ECHOES OF PAIN

[Vanesa Domagala]

Chronic pain often presents following a traumatic event, or alternatively, patients attribute pain to a trauma, whether this link is established or not. The psychological impact of trauma can significantly complicate the treatment of chronic pain. This article aims to review the known interactions between trauma and chronic pain. Following this review, it discusses therapeutic avenues suited to these complex situations, underlining the specific contributions of the different members of a multidisciplinary team.

ECHOES OF PAIN

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Changes in pain produced by psychological factors (e.g., placebo analgesia) are thought to result from the activity of specific cortical regions. However, subcortical nuclei, including the periaqueductal gray and the rostroventral medulla, also show selective activation when subjects expect pain relief. These brainstem regions send inhibitory projections to the spine and produce diffuse analgesic responses. Regrettably the precise contribution of spinal mechanisms in predicting the strength of placebo analgesia is unknown. Here, we show that expectations regarding pain radically change the strength of spinal nociceptive responses in humans. We found that contrary to expectations of analgesia, expectations of hyperalgesia completely blocked the analgesic effects of descending inhibition on spinal nociceptive reflexes. Somatosensory-evoked brain potentials and pain ratings further confirmed changes in spino-thalamo-cortical responses consistent with expectations and with changes in the spinal response. These findings provide direct evidence that the modulation of pain by expectations is mediated by endogenous pain modulatory systems affecting nociceptive signal processing at the earliest stage of the central nervous system. Expectation effects, therefore, depend as much about what takes place in the spine as they do about what takes place in the brain. Furthermore, complete suppression of the analgesic response normally produced by descending inhibition suggests that anti-analgesic expectations can block the efficacy of pharmacologically valid treatments which has important implications for clinical practice.

Participants will join an interactive online video conference twice per month. The interdisciplinary panel includes clinicians in pain management, behavioral health and pharmacy. Together with a team of experts, participants will:

When you join an ECHO program, you use videoconferencing technology to regularly connect to a community of learners. There are many opioid- and pain-related ECHO programs that offer no-cost teleECHO sessions.

Both Sandy and Naomi, as well as their two surviving children, Patrick and Winter, are haunted by the past. When the children were young adults, Naomi finally revealed to them that her biological father was Black; the kids had been raised white and Jewish. "That's what made the lie so painful, honestly, it was that she robbed us of this aspect of who we were, because she was ashamed of it, and then that transferred the shame onto us," Winter explains to her fiancé, Zeno, a construction worker from Mexico.

UC Davis ECHO Pain Management is a peer-to-peer video conference mentoring program designed to support community-based primary care clinicians in their mission to provide high quality, safe and effective pain care. Through weekly videoconference learning and support sessions, the program provides primary care providers with the opportunity to increase their specialized knowledge in pain management.

Providers at participating clinics and health centers convene once a week for 10 months for a one-hour video conference that features didactic presentations on essential pain care topics combined with in-depth case discussions. Each interactive educational session empowers primary care providers with the tools to safely identify and understand pain and deliver safe, compassionate and effective care. All clinical staff members are encouraged to participate.

This clinic is a forum guided by a Pain Management Physician, a Pain Management Psychologist, and a Mental Health and Addiction Specialist. The clinic offers an opportunity to present and discuss patients in your clinic with pain. Learn how to assess and manage your patients with pain through a variety of non-pharmacologic and pharmacologic modalities. Learn best practice approaches to minimizing the risk of addiction.

Based on the University of New Mexico model, the BC ECHO for Chronic Pain is a free, virtual community of practice for BC health care providers that leverages specialist knowledge to support community providers to provide appropriate care to people living with chronic pain. Through our ECHO, health care providers can gain the knowledge, resources, and interprofessional support to provide immediate care to patients with chronic pain in their home communities.

Our ECHO provides a significant opportunity for practitioners to improve their competence in chronic pain care by gaining help with complex cases, receiving support and mentorship, and helping to reduce disparities in the quality of care for rural and underserved areas.

The goal of Opioid, Addiction, & Pain (OAP) ECHO is to help providers manage patients with chronic pain and substance use disorders. There is an ever-growing need to address this public health crisis given the increasing rate of opioid use disorders and overdoses in local communities. This ECHO series will also encourage and assist providers in becoming buprenorphine waivered to better treat opioid use disorders in an outpatient setting.

Dr. Bushey trained at The Johns Hopkins University School of Medicine, where he earned MD and Ph.D. degrees and completed a general psychiatry residency. His training provided an emphasis on highly individualized patient care, which he applied in the assessment of patients with complex pain syndromes for the Johns Hopkins Pain Treatment Program. He joined the Indiana University School of Medicine in 2018, where he is involved in health services research studying models of care for patients with chronic pain and opioid use disorder. In his current practice at Indiana University Health, he specializes in the psychiatric treatment of patients with chronic pain, somatic symptom disorder, functional neurological conditions (i.e. conversion disorders), and medically-unexplained symptoms. He serves as medical director of the Indiana University Health Pain Rehabilitation Program.

This Project ECHO series is a forum led by pain management physician, Denis Patterson, DO, pain psychologist, Michael Lewandowski, PhD, and mental health and addiction specialist, Paul Snyder, MA, LADCS, CPCI. The sessions offer an opportunity to present and discuss patients with pain. Learn how to assess and manage your patients with pain through a variety of non-pharmacologic and pharmacologic modalities, as well as learn best practice approaches to minimizing the risk of addiction.

The Hamas massacre was the deadliest day for the Jewish community since the Holocaust, and one of the largest global terrorist attacks since 1970. And the death toll is still rising. The numbers and the stories behind them devastate: the memories, the moments lost, the lives that could have been. The echoes of these tragedies in our collective conscience bear haunting similarities to the darkest chapters of Jewish history.

The 2021 Israel-Hamas Conflict taught us a painful lesson to we Americans: that acts of violence abroad can breed hatred and animosity at home. The rise of antisemitism and anti-Israel sentiments, including on college campuses, has been a disturbing trend. But the safety of our Jewish community remains paramount. The urgency to protect Jewish institutions and students has never been clearer.

I want peace, dignity and prosperity for Israelis and Palestinians, and I want the Hamas terrorist threat to be eliminated. I want safety and equity for people of all identity groups, whether it is race, religion, ethnicity, sexual orientation, gender identity or any identity, and I want all extremism to be eradicated. In this journey of hope and resilience, we draw from the lessons of our painful past, stand firm in the face of present adversities, and pave the way for a harmonious future.

Pediatric pain is a complex health challenge requiring a multi-modal management approach. It is critical that healthcare providers (HCPs) have access to ongoing, flexible education and mentorship specific to pediatric pain. However, there are significant gaps in available pain education and a need for more opportunities to support interprofessional training. Project Extension for Community Healthcare Outcomes (Project ECHO) is a model for delivering online HCP education and cultivating a virtual community of practice. Within the pediatric pain setting, ECHO has potential to improve local access to specialized pain knowledge, particularly among the physicians, nurses, and allied health providers who primarily manage these cases in community and hospital settings across rural and urban environments. The purpose of this study was three-fold. First, to evaluate the feasibility (participation levels, acceptability) of implementing Project ECHO in the context of pediatric pain. Second, to measure preliminary program impacts on HCP knowledge, self-efficacy, and clinical practice. Third, to characterize HCP program engagement levels before and after onset of the COVID-19 pandemic.

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