Dr. Robert Gereau Honored with Election as Fellow into AAAS
Eleven faculty members at Washington University in St. Louis — the most in a decade-and-a-half — are among 416 new fellows selected by the American Association for the Advancement of Science (AAAS), the world’s largest general scientific society.
Samuel Achilefu; Victoria J. Fraser, MD; Robert W. Gereau; Kathleen B. Hall; Joseph Jez; Mark E. Lowe, MD, PhD; Linda Joy Pike; Deborah C. Rubin, MD; L. David Sibley; Lilianna Solnica-Krezel; and Gary Silverman, MD, PhD, are being named fellows in recognition of their distinguished efforts to advance science and its applications. Election as an AAAS fellow is an honor bestowed upon the organization’s members by their peers.
Robert W. Gereau, the Dr. Seymour and Rose T. Brown Professor of Anesthesiology and director of theWashington University Pain Center at the School of Medicine, was chosen for his contributions to research on determining the cellular and molecular changes that underlie the development of chronic pain conditions.
The new fellows are being announced in the Nov. 29 issue of the journal Science, and will be honored Feb. 16 during the 2019 AAAS Annual Meeting in Washington, D.C.
HHS Leaders visit the Moron-Concepcion Lab in the Department of Anesthesiology
WUMS Department of Health Visit 9/20/2018
Leaders from the U.S. Department of Health and Human Services (HHS) visited the Washington University Medical Campus Sept. 20 to hear about strategies to address the opioid crisis, which has claimed the lives of more than 200,000 people in the United States since 1999. Eric D. Hargan, HHS deputy, led a roundtable discussion, accompanied by U.S. Surgeon General Jerome M. Adams, MD (who is also an anesthesiologist) and Elinore F. McCance-Katz, MD, PhD, assistant secretary for mental health and substance use.
A number of researchers at the School of Medicine are focused on understanding opioid addiction and chronic pain. The HHS leaders toured the laboratory of one of those researchers, Jose Moron-Concepcion, PhD, associate professor of anesthesiology. His work focuses on understanding how opioids affect the brain. He and his colleagues have found that long-term opioid use seems to flip a switch in the brain that triggers cravings for months after drug use stops — an experience that can contribute to relapse. His research could lead to more effective ways to fight addiction.
“There are certain areas of the brain that respond to the repeated use of opioids,” Moron-Concepcion said. “If there was a way to break that cycle between opioid use and cravings, we may be able to help drug users and prevent relapse.”
During their visit to the Medical Campus, Hargan and Adams also met with David H. Perlmutter, MD, the George and Carol Bauer Dean of the School of Medicine, and the Spencer T. and Ann W. Olin Distinguished Professor and executive vice chancellor for medical affairs; Jennifer K. Lodge, PhD, vice chancellor for research; John P. Lynch, MD, professor of medicine and vice president and chief medical officer at Barnes-Jewish Hospital; and Richard J. Leikweg, BJC HealthCare president and chief executive officer. They discussed the roots of the opioid crisis and research underway at the School of Medicine to develop alternatives to opioids for treating patients with chronic pain. They also discussed ways to promote cooperation among healthcare providers in the St. Louis region to address addiction and mental health issues in opioid users.
“As many people know, this issue is personal for me,” said Surgeon General Adams. “I have a brother who currently is in prison because of his addiction. The number of overdose deaths is daunting — someone in the U.S. dies from opioids every 11 minutes — but we’re beginning to make progress. And by bringing together the people with the expertise to fight the problem, we think we can do better. We have to do better.”
Strategy to Battle Opioid Epidemic Encourages Multilevel Approach
Washington University pain expert among researchers to author new recommendations
A new report from the National Academies of Sciences, Engineering and Medicine offers recommendations for how to address the nation’s ongoing opioid epidemic. Among the report’s authors was Jose A. Moron-Concepcion, an associate professor of anesthesiology at Washington University School of Medicine in St. Louis. (Photo: Robert Boston/School of Medicine)
Years of coordinated efforts will be required to contain and reverse the harmful societal effects of the country’s ongoing prescription and illicit opioid epidemic, according to a new report from the National Academies of Sciences, Engineering and Medicine (NASEM). The report, requested by the U.S. Food and Drug Administration (FDA) and published July 13, said it is possible to stem the still-escalating epidemic without eliminating access to opioids for patients who suffer from pain and whose providers prescribe the drugs responsibly.
