David Borenstein

Prevalence of spinal disc disease among interventional cardiologists

A suspected, but undocumented, excess of axial skeletal disease among interventional cardiologists (possibly a consequence of lead apron use) was investigated by comparing questionnaire responses from cardiologists, orthopedic surgeons, and rheumatologists (n = 714). Cardiologists reported more neck and back pain, more subsequent time lost from work, and a higher incidence of cervical disc herniations, as well as multiple level disc disease (all p <0.01): interventionalists disc disease is a confirmed entity.

Report of the NIH Task Force on Research Standards for Chronic Low Back Pain

UNLABELLEDnDespite rapidly increasing intervention, functional disability due to chronic low back pain (cLBP) has increased in recent decades. We often cannot identify mechanisms to explain the major negative impact cLBP has on patients lives. Such cLBP is often termed non-specific and may be due to multiple biologic and behavioral etiologies. Researchers use varied inclusion criteria, definitions, baseline assessments, and outcome measures, which impede comparisons and consensus. Therefore, NIH Pain Consortium charged a Research Task Force (RTF) to draft standards for research on cLBP. The resulting multidisciplinary panel recommended using 2 questions to define cLBP; classifying cLBP by its impact (defined by pain intensity, pain interference, and physical function); use of a minimum dataset to describe research participants (drawing heavily on the PROMIS methodology); reporting responder analyses in addition to mean outcome scores; and suggestions for future research and dissemination. The Pain Consortium has approved the recommendations, which investigators should incorporate into NIH grant proposals. The RTF believes that these recommendations will advance the field, help to resolve controversies, and facilitate future research addressing the genomic, neurologic, and other mechanistic substrates of chronic low back pain. We expect that the RTF recommendations will become a dynamic document and undergo continual improvement.nnnPERSPECTIVEnA task force was convened by the NIH Pain Consortium with the goal of developing research standards for chronic low back pain. The results included recommendations for definitions, a minimum dataset, reporting outcomes, and future research. Greater consistency in reporting should facilitate comparisons among studies and the development of phenotypes.

Report of the NIH task force on research standards for chronic low back pain

UNLABELLEDnDespite rapidly increasing intervention, functional disability due to chronic low back pain (cLBP) has increased in recent decades. We often cannot identify mechanisms to explain the major negative impact cLBP has on patients lives. Such cLBP is often termed nonspecific and may be due to multiple biologic and behavioral etiologies. Researchers use varied inclusion criteria, definitions, baseline assessments, and outcome measures, which impede comparisons and consensus. Therefore, NIH Pain Consortium charged a research task force to draft standards for research on cLBP. The resulting multidisciplinary panel recommended using 2 questions to define cLBP; classifying cLBP by its impact (defined by pain intensity, pain interference, and physical function); use of a minimum data set to describe research participants (drawing heavily on the Patient Reported Outcomes Measurement Information System methodology); reporting responder analyses in addition to mean outcome scores; and suggestions for future research and dissemination. The Pain Consortium has approved the recommendations, which investigators should incorporate into NIH grant proposals. The research task force believes that these recommendations will advance the field, help resolve controversies, and facilitate future research addressing the genomic, neurological, and other mechanistic substrates of cLBP. We expect that the research task force recommendations will become a dynamic document and undergo continual improvement.nnnPERSPECTIVEnA task force was convened by the NIH Pain Consortium with the goal of developing research standards for cLBP. The results included recommendations for definitions, a minimum data set, reporting outcomes, and future research. Greater consistency in reporting should facilitate comparisons among studies and the development of phenotypes.

