2017AnnualClinicalMeetingHiltonSanDiegoBayfront

SanDiego,CAOriginalResearchPosterAbstracts

1. MultidisciplinaryPainManagementPrograminJapan a. Presenter:NaotoTakahashi,MD.,PhDb. FirstAuthor:NaotoTakahashi,MD.,PhDc. FirstAuthorAffiliations:DepartmentofPainMedicine,FukushimaMedicalUniversitySchoolofMedicined. Co-Author(s):SatoshiKasahara,MD.,PhD.,ShojiYabuki,MD.,PhDe. Background:Multidisciplinarypainmanagementisausefulmethodforthetreatmentofintractable

chronicmusculoskeletalpain.TherearefewfacilitiesinJapanthatadministeramultidisciplinarypainmanagementprogram,especiallyaninpatientprogram.WeareimplementinganinpatientmultidisciplinarypainmanagementprogrambasedonbiopsychosocialmodelguidedbytheIASPrecommendations.

f. Objective:Todescribeourinpatientmultidisciplinarypainmanagementprogramusingthebiopsychosocialmethodofself-painmanagement,andtoreportpreliminaryresultsoftheprogram.

g. Methods:Fourteenpatientswereanalyzed.Comparingresultsbeforeandaftertheprogram,thefollowingstatisticallysignificantimprovementwereseeninBPI(p=0.001),PCS(p=0.003),PDAS(p=0.02),HADSanxietyanddepressionscale(p=0.004,p=0.03),PSEQ(p=0.0002),EQ5D(p=0.04),30-secstandingtest(muscleendurance)(p=0.02),and6-minutewalkingtest(physicalfitness)(p=0.03).

h. Results:Fourteenpatientswereanalyzed.Comparingresultsbeforeandaftertheprogram,thefollowingstatisticallysignificantimprovementwereseeninBPI(p=0.001),PCS(p=0.003),PDAS(p=0.02),HADSanxietyanddepressionscale(p=0.004,p=0.03),PSEQ(p=0.0002),EQ5D(p=0.04),30-secstandingtest(muscleendurance)(p=0.02),and6-minutewalkingtest(physicalfitness)(p=0.03).

i. Conclusions:Wehavedevelopedaninpatientpainmanagementprogram.Wemaybeabletoimprovethecopingmechanismsofourpatientsfordealingwithintractablechronicmusculoskeletalpain,andthattheprogramcanimprovetheirqualityoflifeandflexibility.Theinpatientmultidisciplinarypainmanagementprogramshouldbeindicatedfortheintractablechronicmusculoskeletalpainpatients

j. References:None.k. Disclosure:None.

2. Interdisciplinary,Self-managementCourseforChronicPain a. Presenter:JoelKailiab. FirstAuthor:JoelKailia,MDc. FirstAuthorAffiliations:UBCd. Co-Author(s):VincentZenarosa,MDe. Co-author(s)Affiliations:UBCf. Background:Patientssufferingwithchronicnon-cancerpain(CNCP)experienceadiminishedquality-of-life,

whichhasbeenfoundtobethesameas,orworsethan,thequality-oflifeexperiencedbypatientswithadvancedpalliativecancer.MostCNCPcareisdoneintheprimarycaresettings.Painself-managementinterventions(SMI)canbedoneinthesesettingsandareonepotentialforgoodpainmanagement.

g. Objective:Theobjectivesareto(1)createandimplementan8-weekinterdisciplinarycourseforpatientslivingwithchronicpainwiththegoalofeducating,empowering,andsupportingthemand(2)tomakethiscoursefeasible,enjoyable,andreproduciblebothforfurtherstudyandfortransportingtoothercommunities.Wehypothesizethatthis(SMI)coursewillshowimprovedpainscoresforCNCPpatients.

h. Methods:Werecruited8subjectsdiagnosedwithchronicpainfromRISEBCWellnessCentreinNelson,BritishColumbia.Thesubjectsparticipatedinweekly2-hourSMIsessionsfor8-weeks.Thesesessionscoveredavarietyoftopicsincluding:paineducation,mindfulnessbasedstressreduction,cognitivebehavioraltherapy,kinesiology,yogatherapy.Self-reportedquestionnaireswerecompletedandanalyzed.

i. Results:Wedecidedtousethet-testduetothesmallnumberofsubjectsrecruitedforthispilotstudyandtherobustnessofthet-testwithsmallersamplesizes.Quantitativeanalysisshowedthat7outof8subjectsimprovedonthemeaninterferencescoreforpain.Theresultwasstatisticallysignificantatp<0.05.Qualitativefeedbackwaspositiveforallthesubjectswithregardstothecourse.

j. Conclusions:SMIswereeffectiveindecreasingpainseveritybyempoweringthesubjectswithtoolstoovercometheirpain.Subjectsrespondedpositivelytothiseducationalandexercisebasedgroupcourse.SMIswouldbeagreatalternativeforfamilypractitionerstousefortheirchronicnon-cancerpainpatientsasthisislessexpensive,enforcedfasterthanwaitingtobeseenbyapainspecialist'sclinic.

k. References:LynchME.2011.HadjistavropoulosT,MarchildonGP,FinePG,etal.2009.MathewE.,KimE,GoldschneiderK.2014.RobertA.Moore,DSc.2014.BurnsA,DelparteJ,BallantyneE,BoschenK.2013.BourgaultP.LacasseA,ChoinièreM,etal.2015.WilsonM,LavisJ,EllenM.2015.WashingtonDC:InstituteofMedicine,NationalAcademiesPress,2011.

l. Disclosure:Nonem. Encore:No

3. EnhancingtheSuccessofFunctionalRestorationUsingIntegrativePainTherapies:aComparative

EffectivenessAnalysisofActiveDutyServiceMemberswithChronicPain a. Presenter:HonorMcQuinnDNPARNPb. FirstAuthor:DianeFlynnMDMPHFAAPc. FirstAuthorAffiliations:USArmyd. Co-Author(s):ArdithDoorenbosPhD,RN,FAANe. Co-author(s)Affiliations:UniversityofWashingtonf. Background:Painisaleadingcauseofdisabilityamongactivedutyservicemembers.TheArmyestablished

InterdisciplinaryPainCentersatArmymedicalcenters.FunctionalRestoration(FR)isanintensive,medicallysupervisedinterdisciplinaryprogramforpainmanagement.ThisstudyteststhehypothesisthataprogramofcomplimentarytherapiespriortoFRwillimproveoutcomesrelativetostandardcare.

g. Objective:Evaluatethebenefitofaprogramofmultimodalpainmanagementtherapiespriortoanintensivefunctionalrestorationprogram,relativetostandardcare.Identifyprognosticfactors,includingdemographicfactors,psychologicalfactors,andreadinessfactorsthatpredictsuccessfuloutcomesonpainseverityandfunction,followingintensiveinterdisciplinaryfunctionalrestoration.

h. Methods:Acomparativeeffectivenessanalysis,usingaprospectiverandomizedcohortdesign.Participantsrandomizedto3-weeksofFRramp-upcomprisedofeither:StandardCare(SC)(PT,OT,healthpsychology+/-clinicalpharmacology),orComplementaryandIntegrativepaintherapies(chiropractic,acupuncture,yoga+/-massage)inadditiontoSC.Followingthis,bothgroupsparticipatein3weeksFR.

i. Results:Ongoingstudy,inclinicalphase,recruitment>120enrolled.

j. Conclusions:ThereisahighdemandforCIMpaintherapiesandFRamongactivedutyservicemembers.Participationrequireasubstantialcommitmentof90-110hoursoftreatmentoversixweeks,yetdrop-outratesarelow(12%).

k. References:McPhersonF,McGrawL.Treatinggeneralizedanxietydisorderusingcomplementaryandalternativemedicine.AlternativeTherapiesInHealthAndMedicine.2013;19(5):45-50.FlynnDM.Intensivefunctionalrehabilitationforthesoldierandathlete:TheMadiganmedicalcenterexperience.Presentedatthe30thAnnualMeetingoftheAmericanAcademyofPainMedicine.Phoenix,2014.

l. Disclosure:N/Am. Encore:No

4. AnIntegrativePainMedicineTechniquetoReduceOpioidUse a. Presenter:PeterM.Carney,M.D.,F.A.A.NS.b. FirstAuthor:PeterM.Carney,M.D.,F.A.A.NS.c. FirstAuthorAffiliations:CuttingEdgeIntegrativePainCentersd. Co-Author(s):e. Co-author(s)Affiliationsf. Background:Forover5,000yearsthejuiceofthewhitepoppyanditsderivativeshavebeenusedtoreduce

painandproduceeuphoriacreatingbothbenefitsandharmtosociety.OnAugust10,2017PresidentTrumpdeclaredthatourcurrenttreatmentofchronicpainhascreatedtheOpioidCrisisandnowisaNATIONALEMERGENCY,whichneeds"innovativestrategiestocurbtheescalatinghealthcrisis."(1)

g. Objective:1.TohelpmeetthePresident'sneedforinnovativestrategiesbyadvancingtheAIPM'splanthat:wemustaccelerateaccesstoexisting-aswellasdiscover-newevidence-basedpharmacologic,nonpharmacologicandintegrativechronicpaintreatments.2.Toshowthatanonpharmacologic,integrativetechnique,whichusestheprinciplesofphysicsandiscalledEST/CET,doesreduceopioiduse.(2)

h. Methods:TheuseofESTandCETemployscomplexFMsignalsandanoveriddingAMfrequencythatemphasizechaoticsignalingandself-focusingmechanismstore-establishproperpainsignaling,healnerves,andregeneratenerves.(3)Tworecentarticles,lookingatopioiduseinchronicpainpatients(3)andpatientswithperipheralneuropathy(4)confirmedthatthesetechniquesalsodecreaseopioiduse.

