May 2017
David Craig, PharmD | Editor


The 2017 Future Leaders in Pain Research Grants Program is Accepting Applications in June

The call for applications for the 2017 Future Leaders in Pain Research Grant Program opens June 12, 2017

This year APS Future Leaders grants will be funded by the Mayday Fund and the Rita Allen Foundation. Up to two awards for $25,000 each to basic science pain research proposals and one award for $25,000 translational pain research proposals will be given to those demonstrating the greatest merit and potential for success.

The Future Leaders in Pain Research Grant Program was established in 2005 to fund pain research projects of doctoral-prepared investigators who have not yet attained NIH RO1-level funding. The purpose of this grant is to encourage research in pain that will add to the existing body of knowledge and to allow investigators to develop pilot data that will aid them in securing additional major grant funding for continued pain research.

Please review the submission guidelines prior to visiting the grant portal.

For additional information, please contact APS at 847.375.6332 or e-mail Carly Reisner.

Congratulations to the 2016 Future Leaders in Pain Research Grant Winners!

Anna Taylor, PhD
The Regents of the University of California - Los Angeles, CA
Revealing a brain-gut microbiome connection following chronic opioid treatment

Melanie Noel, PhD
The University of Calgary – Calgary, Alberta, CA
The sociolinguistic context of pain memory development in young children

Learn more about previous Future Leaders in Pain Research Recipients.

Review Committee

Patrick M. Dougherty, PhD, Chair
Emily Bartley, PhD
Michael Caterina, PhD
Robert Coghill, PhD
Beth Darnall, PhD
Robert R. Edwards, PhD
Perry Fuchs, PhD
Michael Gold, PhD
Burel Goodin, PhD
Peter Grace, PhD
Susmita Kashikar-Zuck, PhD
Asma Khan, BDS PhD
Allen Lebovits, PhD
Sarah Linnstaedt, PhD
Theodore Price, PhD
Barbara Rakel, PhD RN
Laura Simons, PhD
Kevin Vowles, PhD

Board Liaisons

Robert Edwards
Theodore Price, PhD



Releases from the 36th Annual Scientific Meeting

Practical Clinical Trials Can Help Find Alternatives to Opioids

Lynn DeBar, PhD, plenary speaker at the 36th Annual Scientific Meeting

Pressures on primary care doctors to move away from opioid pain management are increasing, but practitioners need practical, evidence-based information on how to employ multidisciplinary pain care successfully in everyday clinical practice. Lynn DeBar, PhD, a senior investigator for Kaiser Permanente and speaker at the Annual Scientific Meeting, believes wider use of practical clinical trials and more emphasis on patient self-management are key solutions for achieving wider use of multidisciplinary pain care to improve patient function and help lower use and misuse of opioids.

Although the national death toll from opioid overdoses is staggering, DeBar said that a small minority of pain patients are represented in the mortality data. “Given the justified apprehensions of primary care doctors to continue prescribing opioids, the central question focuses on what can we do in primary care to help improve function for pain patients,” said DeBar.

DeBar said the benefits of multidisciplinary pain care, which employs nonpharmacologic treatments, have been well documented in peer-reviewed studies but it still is not widely available due largely to inadequate insurance coverage. “Medicare and other health insurance providers need value-based care metrics and outcomes, and more studies are needed to help implement evidence-based multimodal pain care with attention to feasibility and sustainability in everyday clinical practice,” DeBar explained.

Widespread gaps in evidence-based knowledge about pain management underscore the need to conduct practical clinical trials designed to meet the needs of clinicians and answer their questions. Such trials are of increasing interest to the National Institutes of Health (NIH), which is ramping up efforts to support pragmatic trial initiatives.

“Practical clinical trials can bridge the gap between research and clinical care,” said DeBar. “Traditional randomized clinical trials are slow and expensive, and results often cannot be implemented easily in clinical practice. Findings can be difficult to translate into the real world because treatments are given to carefully selected populations in ideal conditions.”

DeBar said practical clinical trials are designed to improve practice and policy and take place in settings where routine medical care occurs. They seek answers to real-world clinical questions and are designed to test what will work in everyday care. Also, practical clinical trials study diverse populations using broadly inclusive eligibility criteria.

