2023
November 8, 2023
"Policy development for the treatment of chronic pain"
Patricia Herman, PhD ND
Senior Behavioral Scientist, RAND Health Care; Co-Director, RAND Center for Collaborative Research in Complementary and Integrative Health
RAND Corporation
April 26, 2023
"Access and Equity: How the Policy Environment Shapes Care of People with Pain, People with Addiction, & People at the Intersection"
Kate Nicholson
Founder and Executive Director
National Pain Advocacy Center (NPAC)
Summary:
Ms. Nicholson, the founder and executive director of the National Pain Advocacy Center (NPAC), explains the how disconnect between media coverage and science creates false narratives that drive laws and policies which in turn perpetuate negative stigmas and impact the quality of healthcare services provided. Ms. Nicholson discusses how laws and policies create barriers in addiction treatment such as regulating methadone, and limiting who is allowed to prescribe medications for opioid use disorder (MOUD), leading to fewer than 22% of patients who need MOUD being prescribed the medications. She also focuses on the 2016 CDC Prescribing Guidelines which led to many concrete numbers being adapted into strict laws and forced tapering. Ms. Nicholson warns of the misapplication of a one-size-fits-all opioid guideline and cites a “secret shopper” study that found that 40-50% of clinics in America refuse care to patients taking opioids. She goes on to discuss bias, inequities and disparities in pain and addiction care, noting that BIPOC, women, people with disabilities, and LGBTQIA+ individuals were more likely to have their pain discounted and were less likely to receive care for their pain, while Black, American Indian, and Alaska Native individuals had the highest rates of overdose but the most limited access to medications. She then highlights positive legal interventions and the work at NPAC, stating that they have helped Federation of State Medical Boards revise their opioid guidelines and fought to pass state bills protecting people on opioids from being denied care, among other impressive works. Ms. Nicholson concludes with her ongoing work developing a positive pain agenda, creating an Interagency Pain Research Coordinating Committee, global advocacy symposiums, and other attempts to bridge the gap between pain and care.
January 25, 2023
"Understanding and Treating Pain in Persons with Opioid Use Disorder"
Dr. Kelly Dunn
Associate Professor, Department of Psychiatry and Behavioral Sciences
Johns Hopkins University, School of Medicine
2022
November 9, 2022
"Patient-Centered and Scalable Innovations for Pain Relief and Opioid Stewardship"
Dr. Beth Darnall
Professor, Department of Anesthesiology, Perioperative, and Pain Medicine
Stanford University, School of Medicine, Stanford, CA
September 28, 2022
"New psychoactive substances surveillance through DEA TOX: It’s all about fentanyl, fentalogs and nitazenes"
Dr. Roy Gerona
Assoc. Professor, Department of Obstetrics, Gynecology, & Reproductive Sciences
University of California, San Francisco
Summary:
Dr. Gerona gives an overview of the DEA’s Toxicology Testing Program (DEA TOX) workflow in collaboration with UCSF, demonstrates how liquid chromatography-high resolution mass spectrometer (LC-HRMS) can accurately identify new psychoactive substances (NPS) and traditional illicit drugs (TIDs), and discusses the findings of DEA TOX from the previous year. Dr. Gerona explains that DEA TOX is the toxicology testing of cases resulting from the ingestion of NPS where traditional drug screening has produced no identification. Dr. Gerona describes the HRMS analytical platform and its ability to perform both targeted and non-targeted data acquisition and data analysis with only 0.25 ml samples for quantification. He explains that the LC-HRMS targeted analysis not only follows strict match criteria, but MS/MS Library matching is also performed to confirm the compound to a reference standard. Dr. Gerona then analyzes the data from 2021 DEA TOX reports, highlighting that 82% of all cases were NPS/TID cases and mostly opioid cases. The most commonly detected opioids in NPS were para-Fluorofentanyl, Mitragynine, and Metonitazine, while the most commonly detected opioids in TIDs were Fentanyl, Norfentanyl, and Beta-Hydroxyfentanyl. He emphasizes that fentanyl death to overdose frequency was 6:1 and was found to co-occur with other drugs such as methamphetamines, which increase the proportions of deaths. Dr. Gerona states that future directions include expanding analysis to hair samples, and to increase collaborations with other states and addiction centers.