i. Results:16patientswithvariouspainsyndromesreceivedEST/CETwitha67%reductionintheiropioiduse.Eighttotallystoppedopioiduse,2hada50%reduction,3hada33%reductionandanother3hada25%reduction.Fourof14painfulneuropathypatientstookopioidspriortotherapy.Attheirfinalfollow-upvisit3ofthese4hadanaverageopioidreductionof72%(50,65,&100%respectively)

j. Conclusions:Thesestudiesshowedthatpatientswithawidevarietyofpainsyndromesreducedtheiropioidusagebyexploitingtheprinciplesofphysicsratherthanpharmacology.AIPManditssupportinginstitutionshaveagoldenopportunityto"accelerateaccessto...nonpharmacologicandintegrativechronicpaintreatments"byvalidatingtheconceptthatusingphysicswilltransformourtreatmentofpain.

k. References:1.Gostinetal."ReframingtheOpioidEpidemicasaNationalEmergency"JAMAonline.August23,20172.OdellRH&SorgnardRE."Anti-InflammatoryEffectsofElectronicSignalTherapy"PAINPHYSICIAN11:2008:P891-9073.CarneyPM,etal."ElectricCellSignalingReducesNeedforOpioids"PAINMEDICINE18:2017:p5694.OdellRH&CarneyPM."RegeneratingNerves"AAPMMEETINGMarch,2017

l. Disclosure:Nonem. Encore:No

5. *DHEADeficiencyinFibromyalgia

a. Presenter:ThomasJ.RomanoMD,PhdFACPFACRDAAPMABIMb. FirstAuthor:ThomasJ.RomanoMD,PhDFACPFACRDAAPMABIMc. FirstAuthorAffiliations:PrivatePracticed. Background:FibromyalgiaFM)isachronic,common,andpainfuldisorderthatcanbedebilitating.Treating

FMpatientsisoftenchallenging.Theterm,"resistantfibromyalgia"hasbeencoined,particularlyifco-morbiditiesexist.Co-morbiditiesdescribedincludearthritis,endocrineproblems,andelectrolyteabnormalities.IthasbeensuggestedthatDehydroepiandrosterone(DHEA)maybedeficientinFM

e. Objective:ToobtainserumlevelsofDHEA-sulfatefromFMpatientsanddetermineifDHEAdeficiencyexistsinsuchpatients,and,ifso,howprevalentitis.

f. Methods:108femaleFMpatients,meanage49yrs(range25-68yrs.),wereevaluatedinasolocommunity-basedrheumatologypracticebetween2012and2016.AllfulfilledAmericanCollegeofRheumatology1990and2010FMcriteria.BloodsampleswereobtainedattheinitialvisitandsenttoQuestDiagnostics(Pittsburgh,PA,USA)foranalysis.DHEA-SlevelsinFMpatientswerecomparedtopublishednorms.

g. Results:Ofthe108femaleFMpatientstested,83(77%)hadlow-for-ageDHEA-Slevels.SixpatientshadnodetectableDHEA-S.Thelevelsrangedfrom0to679mcg/dlwith75patientshavinglevelsbelow100mcg/dl.ThemeanDHEA-Slevelwas96.8mcg/dlintheFMpatientscomparedtotheexpectedlevelofapproximately150mcg/dl.

h. Conclusions:AveryhighpercentageoffemaleFMpatientshadDHEAdeficiencywhichcouldaccountforsuchsymptomsasfatigue,lowstamina,anddecreasedlibidooftenseeninsuchpatients.ThissuggeststhatDHEAsupplementationcouldimprovethequalityofli9feformanyFMpatients.

i. References:1.Wolfe,F.etal.Theprevalenceandcharacteristicsoffibromyalgiainthegeneralpopulation.ArthritisRheum1995:38,19-28.2.Bennett,R.DisablingFibromyalgia:AppearanceversusReality.JRheumatol.1993:20,1821-1822.3.Wilke,W.Treatmentof"resistantfibromyalgia".RheumClinicsofNorthAmerica.1995:21,247-260

j. Disclosure:N/Ak. Encore:No.

6. TolerabilityAndAcceptanceOfMicroglialSuppressingAgents a. Presenter:ForestTennantM.D.,Dr.P.H.b. FirstAuthor:K.ScottGuess,PharmD,MSPharm,R.Ph,DAAPMc. FirstAuthorAffiliations:VeractIntractablePainClinicd. Co-Author(s):ForestTennantM.D.,Dr.P.H.e. Co-author(s)Affiliations:VeractIntractablePainClinicf. Background:Neuroinflammationandcentralizationofpainisnowknowntooccurduetomicroglial

activation.Animalandin-vitrostudieshaveidentifiedthesethreeagentsthatsuppressmicroglialactivity:(1)acetazolamide;(2)metformin;and(3)pentoxifylline.

g. Objective:Todate,therearenoreportswhethertheseagentswillbetoleratedandacceptedbychronicpainpatientswhoareinpaintreatmentandmaybenefitbyaddingoneormoretoastandardpaintreatmentregimen.

h. Methods:Intractablepainpatientsintreatmentwithavarietyofsymptomatic,neuropathicagentsandopioidswereinitiallygivenoneoftheseagents:(1)acetazolamide(N=11);(2)metformin(N=22);or(3)pentoxifylline(N=19).Startingdosagesofeachdrugwereasfollows:(1)acetazolamide75mgeveryotherday;(2)metformin500mgatbedtime;and(3)pentoxifylline400mgeveryotherday.

i. Results:Eleven(11)patientswhostartedwithacetazolamidehadtheothertwoagentsaddedwithin90daysofitsinitiation.All11tolerated,accepted,anddesiredtocontinueall3agents,astheyperceivedenhancedpaincontrolandfunctionalstability.Patientswhowerestartedonpentoxifyllineormetforminandthenhadtheotheragentsaddedfoundthecombinationstobetolerableandeffective.

j. Conclusions:Allpatientsacceptedtheseagentsatlowstartingdosagesandperceivedthemtobetolerableandeffectiveinreducingpain.Suppressionofmicroglialactivitytoreduceneuroinflammationandenhancepainreliefandneuroregenerationisanewconceptinpainmanagement.Thispilotstudysuggeststhatmicroglialsuppressorsshouldbeaddedtostandardpaintreatmentregimens.

k. References:Nonel. Disclosure:Nonem. Encore:No

7. ElectromagneticEnergyLowersC-ReactiveProteinLevels a. Presenter:ForestTennantM.D.,Dr.P.H.b. FirstAuthor:ForestTennantM.D.,Dr.P.H.c. FirstAuthorAffiliations:VeractIntractablePainClinicd. Co-Author(s):JohnMoffett,PhDe. Co-author(s)Affiliations:RegenesisBiomedcal,Inc.f. Background:Persistentpainfollowinglumbarbacksurgeriesisaproblemoflong-standing.Boththecause

andtreatmentofpost-operativelumbarbackpain(POLBP)areunclearanduncertain.AprobleminevaluationandtreatmentofPOLBPisthelackofobjectivemeasurements.

g. Objective:InflammationisgenerallythoughttoplayaroleinPOLBP.Pulsedelectromagneticfieldtherapy(PEMF)isbelievedtoreduceinflammation,butthereisessentiallynodatainhumansubjectstodocumentthisbelief.TheobjectiveofthisstudywastodetermineifPEMFmaylowerserumhigh-sensitivityC-reactiveprotein(hsCRP)levels.

h. Methods:Thirty-three(33)POLBPpatientswererandomlyandblindlyassignedtoreceiveshamtreatment(N=13)orPEMFatapulsewidthof38µs(N=11)or42µs(N=9).PEMForshamtreatmentwasadministered2timesadayfor60days.Painscoresweredeterminedevery5days,andhsCRPwasdeterminedatthestartandondays15,30,and60ortreatment.

i. Results:Painscoresdroppedinall3groupsover60days,howeverthegreatestdropwasinthegrouptreatedwithPEMFatapulsewidthof42µs.ThissamegroupsignificantlydroppedtheirmeanhsCRPserumproteinlevelsfrom3.2±2.72to2.7±2.32(P<.05).Theshamand38µspulsewidthgroupsdidnotlowertheirhsCRP.

j. Conclusions:PEMFtherapyhaslongbeenbelievedtoreducepainbyreducinginflammationandincreasingbloodandlymphflow.SincehsCRPsignificantlyloweredinthe42µsgroupofpatients,objectiveevidenceisprovidedthatthisspecificenergeticofPEMFmeaningfullyreducesinflammation.

k. References:Nonel. Disclosure:Nonem. Encore:No

8. ARapidScreeningToolForAdhesiveArachnoiditisa. Presenter:ForestTennantM.D.,Dr.P.H.b. FirstAuthor:ForestTennantM.D.,Dr.P.H.c. FirstAuthorAffiliations:VeractIntractablePainClinicd. Co-Author(s):e. Co-author(s)Affiliationsf. Background:Adhesivearachnoiditis(AA)israpidlyincreasinginincidenceandprevalence.Common,

chronicspinaldisorderssuchasherniateddiscs,stenosis,arthritis,scoliosis,andosteoporosismayallleadtocaudaequinanerverootneuroinflammationwhichmaylaterformadhesionstothearachnoidliningofthespinalcanal(i.e.thecalsac).

g. Objective:EarlydiagnosisofAAisessentialasitmayproducesevereconstantpainandprogressive,neurologicimpairments.ThepurposeofthisstudywastodeveloparapidscreeningtooltoidentifybackpainpatientswhomayhaveAA,sothattreatmentmaybeinitiatedtoretardprogressionofthedisease.

h. Methods:Thirty(30)patientswithdocumentedAAbymagneticresonanceimaging(MRI)wereaskedthese5questions:Doyouhaveconstantbackpain?;Doyouhavedifficultystartingofstoppingurination?;Doyouhaveburningonthebottomofyourfeet?;Doyouhaveblurredvisionorringingintheears?;andDoyouhavetostandafteryouhavesatfor10minutes?

