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    <recommendedItem id="20100101_19_463"
                     title="AAPM: Online Program Helps Manage Pain (CME/CE)"
                     score="0.014"
                     href="http://www.medpagetoday.com/MeetingCoverage/AAPM/tb/18393?impressionId=1265785924398"
                     
      &lt;p&gt;SAN ANTONIO  --  A personalized, online self-management program helped patients with pain syndromes improve coping skills and reduce stress and depression in two studies reported here.&lt;/p&gt;
&lt;p&gt;Patients randomized to the self-management program demonstrated significant improvement in multiple social, emotional, and behavioral outcomes after six months (&lt;em&gt;P&lt;/em&gt;&amp;lt;0.05 to &lt;em&gt;P&lt;/em&gt;&amp;lt;0.01). Improvement in some parameters occurred within one month. A control group that was not exposed to the program showed no significant improvement.&lt;/p&gt;
&lt;p&gt;&quot;Our goal is to help people communicate better with providers, understand better how they can use social support, understand the comorbid conditions, like anxiety and depression, and develop cognitive skills to help get them through their pain episodes,&quot; said Emil Chiauzzi, PhD, of Inflexxion, the Newton, Mass. company that developed the program.&lt;/p&gt;
&lt;p&gt;Although the studies involved patients with migraine or low-back pain, programs are being developed for other types of pain condition, including several forms of neuropathic pain.&lt;/p&gt;
&lt;p&gt;The online program, demonstrated at &lt;a href=&quot;http://www.painACTION.com&quot; mce_href=&quot;http://www.painACTION.com&quot; target=&quot;_blank&quot;&gt;www.painACTION.com&lt;/a&gt;, employs patient-specific information to generate individualized self-management strategies.&lt;/p&gt;
&lt;p&gt;Patient responses to assessments are analyzed by a &quot;recommendation engine,&quot; which produces content recommendations designed to address each patient&apos;s informational and self-management needs.&lt;/p&gt;
&lt;p&gt;Elements on the Web site include multimedia education units, a pain inventory, interactive tools that provide information based on patient-provider communication, and medication risk management.&lt;/p&gt;
&lt;p&gt;&quot;The content on the Web site is focused on teaching people practical skills to manage the behavioral side of pain,&quot; Jonas Bromberg, PsyD, also of Inflexxion, said in an interview.&lt;/p&gt;
&lt;p&gt;Bromberg presented results of a randomized study involving 210 patients, all of whom met International Headache Society diagnostic criteria for migraine, with or without aura.&lt;/p&gt;
&lt;p&gt;Patients assigned to the online program completed at least eight 30-minute session during the first month of the study and at least five more 30-minute sessions during the five-month follow-up period. Patients in the control group continued to receive usual care without exposure to the Web site.&lt;/p&gt;
&lt;p&gt;Participants assigned to the online program had a minimum set of requirements for each session, which were provided at log-in. Follow-up assessments occurred at one, three, and six months.&lt;/p&gt;
&lt;p&gt;The two groups were balanced with respect to sex and headache frequency and severity, the researchers said.&lt;/p&gt;
&lt;p&gt;Bromberg reported that patients assigned to the self-management program demonstrated significant improvement in: &lt;ul&gt; &lt;li&gt;Headache self-efficacy (&lt;em&gt;P&lt;/em&gt;&amp;lt;0.01 compared with baseline)&lt;/li&gt; &lt;li&gt;Use of relaxation (&lt;em&gt;P&lt;/em&gt;&amp;lt;0.05 to &lt;em&gt;P&lt;/em&gt;&amp;lt;0.01)&lt;/li&gt; &lt;li&gt;Use of social support (&lt;em&gt;P&lt;/em&gt;&amp;lt;0.01)&lt;/li&gt; &lt;li&gt;Pain catastrophizing (&lt;em&gt;P&lt;/em&gt;&amp;lt;0.01)&lt;/li&gt; &lt;li&gt;Depression (&lt;em&gt;P&lt;/em&gt;&amp;lt;0.05 to &lt;em&gt;P&lt;/em&gt;&amp;lt;0.01)&lt;/li&gt; &lt;li&gt;Stress (&lt;em&gt;P&lt;/em&gt;&amp;lt;0.01)&lt;/li&gt; &lt;/ul&gt;&lt;/p&gt;
&lt;p&gt;Chiauzzi presented results from a randomized study of 209 patients with low-back pain. The design was similar to that of the migraine study, except results were analyzed for between-group differences.&lt;/p&gt;
&lt;p&gt;The results showed significant improvement in the study group versus control group with respect to: &lt;ul&gt; &lt;li&gt;Stress (&lt;em&gt;P&lt;/em&gt;&amp;lt;0.01)&lt;/li&gt; &lt;li&gt;Coping (&lt;em&gt;P&lt;/em&gt;&amp;lt;0.01)&lt;/li&gt; &lt;li&gt;Social supports (&lt;em&gt;P&lt;/em&gt;&amp;lt;0.05)&lt;/li&gt; &lt;/ul&gt;&lt;/p&gt;
&lt;p&gt;The data showed significant effects of both treatment (&lt;em&gt;P&lt;/em&gt;&amp;lt;0.01) and time (&lt;em&gt;P&lt;/em&gt;&amp;lt;0.01) favoring the Web site versus control. Chiauzzi said patients assigned to the Web site had greater mean improvement at posttest, three months, and six months.&lt;/p&gt;
