2016 was a watershed year in the United States in the attempt to reverse the epidemic of opioid overdose deaths and addiction. Perhaps no event crystallized this intention more than a set of guidelines released by the Centers for Disease Control and Prevention offering evidence-based prescriptions for responsible opioid prescription. This influential document did have the net effect of reducing opioid prescriptions for pain, but also had unintended effects in the process. 

Dr. Roger Chou is here to discuss the intended and unintended effects three years out. Dr. Chou is a unique authority in the pain medicine field because of his influential scientific publications and, more uniquely, his participation as a member of the CDC consensus panel that created the 2016 guidelines. He is a recent co-author of a New England Journal of Medicine editorial that discusses his reservations about how the guidelines have been misunderstood and misapplied. 

Dr. Joshua Schrecker is a member of the clinical team at Aegis Sciences Corporation. He received his Doctor of Pharmacy from the University of Tennessee College of Pharmacy. He has expertise in developing leadership skills within a corporate environment and has received certifications through completion of advanced cardiac life support courses. On this episode, Dr. Schrecker discusses the clinical utility and role of urine drug screens. 

Dysautonomia is the most important nervous system problem you have probably never heard about. It is a vast grouping of diseases that affects the body's most basic functions that occurs below the level of direct conscious control--temperature control, digestion, and regulation of blood pressure are some of the critical functions of this unheralded system. When things go wrong with the system, it is obvious to patients. The problem is the cultural awareness and conventional medical system has been slow to recognize and effectively treat this dysautonomia.

Enter: Kelly Freeman. A survivor turned patient advocate, Kelly is the founder of The Dysautonomia Project dedicated to educating patients and clinical providers alike to close this big gap. Having survived dysautonomia herself, she has founded The Dysautonomia Project to provide patient advocacy and education. She is the co-author of a book of the same name and her website can be found at thedysautonomiaproject.org.

Dr. Christina Hayhurst is an assistant professor of Anesthesiology and Critical Care medicine at Vanderbilt University Medical Center. She trained at the University of Virginia, where she first began to explore opioid-sparing anesthetics and the effects of high-dose opioids on post-operative outcomes. At Vanderbilt, in addition to critical care, she is a member of the Perioperative Anesthesia service, which designs and implements enhanced recovery protocols for a variety of surgical services, with an emphasis on opioid reduction. Her research interests include the clinical implications of opioid-induced hyperalgesia in the perioperative and critically ill patient populations.

We welcome Dr. Lani Simpon. Dr. Lani is a certified clinical densitometrist and has a doctorate in chiropractic care. She is the author of the highly-regarded book Dr. Lani’s No-Nonsense Bone Health Guide and will be discussing osteoporosis with us today. You can learn more about Dr. Lani and find more educational resources at her website lanisimpson.com.

Our guest today is Renzo Lanfranco, LPsy, MSc. Dr. Lanfrano is trained in clinical psychology and obtained a Masters of Science in neuroscience from the University of Chile, where he is currently adjunct professor. He is an associate investigator in the Laboratory of Cognitive and Social Neuroscience at the Center of Investigation UDP- Foundation INECO for the Neurosciences. Dr. Lanfranco will discuss hypnoanalgesia with us today and his recently published article, Hypnoanalgesia and the study of pain experience: from Cajal to modern neuroscience. 

Discussed article citation:

Lanfranco, Renzo C., Andrés Canales-Johnson, and David Huepe. "Hypnoanalgesia and the study of pain experience: from Cajal to modern neuroscience." Frontiers in psychology 5 (2014).

Our guest today is Michael D. Stubblefield, MD, a cancer rehabilitation physiatrist at Memorial Sloan Kettering Cancer Center in New York. Dr. Stubblefield has numerous publications, including original research on the neuromuscular, musculoskeletal, and functional complications that patients sometimes develop as a result of cancer and cancer treatments. He is the author of the most authoritative textbook on the field entitled Cancer Rehabilitation: Principles and Practice and will speak with us today about the medical and clinical aspects of cancer rehabilitation.

We discuss nutrition after traumatic brain injury with Angus Scrimgeour, PhD. Dr. Scrimgeour is currently serving as a nutritional biochemist at the United States Research Institute of Environmental Medicine where he investigates evidenced-based applications of nutrition for traumatic brain injury. His review, cited below, serves as the focal point of our interview and describes four nutrients demonstrating potential benefit: omega-3, zinc, vitamin-D, and glutamine.

Featured article citation:

In our third episode, we interview Dr. Scott-Wyard on congenital lower limb deficiencies. Dr. Scott-Wyard, who completed her combined PM&R/pediatric residency at Cincinnati Children's Hospital Medical Center, is a pediatric physiatrist at Shriners Hospitals for Children in Los Angeles where she heads the Children's Amputee Prosthetics Project.

Disclaimer:

The PM&R Podcast is an independent project aimed at providing informational interviews with authorities in the field. As such, the views expressed on the podcast do not represent the views of any institution. Views expressed by our guests are not necessarily shared by The PM&R Podcast.

By listening to this podcast, you agree not to use the content as medical advice to treat any medical condition in yourself or others, including but not limited to patients under your care. Consult your own physician for any medical issues that you are having. This entire disclaimer applies to any hosts, guests and contributors; we are not responsible for damages arising from the use of the podcast.

 This podcast should not be used in any legal capacity whatsoever, including but not limited to establishing "standard of care" in a legal sense or as a basis for expert witness testimony. No guarantee is given regarding the accuracy of any statements or opinions made on the podcast or blog. 

In our first episode, we discuss a review article The Use of Ketamine in Neuropathic Pain with co-author Dr. Sanjog Pangarkar. Dr. Pangarkar is the director of the West Los Angeles VA pain medicine service and is board certified in internal medicine, physical medicine and rehabilitation and pain medicine. Learn about ketamine's history, mechanism of action, clinical applications, economic considerations, and a first-hand account of how it is administered. 

Citations include the primary article and a case report that we co-authored with Dr. Pangarkar that is referenced during the interview. 

Primary article: 

O’Brien, Sarah Lee, Sanjog Pangarkar, and Joshua Prager. "The Use of Ketamine in Neuropathic Pain." Current Physical Medicine and Rehabilitation Reports 2.2 (2014): 128-145.

Case report: 

Zappaterra, Mauro, Lysander Jim, and Sanjog Pangarkar. "Chronic pain resolution after a lucid dream: A case for neural plasticity?." Medical hypotheses(2013).