i. Results:All30AApatientsansweredyesto4or5ofthequestions.Althoughthescreeningquestionsmayappearunrelated,AAmayentrapneuralconnectionstothebladder,gastrointestinaltract,sexorgans,andlowerextremitiesandimpairspinalfluidflow.

j. Conclusions:Treatmentprotocolshavenowbeendeveloped,sothediagnosisofAAshouldbemadeassoonaspossible.Severe,backpainpatients,particularlythosewithneurologicsymptomsseeminglyunrelatedtothelowerspine,shouldbescreenedforAAsotreatmentcanbeinitiatedinanefforttorestrainprogressionofthisneuroinflammatorydisease.

k. References:None.l. Disclosure:N/Am. Encore:No

9. UndiagnosedEhlers-DanlosSyndromeInChronicPainPatients a. Presenter:ForestTennantM.D.,Dr.P.H.b. FirstAuthor:ForestTennantM.D.,Dr.P.H.c. FirstAuthorAffiliations:VeractIntractablePainClinicd. Co-Author(s):CaronPedersen,FNP-C,DC,BSN,BS-PTandK.ScottGuess,PharmD,MSPharm,R.Ph,

DAAPMe. Co-author(s)Affiliations:VeractIntractablePainClinicf. Background:Somepatientspresentforpaintreatmentwithvagueormulti-systempaincomplaints.The

painmaybesevere,disabling,andthepatientandfamilymaydemandhighdoseopioidtherapyasnon-opioidandlowdoseopioidmeasureshavefailedtoprovidecomfortandallowdailyfunction

g. Objective:WehavefoundthatsomepatientswhopresentwithmanifestationsofcommonpainfulconditionshaveEhlers-DanlosSyndrome(EDS).Thisconditionisagenetic,connectivetissuediseasethatcanproduce,over-time,abreakdownoftissuestructuresinalmostanyorganofthebody.Severepain,may,therefore,appearinunusualpatternsthatcanmimicanumberofpainfulconditions.

h. Methods:One–hundred-thirty-seven(137)chronicpainpatientsintreatmentwerescreenedforEDSbyquestionsregardingdouble-jointedness,extremityflexibility,bending,andjointdislocation.Ifsomescreeningquestionswereanswered"yes",patientswerefurtherassessedbyaBeightonscoreandthediagnosticcriteriaoftheInternationalConsortiumofEhlers-DanlosSyndromeandRelatedDisorders.

i. Results:All137patientshadbeenreferredforpaintreatmentwithanon-EDSdiagnosisandweretakingmultiplepharmacologicagents.Eleven(11)ofthe137(8.0%)werefoundtohaveundiagnosedEDS.Thereferringpaindiagnoseswere:headandspinepain(3);fibromyalgia(3);adhesivearachnoiditis(2);abdominaladhesions(1);Lymedisease(1),andrheumatoidarthritis(1).

j. Conclusions:EDSisageneralized,geneticconnectivetissuedisorderthatmaydevelopavarietyofverypainful,clinicalmanifestations.Aggressivepaintreatmentincludinghighdose,dailyopioidsmayberequired.AllseverechronicpainpatientsshouldbescreenedforEDS.

k. References:Nonel. Disclosure:Nonem. Encore:No

10. SublingualOxytocinandKetamineForPainReliefa. Presenter:ForestTennantMD,DrPHb. FirstAuthor:ForestTennantMD,DrPHc. FirstAuthorAffiliations:VeractIntractablePainClinicd. Co-Author(s):CaronPedersen,FNP-C,DC,BSN,BS-PTe. Co-author(s)Affiliations:VeractIntractablePainClinicf. Background:Thereiscurrentlyanationalpublichealthmovementtoreduceopioiduseandit’s

complications.Urgentlyneededarepotentnon-opioidanalgesics.Todate,avarietyofanti-seizure,antidepressant,anti-inflammatory,andadrenergicblockingagentshaveproventoprovidemildtomoderatepainreliefbutnotsubstituteforopioidsincasesofseverepain.

g. Objective:Ketamineandoxytocinprovideanalgesiabymechanismsotherthanstimulatingopioidreceptors.Wehavegiventheseagentstomultiplepainpatientsbythenasal,oral,andsublingualroutestofindaneffectivedosageandrouteofadministration.Ourobjectiveherewastodetermineiftheseagents,giveninliquidformbythesublingualroute,maysubstituteforpotentopioids.

h. Methods:Fivechronicpainpatientswhohadusedoxycodone,morphine,hydrocodone,orhydromorphoneforoverayearweretested2to4hoursaftertheirlastoral,opioiddosage.Theyweregivenliquidoxytocin,0.5ml(20units)ofa40unitspermlconcentrationsublinguallyfollowedwithin15minutesby.25to.50ml(12.5to25mg)ofliquidketamineataconcentrationof50mgperml.

i. Results:Within10minutesallfivepatientsreportedvaryingdegreesofpainrelieffromoxytocin.Ketamineenhancedthispainrelief.Twopatientsbecamepainfree.Relieflastedabout4hours.Therewerenosideeffects.

j. Conclusions:Thisinvestigationindicatesthatliquidoxytocinand/orketaminegivensublinguallymaysubstituteforsomepotent,oralopioids.Immediateandfurtherinvestigationofthesenon-opioidagentsisneeded.

k. References:Nonel. Disclosure:Nonem. Encore:No

11. GeneticVariationsinPainPatientsTakingHighDoseOpioids a. Presenter:ForestTennantMD,DrPHb. FirstAuthor:ForestTennantMD,DrPHc. FirstAuthorAffiliations:VeractIntractablePainClinicd. Co-Author(s):RamVairavan,PhDe. Co-author(s)Affiliations:AutoGenomics,Incf. Background:Morethan100millionpeoplesufferfromacuteorchronicpaineveryyearaccordingtothe

NationalInstituteofMedicine.Asmallpercentageofthesepatientsrequirehighdoseopioidsforadequatepaincontrol.

g. Objective:Geneticfactorsarebelievedtoplayaroleinopioidprescriptionaddictionaswellwhichagentsareeffectiveforpaincontrol.Thepurposeofthisstudyistoassesstheutilityofamulti-variantgeneticpaneltohelpidentifychronicpainpatientswhorequirehighdoseopioidsorwhomaybeatriskforabuseandaddiction.

h. Methods:Seventyseverechronicpainpatientswhoweretakingover100mgadayofmorphineequivalenceweregeneticallytested.Sixteen(16)singlenucleotidpolymorphismsinvolvedinthebrainrewardpathwaywereanalyzedwithfourcategoriesofgeneticmarkers:(1)ReceptorBindingandActivity;(2)Neurotransmittertransporters;(3)CentralNervousSystem(CNS)Enzymes;(4)CytochromeP450Enzymes.

i. Results:All70patientshadageneticvariationinoneormoredopaminereceptors(DRD1,DRD4,DOR).Only17(30%)hadvariantsinthe3opioidreceptorswhichweretested.Forty-oneof70(58.6%)hadoneormorecytochromeP450defects.Nomarkersexceptthedopaminereceptormarkershadover90%geneticvariation.

j. Conclusions:Itisinterestingthatallpatientshaddefectsintheirdopaminereceptorsystem.Thesefindingsneedtobeinvestigatedinnormalsubjectsandothergroupsofpainpatientswhorequirehighdoseopioidstodetermineifdopaminergicdefectsareanunderlying,geneticcauseofhighdoseopioidrequirements.

k. References:Nonel. Disclosure:Nonem. Encore:No

12. AnOngoingCymbaltaPregnancyRegistry:7-yearExperiencea. Presenter:HuLib. FirstAuthor:HuLi

c. FirstAuthorAffiliations:EliLillyandCompanyd. Co-Author(s):MarkBangsMD,HimanshuPUpadhyayaMD,RenataMehtaMSce. Co-author(s)Affiliations:Mrs.RenataMehtaisaffiliatedwithFocusClinicalConsultingInc.f. Background:Cymbalta(duloxetinehydrochloride)isaserotonin-norepinephrinereuptakeinhibitor

approvedintheU.S.Manyoftheapprovedindicationsareprevalentinwomenofchildbearingage.ApregnancyregistrywasestablishedinJuly2009andisongoing.Theregistryisoverseenbyanindependentadvisorycommittee,andmanagedbyINCResearchonbehalfofEliLillyandCompany.

g. Objective:TheprimaryobjectiveofthisprospectiveobservationalstudyistoestimatetheriskofmajorcongenitalanomaliesamongpregnanciesexposedtoduloxetineduringpregnancyintheU.S..Theenrollmenttargetis484pregnancies.Sincetheplannedenrollmenttargetisnotyetreached,thisreportisbasedona7-yearexperiencewiththeregistry.

h. Methods:ThisisanongoingU.S.-based,voluntary,observational,exposure-registrationandfollow-upstudyofwomentakingduloxetineduringpregnancy.Dataarecollectedatstudyregistration,theendofthesecondtrimester,theoutcomeofpregnancy,and4and12monthspostpartum.Breastfeedingmotherscompleteaquestionnaireat3,6,9,and12monthspostpartum.

i. Results:FromJuly2009toAugust2016,only97prospectivecaseswereenrolled:85withknownpregnancyoutcomes(83livebirths,2spontaneousabortions,and0non-livebirthsorfetaldeaths),4withpendingpregnancyoutcomes,and8losttofollow-up.Reportedoutcomesincluded8prematurebirthsand4birthdefects.Twoinfantsexperiencedsymptomsofneonatalwithdrawalorpoorneonataladaptation.

j. Conclusions:Theregistrysupplementstheongoingmonitoringofduloxetinesafetyduringpregnancy.Theinabilitytocalculateaccuratebirthdefectratesduetotheveryslowenrollmentandsmallnumberofreportedcaseslimitsanyreliableconclusion.Informationregardingtheregistrymaybeobtainedbycalling1-866-814-6975orbyvisitingwww.cymbaltapregnancyregistry.com.