May 25, 2022
"Regulation of Synaptic Plasticity by α2δ-1 Protein in Neuropathic Pain"
Dr. Hui-Lin Pan
Professor, Department of Anesthesiology and Perioperative Care
University of Texas, MD Anderson Cancer Center
April 27, 2022
"Intricacies of Signaling by Endogenous Opioid Peptides and Novel Neuropeptides"
Dr. Lakshmi Devi
Professor, Departments of Pharmacological Sciences, Neuroscience, and Psychiatry
Icahn School of Medicine, Mount Sinai
March 23, 2022
"How the Brain Controls Pain: Top-Down and Bottom-Up Modulation"
Dr. Mary Heinricher
Associate Dean for Research, School of Medicine Professor and Vice Chair for Research, Neurological Surgery | Professor Behavioral Neuroscience
Oregon Health & Sciences University
2021
November 17, 2021
"Transcranial Magnetic Stimulation (TMS) for Pain and Co-morbid Conditions"
Dr. Albert Leung
Professor, Department of Anesthesiology
University of California, San Diego, School of Medicine
October 27, 2021
"Rapid high-dose induction in the Emergency Department and by Paramedics: initial observations and future directions "
Dr. Andrew Herring
Medical Director/Co-PI, Highland Hospital Substance Use Treatment Program
Assistant Clinical Professor, University of California, San Francisco
May 24, 2021
"Integrative Pain Management with Acupuncture, Spinal Manipulation, Mindfulness: What do we know? "
Dr. Wolf Mehling
Professor, Department of Family and Community Medicine
University of California, San Francisco
Summary:
Dr. Mehling presents evidence, though low quality, that strongly supports the recommendation of acupuncture for both chronic and acute low back pain (LBP). Additionally, he advocates for physical therapists to pursue education and certification in spinal manipulation while also highlighting mindfulness as a highly effective approach for reducing pain sensation. Dr. Mehling analyzes multiple academic studies, investigating the placebo effect and identifying the specific subgroup, characterized by factors such as a current episode duration of fewer than 16 days, absence of sciatica, and a Fear-Avoidance Beliefs Scale score below 19, that would benefit from spinal manipulation. Additionally, Dr. Mehling explores the correlation between mindfulness and the activation/structural differences observed in the insula and anterior cingulate cortex (ACC). Dr. Mehling also describes ongoing and future studies centered around the interoceptive neural pathways and mindfulness interventions such as yoga as treatment for back pain.
April 26, 2021
"Cannabis and Opioid Pathways to and from Addiction"
Dr. Yasmin Hurd
Professor, Departments of Psychiatry and of Neuroscience
Icahn School of Medicine, Mount Sinai, New York
Summary:
Dr. Hurd presents evidence that CBD may be used to treat cue-induced cravings and anxiety in opioid use disorder (OUD) patients. She summarizes the clinical and translational evidence behind using cannabinoids as treatments for OUD and chronic pain, specifically focusing on neurobiology and genetics. Dr. Hurd discusses environmental and epigenetic influences that affect stress behaviors, stress regulation, and developmental changes in opioid receptors as well as differences between the effects of THC and CBD such as synaptic remodeling, changes in drug-seeking behavior, and intoxication as shown in animal models and pilot clinical studies. Dr. Hurd then highlights potential research in developing treatments for OUD with a combination of CBD and epigenetic inhibitors such as Bromodomain and Extraterminal (BET) inhibitors particularly for heroin use, as well as the development of effective dose and treatment regimens for patients.