&lt;p&gt;Qualitative analysis suggested that Web site participants had clinically meaningful improvement in depression, anxiety, and stress.&lt;/p&gt;
&lt;p&gt;Additionally, patients in the self-management program reported a 12.3% decrease in pain from baseline, versus 7% in the control group.&lt;/p&gt;
&lt;p&gt;Access to the Web site did not improve physical functioning.&lt;/p&gt;
&lt;div style=&quot;float:left;border-style:solid;border-width:1px;border-color:#8dabbc;font-family:arial;font-size:12px;background-color:#DBE9F2;padding:5px;&quot;&gt;&lt;p&gt;The studies were funded by the National Institutes of Health.&lt;/p&gt;&lt;p&gt;Chiauzzi and Bromberg are employees of Inflexxion, developer of the online program.&lt;/p&gt;&lt;/div&gt;&lt;div style=&quot;clear:both;&quot;&gt;&lt;/div&gt;
    </recommendedItem>
    <recommendedItem id="20100101_19_424"
                     title="AAPM: Facet Graft Quells Refractory Back Pain (CME/CE)"
                     score="0.013"
                     href="http://www.medpagetoday.com/MeetingCoverage/AAPM/tb/18343?impressionId=1265785924398"
                     
      &lt;p&gt;SAN ANTONIO  --  Minimally invasive facet arthrodesis significantly reduced pain and improved physical function for one&lt;strong&gt; &lt;/strong&gt;year in patients with medically refractory facet arthropathy, according to data from a prospective clinical series.&lt;/p&gt;
&lt;p&gt;Most patients discontinued narcotic pain relievers, researchers reported here, and only one of 28 patients in the series had no appreciable change in pain after the noninstrumented spinal surgery.&lt;/p&gt;
&lt;p&gt;&quot;The procedure does not disrupt stabilizing ligaments or muscular structures of the posterior spine, allowing unimpeded physiotherapy for low back muscular strengthening after 16 weeks,&quot; Daniel Bennett, MD, of Integrative Treatment Centers in Denver, told attendees at the American Academy of Pain Medicine meeting.&lt;/p&gt;
&lt;p&gt;&quot;If fusion occurs, symptoms should not return, as with traditional treatment modalities, such as thermal radiofrequency neurolysis.&quot;&lt;/p&gt;
&lt;p&gt;The results have provided the foundation for a prospective, multicenter, randomized clinical trial to compare radiofrequency neurolysis and minimally invasive spine facet arthrodesis, he added.&lt;/p&gt;
&lt;p&gt;Medical management of low back pain related to facet degeneration often provides minimal pain relief and can interfere with functioning. Direct injection of anesthesia into an affected joint also leads to negligible long-term benefits, said Bennett. Radiofrequency neurolysis provides only temporary pain relief and must be repeated because of nerve regeneration.&lt;/p&gt;
&lt;p&gt;All the patients had a return of pain after previous radiofrequency neurolysis and were eligible for repeat neurolytic procedures. Affected areas were confirmed by anesthetic injection, followed by a provocatory examination.&lt;/p&gt;
&lt;p&gt;The patients underwent a standardized procedure that included a small incision at the affected area, insertion of surgical pins to stabilize the joint, use of a surgical drill to achieve joint separation, and insertion of 5-mm or 7-mm Morse tapered cortical allografts.&lt;/p&gt;
&lt;p&gt;After surgery, patients wore a rigid brace for 16 weeks, at which point they began physical therapy to strengthen back muscles.&lt;/p&gt;
&lt;p&gt;The patients received a total of 102 grafts at 51 levels, and four dislodgements (3.9%) occurred. None of the patients had a return of pain after dislodgement.&lt;/p&gt;
&lt;p&gt;&quot;Among patients who retained grafts, all showed callus formation of the posterior joint and incorporation of the cortical allograft,&quot; said Bennett.&lt;/p&gt;
&lt;p&gt;At the 52-week follow-up, the average score on a 100-point visual analog pain scale was 23, down from an average of 79 prior to the intervention. Patients&apos; scores on the Oswestry Disability Index averaged 8.32, compared with 33.46 at baseline.&lt;/p&gt;
&lt;p&gt;All but four patients discontinued narcotic medication, and the morphine dose required by those four decreased from a baseline range of 150 to 360 mg to a range of 10 to 30 mg at one year.&lt;/p&gt;
&lt;div style=&quot;float:left;border-style:solid;border-width:1px;border-color:#8dabbc;font-family:arial;font-size:12px;background-color:#DBE9F2;padding:5px;&quot;&gt;&lt;p&gt;The study was supported by Prism Healthcare Foundation.&lt;/p&gt;&lt;p&gt;Bennett disclosed relationships with Alphatec Spine, miniSURG, Boston Scientific, Cephalon, Nevro, and Paylon.&lt;/p&gt;&lt;/div&gt;&lt;div style=&quot;clear:both;&quot;&gt;&lt;/div&gt;
    </recommendedItem>
    <recommendedItem id="20090101_4_108"
                     title="AAPA: Clinicians Who Treat Pediatric Sleep Apnea Must Work in the Dark"
                     score="-0.005"
                     href="