k. References:N/Al. Disclosure:N/Am. Encore:No

13. Adverseeventsinchronicpainpatientstreatedwithopioidsa. Presenter:ZahVladimir,PhDb. FirstAuthor:ZahVladimir,PhDc. FirstAuthorAffiliations:ZRxOutcomesResearchInc.,Toronto,ON,Canadad. Co-Author(s):MartinaImroMSc1,SimonaTatovicMSc1,AnaSikoraMSc1,MartaSokolowskaPhD2e. Co-author(s)Affiliations:1ZRxOutcomesResearchInc.,Toronto,ON,Canada.,2DepomedInc.San

Francisco,CA,USAf. Background:Thereisagrowingconcernaboutpossibilityofopioidanalgesicstocausevariousadverse

effects(AEs)inpatientswithchronicpain.TapentadolExtendedRelease(TapER)hasdemonstratedinseveralclinicaltrialsitslowerabilitytocauseAEswhencomparedtosomeotherwidelyusedopioids.ThesedataareyettobeconfirmedwithRealWorldEvidence(RWE).

g. Objective:ToobtainRWEonsafetyofTapERvs.widelyprescribedERopioids(oxycodoneER(OxnER)ormorphinesulfateER(MsER))usingIBMTruvenHealthMarketScan®CommercialClaimsandEncountersDatabasedatingfromOctober2010throughMarch2016.

h. Methods:Totalof72,781patientswasobserved.Theadherent(proportionofdayscovered≥0.8)patientswereselectedforcomparisonduring90,180,and365daysofLAOtherapy(Tx).Constipation,nausea/vomitingandheadachewereassessedwithICD9/10codeclaims.ProportionsofpatientsexperiencingAEscommonforopioidswerecompared,inregardtotheirLAOtreatmentanditsduration.

i. Results:ConstipationwasloweronTapERvs.OxnERandMsERon90-dayTx(2.5%vs.3.6%and4.2%,p<0.001each),180-dayTx(4%vs.4.9%,p<0.05,and5.7%,p<0.001)and365-dayTxforTapERvs.MsER(6.5%vs.8.1%,p<0.05).Nausea/vomitingwaslowerforTapERvs.MsER(2.3%vs.3%,p<0.05)during90-dayTx.Meanwhile,headachesweremorefrequentonTapERvs.OxnERandMsER(6%vs.4.7%and5%,p<0.05each).

j. Conclusions:UsingRWE,TapERshowedstatisticallysignificantlylowerratesofconstipationcomparedtoOxnERandMsERduring90-and180-daytherapy,andcomparedtoMsERduringoneyearlongLAOtreatment.Theratesofnausea/vomitingwerestatisticallysignificantlyloweronTapERcomparedtoMsERduring90-dayLAOtherapy,withmorefrequentheadachesreportedforTapERduringthefirst90days.

k. References:1.SantosJ,etal.Tapentadolforchronicmusculoskeletalpaininadults.CochraneDatabaseofSystematicReviews2015.2.BaxterG,etal.AssociationofAdverseEventsandHealthServiceUsageWithTapentadolProlonged-ReleaseTreatmentComparedWithMorphineControlled-Release(Cr)AndOxycodoneCr:AUkPrimaryCareObservationalStudy.ValueHealth.2015.

l. Disclosure:ThisstudywassponsoredbyDepomed,Inc.themanufactureroftapentadolER,throughanunrestrictedgrant.Allauthorswereinvolvedinthestudydesign.VZ,MI,STandNMdidthedataanalyses.VZ,NM,MIandSTanalyzedandinterpretedtheresults.VZacceptsoverallresponsibilityfortheaccuracyofthedata,itsanalysisandthisabstract.

m. Encore:No

14. Useofco-medicationsinchronicpainpatientsonopioids a. Presenter:ZahVladimir,PhDb. FirstAuthor:ZahVladimir,PhDc. FirstAuthorAffiliations:ZRxOutcomesResearchInc.,Toronto,ON,Canada.d. Co-Author(s):MartinaImroMSc.1,NikolayMatveevPhD.1,AnaSikoraMSc.1,MartaSokolowskaPhD.2e. Co-author(s)Affiliations:1.ZRxOutcomesResearchInc.,Toronto,ON,Canada.,2.DepomedInc.,San

Francisco,CA,USAf. Background:Opioidsarewell–acceptedbychronicpainpatients,partiallybecauseoftheirabilityto

positivelyaffectpatient’smoodwhilerelievingpain.Thiscanleadpatientstocombineopioidswithbenzodiazepines(BZD)and/orBuprenorphine(Bup)orBup/Naloxone(Bup/Nal).Hence,itisimportanttoreviewrealworddataonlong-actingopioids(LAO)associatedwithhigherconcomitantusageofthesedrugs.

g. Objective:ExploringpotentialrateofmisusethroughprescriptionofconcomitantBZDsandBuporBup/NalinpatientsusingexclusivelyoneofLAOs:tapentadolextendedrelease(TapER),oxycodoneER(OxnER)oroxymorphoneER(OxmER),withdataobtainedfromIBMTruvenHealthMarketScan®,July2011-March2016

h. Methods:Patientsadherent(proportionofdayscovered≥0.8)during180-dayLAOtherapywere≥18yearsoldatindexdate(firstprescriptiondateofselectedopioid)andinsuredminimum3monthsbeforetheindexdateandduringLAOtherapy.ChronicpainconditionwasassessedusingICD9/10codes.ProportionofpatientswithadditionalBZDs’fillsorwithBuporBup/NalwascalculatedforeachLAO.

i. Results:Totalof36,479patientswereidentified.SignificantlylesspatientsonTapERhadBZDs’fillsduringLAOtherapy,comparedtopatientsonOxnERandOxmER(40.1%vs.47.5%and46.3%,respectively,p<0.001bothcomparisons).LowerpercentageofpatientsonTapERhadBuporBup/NalfillsduringLAOtherapythanOxnER(0.2%vs.0.3%,p=0.466)andOxmER(0.2%vs.0.6%,p<0.05).

j. Conclusions:TapERpatientshadlowerconcomitantuseofBZDsand/orBuporBup/NalwhencomparedtoOxnERandOxmERduringfirst180daysofchronicpaintherapy.FurtherstudyintotheeffectofconcomitantBZDsand/oropioid-dependencetreatmentutilizationduringLAOtherapyanditsimpactonqualityoflifeofthepatientandtreatmentcostisrecommended.

k. References:1.JermaineD.Jones,ShanthiMogali,SandraD.Comer,Polydrugabuse:Areviewofopioidandbenzodiazepinecombinationuse,DrugandAlcoholDependence,2012.2.AlhoH,SinclairD,VuoriE,HolopainenA.Abuseliabilityofbuprenorphine-naloxonetabletsinuntreatedIVdrugusers.DrugAlcoholDepend.2007.

l. Disclosure:ThisstudywassponsoredbyDepomed,Inc.themanufactureroftapentadolER,throughanunrestrictedgrant.Allauthorswereinvolvedinthestudydesign.VZ,MI,ASandNMdidthedataanalyses.VZ,NM,MIandASanalyzedandinterpretedtheresults.VZacceptsoverallresponsibilityfortheaccuracyofthedata,itsanalysisandthisabstract.

m. Encore:No

15. Economicburdenofchronicpainopioidtherapy

a. Presenter:ZahVladimir,PhD.b. FirstAuthor:ZahVladimir,PhD.c. FirstAuthorAffiliations:ZRxOutcomesResearchInc.,Toronto,ON,Canadad. Co-Author(s):MartinaImroMSc.1,SimonaTatovicMSc.1,AnaSikoraMSc.1,MartaSokolowskaPhD.2e. Co-author(s)Affiliations:1.ZRxOutcomesResearchInc.,Toronto,ON,Canada;2.DepomedInc.San

Francisco,CA,USAf. Background:Thehighratesofchronicpainconditionsrepresentahealthcareproblemwithasubstantial

economicburden.Thewideuseoflong-actingopioids(LAOs)inchronicpainsubstantiatesaneedtoobtainrealworldevidence,aspreviousstudiesidentifiedalowertotalhealthcarecostspermonth(HCPM)comparingtapentadolExtendedRelease(TapER)tooxycodoneER(OxnER)inchronicpainpopulation.

g. Objective:TocompareHCPMinasubsetofmatchedpatientswithchronicpain(musculoskeletalpain,neuropathicpain,andneoplasm-relatedpain),treatedwithTapERorOxnERforatleast90andupto400days,adherenttoLAOtreatment.PatientswereselectedusingdatafromIBMTruvenHealthMarketScan®CommercialClaimsandEncountersDatabase,fortheperiodofOctober2010throughMarch2016.

h. Methods:Allpatientswere≥18yearsold,continuouslyinsured12monthsbeforeandduringtheLAOtreatmentperiod.PatientswereclassifiedbasedonMedicalPossessionRatio(MPR)andProportionofDayscovered(PDC),withMPR=0.8-1.1andPDC≥0.8.Thepatientswerematchedusingpropensityscore,basedonbaselinevariablesthatsignificantlyimpactHCPMinratioof1:6,TapER:OxnER.

i. Results:Overall2,824TapERwerematchedto16,716OxnERpatients.SignificantlylowerHCPMwasobservedinpatientsonTapERtreatmentvs.OxnER(mean(SD),$2,512(4,218)vs.$3,722(7,612),p<0.001).PatientstreatedwithTapERvs.OxnERhadsignificantlylowerinpatientcostpermonth($502(3,025)vs.$1,091(4,769),p<0.001)andloweremergencyroomcostpermonth($97(348)vs.$141(560),p<0.001).

j. Conclusions:Thisstudyconfirmedchronicpainpopulationpreviousfindingsthatevenamongmatchedchronicpainpatients,beingontapentadolextendedreleaseandoxycodoneextendedreleasetreatment,averagecostofmonthlyTapERtreatmentappearstobeless,accountingfordrug,inpatientandoutpatientcosts.

k. References:GoreM,etal.Theburdenofchroniclowbackpain:clinicalcomorbidities,treatmentpatterns,andhealthcarecostsinusualcaresettings.Spine(PhilaPa1976).2012.ColuzziF,RuggeriM.Clinicalandeconomicevaluationoftapentadolextendedreleaseandoxycodone/naloxoneextendedreleaseincomparisonwithcontrolledreleaseoxycodoneinmusculoskeletalpain.CurrMedResOpin.2014.

l. Disclosure:ThisstudywassponsoredbyDepomed,Inc.themanufactureroftapentadolER,throughanunrestrictedgrant.Allauthorswereinvolvedinthestudydesign.VZ,MI,STandASdidthedataanalyses.VZ,MI,ASandSTanalyzedandinterpretedtheresults.VZacceptsoverallresponsibilityfortheaccuracyofthedata,itsanalysisandthisabstract.

m. Encore:No.

