35-1 Podiatric Pain Management: Update 2024

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EDITORIAL

» Pain management remains an understudied yet nuanced, growing endeavor for the podiatric physician and surgeon. Laws and regulations ...

… surrounding opioids, which are designed to educate prescribers, have failed to take into account that each and every prescriber would best benefit from education in their specialty beyond just the general pharmacokinetics of opioids.

Prescribers know that opioids can be addicting. We know “not to prescribe too much.” Many states have cut down on what we can prescribe for acute pain, and national laws such as the Drug Enforcement Administration’s Medication Access and Training Expansion (MATE) Act now require almost all prescribers with DEA registration/licensing to partake in eight hours of opioid-related training. However, the very same MATE Act has excluded podiatric medical societies and organizations (i.e., the American Podiatric Medical Association, American College of Foot and Ankle Surgeons, American College of Podiatric Medicine, etc.) from providing/participating in that eight hours of required education. This is truly a tragedy. Not only is it clear discrimination, but if the point of such teaching is peer-to-peer education for prescribers on what they can improve upon in their area of expertise, the MATE Act has failed both podiatry and the public.

For decades, podiatric physicians and surgeons have led the way in providing stellar pain management to patients with foot and ankle pathology. Giants and living legends within our profession (such as Dr. Robert G. Smith, DPM, MSc, RPh, FNAP and others) have advanced podiatric pain management forward for years. Discrimination within the MATE Act, while hugely unfortunate, is “chump change” to what many of our DPM predecessors had to face; they were truly “Happy Warriors.” The team behind this issue and I are proud to stand on their shoulders. We dedicate this issue to these men and women as a small “thank you” for taking us this far, while acknowledging that we still have more work to do.

The team who have put together this issue of Foot and Ankle Quarterly worked hard to introduce you to important, timely opioid-related research conducted for our profession, by members of our profession. In this special issue, you will learn various strategies and approaches – both conceptual and concrete – to enhance your pain management strategy. Our main focus is on the postoperative period, but these same principles can be applied to any aspect and stage of podiatric pain management.

If you have any questions, concerns or thoughts, please don’t hesitate to reach out to me for discussion at Brandon.M.Brooks@dartmouth.edu.

Kind regards,
Brandon M. Brooks, DPM, MPH


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The ideas and opinions expressed in Foot and Ankle Quarterly are those of the authors and do not necessarily reflect those of the Editor or the Publisher. Publication of an advertisement or other product mentioned in Foot and Ankle Quarterly should not be construed as an endorsement of the product of the manufacturer’s claims. Readers are encouraged to contact the manufacturer with any questions about the features or limitations of the products mentioned. The Publisher does not assume any responsibility for any injury and/or damage to any persons or property arising out of or related to any use of the material contained in this periodical. The reader is advised to check the appropriate medical literature and the product information currently provided by the manufacturer of each device or of each drug to be administered to verify the dosage, the method and duration of administration, or contraindications. It is the responsibility of the treating physician or other healthcare professionals, relying on independent experience and knowledge of the patient, to determine drug dosages and the best treatment for the patient.


Disclosure

Data Trace Publishing Company Continuing Education Mission Statement

Data Trace Publishing Company is committed to providing high-quality print and internet-based enduring continuing education programs, including lectures, feature articles, and condensations and commentaries on current clinical podiatric topics and medical risk management topics which lead to improved delivery of patient care and help reduce the potential for medical errors. These programs are provided to meet the educational needs of the podiatric medical profession and thereby enhance the quality of patient care.

Program Objectives

Foot and Ankle Quarterly (FAQ) is a unique program designed to help today’s podiatric physician manage an ever-increasing flow of information. After completing the Foot and Ankle Quarterly, Volume 35 program, the learner should be better able to: develop and refine a perspective on current treatment recommendations, updates, and advances pertinent to podiatric practice; evaluate the implications of the learned information as it pertains to the diagnosis and treatment of podiatric disorders and societal issues and barriers, and; apply current trends, standards, and best practices into learner’s own practice.

Data Trace Publishing Company Continuing Education Accreditation Statement

Data Trace Publishing Company is approved by the Council on Podiatric Medical Education (CPME) as a provider of continuing education in podiatric medicine. Data Trace Publishing Company has approved this activity for a maximum of 6 continuing education contact hours (CECHs). Physicians should claim only the contact hours commensurate with the extent of their participation in the activity.

Estimated time to complete activity: 6 hours
Date of release: May 15, 2024
Expiration Date: May 15, 2027 (unless further validated and extended by provider). For amended dates of activity expiration, please see FAQ Activity Effective Dates at www.datatrace.com).

Commercial Interests

No commercial interest provided financial support for this continuing education activity.

