Episode Summary:

Welcome back to the Pain Matters podcast, where Dr. Sudheer Potru, DO, alongside Dr. Mustafa Broachwala, DO, delves into crucial topics on acute low back pain guidelines. Featuring insights from Dr. Jessica Oswald, MD, MPH and Dr. Devin Kansagara, MD, FACP, this episode focuses on the implications of FDA-funded guidelines, co-sponsored by the American Academy of Pain Medicine. This expert panel discusses the nuances of managing acute low back pain, emphasizing evidence-based practices to improve patient care.
Throughout the episode, Dr. Oswald and Dr. Kansagara explore the guidelines’ perspectives on imaging, opioids, and alternative therapies. Discussing the common tendency to order imaging tests for low back pain, the conversation shifts to effective patient communication and strategies for reducing unnecessary imaging. They also address opioid use, highlighting its role as a third-line option and discussing the importance of evaluating individual patient needs to optimize function without escalating risks. The episode also emphasizes non-pharmacological interventions, such as early physical therapy, and overcoming challenges related to access bottlenecks.

Key Takeaways:

• Guideline Applicability: Emphasizing the acute stage, the guidelines apply to pain lasting less than six weeks.
• Imaging Insights: Many clinicians still rely heavily on imaging for acute low back pain despite evidence showing limited benefit. Patient communication is crucial in managing expectations.
• Opioid Recommendations: Reserved as a third-line treatment, opioids are not usually recommended for acute low back pain due to risks outweighing benefits in most cases.
• Non-Pharmacological Therapies: Early engagement in physical therapy and alternative therapies can enhance long-term recovery, highlighting the importance of patient education and movement.
• Epidural Injections and Controversies: The discussion points out the limited evidence for epidural steroid injections, prompting nuances in clinical decision-making amid evidence shortages.

Episode Summary:

In this episode of the Pain Matters podcast, Host Sudheer Potru, DO, FASA, FASAM, and Co-Host Zafeer Baber, MD, offer a comprehensive discussion of the (relatively) new analgesic medication suzetrigine, emphasizing its impact on acute pain management. Approved by the FDA in January 2025, this oral medication offers promising alternatives for moderate-to-severe postoperative pain management. Delving into its mechanism, the conversation also covers the history of voltage-gated sodium (“NAV”) 1.8 channel research and its implications for patient care.

Throughout the episode, the hosts highlight suzetrigine’s unique mechanism of action, acting preferentially on the NAV 1.8 sodium channels located predominantly in the peripheral nervous system. The dialogue explores its advantages over traditional opioids, including reduced side effects such as sedation and constipation, making it an attractive option for enhancing postoperative recovery protocols like ERAS (Enhanced Recovery After Surgery). The conversation expands on the complexities of treating chronic pain and the potential for new Nav channel-targeting agents to revolutionize pain management employing targeted strategies.

Key Takeaways:

• Understanding Suzetragine: Suzetragine acts as a novel analgesic focusing on the NAV 1.8 sodium channels, offering reduced side effects compared to opioids, especially in postoperative settings.
• Mechanism and Discovery: The NAV 1.8 sodium channel, essential for pain signal propagation, was key to designing suzetrogine. Its function was inadvertently highlighted by genetic mutations found in individuals who couldn’t feel pain due to alterations in similar channels.
• Economic and Clinical Implications: Although suzetrogine is more expensive than traditional pain medications, its potential to reduce hospital-acquired complications could justify its cost in clinical settings.
• Future Prospects in Chronic Pain: Ongoing research into suzetrogine’s effectiveness for conditions like diabetic neuropathy could offer new opportunities in managing chronic pain.
• Broader Pharmacological Impacts: The development of NAV channel-targeted medications marks a significant milestone, signaling a shift towards more specialized pain management options.

*Views expressed by our hosts and guests are their own and do not necessarily reflect those of the hosts, their institutions, or the American Academy of Pain Medicine.

Episode Summary:

In this engaging and informative episode of the Pain Matters Podcast, hosts Sudheer Potru, DO, FASA, FASAM, and Co-Host Zafeer Baber, MD, sit down with renowned chronic pain advocate, Tom Norris. With a four-decade-long journey through the challenges of chronic pain, Tom shares his invaluable insights regarding the newly drafted Acute Low Back Pain Guideline** (drafted by the Pacific Northwest Evidence-based Practice Center at Oregon Health & Science University (OHSU EPC) and the American Academy of Pain Medicine), recently submitted to Pain Medicine Journal and currently under review. His unique perspective underscores the critical need for clear communication and collaboration between clinicians and patients, especially in the context of guideline development and healthcare delivery.

Throughout the discussion, the trio delves into practical strategies for managing acute and chronic pain, emphasizing the importance of patient-centered communication, the role of alternative therapies, and the power of support groups. Tom candidly discusses his military background and how it has shaped his ability to advocate effectively for himself and others within the medical community. The episode also explores the significance of understanding non-pharmacologic pain management techniques, such as virtual reality, acupuncture, and Tai Chi, and the need for greater awareness and education on these options. Anchored by Tom's wealth of experience and wisdom, this episode serves as a robust resource for both healthcare providers and patients seeking to enhance their pain management approaches.

Key Takeaways:

• Patient-Centered Communication: Building trust and understanding between clinicians and patients is crucial in effectively managing pain and implementing guidelines.
• Integrative and Alternative Therapies: Non-drug approaches like acupuncture, virtual reality, and Tai Chi can be beneficial in managing pain, but public awareness about these methods is limited.
• Support Groups' Role: Connecting with others facing similar pain challenges can provide essential support and insights, offering solace and practical advice.
  Empowering Patients: Patients should proactively educate themselves, prepare questions for their providers, and seek various treatment avenues to optimize their care.
• Guideline Development Insight: Having patients involved in the creation of medical guidelines ensures that the recommendations are practical and resonate with those they are designed to help.

*Views expressed by our guests are their own and do not necessarily reflect those of the hosts, their institutions, or the American Academy of Pain Medicine.

**The Pacific Northwest Evidence-based Practice Center (PNW-EPC) at Oregon Health & Science University (OHSU) is partnered with AAPM for the development of an evidence-based clinical practice guideline on the assessment and management of acute low back pain (ALBP). This project was financially supported by the Food and Drug Administration (FDA) of the U.S. Department of Health and Human Services (HHS) as part of a financial assistance award [FAIN] totaling $1,999,980.00, with 100 percent funded by FDA/HHS. The contents are those of the authors and do not necessarily represent the official views of, nor an endorsement by, FDA, HHS, or the U.S. Government. The funders had no decision-making role in designing and conducting systematic review, data collection, analysis, and interpretation of the data or approval privilege on the recommendation and good practice statements. As requested, the FDA provided nonbinding feedback and technical support to the guideline panel and methodological team.

A methodologically rigorous systematic review on assessment and management of ALBP was conducted by the PNW-EPC to provide evidence for guideline development. An independent, multidisciplinary guideline development used evidence from the systematic review to formulation evidence-based clinical recommendations to the guide assessment and management of ALBP.