16. TotalHealthcareCostsofOpioidsBasedonChronicPainType a. Presenter:ZahVladimir,PhD.b. FirstAuthor:ZahVladimir,PhD.c. FirstAuthorAffiliations:ZRxOutcomesResearchInc.,Toronto,ON,Canadad. Co-Author(s):MartinaImroMSc.1,SimonaTatovicMSc.1,AnaSikoraMSc.1,MartaSokolowskaPhD.2e. Co-author(s)Affiliations:1.ZRxOutcomesResearchInc.,Toronto,ON,Canada;2.DepomedInc.San

Francisco,CA,USAf. Background:Ashighlyeffectiveinprovidingreliefinpatientssufferingfrommoderatetoseverechronic

pain,long-actingopioids(LAO)areprescribedforvariouschronicpainconditions.g. Objective:Tocomparetotalhealthcarecostspermonth(HCPM)betweenpatientsontreatmentwith

tapentadolExtendedRelease(TapER),oxycodoneER(OxnER)andmorphinesulfateER(MsER),classifiedbytheirtypeofchronicpain:musculoskeletalpain(MS),neuropathicpain(NP)orcancer-relatedpain(CP),usingIBMTruvenHealthMarketScan®CommercialClaimsandEncountersDatabase,October2010–March2016

h. Methods:Patientsbeing≥18yearsoldonLAOtreatmentfor90upto400days,withchronicpainassessedwithICD9/10codedoutpatientandinpatientclaims.Allpatientshadcontinuoushealthplanenrollmentforatleast12monthspriortoindexdate(firstprescriptiondateofselectedopioid)andduringanalgesictreatment.TotalHCPMwascomparedacrossLAOtreatmentgroups,basedonchronicpaintype.

i. Results:Totalof72,672patientswereidentified.HCPMforMSweresignificantlylowerforTapERvs.OxnERandMsER(mean(SD)$2,446(4,349)vs.$4,074(8,020)and$3,068(7,305),p<0.001each),aswellasforCPpatients($10,226(16,827)vs.$21,926(20,144)vs.$19,999(17,863),p<0.05each),respectively.InNPpatients,HCPMwerelowerforTapERvs.OxnER($4,048(8,197)vs.$5,555(8,299),p<0.05).

j. Conclusions:Patientssufferingfrompaincausedbycancer,demonstratedsubstantiallyhighertotalhealthcarecostincomparisontopatientswithmusculoskeletalorneuropathicpain,ineachopioidtreatmentgroup,asanticipated.TapentadolERtreatmentappearstobesignificantlylessexpensiveincomparisontooxycodoneERandmorphinesulfateERtreatments,regardlessoftypeofchronicpain.

k. References:None.l. Disclosure:ThisstudywassponsoredbyDepomed,Inc.themanufactureroftapentadolER,throughan

unrestrictedgrant.Allauthorswereinvolvedinthestudydesign.VZ,AS,STandMIdidthedataanalyses.VZ,AS,MIandSTanalyzedandinterpretedtheresults.VZacceptsoverallresponsibilityfortheaccuracyofthedata,itsanalysisandthisabstract.

m. Encore:No.

17. PrescribingTrendsforUnapprovedtopicalPainProducts a. Presenter:RiaWestergaard,PharmDb. FirstAuthor:RiaWestergaard,PharmDc. FirstAuthorAffiliations:ExpressScriptsd. Co-Author(s):AanalPatel,MSIT;RebeccaLevin,MPHe. Co-author(s)Affiliations:AanalPatel:ExpressScripts;RebeccaLevin:UnitedBioSourcef. Background:TheFoodandDrugActrequiresthatprescriptiondrugsdemonstratebothsafetyandefficacy

priortomarketing.Someprescriptionproducts,however,enterthemarketplacewithouthavingformalapproval.PrescribersthereforecannotassumethatallmarketeddrugshavebeenreviewedbytheFoodandDrugAdministration(FDA).1Coverageoftheseproductsbypharmacybenefitmanagersmayalsovary.

g. Objective:Thisanalysisexaminesthevolume,cost,anddemographicinformationassociatedwithprescriptionsforproductsusedforpain-relatedconditionsthathavenotreceivedformalFDA-approvalorundergoneformalclinicaleffectivenessstudies.Itfocusesonthemostwidelyprescribedproductsclassifiedas“unapproveddrugother,”asnotedbytheFDAOnlineLabelRepository.2

h. Methods:ThisretrospectivecohortanalysisofExpressScripts’pharmacyclaimsdatabase(July1,2016toJune30,2017)identifiedthetop“unapproveddrugother”paidandrejectedclaimsforpatientswhohaveExpressScriptsastheirpharmacybenefitmanager.Profilesofpatientswhoseclaimswererejectedwerefurtheranalyzedtodeterminewhetheralternateprescriptiontherapywasprescribed.

i. Results:In12months,13,402patientswereprescribed22,651prescriptionsforaselectgroupoftopicalproducts;85%ofwhichwererejected.Lidocaine-containingformulationsrepresented97%oftheclaimvolumewithremainingclaimsattributedtotopicalpatchescontainingmentholandcapsaicin.Plansponsorswerebilled$23,781,278,equatingtoanaveragewholesaleprice(AWP)of$1,049.90perclaim.

j. Conclusions:Thisstudydemonstratesthatanumberofproductsclassifiedas“unapproveddrugother”arebeingprescribed,usuallyatamuchhigherpricethanalternativetherapies.FDA-approvedtherapeuticalternativesthatcontainsimilaringredientsareavailableandoffercost-savingsopportunitiestopatientsandplansponsors.

k. References:1.USFDA.UnapprovedPrescriptionDrugs:DrugsMarketedintheUSThatDoNotHaveRequiredFDAApproval.Updated3Jan2017.From:https://www.fda.gov/Drugs/GuidanceComplianceRegulatoryInformation/EnforcementActivitiesbyFDA/SelectedEnforcementActionsonUnapprovedDrugs/default.htmAccessed30Aug2017.2.USFDA.FDAOnlineLabelRepository.From:https://labels.fda.gov/Accessed30Aug2017.

l. Disclosure:No.m. Encore:No.

18. Singlelevelsonogramguidedlumbarfacetjointinjection a. Presenter:AbrahamT.Rasul,Jr.,MD,FAAPMRb. FirstAuthor:AbrahamT.Rasul,Jr.,MD,FAAPMRc. FirstAuthorAffiliations:NeuroSpineInstituteSierraVistaRegionalMedicalCenterd. Background:Facetjointinjectionsdonewithimagingguidancehadbeenassociatedwithreliefofpain.

Theseinjectionshadbeendoneusingfluoroscopyandcomputedtomography(CT)scanning.Sonogramguidedlumbarfacetjointinjectionshadshownsuccessinanumberofstudies.Thiseliminatesexposuretoradiationforboththepatientandtheprovider.

e. Objective:Thepurposeofthisstudyistodemonstratethefeasibilityandresultsofdoingsonogramguidedlumbarfacetinjectionsinanofficesetting.

f. Methods:Twohundredfiftythreepatientswithlumbarfacetjointpainwereincludedinthisstudy.Patientswhodidnotgetanyrelieforcouldnottoleratetheoralsteroidreceivedthesinglelevelsonogramguidedlumbarfacetjointinjectiondoneintheoffice.Treatmenteffectivenesswasassessedusingthevisualanaloguescale(VAS),physicalexamination,reductioninuseofpainmedications,

g. Results:Oftheninety-twopatientswhodidnotrespondtoorcouldnottaketheoralsteroids,almosthalf(48.2%)hadsignificantreliefafteronesinglelevelinjectionwhilelessthanhalfofthisgroup(43.6%),notedreliefonlyaftergetting2ormoresubsequentinjections.

h. Conclusions:Sonogramguidedlumbarfacetinjectionsdoneinanofficesettingprovideasafeandviablecostefficienttreatmentoflumbarfacetpain.

i. References:Darrieutort-LafitteC,HamelO,GlemarecJ,MaugarsY,andLeGoffB.Ultrasonographyofthelumbarspine:sonoanatomyandpracticalapplications.JointBoneSpine.2014Mar:81(2):130-6.

j. Disclosure:N/Ak. Encore:No.

19. MentalHealthandFunctioninginanActiveDutyPainClinica. Presenter:EmmanuelPEspejo,Ph.D.b. FirstAuthor:EmmanuelPEspejo,Ph.D.c. FirstAuthorAffiliations:NavyMedicalCenterSanDiegod. Co-Author(s):SheilaMedina,MPD,andIanFowler,MDe. Co-author(s)Affiliations:NavyMedicalCenterSanDiegof. Background:Emotionaldistressisincreasinglyrecognizedasplayingaroleintheexperienceofchronic

painandchronicpaindisability.Recentmeta-analysesindicatethatemotionaldistressaccountsforupto30%oftherelationshipbetweenpainanddisability(Leeetal.,2015).Thus,addressingemotionaldistressinpatientswithchronicpainmaybecriticaltotheirsuccessfultreatment

g. Objective:Tocharacterizeemotionaldistresssymptoms,includinganxiety,depression,anger,fatigue,andsleepimpairment,endorsedbyasampleofpatientsseekingtreatmentinapainspecialtyclinicforactive-dutymilitary.Toidentifyspecificdimensionsofemotionaldistressmostpredictiveofdisabilityinanactive-dutytreatmentseekingsample.

h. Methods:Thecurrentstudyincludes669activedutyservicemembers,approximately80%male,whopresentedforanevaluationatthePainManagementClinicatNavalMedicalCenterSanDiego.Patientscompletedabatteryofquestionnairesincludingmeasuresofanxiety,depression,anger,fatigue,andsleepimpairment,aswellasmeasuresofpaininterferenceandphysicalandsocialfunctioning.

i. Results:Approximately70%ofpatientsreportedclinicallyelevatedlevelsonatleastoneofthefivesymptomscales,withsleepimpairmentandfatiguebeingthemostcommoncomplaints.Regressionanalysesrevealedthatsleepimpairment,fatigue,anddepressionweresignificantpredictorsofpaininterferenceandphysicalandsocialfunctioningaftercontrollingforreportedaveragepainlevel(ps<.05).

j. Conclusions:Clinicallyelevatedlevelsofemotionaldistressarehighlycommoninactive-dutymilitarymembersseekingtreatmentforpain.Sleepimpairment,fatigue,anddepressionlikelyinfluencepatientfunctioningbeyondreportedpainlevels.Psychosocialandpsychiatricinterventionstargetingsleepimpairment,fatigue,anddepressionmayhelpimprovefunctionaloutcomesinthistreatmentpopulation.

k. References:Lee,H.,Hübscher,M.,Moseley,G.L.,Kamper,S.J.,Traeger,A.C.,Mansell,G.,&McAuley,J.H.(2015).Howdoespainleadtodisability?Asystematicreviewandmeta-analysisofmediationstudiesinpeoplewithbackandneckpain.Pain,156(6),988-997

l. Disclosure:TheviewsexpressedinthisabstractarethoseoftheauthorsanddonotnecessarilyreflecttheofficialpolicyorpositionoftheDepartmentoftheNavy,DepartmentofDefense,ortheU.S.Government.

m. Encore:No

20. HRVBiofeedbackReducesSymptomsinChronicPainPatientsa. Presenter:JPGinsberg,PhDb. FirstAuthor:JPGinsberg,PhD,LicensedClinicalPsychologist/Neuropsychologistc. FirstAuthorAffiliations:DornVAMC,USCSchoolofMedicined. Co-Author(s):e. Co-author(s)Affiliationsf. Background:Effectsofchronicpainincludestress,depression,fatigueandsleepdisorder.Sympathetic

overdriveshownasreducedheartratevariability(HRV)isacommonfactorofthissymptomcluster.HRVcanbeincreasedwithHRVbiofeedback(HRVB)leadingtoimprovedoutcomesinchronicdiseasepatientswithpain.

g. Objective:Conductaseriesofrandomized,controlledclinicalstudiestoassesssymptomclusterincludingpain,stress,depression,fatigue,catastrophizing,andsleepoutcomesafterHRVBinterventionsinchronicpainpatients.ChangesinHRVandoutcomevariableswillbemeasuredpre-posttrainingintervention.

h. Methods:AssesseffectofHRVBonsymptomclusterin3studies:1.Pilot;Veteranswithchronicpain,treatmentasusual(TAU)control;pre-post;singleprimaryendpointofpainandstressratings;2.Phase1;cancersurvivors;TAUcontrol;pre-post;primary,secondaryendpoints;3.Phase1;Veteranswithchronicpain,inactivetreatmentcontrol;4timepoints;primary,secondary,exploratoryendpoints

i. Results:Study1:n=18;Post-HRVBsignificantlylowerthancontrolonalloutcomemeasures(p’s<.05);Study2:n=34;HRVBisfeasible,symptomclusterindicatorsintercorrelated;HRVincreasedbyHRVB;allsymptomclusterindicatorssignificantlydecreased;Study3:n=80;collectingdata;30enrolled;symptomclusterindicatorsincludingcatastrophizingallintercorrelated;groupeffectsnotanalyzedyet

j. Conclusions:Benefitsonsymptomclusteroutcomesshownbyall3studies.HRVBisapromisingintervention.Plannedresearch:(1)NIHRO1,Phase2,singlesite,Veterancancersurvivors;psychoeducationalself-managementcontrol;4timepoints;primary,secondary,exploratoryendpoints(2)NCINCORP,Phase2,multi-site,cancersurvivors.;pre-post;primary,secondary,exploratoryendpoints

k. References:Berry,Metal.2014Non-pharmacologicalinterventionforchronicpaininVeterans:ApilotstudyofheartratevariabilitybiofeedbackGlobalAdvHlthMed3(2),28-33Gharbo,Retal2016HeartRateVariability,ChronicPain,andRehabilitatingtheAutonomicNervousSystemPainPract26,5(17-18)O'Rourke,Metal2017HRVtrainingforsymptomcontrolincancersurvivorsJClinOcol35,15-S10

l. Disclosure:Nonem. Encore:No

21.*RealWorldExperienceofFlavocoxidUseinPainManagementPresenter:LataHandiwala,PharmDFirstAuthor:LataHandiwala,PharmDFirstAuthorAffiliations:Co-Author(s):KitS.Mays,MDCo-author(s)AffiliationsBackground:Olderadults(≥65)withchronicinflammatorypaincanoftenonlyfindreliefwiththeadditionofanopioid.Studieshaveshown46%ofallopioidprescriptionswereforthosebetween40and59yearsold,with28%inthoseover65.Overtime,cliniciansfindthatthesepatientsmayneedtoescalatetheiropioiddoseinordertoachieveadequatepaincontrol.

Objective:Ourstudysoughttoinvestigatethealternativesforinflammatorypainmanagementinolderadults,andwhetheritwouldbepossibletoeitherreducetheuseofopioidsoratleastbeeffectiveenoughtokeepfromescalatingtheopioiddose.Methods:Asingle-site,retrospectivechartreviewwasconductedin108patients.ataspecialtypainclinic.Achartwaseligibleforreviewifthepatientwasbeingtreatedwithflavocoxidandfollowedforatleast3months.Patientswereassessedforopioidusage/dosingatbaselineandafterflavocoxidtherapy,painseverityscoresatbaselineandat6months,andadverseevents.Results:About70%ofpatients(74/108)were≥65years(meanage:77).Theaveragedurationofflavocoxidusewas12.5months.At6months,50%ofelderlypatientsreportedpainscorestobebetterormuchbetterand20%reportednochange.Mostpatients(81%)hadnochangeinopioiddosingorhadtheirdosedecreased.Twoadverseevents,diarrheaandheadache,werereported.Conclusions:Thisretrospectiverealworldanalysissuggeststhatflavocoxidimproves/maintainspainscoresat6monthsandiseffectiveatreducingtheneedtoincreaseopioiddosingintheelderlypopulation.Flavocoxidcouldbeanadjunctivetherapytohelpreduceopioiduse,particularlyinpatientswithchronicdiseaseandmultipleco-morbidities.Thisanalysiswarrantsfurtherprospectiveinvestigations.References:VolkowND,McLellanTA,CottoJH,KarithanomM,WeissSRB.CharacteristicsofOpioidPrescriptionsin2009.JAMA.2011;305(13):1299-1301.doi:10.1001/jama.2011.401.Buntin-MushockC,PhillipL,MoriyamaK,PalmerPP.Age-dependentopioidescalationinchronicpainpatients.AnesthAnalg2005;100:1740-5Disclosure:LataHandiwalaiscurrentlyaconsultanttoAugurHealth,ahealthcareconsultantagencythatworkswithpharmaceuticalanddevicecompanies.Dr.KitMaysiscurrentlytheClinicalAssistantProfessoratUniversityofTennessee,CollegeofMedicine.HefoundedandpracticesattheMaysandSchnappPainClinicandRehabilitationCenter.Encore:No.

2017AnnualClinicalMeetingSanDiegoHiltonBayfront

SanDiego,CABasicScience/Review/CaseStudyPosterAbstracts

22.NewPainTreatmentHelpsEliminatetheNeedforOpioids(PT/electro) Presenter:JohnE.Garzione,DPT,DAAPMFirstAuthor:KristenM.Lake,PT,DPTFirstAuthorAffiliations:Co-Author(s):JohnE.Garzione,DPT,DAAPMCo-author(s)AffiliationsBackground:WiththerecentCDCguidelinesforopioidprescriptionthepushfornon-drugtreatmenthasincreasedoverthepastfewyears.Manypatientsareattemptingtodecreasetheiropioidintakeandaresearchingforwaystomodulatetheirpainduringthatprocess.Inthiscasestudy,theadjunctiveuseofBAUD(Bio-AcousticalUtilizationDevice)enabledonepatienttoendhis35-yearhistoryofopioiduseObjective:Patientisa64-year-oldmalewhohasmedicalhistoryofFibromyalgia,chroniclowbackandneckpain.Hewasfirstgivenopioidsin1982tomanagehispainafteranacuteshoulderinjury.OvertheyearshewasprescribedHydrocodone,Oxycodone,MethadoneandFentanylpatches.In2015thepatientwasreferredtoPhysicalTherapy(PT)byhisPrimaryCareProvider(PCP)forvertigo...Methods:ThepatientwashighlymotivatedtodiscontinueOpioiduseandwaswillingtotryalternativemethodstomodulatehischronicpainduringhisphysicaltherapyforspinal.Hewastreatedwithelectricalstimulation,iontophoresis,thermotherapy,andtherapeuticexercise.InadditiontothesetreatmentshewasgivenBAUDfor15minuteswithsettingschosenthatthepatientconfirmedreducedhispainResults:BeforeBAUDhispainwas10/10onthenumericratingscale,andafterBAUDhispainwasratedas5/10.WhenaskedifhebelievedtheuseofBAUDhelpedhimmodulatehispainwhiledecreasinguseofopioidsheresponded,“Yes!UsingtheBAUDreallyhelpedreducemypainwhenIwashavingreallybaddays,ifitwasn’tforthatIdon’tknowifIcouldhavedoneit."Conclusions:Patientwasseenintherapytwiceaweekandhad8totalBaudtreatmentsuntilhestartedhavingspinalinjectionsinJuly2017andwasdischarged.InAugust2017,thepatientcametotheclinictogiveanupdate.Hewasdoingwellforafewdaysafterthefirstinjectionandwasscheduledforasecondinthefollowingweeks.Hispainlevelremainedlowandwasnottakinganyopioids...References:Ault,A.(2017,July31).OpioidCommission:DeclareaStateofEmergency,Mr.President.RetrievedfromMedscape:http://www.medscape.com/viewarticle/883627Garzione,JE,BruursemaL.R.(2017).AcousticalNeuromodulationforChronicPainManagement.ThePainPracitioner,24-27.pleaseseee-mailattachmentforfullreferences.Disclosure:NoneEncore:No