CECH Note

Participants of Volume 35, Issue 1 will receive a maximum of 6 CECHs for a correctly-completed CME Answer Form. In order to qualify for CECHs, a score of 70% or more must be achieved on the written examination material. Any participant who does not pass the first time may take the exam one additional time (within 90 days of receipt of results). One retake test may be taken for a fee of $15. You will be responsible for notifying your state of the number of contact hours you have received.

Participants are required to complete a course evaluation for use in developing future issues and to meet the unique educational needs of podiatric physicians.

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Article Authors and Lecturers

  • Bradley M. Brooks (n.)Brandon M. Brooks (1. Data Trace Publishing Co.)
  • Malachi Brown (n.)
  • Ashley M. Nettles (n.)
  • Camille P. Ryans (n.)
  • Tiffany T. Tran (n.)

 FAQ Journal Planning Committee

  • Chrissy Wesolowski (n.)
  • Lauren Molander (n.)
  • Stephanie Wu, DPM, MSc (n.)

Foot and Ankle Quarterly 35-1 Contributors

Guest Editor

Brandon M. Brooks, DPM, MPH
Staff Podiatrist, Wm. Jennings Bryan Dorn VA Medical Center, Columbia, SC; Treasurer and Fellow, American College of Podiatric Medicine (ACPM); 6th Public Health Fellow, American Podiatric Medical Association (APMA); Diplomate with Certificate of Added Qualification in Podiatric Surgery, American Board of Podiatric Medicine; Fellow, American Society of Podiatric Surgeons

Contributors

Bradley M. Brooks, DO
Psychiatrist, AltaPointe Health Systems, Mobile, AL; Adjunct Assistant Professor, University of South Alabama College of Medicine Department of Psychiatry, Mobile, AL

Malachi Brown, MS 3
Podiatric Medical Resident – Year 3, Barry University School of Podiatric Medicine, Miami, FL; President, Study Body and Florida Podiatric Medical Student Association; Public Health Ambassador, Florida Department of Health; Student Liaison, American Public Health Association Foot and Ankle Health Section

Ashley M. Nettles, DPM
Section Chief, Podiatry, Columbia VA Health Care System, Columbia SC

Camille P. Ryans, MPH, DPM, DABPM, FACFAS
Staff Podiatrist, Naval Medical Center Portsmouth, Portsmouth, VA

Tiffany T. Tran, DPM
Podiatry Resident, Kaiser Permanente Santa Clara Podiatric Residency Program,  Santa Clara, CA


35-1 In this issue:

  • FEATURE ARTICLE: A Brief Guide to Postoperative Prescribing Practice after Foot and Ankle Surgery
    Brandon M. Brooks, DPM, MPH
  • CONDENSATIONS and COMMENTARIES
    • Opioid-Prescribing Approaches: One-Size-Fits-All vs. Patient-Centric and Procedure-Focused among Podiatric Physicians. A Cross-Sectional Study
      Commentary by Malachi Brown, MS3 and Brandon M. Brooks, DPM, MPH
    • American Podiatric Surgeons’ Postoperative Multimodal Analgesic-Prescribing Practice: A 2019 to 2020 National Survey
      Commentary by Ashley M. Nettles, DPM
    • Post-Procedural Opioid-Prescribing Practice in Nail Surgery: A National, Questionnaire-Based, Cross-Sectional Study with Recommendations
      Commentary by Malachi Brown, MS3 and Brandon M. Brooks, DPM, MPH
    • The Diabetic Foot-Pain-Depression Cycle
      Commentary by Tiffany T. Tran, DPM
    • The Opioid Use Agreement in Foot and Ankle Surgery: An Addition to Your Informed Consent
      Commentary by Tiffany T. Tran, DPM
    • The Anesthetic Effects of Lidocaine with Epinephrine in Digital Nerve Blocks
      Commentary by Tiffany T. Tran, DPM
    • Cognitive Bias in Postoperative Opioid-Prescribing Practice
      Commentary by Brandon M. Brooks, DPM, MPH and Bradley M. Brooks, DO
    • Concomitant Use of Spasmolytics and Opioids for Postoperative Pain after Foot and Ankle Surgery: Fair or Foul?
      Commentary by Bradley M. Brooks, DO
    • Postoperative Opioid-Prescribing Practice in Foot and Ankle Surgery
      Commentary by Camille P. Ryans, MPH, DPM, DABPM, FACFAS
    • Podiatry and the Opioid Epidemic: A Call to Action
      Commentary by Bradley M. Brooks, DO
  • AUDIO LECTURE 1: Evidence-Based Opioid Prescribing Pearls in Foot and Ankle Surgery, Part 1
    Brandon M. Brooks, DPM, MPH
  • AUDIO LECTURE 2: Evidence-Based Opioid Prescribing Pearls in Foot and Ankle Surgery, Part 2
    Brandon M. Brooks, DPM, MPH
  • CONTINUING EDUCATION QUESTIONNAIRE