The 18-person committee that authored the report recommended actions the FDA, other federal agencies, state and local governments, and health-related organizations should take — including promoting more judicious prescribing of opioids, expanding access to treatment for opioid-use disorder, preventing more overdose deaths, weighing societal impacts in opioid-related regulatory decisions, and investing in research to better understand the nature of pain and develop nonaddictive alternatives.
The committee was composed of experts involved in different aspects of pain management and opioid-use disorders. Among them was Jose A. Moron-Concepcion, associate professor of anesthesiology at Washington University School of Medicine in St. Louis. He studies the emotional component of pain and opioid receptors that modulate the sensory component of pain and the negative emotions associated with it. He discussed some of the key points addressed in the new report:
What is the status of the ongoing epidemic?
We were asked to characterize the epidemic and recommend actions the FDA and other organizations should take to respond. Overall, we found that the opioid epidemic is getting worse. Each day, 90 individuals in the United States die from an overdose that involves an opioid. Trends indicate that premature deaths associated with the use of opioids are likely to climb and that opioid overdose and other opioid-related harms will dramatically reduce the quality of life for many people in years to come.
What, in general terms, is recommended in the new report?
These are the key elements highlighted in the report:
Changing the culture of prescribing, partially through enhancing education for physicians and the general public.
Investing in treatment for the millions of individuals with opioid-use disorder and removing impediments to those treatments. Also, improving health-care provider education for opioid-use disorder.
Preventing overdose deaths, including access to naloxone (also known by its brand name Narcan) and safer injection equipment.
Weighing societal impacts, not just an individual’s, regarding opioids, such as incorporating public health considerations into the FDA’s current framework for making regulatory decisions regarding opioids.
•Investing in basic research, particularly to better understand the nature of pain and the neurobiology of the intersection between pain and opioid-use disorders. In addition, increasing the investment in developing nonaddictive alternatives to opioids for pain management.
Opioids are still known to be effective drugs for pain. How does the report balance the needs of patients who need pain treatment with reducing the availability of opioids?
When examining what actions to take, we also wanted to get the balance right and ensure that whatever measures we recommend to the FDA would still leave room for responsible prescribing and reasonable access for patients and physicians. As mentioned above, this also includes changing the culture of prescribing, which will necessitate improvements in education for the medical community, including establishing pain-education materials and curriculum for health-care providers. For the general public, we recommend evaluating the impact of patient and public education about opioids in an attempt to promote safe and effective pain management. The epidemic took nearly two decades to develop, and it will take many years to control, contain and reverse. Therefore, years of a sustained and coordinate effort will be required.
You and your colleague Adrianne Wilson-Poe, instructor in anesthesiology, recently published a review article about this problem, an update on where things stand regarding the chronic pain and opioid epidemics. Does this new report help to address some of the issues raised in your article?
Yes. As we also reported in our review article, we found that despite a decrease in the number of opioids being prescribed, many people who otherwise would have been using prescription opioids have transitioned to heroin, with a threefold increase in heroin-involved deaths from 2010 to 2014. Based on this, a change in prescribing and in patient behavior is crucial.
Importantly, our review also highlighted the need for a major investment in basic research to further elucidate the neurobiology of pain and opioid-use disorders. As mentioned above, the new report recommends a significant increase in funding to improve understanding of the neurobiology of pain, to support the discovery of innovative treatments and to improve understanding of the intersection between pain and opioid-use disorders.
Robert Boston Photographer Jose Moron-Concepcion, Anesthesiology Pain Center
Jose A. Moron-Concepcion, associate professor of anesthesiology at Washington University School of Medicine in St. Louis, was on a committee that authored new recommendations on how to address the opioid epidemic. (Photo: Robert Boston/School of Medicine)
Washington University School of Medicine’s 2,100 employed and volunteer faculty physicians also are the medical staff of Barnes-Jewish and St. Louis Children’s hospitals. The School of Medicine is one of the leading medical research, teaching and patient-care institutions in the nation, currently ranked seventh in the nation by U.S. News & World Report. Through its affiliations with Barnes-Jewish and St. Louis Children’s hospitals, the School of Medicine is linked to BJC HealthCare.
A Stimulating Approach to Relieve Back Pain without Opioids
As many as one in three Americans suffer from low back pain. Its economic impact is greater than that of heart disease and cancer combined.
Doctors who treat patients suffering from back pain are exploring new approaches that help some patients avoid opioid drugs. The highly addictive prescription painkillers are fueling an epidemic of abuse and overdose deaths.
One opioid-free option available at the Washington University Pain Center involves stimulating the spinal cord with very short pulses of electricity. Patients can’t feel the electrical stimulation, yet it often effectively can mask the perception of pain.
Spinal cord simulation to relieve pain is not new. It was first introduced many years ago, but older stimulators produce a tingling sensation designed to replace pain with less unpleasant tingling. The newer, high-frequency spinal cord stimulators deliver more energy but without the tingling sensations.
“Patients with back pain have many treatment options, but many don’t get relief after surgery or injections,” said Michael Bottros, MD, Washington University pain management specialist. “Opioids can help some patients temporarily, and physical therapy also helps, but the new-generation stimulators fill an important niche, helping people return to normal activity without pain or the side effects that can result from opioids.”
ONE PATIENT’S STORY
Deanna Conley, of St. Louis County, had endured back pain for nearly 40 years.
Despite multiple surgeries, she needed a wheelchair to walk any significant distance. “I couldn’t cook a whole meal or even stand at the sink to wash dishes. I had spinal injections and even saw a pain psychologist.”
In addition, she began to worry about the number of pain pills she took each day. “I was supposed to take one hydrocodone pill at night before bed,” Conley said. “But it got to where I was taking two pills a day and then three, and I worried I might end up being a drug addict at age 77.”
Dr. Bottros determined Conley was a good candidate for a high-frequency stimulator. Studies have shown the devices may be more effective in patients who have had previous back surgery but still have back pain. Research also indicates that although traditional stimulators work well when pain in the back is radiating into arms or legs, the high-frequency stimulators may be more effective when pain is located in the back itself.
“Traditional spinal cord stimulators provide a pleasant sensation in place of pain from sciatica problems or pain down the arm caused by cervical spine problems,” Dr. Bottros explained. “But for people like Ms. Conley, who had already had back-fusion surgery and still had pain, those older devices often aren’t as effective.”
Dr. Bottros inserted electrodes into the area of Ms. Conley’s back where her pain was most acute. The stimulator initially remained outside her back, but after verifying that the approach was having an effect, he used a minimally invasive technique to implant the entire device into the lower part of her back.
Ms. Conley reported a 70 to 80 percent reduction in back pain almost immediately. She is able to walk without assistance for considerably longer distances than she could before the stimulator was implanted, and she even registered for an exercise class.
She’s receiving physical therapy and getting stronger now that she is able to use muscles she couldn’t use previously because of her back pain.
“I feel like I’ve got a whole new lease on life. I’m going to dance at my granddaughter’s wedding!” Ms. Conley exclaimed.
IT’S A TEAM APPROACH
“It’s important that we use a team approach involving doctors, physical therapists and psychologists who help people focus their thoughts on things other than their pain,” Dr. Bottros said. “Even when a device like this reduces pain, there still is muscle weakness to overcome, so patients need physical therapy to get stronger, to make sure they’re walking correctly and to focus on core stabilization to keep the pain in check.”
“Not long ago, we thought of pain as a symptom of some other underlying disease process,” Dr. Bottros said. “Now we’re learning that pain also may be a disease itself. And in this time of opioid abuse, we must be vigilant in insisting that pain-killing drugs aren’t overused.
Some patients benefit from opioids, but other interventions, combined with a multidisciplinary approach to care, may provide pain management without the adverse side effects and risks associated with opioids.”
For more information about spinal cord stimulation, or to make an appointment with Dr. Bottros, or one of our Washington University pain management specialists, please call:
Pain Management Center
Center for Advanced Medicine
4921 Parkview Place, Suite 14C
St. Louis, MO 63110 (314) 362-8820
Barnes-Jewish West County Hospital
969 N. Mason, Suite 240
St. Louis, MO 63141 (314) 996-8631
Missouri Baptist Medical Center
Pain Management Center
3015 N. Ballas Road
St. Louis, MO 63131 (314) 996-7200
Treating pain in older adults takes more than painkillers
Pharmacotherapy and polypharmacy pose special risks for elderly patients, and the use of interventional strategies is increasingly recognized as important for this population. Dr. Bottros reviews some options to consider.
Improving Quality of Life Through Cooled Radiofrequence Therapy
Dr. Guarino and Alex Fridman
As a person ages, increasing joint pain in the knees and hips is not uncommon, and for many, relief can be found through joint replacement surgery. But there are those who either face health concerns that prohibit surgery altogether or who have found their surgery did not eliminate their pain.
In these cases, a new procedure is now available at the Pain Management Center at Barnes-Jewish West County Hospital to help alleviate the pain and provide a return to a better quality of life.
The specially trained nursing and support staff alongside Washington University pain management specialist and board-certified anesthesiologist Anthony H. Guarino, MD, director of the Pain Management Center, have been providing this cutting-edge procedure to patients for more than a year and are seeing positive results.
“We now have an option to treat intractable pain in the knees and hips that was not available five years ago,” Dr. Guarino says. “There is no rehab required for most patients. If they take it easy the next day, they can usually get on with their lives.”
Cooled radiofrequency therapy is a nerve-burning procedure that alters the nerve signals coming from painful joints, Dr. Guarino says. It gives about six months of pain relief and can be repeated.
The procedure is similar to radiofrequency ablation, often used in the treatment of back pain, says Alex Fridman, RN, assistant nurse manager of the Pain Management Center. “Compared to radiofrequency, cooled radiofrequency allows for higher power delivery and treats a larger volume of treated tissue,” he says.
The outpatient procedure typically takes a little more than two hours because patients may receive minor sedation to help with the pain associated with the procedure. “The risk for complications is very low,” Dr. Guarino says. “Every procedure has some discomfort, but we try to minimize it. Usually within four to six weeks, I follow up with patients and we can determine if the procedure has been successful.”
Finding relief amid health concerns
Viola Phillips, 76, found success almost immediately after undergoing cooled radiofrequency therapy at the Pain Management Center for both of her hips.
Phillips has been battling a series of health concerns over the years, including cancer, diabetes, and heart and kidney problems. In addition, she’s had severe back pain that contributed to her hip problems.
When her nephew recommended she see his physician, Dr. Guarino at the Pain Management Center, for her back problems, she took him up on the offer, and the two traveled from Perryville, Mo., to the center. While undergoing treatment for her back pain, Dr. Guarino told Phillips about a new procedure he was going to do that might help her hips.
“My hips are bone on bone, and I need total replacements, but due to my health problems, I’ve been told it’s totally impossible,” she says. “I was Dr. Guarino’s first patient, and the results were miraculous. I had tremendous relief almost immediately.”
Dr. Guarino says for patients like Phillips, joint replacements are out of the question because they put too much stress on an already stressed body. “I wish I had done this procedure sooner. It didn’t take long at all and has really made a difference in my life,” Phillips says. “I can’t praise Dr. Guarino enough and everyone in his office. His whole staff is so kind, caring and helpful. They are 100 percent top-notch.”