23.*PainMayPredictTraumaticStressinPersonsWithCancerBHPresenter:BethL.Dinoff,PhDFirstAuthor:BethL.Dinoff,PhDFirstAuthorAffiliations:UniversityofNorthCarolinaChapelHillCo-Author(s):M.LindseyJacobs,PhD,andEmilyVenezia,BGSCo-author(s)Affiliations:Jacobs(BostonVAMedicalCenter)andVenezia(UNCChapelHill)Background:Weproposeanewperspectiveontheroleofpainasamarkerfortraumaticstressinpatientswhohaveundergonesurgeryformalignantneoplasms.TheintersectionsbetweencomorbidpainandPTSDhavebeenexploredpreviously;however,inthisposterwehighlightpainasamarkerfortraumaincancerpatientswithpost-surgicalpains.Manypeoplewithvariouscancersundergodisfiguringsurgeries.Objective:TheIOM’s“RelievingPaininAmerica”listedpreventionofchronicpainasoneofitsguidingprinciples.HealthandHumanServicesrecommendationsemphasizetheneedtoreducetheincidenceofpost-surgicalpain.Giventhecurrentopioidcrisis,understandingpainasamarkerfortraumamayleadtoreductioninopioiduse,improvedmedicaloutcomes,andenhancementofresearchstrategies.Methods:Wereviewtheacuteandchronicpresentationsoftraumaandpain.Wealsoexaminetheincidenceandprevalenceofcomorbidpaininpeoplewhohaveundergonesurgicaltreatmentforcancer,includingmastectomy,amputation,andtreatmentofheadandneckcancers.Finally,webrieflyofferaconceptualrationaleforunderstandingpainasamarkerfortraumaticstressinpeoplewithpost-surgicalpain.Results:Painandtraumaticstressfrequentlyco-occurinthepopulationofpatientsundergoingsurgicalinterventionsforcancer.Whenpeoplehavecomorbidpainandtraumaticstress,theyfrequentlyexperienceworseoutcomes,higherlevelsofdisability,andtheneedforhigherdosesofopioids.Werecommendthatcliniciansrecognizepainasamarkerfortraumaticstressanddevelopearlydetectionplans.Conclusions:Acuteandchronicpresentationsoftraumaandpainarereviewed.Wealsoexaminetheincidenceandprevalenceofcomorbidpaininpeoplewhohaveundergonesurgicaltreatmentforcancer,includingmastectomy,amputation,andresectionofhead/neckcancers.Finally,weproposeaconceptualrationaleforunderstandingpainasamarkerfortraumaticstressinpeopleexperiencepost-surgicalpain.References:Asmundson,GJ,Coons,MJ,Taylor,S,&Klatz,J.PTSDandtheexperienceofpain:Researchandclinicalimplicationsofsharedvulnerabilityandmutualmaintenancemodels.CanJPsychiatry2002,47,903-907.Beck,JG,&Clapp,JD.Adifferentkindofcomorbidity:Understandingposttraumaticstressdisorderandchronicpain.PsycholTrauma,3(2),101-108.Disclosure:None.Encore:No.

2017AnnualClinicalMeetingSanDiegoHiltonBayfront

SanDiego,CAStudentPosterAbstracts

24.EfficacyofEarlyVertebroplasty,Kyphoplasty,orVertebralAugmentationafterVertebralCompressionFractures.a.Presenter:AldoF.BertiMDb.FirstAuthor:AldoF.BertiMDc.FirstAuthorAffiliations:UniversityofNewMexicoHospitald.Co-Author(s):EugeneKoshkin,MD,TimothyPetersen,PhD,DanielleEckartSorte,MDe.Co-AuthorAffiliations:UniversityofNewMexicoHospitalf.Background:Vertebralcompressionfractures(VCF),typicallyosteoporotic,traumatic,orpathologic/neoplastic,arecommonaffecting1.5million(750,000fromosteoporosis)Americanseachyearandareasignificantsourceofbackpain,disability,healthcareexpenditures,andlostwages.ThereisincreasingevidencethatearlyVCFsurgicalcorrection(<6weeksfrominjury)leadstobetterlong-termoutcome.g.Objective:WeundertookapilotstudytoevaluateearlyversusdelayedminimallyinvasiveVCFtreatmentusingtheprimaryendpointsofpainandopiateuse.Wehopedtoobtainpreliminarydatainanticipationofalarger,prospectivetrial.h.Methods:Weretrospectivelyreviewed38patients(60levels)withpainfulcompressionfracturesandcollectedpatientageandgender,leveltreated,typeoffracture,weekselapsedbetweenfractureandfinaltreatmentdate,typeofintervention(vertebroplasty,balloonkyphoplasty,orvertebralaugmentationwithcementandimplantplacement),painlevelbeforeprocedureandatfirstfollowup,opioidusagebeforeprocedureandatfirstfollowup.Statisticalanalysiswasdoneusingcorrelation.i.Results:Timetotreatment(TTT)inweeksanddifferenceinpainbeforeandafterhadastatisticallysignificantrelationship(p=0.0046)with15%ofthevariationinpainleveldifferenceattributabletoTTT(r=0.39).TTTanddifferenceinopioidusebeforeandafterhadastatisticallysignificantrelationship(p=0.0425)with8.5%ofvariationinopioidreductionattributabletoTTT(r=0.29).j.Conclusions:TherewereweakbutstatisticallysignificantpositiverelationshipsbetweenTTTandbothpaindifferenceandopioidusagedifference.Allofthecases(N=9)thathadapaindifference≥6hadtheirproceduresperformedwithin8weeksoffracturedate.Ourgoalwastogenerateapowercalculationforaprospectivestudywithprimaryoutcomesofopiateuse,lengthofhospitalstay,andpainlevels.k.References:AlexandruD,SoW.EvaluationandManagementofVertebralCompressionFractures.ThePermJ.2012;16(4):46-51.Phillips,F.M.(2003).Minimallyinvasivetreatmentsofosteoporoticvertebralcompressionfractures.Spine,28(15S),S45-S53.Hulme,P.A.,(2006).Vertebroplastyandkyphoplasty:asystematicreviewof69clinicalstudies.Spine,31(17),1983-2001.ClarkW,VAPOUR.Trials.2015;16:159.

l.Disclosure:N/A

[x]PradhanBK,GrayRM,ParikhT,AkkireddiP,PumariegaA.TraumaInterventionsusingMindfulnessBasedExtinctionandReconsolidation(TIMBER©)asmonotherapyforchronicPTSDinadolescents:apilotstudy.AdolescentPsychiatry.2015;5(2):125–31.[xi]PradhanBK,ParikhT,MakaniR,SahooMl.Disclosure:No

25.QuadratusLumborumandTotalHip:ARetrospectiveStudya.Presenter:AyeshaHameed,MDb..FirstAuthor:AyeshaHameed,MDc.FirstAuthorAffiliations:n/ad.Background:Painmanagementfollowingtotalhipreplacementsurgery(THA)continuestobeaconcerndespitethegrowingnumberofproceduresperformedannually.ThepurposeofthisstudyistoexaminetheefficacyoftheQLblockaspartofamultimodalpainmanagementprotocolinthemanagementofTHApostoperativepain.e.Objective:WehypothesizethattheuseofquadratuslumborumblockaspartofamultimodalTHApostoperativepainmanagementprotocolwillleadtoimprovedpainreliefwhileresultingindecreasedopioidusageandopioid-relatedadverseeventssuchasnauseaandvomiting,thusimprovingpatientrecoveryandsatisfaction.f.Methods:Dataforpatientsaged18andolderundergoingTHAatLIJMCfromJanuary2016toFeb2017.Severaloutcomesincludingnarcoticuse,lengthofstay,andphysicaltherapymilestoneswerecompared.Variousstatisticalanalysiswasperformed.Ap-valueof<0.05willbeconsideredsignificant.g.Results:Atotalof128anesthesiarecordswerereviewed-65subjectsreceivedspinalanesthesia(Group1)and63subjectsreceivedspinalanesthesiawithquadratuslumborumblock.Groupsweresimilarwithrespectdemographics(ASAstatus,age,BMI,genderraceandethnicity).Postopopioiduse,measuredinmorphineequivalents,withinfirst24hrsweresignificantlydecreasedinQLgroup.h.Conclusions:Basedonthisretrospectivedata,theQLblockofferstremendouspotentialinmanagingpostopanalgesiafortotalhiparthroplasty.Inthefuture,wehopetoperformaprospectiverandomizedcontroltrialtofurtherelicitotheroutcomesofsignificanceandadvantage.i.References:HockettMM1,HembradorS,LeeA.ContinuousQuadratusLumborumBlockforPostoperativePaininTotalHipArthroplasty.AACaseRep.2016Sep15;7(6):129-31.Ueshima,Hironobu,SakatoshiYoshiyama,andHiroshiOtake."Theultrasound-guidedcontinuoustransmuscularquadratuslumborumblockisaneffectiveanalgesiafortotalhiparthroplasty."Journalofclinicalanesthesia31(2016):35.j.Disclosure:None