Report of the American College of Rheumatology Pain Management Task Force

Pain is the most common symptom of patients with rheumatic disorders and can occur in both inflammatory and noninflammatory conditions. As a complex phenomenon with a strong subjective component, pain can be influenced by the nature of the underlying disease, personal predisposition (biologic and psychological), as well as environmental and psychosocial factors that impact the pain experience. In the management of patients with musculoskeletal disease, therefore, the characterization of pain (e.g., its onset, duration periodicity, and impact on functioning) is important in establishing the diagnosis and developing a comprehensive treatment plan to reduce pain and to improve quality of life. Although rheumatologists diagnose and treat pain, they do not characterize themselves as “pain physicians.” Rather, in their professional identity, many rheumatologists consider themselves more narrowly as subspecialists who treat musculoskeletal disorders that have a component of acute and chronic nonmalignant pain. Furthermore, rheumatologists have traditionally approached pain from the perspective of the proximal causes of pain such as tissue injury and inflammation, and have concentrated therapy on reducing inflammation either locally or systemically. The therapies used have been predominantly pharmacologic and include nonsteroidal antiinflammatory drugs (NSAIDs), disease-modifying agents including biologics, and corticosteroids. Although commonly recommended, nonpharmacologic psychosocial interventions such as cognitive–behavioral therapy or body-based therapies including exercise are generally considered less effective by rheumatologists despite evidence that such approaches can be highly efficacious depending on the setting or disease (1–3). For most conditions treated by rheumatologists, the etiology of pain has been conceptualized primarily in the context of events in peripheral tissue. As a result, rheumatologists have relied heavily on pharmacologic therapies directed at the immune system to control symptoms, especially in inflammatory disease. Correspondingly, for patients with major or irreversible tissue damage, whether arising in inflammatory or noninflammatory disease, surgery has been the mainstay of treatment, with pharmacologic therapy used as a transition until a definitive operation is performed. Given this approach, events in the central nervous systems contributing to the experience of pain have received less attention in treatment, with additional analgesic, psychosocial, or interventional therapies receiving neither extensive investigation nor widespread or appropriate use. This approach may limit the utilization of newer and multidisciplinary approaches to pain manMembers of the American College of Rheumatology Pain Management Task Force are as follows: David Borenstein, MD: Arthritis & Rheumatism Associates, Washington, DC; Roy Altman, MD: University of California, Los Angeles; Alfonso Bello, MD, MHS: Illinois Bone & Joint Institute, Glenview; Winn Chatham, MD: University of Alabama, Birmingham; Daniel Clauw, MD: University of Michigan, Ann Arbor; Leslie Crofford, MD: University of Kentucky, Lexington; Joseph Croft, MD: Bethesda, Maryland; Afton Hassett, PsyD: Robert Wood Johnson Medical School, New Brunswick, New Jersey; Franklin Kozin, MD: Scripps Clinic Medical Group, La Jolla, California; David Pisetsky, MD, PhD: Durham VA Hospital, Durham, North Carolina; Jan Richardson, PT, PhD, Laura Schanberg, MD: Duke University, Durham, North Carolina; Terence Starz, MD: Arthritis & Internal Medical Associates, Pittsburgh, Pennsylvania; James Witter, MD, PhD: NIH, Bethesda, Maryland. The American College of Rheumatology is an independent, professional, medical and scientific society which does not guarantee, warrant, or endorse any commercial product or service. Dr. Borenstein has received consultant fees, speaking fees, and/or honoraria (less than

Focus article: report of the NIH task force on research standards for chronic low back pain

10,000 each) from Pfizer and King, and (more than

Report of the NIH Task Force on Research Standards for Chronic Low Back Pain.

10,000) from Cephalon. Dr. Altman has received consultant fees, speaking fees, and/or honoraria (less than

Report of the National Institutes of Health task force on research standards for chronic low back pain.

10,000 each) from Nutramax, McKinsey, Endo, Cypress, Theralogix, Forest Laboratories, and NicOx, and (more than

Focus article report of the NIH task force on research standards for chronic low back pain.

10,000 each) from Ferring and Smith & Nephew. Dr. Bello has received consultant fees, speaking fees, and/or honoraria (less than

901-15 Interventional Cardiologists Suffer an Excessive Incidence of Spinal Disc Disease

10,000 each) from Abbott, BMS, Amgen, Lilly, and UCB, and (more than

Pain Management in Rheumatology Research, Training, and Practice.

10,000 each) from Pfizer and Horizon Therapeutics. Dr. Hassett has received consultant fees, speaking fees, and/or honoraria (less than