Thanks to her nephew, whom she calls “one in a million” and his recommendation of Dr. Guarino, she feels like she has a new lease on life. “I live a pretty fulfilling life, and I want to keep doing that as long as I can,” she says. “This has helped me stay active and independent.”
And that’s all Dr. Guarino can ask for.
“We want our elderly population to be active. Joint pain can affect your overall health and be a detriment to your quality of life,” he says. “I’m excited we can offer this procedure to patients and help them have fuller lives.”
If you have a patient who could benefit from cooled radiofrequency therapy, please contact Alex Fridman, assistant nurse manager of the Pain Management Center at 314-996-8631 or click here to send an email.
The Pain Management Center is located at 969 N. Mason Road, Suite 204, Creve Coeur, Mo.
Dr. Jose Moron-Concepcion receives a NARSAD Grant
Congratulations to Dr. Jose Moron-Concepcion, who has received a NARSAD Grant!
The Brain & Behavior Research Foundation, the top non-governmental funder of mental health research grants, today announced its 2017 Independent Investigator grants, which award $3.9 million in funding to 40 mid-career scientists from 36 institutions in 10 countries for basic research, new technologies, early intervention/diagnostic tools, and next-generation therapies for schizophrenia, depression, bipolar disorder, ADHD, autism, PTSD, and other serious mental illnesses.
To accomplish its mission of alleviating the suffering caused by mental illness, which affects one in five people, the Foundation awards grants that will lead to advances and breakthroughs in scientific research. Its Independent Investigator grants are part of ongoing efforts by the Brain & Behavior Research Foundation to support scientists at every stage of their careers by funding cutting-edge research for the understanding, early detection, prevention, treatment and cure of brain and behavior disorders.
Independent Investigator grants provide $50,000 per year for up to two years to support investigators during the critical period between the initiation of research and the receipt of sustained funding.
Chronic Pain in Children
How is chronic pain assessed and Managed? How and when is it diagnosed? What are the long-term affects? Jacob AuBuchon, MD, Washington University pediatric anesthesiology and director of the Pain Management Clinical at St. Louis Children’s Hospital will answer these questions and more.
Robert Gereau, PhD receives 2017 Frederick W.L. Kerr Basic Science Research Award
This award and lectureship were established in 1987 in honor of Frederick W. L. Kerr, a founder of the American Pain Society, to recognize individual excellence and achievement in pain scholarship. Since then, the Kerr medallion has been presented to 25 outstanding pain professionals—researchers and clinicians—whose career achievements have made important contributions to the field of pain.
Dr. Gereau is the Dr. Seymour and Rose T. Brown Professor of Anesthesiology, and serves as Director of the Washington University Pain Center. He earned a Bachelor’s degree from Missouri State University, and a PhD in Neuroscience from Emory University (1995). Following postdoctoral training at the Salk Institute (1998), he took a faculty position in Neuroscience at Baylor College of Medicine, serving as Assistant and Associate Professor until 2004, when he was recruited to Washington University School of Medicine.
Gereau’s laboratory utilizes a combination of electrophysiology, optogenetics, and molecular approaches to understand mechanisms of maladaptive plasticity underlying the development of chronic pain. These studies include development of new enabling technologies for wireless measurement and manipulation of neural function. The lab also conducts translational research, including comparative studies of human and animal physiology, as well as healthy human volunteer studies aimed at establishing proof of concept for novel therapies. Dr. Gereau’s work has been supported by the NIH for over 20 years, including an NIH SPARC Award and the NIH Director’s Transformative Research Award.
Dr. Gereau has served on the scientific program committee and as a member of the Board of Directors for APS for several years. He has also served as reviewing editor for Journal of Neuroscience, as Associate editor for Pain, and on the Editorial boards of Pain Reports, Molecular Pain, Neurobiology of Pain, and Journal of Neurophysiology. He served as member or chair of multiple NIH review panels, and serves on the Board of Scientific Counselors for NIDCR.