The NIH Health Care Systems Research Collaboratory is spearheading execution of pragmatic clinical trials in pain management by partnering with health systems and physician groups. “Engaging health systems, providers, and patients as partners in pragmatic research accelerates realistic integration of research, policy, and practice,” said DeBar. She reported that Kaiser Permanente is organizing a practical clinical trial in pain management involving 851 patients in the Portland, OR, area.

DeBar also spoke about the benefits of adopting alternative treatment approaches, such as virtual reality and patient-to-patient reinforcement methods. “Remote interventions with cognitive behavioral therapies are proving effective and so are new smartphone apps that allow patients to transmit real-time information about their pain,” said DeBar. “Also, more attention should be given to patient-driven models of support, similar to programs like Weight Watchers, which empower patients to take more active roles in managing their care.”

Holistic, Patient-Centered Care Gaining Acceptance for Pain Management

David Katz, MD, keynote speaker at the 36th Annual Scientific Meeting

Treating the whole person and not just the pain has been a mantra of APS for decades. In his keynote address at the organization’s Annual Scientific Meeting, holistic medicine expert David Katz, MD, director of the Preventative Research Center at Yale University, called for clinicians to stop relying exclusively on pain medications and adopt patient-centered, holistic approaches for treating chronic pain patients.

“There are lots of choices for managing pain, but many worthwhile options are neglected,” said Katz. “Pain is almost always part of a bigger health picture, and just focusing on pain can lead to medication abuse. The first priority should be helping patients get healthier because truly healthy people are less prone to pain.”

Katz urged APS attendees to follow an integrated treatment approach in which medical, social, psychological, and lifestyle factors are addressed in developing pain management treatment plans. Often, a complex array of problems must be addressed for successful pain management, and, if ignored, they inevitably worsen and the net effect is a downward spiral into permanent disability and depression.

How should clinicians deal with myriad lifestyle variables when adopting a patient-centered approach for treating chronic pain? Katz advised that treating sleep deprivation often is the most appropriate first step.

“Pain causes sleep difficulties. People who don’t get enough sleep have less energy, are less active physically, and usually gain weight, which can exacerbate pain,” said Katz. “Also, poor sleep can cause or compound depression and social isolation, which can lower pain thresholds.”

Katz explained that with successful interventions to improve sleep, patients may feel less pain, have more energy, and adopt a more hopeful outlook. “For example, a little exercise further improves energy and sleep. Physical activity becomes less problematic and increases incrementally. As a result, weight loss and improved social engagement occur. One step at a time, the patient begins to achieve improved vitality and ultimately better pain management.”

According to Katz, patient-centered care is becoming more widely adopted as many physicians rely less on pharmacotherapy and choose more holistic treatment approaches. “Holistic practitioners look beyond the pain condition and examine the body, mind, and spirit, which can lead to significant lifestyle changes to improve overall vitality and lower dependence on pain medications.”

Better Self-Management Improving VA Outcomes for Chronic Pain Care

Robert Kerns, PhD, Wilbert E. Fordyce Clinical Investigator Award lecturer at the 36th Annual Scientific Meeting

Self-management programs are teaching veterans with chronic pain to become more active, manage symptoms, reduce stigma and frustration, and minimize depression and other mood disorders.

Robert Kerns, PhD, professor of psychiatry, neurology, and psychology at Yale University, spent 38 years practicing in Department of Veterans Affairs (VA) health care, most recently the VA Connecticut Healthcare System. He reported in a plenary session presentation that the VA’s applications of cognitive-behavioral therapies (CBT) and other approaches help veterans better manage their pain through standardized pain assessments, alternative therapies, patient education, and self-care. The VA also is succeeding in reducing drug use.

“The proportion of VA patients receiving high doses of opioids has decreased significantly in the last 4 years concurrent with greater use of nondrug alternative pain therapies,” said Kerns. “Several trials have shown that when patients are engaged in their own care they have less pain and less depression, and are more physically active.”

The VA estimated in one study that 44% of soldiers in an Army infantry brigade reported chronic pain 3 months after returning from tours of duty in Afghanistan and Iraq, which is double the rate than among civilians. Spinal disorders have increased by 300% in the last 50 years and now rank as the number-one cause of disability in the United States and in the military.