26.Ketamineforthetreatmentofpainanddepressiona.Presenter:JonathanDang,M.D.b.FirstAuthor:JonathanDang,M.D.c.FirstAuthorAffiliations:d.Co-Author(s):WaguihIsHak,M.D.,CharlesLouy,M.D.,BrigitteVanle,PhD.,LekeishaSumner,PhD.

e.Background:Theeffectivenessofthetreatmentislimitedwithjust30-40%ofthepatientsshowingadequatepainreliefandremissionofdepressivesymptoms-suggestingthatasingletreatmentofketaminemaybeusefulforaddressingpainanddepression.f.Objective:1.Acquireknowledgeaboutcurrenttreatmentofpainanddepression2.ShareanddiscusstwoketamineprotocolsusedbyexpertatCedars-SinaiMedicalCenter.3.Presentpilotclinicaldataofketamineeffectivenessfortreatingpainanddepression4.Discussongoingchallengesofketamineintermsofeffectivenessandimplementationg.Methods:Painanddepressionscreening.IVketamineinfusionBaselineMeasurements,1hr,and72hrpostinfusionh.Results:Ketamineplaysanimportantroleinblockingpainanddepression.ItbindstotheNMDARtoblockthetransmissionofpain.Indepression,itbindstotheNMDARontheGabanergicinterneuroncausingadisinhibitionwhichresultinaglutamateburstwhichrapidlyincreasesBDNF.i.Conclusions:Singletreatmentofketaminemaybeusefulforaddressingpainanddepression.j.References:Maheretal.,Anesthesia&Analgesia.2017Krugersetal.,NatureReviewsNeuroscience.2010Dumanetal.,NatureMedicine,2015Disclosure:None

27.Ketamine,Yoga,Mindfulness,CBTforChronicPain(YMBCTpain)a.Presenter:RobertGessmanMDPainManagementFellowCooperUniversityHospitalb.FirstAuthor:Dr.BasantK.Pradhan,MDc.FirstAuthorAffiliations:CooperUniversityHospitalinCamden,NewJersey.d.o-Author(s):MichaelSabiaMD,RobertGessmanMDe.Co-AuthorAffiliations:CooperUniversityHospitalf.Background:KetamineforPainModulation-analgesicanddissociativeanestheticinhibitingNMDAR[v],[vi]1.Benefitschronicpain,depression,andPTSD2.Mayprovidelastingimprovementformonthsfollowinginfusionsof1-6sub-anestheticdoses.[iv],[vii],[viii]g.Objective:1.Identifyfivekeycomponentsfromthecoreofpainexperience:maladaptivesensations/perceptions,feelings,thoughts,memories,maladaptiveurges/impulses2.Developawarenessofpaincomponentsanddevelopbettercopingskillsusingmeditation,mindfulness,yoga,andCognitiveBehavioralTherapy(CBT)3.IncorporatephilosophyofBuddha’s“TheMiddleWay”advocatingmoderationandbalanceh.Methods:1.Sub-anestheticIVketamine1mg/kgover1hrtoachievedissociationofpainpathwaywhileallowingpatientstoparticipateinmeditationandmindfulnesspractice2.AshtangaYoga(asubtypeofHatha)linksmovementbreathbasedonPantajali’s(postures)torelaxthepatient’sspecificpaincondition3.FA(Focused-Attention)MindfulnessNon-judgmentalawareness,disengagementandshiftofattention

4.Mindfulness-BasedGradedExposureTherapy(MB-GET):usedtochangethecontentsofthedysfunctionalthoughts,feelings,andbehaviorswhileimprovingcopingmechanismsinregardstoavoidancei.Results:N/A(conceptposter)j.Conclusions:N/A-Futurestudycurrentlyseekingfunding:Conductarandomizedcontrolledtrialof50patientswithchronicpaincomparing3-weeklysub-anestheticketamineinfusions+10officevisitstoincorporateY-MBCTpainprotocolvsconservativepainmanagement.k.References:References[i]BairMJ,RobinsonRL,KatonW,KroenkeK.Depressionandpaincomorbidity:aliteraturereview.ArchInternMed.2003;163(20):2433–45.[ii]PradhanB.PsychiatricAspectsinChronicPainandUtilityofYogaandMindfulness-BasedCognitiveBehavioralTherapyforPain(Y-MBCTPain)asaTranslationalModel.InUrogenitalPain2017(pp.207-235).SpringerInternationalPublishing.[iii]NiestersM,MartiniC,DahanA.Ketamineforchronicpain:risksandbenefits.Britishjournalofclinicalpharmacology.2014Feb1;77(2):357-67.[iv]NoppersI,NiestersM,AartsL,SmithT,SartonE,DahanA.Ketamineforthetreatmentofchronicnon-cancerpain.ExpertOpinPharmacother2010;11:2417–29.[v]OrserBA,PennefatherPS,MacDonaldJF.Multiplemechanismsofketamineblocka

[ix]PradhanBK.Yogaandmindfulnessbasedcognitivetherapy:aclinicalguide.Cham:Springer;2014.

28.*EffectsofMindfulnessonAnxiety&AcademicGoalsinMedicalStudentsa.Presenter:JenniferGolden,OMS-IVb.FirstAuthor:JenniferGolden,OMS-IVd.Co-Author(s):MichaelBlahut,M.S.,OMSII,AlexandraColladoOMSII,DeborahSchmidt,D.O.,MitchellDandignac,M.S.,LanceRidpath,M.Sf.Background:Researchhasshownthatmindfulnesstraininghashelpedmedicalstudentsreduceanxietyandstress(Shapiroetal.,1998),aswellasfatigue,bewilderment,andemotionaldistress(Rosenzweig,etal.,2003).Researchalsoindicatesthatthiseffectpersistsduringstressfulexamperiods(Shapiroetal.,1998).However,nostudieshaveinvestigatedtheseeffectsinthemedicalstudentpopulation.g.Objective:Tostudytheeffectsofan8-weekMindfulnessBasedStressReductioncoursewithinthemedicalstudentpopulationoverthecourseofthreemonths.TheresearcherswereinterestedinobservingtheeffectsofMindfulnessontheoutcomesofanxietyandacademicgoalachievementinthehighstressenvironmentofmedicalschool.h.Methods:VolunteersfromtheMBSRgroup(n=8)andcontrolgroup(n=15)completedbimonthlyelectronicsurveysforthreemonths.ThesurveygathereddataonhowmanyminutesthestudentutilizedMBSRtechniques,amountofminutesusingexercise,theirscoreontheGeneralizedAnxietyScale(GAD-7),andanumericscaleofhowthesubjectthoughttheywereachievingtheiracademicgoals.i.Results:AmountofmindfulnessthatstudentsutilizedwascorrelatedwithreducedanxietyscoresontheGAD-7.Specifically,theparticipantsinthegroupthatwastaughtmindfulnesstechniquesconsistentlyreportedreducednervousnessandworry.Wedidnotdiscoveracorrelationbetweendurationofexerciseandstressscore,nordurationofmindfulnesswiththelikelihoodofacademicgoalachievement.j.Conclusions:PerformingMBSRdecreasedanxietyamongstudentsbutdidnotrevealasignificantimpactonacademicgoalachievement.ThegroupthatwastrainedinMBSRshowed

theydidinfactperformmoreminutesinmindfulnesscomparedtothecontrolgroupoverthreemonths.k.References:ShapiroSL,SchartzGE,BonnerG.“Effectsofmindfulnessbasedstressreductiononmedialandpremedicalstudents.”JBehavMed.1998Dec;21(6):581-599RosenzweigS,ReibelDK,GreesonJM,BrainardGC,&HojatM.“Mindfulnessbasedstressreductionlowerspsychologicaldistressinmedicalstudents.”TeachLearnMed.2003Spring;15(2):88-92HjeltnessA,BinderPE,MoltuC,DundasI.29.WestVirginia'sNeighborhoodNutritionProjecta.Presenter:JenniferGolden,OMS-IVb.FirstAuthor:JenniferGolden,OMS-IVd.Co-Author(s):f.Background:WVNNPisafarmtopatientconceptfortheapplicationofclinicalnutrition.Byunitingcommunityclinics,farmersmarkets,andSWCmedicalstudentswecanpromotenutritionaleducationandaccesstoqualityfoodsataffordablepricesthroughoutthestateofWestVirginia.Thisprojectwouldenabletheexpansionofourpilotprogramstartedin2015atWVSOM,HealthYeah!.g.Objective:Monthlycookingworkshopsorganizedandledbymedicalstudentstogivethemtheopportunityforinteractivenutritionaleducationexperienceswithpatientswithfoodprovidedbylocalgrowersfromthecommunity.Patientswilllearnnutritionalfacts,howtoaccesshealthyfood,andhowtocreatemealsfordiseasepreventionandbetterhealthoutcomes.Farmersincreasesalesandthrive.h.Methods:Surveyswillbeconductedonavolunteerbasisbystudentshostingthecookingworkshopstogainanideaofwhetherthisprojectisenhancingtheirnutritionaleducationandtheircompetencytocommunicateeffectivelywithpatientsonthesubjectofnutrition.Patientswillcompletesurveysonavolunteerbasistomeasurecontinuedinterestandachievementofobjectives.i.Results:Outcomesurveyresultswillbeassessedforobjectiveachievementandusedtoinspirecontinuedgrantfundingj.Conclusions:Inastateplaguedbyobesityandopioidcrisesyethostsvastagricultureproduction,thelargestbarriertohealthseemstobeconvincingpeopleofthebenefitsofrealfoodthatisgrownnextdoorandsatiatesthepalate.Thisissuelendsitselfwelltodevelopinganexperientialeducationalprocesstopromoteclinicalnutritionalforstudentsandpatientswhilesupportinglocalfarmers.k.References:WestVirginiaSchoolofOsteopathicMedicine,HealthYeah!