I concluded my 2012 conference experience at the 16th Annual North American Neuromodulation Society (NANS) Meeting at the Wynn Las Vegas. As you may already be aware, this is a world-class pain conference that draws over a thousand attendees from all over the world. This year marked my first time participating as an attendee, exhibitor, AND presenter. Once again, this was a fantastic conference for Hartley Medical and me.
I had the opportunity to attend a wide array of lectures. One in particular, was Dr. Jay Grider’s, “Low Dose Intrathecal Opioid Trialing for Chronic Nonmalignant Pain: A Prospective Cohort Study and an 18-Month Follow-up.” His first slide read, “Micro-dosing: Fact or Fiction?” He described micro-dosing as being something like the Loch Ness monster or Bigfoot. Is it real? He considered micro-dosing a concept that attempts to maximize therapeutic effect with minimal side effects. Dr. David Caraway was an early clinician to embrace micro-dosing; there was criticism in the past, but now more evidence has revealed it can produce good results.
Dr. Grider then discussed the morbidity and mortality granuloma issues as they relate to micro-dosing, as well as the physicians who were involved with micro-dosing during the 60s and 70s. He credits Dr. William Witt, an early pioneer of micro-dosing, with applying knowledge from previous studies and literature to the micro-dosing arena for the treatment of chronic pain. Dr. Grider has developed his own protocol, which is as follows:
1. Opiate free for six weeks;
3. Inpatient intrathecal trial;
4. Implantation; and
5. Trialing process
Dr. Grider highlighted an article in Pain Medicine 2012 entitled, “Low-Dose Treatment with Opioids for the Management of Chronic Pain.” The article focused on opiate tolerance reversal; thus, necessitating a 4 to 6 week detox to allow the body to rid itself of opioids. In this study, patients were surprised that their pain scores had not changed much with the withdrawal of opioids. The average dose after one week of initiating micro-dose was 140 µg per day. Over a 12-month period, this increased to 335 µg a day. Thirty months later the average dose was 356 µg per day. He also discussed that there is a possibility of a gender-effect because females responded more than males when small volumes were being infused. This was a very interesting and enlightening discussion of micro-dosing.
For more conference recaps, visit Hartley Medical’s Knowledge Center by clicking here.
To watch a brief video overview of the 16th Annual NANS Meeting, click the video below:
To watch William Stuart, RPh, give his notations from the 2012 NANS Meeting, click the video below: