1. NeuroPAS Global A Biomarker for Musculoskeletal Pain Spine Foundation Chicago 2016

2. The Epidemic of Spinal Disability  This presentation does not cover spinal cord injury, fractures, cancer, infections.  It focuses on Subacute and Chronic Pain. *************************  100 Million Americans have chronic or recurrent pain.  If current trends continue, 30% of all 20 year-olds will become disabled before age 65.  Spinal Pain is the most common cause of worker disability.  The disabled have 23% less annual income despite social support from insurance and other sources.

3. The Technological Paradox  The Spinal Disability Epidemic continues despite Technological Advances  Better imaging techniques [MRI/CT scans and others]  Improvements in Surgical procedures [e.g., minimally invasive surgery and others]  Improvements in Anesthetist Injections  New medications  Multidisciplinary pain programs. WHY?  The question must be WHY?

4. Patient Selection: Understanding the Patient’s Pain Experience  The difficulty: Matching the person’s Specific Needs to the Most Appropriate Treatment.  The cause: Difficulty finding an Objective and Accurate Pain Assessment Tool.  Why: Pain is Personal, Subjective, and Multifactorial !!

5. Standard Medical Training  For the last 40 years, Medical Training regarding Spinal Disability has focused on:  Anatomy  Anatomically-based diagnoses  Medications, physical modalities, injections, and surgeries.  Medical Experience now proves that:  Frequently, anatomy does not match pain or function  People with the same “diagnoses” vary greatly in their response to treatment and outcomes.

6. The Nature of “PAIN”  SCIENCE proves pain is complex and combines:  Tissue Pain Generators [muscle, nerve, bones, and joints]  Emotions [Fear, Anxiety, Depression]  Cognition [Culture, Past experiences, Stressors, and others]  This Complexity is necessary for Survival and Healing:  Ancient man  Man in Nature  If the Patient gets it wrong:  Underestimates danger, could die.  Overestimates danger, creates unnecessary suffering and non-healing due to improper responses.

7. If We Could Know ?  We would KNOW [not guess or predict] when to:  Give the needing patient Injections or Surgery for a painful disc/joint  Continue treating unresponsive muscle-tendon tenderness  Address Fear Avoidance, Depression, etc.  Wisely use Opioids, and How Much  The Results will be Better Outcomes:  Reduced disability  Reduced absenteeism  Reduced social disengagement  Faster development and implementation of New Technologies.

8. NeuroPhysiologic Pain Profile [NP3]  Award-winning technology that identifies in a Specific Patient:  Tissue Pain Generators [muscle, joint, nerve, etc.].  Biological reactions associated with fear, anxiety, depression, etc.  Sociodynamic factors that increase the pain experience.  Based on the well-understood “Fight or Flight” response, the NP3 Assessment is objective, unbiased and scientifically valid. know  Combined with other standard technology and tools, the NP3 Assessment provides unprecedented data that lets patient and healthcare physician know what is necessary.

9. Three NP3 Examples An established assessment tool is now available that identifies the components of a patient’s pain experience [Physical-sensory, “Emotional” and Sociodynamic]. This assessment allows the physicians and case managers to accurately identify a person’s needs for pain relief that can be addressed prior to invasive procedures, that all too often result in spinal disability. EmotionalSensory Physical Sociodynamic

10. Spine 10 x 25 Initiative Change  The Paradigm Shift will take effort:  Habits and routines are engrained  Physicians, healthcare providers  Patients, officials, and the public  The Scope of the Problem has been under-appreciated  Change is disruptive, and difficult to achieve  Change requires:  Educational efforts  Organizational implementation  Institutional change

11. We Must Start the Change  The Spinal 10 x 25 Initiative goals are readily achievable.  Success is necessary  Why?  Einstein: “Insanity is doing the same thing over and over again and expecting different results.”  Mark Twain: “If you give someone a hammer, everything looks like a nail.”  How?  Einstein: “If I had an hour to solve a problem I'd spend 55 minutes thinking about the problem and 5 minutes thinking about solutions.”