not in deep muscles. They are called myofascial TrPs whereas the hardening of the fascia is termed fibrosis. TrPs and fibrosis can develop through injury caused by overuse in sports, at work or at home. Chronic pain syndromes develop when TrPs and fibrosis are not diagnosed and treated early.
Dr. Bauermeister explained that ultrasound Elastography (Us-E) is the only method which allows practitioners to see TrPs. In real-time imaging generated from this technology, practitioners can view TrPs in vivid colors. They appear (depending on the color scale) as reddish-yellow spots indicating hard tissue compared to the softer, more blue appearing surrounding tissue. The typical diameter of TrPs is usually 1.5-2.0mm but they can lump together and get significantly bigger. The accompanying pictures are of a patient who complained about right-sided sciatic type of pain. In the Us-E (Figure 1) the red-yellow spots indicate TrPs, which can be seen even at a depth of 8 cm. The Us-E mage (Figure 2) of the same patient shows only a few TrPs and clinically only minor pain on the left side.
Shock wave stimulation of muscles helps to locate trigger points. When shock waves reach the nociceptors around the trigger points, the patient experiences local pain. When the trigger points are “active” the patient feels a referred pain in addition to the local pain.
In his presentation and workshop, Dr. Bauermeister revealed that trigger points are usually treated in a certain distance from the painful site, since trigger points refer pain into other parts of the body. The principles of this type of trigger point treatment are the same in all muscles.
For more information about this process please refer to the TAP Chronic Pain post conference videos where you can see Dr. Bauermeister using this technology and TrPs reatment to help a fibromyalgia patient. www.paintap.org/buy-live-stream