Kerns added the National Pain Strategy’s strong advocacy of self-care will provide more educational resources and greater incentives to help physicians empower their patients to become more proficient at managing and coping with their pain.

The National Pain Strategy, released last year by the U.S. Department of Health and Human Services, places a strong emphasis on self-management and patient education as critical pathways for improving treatment of chronic pain. Kerns added that the VA is funding several research projects to evaluate the efficacy self-management interventions for persistent pain, including novel approaches that employ advanced communication technologies.

“Specifically for pain management, self-care programs involve gaining knowledge about pain and building skills and confidence to prevent, cope with, and reduce pain,” said Kerns. The overall objective is to promote adoption of an effective approach to pain self-management, similar to models for treating chronic illnesses.”

Kerns added that in reconceptualizing pain as a chronic disease, it is imperative to understand that pain management is not a cure, realistic therapy goals must be established, and the overall focus should be placed on achieving optimal functioning, well-being, and quality of life.

Elements for successful self-management of chronic pain include

  • empowering people with pain through reassurance, encouragement, and education
  • conservative use of analgesics and adjuvant medications
  • promotion of regular exercise and healthy and active lifestyles
  • development of adaptive strategies for managing pain.

Kerns described the role communication technology is playing in helping the VA to promote access and engagement in pain self-management. “Attendance at sessions is the key variable governing treatment outcomes,” said Kerns. “Technology is making it easier for more vets to participate in cognitive-behavioral therapy through real-time video conferencing, apps for smartphones, phone-based interactive voice response, and web-based CBT interventions for pain and coprevalent mental and behavioral health problems.”

Outcomes for the VA program were published in JAMA Internal Medicine this year and showed that patients accessing CBT remotely did just as well as patients receiving in-person therapy. Patient surveys provided additional verifications. On a seven to 10 scale, the average response of 22 patients was 7.75 in answering the question: “How confident are you that this treatment successfully helped you with your pain?”

Wearable Devices Communicate Vital Brain Activity Information

Rosalind Picard, ScD FIEEE, plenary speaker at the 36th Annual Scientific Meeting

What can we learn about emotions, the brain, and behavior from a wristband? Plenty.

Rosalind Picard, ScD FIEEE, and her team at MIT pioneered the use of wearable technology to recognize changes in human emotion. They have made several new discoveries, including that autonomic activity measured through a sweat response is not as general as previously thought and carries more specific information related to different kinds of brain activity.

“The skin is purely innervated by the sympathetic branch of the autonomic nervous system,” said Picard. “We can observe increases in sympathetic brain activation by monitoring subtle electrical changes across the surface of the skin.”

Sympathetic activation occurs when experiencing excitement or stress, whether physical, emotional, or cognitive. In some medical conditions, such as epilepsy, it shows significant increases related to certain areas of the brain being activated.

Wristwatch-like devices can employ sensors for continuous, real-time data gathering. Picard explained that changes in electrodermal activity occur as the result of atypical activation in deep regions of the brain. This discovery already has been commercialized for use in seizure monitoring.

Seizures occur when there are abnormal, excessive, or synchronous neuronal activity and can cause convulsions evidenced by violent shaking and loss of control and consciousness.

When someone has recurring seizures, the diagnosis usually is epilepsy. When some regions of the brain—such as those involved with anxiety, pain, stress, and memory—are activated during a seizure, they can elicit patterns of electrical changes in the skin.

Picard reported her group has built an automated machine learning method that can detect compulsive seizures by combining measures of electrodermal activity on the wrist with measures of motion. The wrist-worn detector is now more than 96% accurate for detecting convulsive seizures.

Although they have not demonstrated detection of nonconvulsive seizures, 42%–86% percent of nonconvulsive, complex partial seizures also have significant electrodermal responses.

Picard said other clinical applications for wristband electrodermal monitoring include anxiety, mood, and stress monitoring and measuring analgesic responses. “We know that pain exacerbates anxiety and stress and we are doing more studies to determine how reductions in anxiety and stress could indicate an analgesic response activated by a pain management therapy,” said Picard.