March 22, 2021
"Applying a Systems Biology Approach to Chemotherapy-Induced Peripheral Neuropathy"
Dr. Kord Kober
Asst. Professor, Department of Physiological Nursing
University of California, San Francisco
Summary:
Through a systems biology approach to evaluating the molecular mechanisms of CIPN, Dr. Kober explains that peripheral blood may be used as a biomaker or surrogate for neuronal tissue, or as a direct signal. Dr. Kober discusses studies that identified differences in clinical benchmarks between patients affected by CIPN including upper/lower extremity sites’ pain thresholds, grip strength and reflexes, balance, pain characteristics, and pain interference. Dr. Kober also examines data-integrated analyses used to identify gene pathways, coexpression networks, and protein-protein interaction (PPI) networks for mitochondrial dysfunction, neuroinflammation, and cytoskeleton and axon morphology,; such as the multi-staged data- integrated multi-omics analysis that identified the HIF-1 signaling pathway and logistic regression which was used to evaluate for associations between latent class membership an expression quantitative trait loci (eQTL) variation in the KEGG pathway. Dr. Kober states that next steps include identifying molecular features that could be used as targets for pharmacological interventions or as diagnostic biomarkers, developing prediction models of CIPN using EHR data, compound screening in vitro, and more
February 22, 2021
"A multi-modal approach to treatment of patients with opioid use disorder at ZSFG"
Dr. Kathy LeSaint
Asst. Professor, Department of Emergency Medicine
University of California, San Francisco
Summary:
Dr. LeSaint discusses insight from ongoing projects into the significance of educating clinicians about buprenorphine and substance use disorder (SUD) while enhancing community access to care. She provides an overview of the population affected most by SUD, acknowledging that many of these patients have co-occurring mental illnesses, are unconnected to care, and are among the lowest quartile of income. Dr. LeSaint then discusses a multi-modal approach to treating patients with OUD including the efforts and challenges of multiple projects: the CA Bridge Project which tackles the issue of administering and prescribing buprenorphine from the ED and providing an in-patient Addiction Care Team (ACT) that assists the primary team, Project FRIENDS which is San Francisco’s first EMS-led naloxone distribution effort, and the California Substance Use Line which provides SUD counseling to California clinicians. Dr. LeSaint states that future directions for these projects will encompass expanded coverage and outreach, piloting a follow-up program, formal consultations in the ED by ACT nurse practitioners, and collaborations with ambulatory care among other goals.
January 25, 2021
"Acetylcholine as a neuromodulator: Ach signaling in the basolateral amygdala during reward learning"
Dr. Marina Picciotto
Professor, Department of Psychiatry
Yale University
Summary:
Dr. Picciotto summarizes data from experiments that led to the conclusion that acetylcholine (ACh) functions as a neuromodulator in the basolateral amygdala (BLA) and is responsible for improving cued-reward learning. Dr. Picciotto explains that ACh signaling in the BLA is mediated through nicotinic ACh receptors (nAChRs) and muscarinic ACh receptors (mAChRs), and through a c-Fos screen it was shown that a decrease in nAChR activity decreased c-Fos levels in the BLA, and by using shRNA to target specific nAChRs, confirmed that ACh acts through nAChRs to contribute to baseline BLA excitability. Dr. Picciotto then examines a rat cued-reward learning study using genetically encoded GFP-coupled mAChRs, fiber photometry, and AAV-DiO-GcAMP7s (Cre-dependent) infused into ChAT-Cre mice, revealing that salient events in the learning task trigger BLA ACh release, which enhances reward learning even when it is non-contingent, suggesting its involvement in synaptic plasticity; additionally, the study confirms ACh release from the nucleus basalis of Meynert (NBM) and establishes that ACh does not influence the output of BLA principal neurons while demonstrating the necessity of mAChRs, but not nAChRs, in cue-reward learning. Dr. Picciotto then describes future steps to research whether aversive or appetitive learning is most responsive to ACh, the role of nAChRs in reward behavior, and the temporal dynamic of plasticity triggered by ACh release.
2020
December 7, 2020
"Molecular profiling of the human peripheral nervous system in chronic pain states"
Dr. Theordore Price
Professor, Department of Neuroscience
University of Texas, Dallas
November 23, 2020
"Disparities in Perioperative Pain Management"
Dr. Arthur Wood
Associate Professor, Department of Anesthesia and Perioperative Care
University of California, San Francisco
October 26, 2020
"Using the neurobiology of intrusive thinking to treat substance use disorder"
Dr. Peter Kalivas
Professor, Department of Neuroscience
Medical University of South Carolina
September 28, 2020
"Endosomal Platforms for the Signaling Train to Pain"
Dr. Nigel Bunnett
Professor and Chair, Department of Molecular Pathobiology
New York University College of Dentistry