Scientific Summit Schedule of Events

Through this course attendees will truly understand exactly how, why, and where legal entities should be used for both lawsuit prevention and income tax reduction. Our course is both engaging and easy to understand. When completed, attendees will have an understanding of the proper use of legal tools, and will have an organized approach to taking effective action.

According to the 2011 Institute of Medicine (IOM) report on Relieving Pain in American, chronic pain is a public health epidemic costing more than $600 billion for utilization of healthcare services and lost work wages. Not only is chronic pain resistant to conventional treatments at doses that do not reduce quality of life or increase risk for opioid misuse and addiction, but in many cases, chronic pain with a neuropathic component worsens over time. The most common definition of neuropathic pain is pain that is caused by a disease of, or damage to, the somatosensory nervous system. Hallmarks include episodic or continuous pain arising from normally non-painful stimuli (allodynia) and/or unpleasant, abnormal sensations termed dysesthesias. Our research has focused on spinal cord injury (SCI)-induced neuropathic pain. The majority of SCI patients report long lasting neuropathic pain at or below the level of the lesion and rate the intensity as moderate to severe. Unfortunately, there is limited information regarding the mechanisms underlying spinal cord injury-induced chronic neuropathic pain and most pharmacological and non-pharmacological therapies provide inadequate pain relief. Given this, the identification of novel therapeutic targets that might be exploited to reduce or eliminate chronic SCI-induced pain are critically needed. Early after SCI, reactive astrocytes undergo morphological changes and demonstrate enhanced proliferation, migration, and synthesis of glial fibrillary acidic protein (GFAP), leading to the formation of the glial scar. While the glial scar can be protective, it can also limit axonal regeneration. In addition, changes in glial cells post-SCI can also contribute to neuropathic pain through production of chemokines, pro-nociceptive growth factors and cytokines. We have been focused on the potential role of the truncated Brain-derived neurotrophic factor (BDNF) receptor, tropomyosin-related kinase B T1 (trkB.T1), in SCI-induced neuropathic pain. While BDNF has been shown to be a potent modulator of pain signaling by binding of mature BDNF to its catalytically-active full-length receptor, trkB.FL, much less is known about the function of the truncated trkB.T1 receptor and its possible role in pain signaling. However, we and others have shown that trkB.T1 receptor expression is up-regulated at early and late timepoints following SCI in rodent models, coincident with the development of nocifensive responses and locomotor dysfunction. Since astrocytes, which are the main component of the glial scar, express only the truncated isoform of the BDNF receptor trkB, we reasoned that trkB.T1 signaling in astrocytes could be contributing to the formation of the glial scar and in turn, neuropathic pain and locomotor dysfunction. Our data to date demonstrate that genetic deletion of trkB.T1 globally or specifically in astrocyte only, demonstrate less mechanical and thermal hypersensitivity, reduced mechanical hyperesthesia and better locomotor recovery following injury. We conducted differential gene expression analyses in cultured astrocytes derived from neonatal trkB.T1 knockout mice to examine transcriptional differences associated with the loss of trkB.T1, and found that genes related to proliferation and migration were significantly reduced relative to wildtype controls. These findings were confirmed in functional assays, in which we found that the lack of trkB.T1 significantly decreased both proliferation and migration in response to serum and exogenous BDNF application. In vivo in the spinal cord, we also found reduced astrocyte proliferation and gliopathy following SCI. These results provide mechanistic insight into post-SCI neuropathic pain provide insight into the contribution of trkB.T1 signaling in astrocytes.

The Neuropathic Pain Special Interest Group (NeuPSIG) of the International Association for the Study of Pain suggested in 2008 that neuropathic pain (NP) be redefined as “pain arising as a direct consequence of a lesion or disease affecting the somatosensory system.” Considering the clinical presentations and possible confirmatory diagnostic tests, a revised grading system was published to better reflect clinical practice and allow appropriate treatment decisions to be made, despite diagnostic uncertainty. Extensive research in the last two decades have contributed substantially to our understanding of the pathophysiologic mechanisms of NP. However, the clinical management of NP continues to be challenging with only a minority of patients achieving a satisfactory response from drug therapy. A number of evidence-based clinical practice guidelines for the pharmacologic and interventional management of NP have been published in recent years with stepwise recommendations. These guidelines highlight factors that contribute to therapeutic challenges, such as modest efficacy of the active drugs, high placebo response in trials, the heterogeneity of NP patients and an inadequate classification of patients included in clinical trials. Recent reports emphasize the heterogeneity of the etiology, mechanisms, and clinical presentations of patients with NP and suggest algorithms for stratifying patients, based on their sensory profiles. This research direction offers the opportunity for developing a personalized, multimodal approach to the management.

This symposium will consist of an interactive and integrated basic science, psychological, and clinical research perspective with presentations of new and emerging data from research conducted with human participants. Topics discussion will focus on of the interactions between altered pain psychology and behavior, endogenous opioid system dysfunction and variability, and neurobiological alterations in individuals with chronic pain.

This symposium will address considerations for designing mechanistically informed clinical trials, including eligibility criteria, patient-reported assessments, and biomarkers based on the current understanding of basic and clinical science mechanisms, neurobiology, and clinical course of painful CIPN. Considerations presented in this workshop will be generalizable to clinical trial design in other pain conditions.

The purpose of this session is to highlight the critical need for greater research on muscle and deep tissue afferents in preclinical and clinical studies for chronic pain. Deep tissue sources driving and maintaining chronic pain are vastly understudied compared to cutaneous sources or to non-target-identified sensory somata. Further, the session will tether clinical studies and human tissue investigations of deep afferent pain together with preclinical studies, with the goal of higher bidirectional translation between preclinical models and patients.

This symposium is dedicated to the memory of Edward R. Perl, MD, and William D. Willis, Jr., MD PhD, both of whom made seminal contributions to the fields of pain and neuroscience.

In this session, clinical scientists will present a multi-faceted discussion of their research findings on the impact of pain processing phenotypes (quantitative sensory testing), psychosocial factors, central sensitization, genomics, and gene-environmental interactions on acute post-surgical pain, opioid responsiveness, and the development of chronic post-surgical pain.

This program will highlight the shifts in opioid prescribing practices for patients with chronic pain that have been proposed by several major national organizations (e.g., the CDC). Based on evidence summarized in multiple systematic reviews, it is now clear that opioid therapy is not indicated for the long-term treatment of most chronic pain disorders. At the same time, long-term opioid exposure substantially increases the risk for problematic opioid use, addiction, and overdose. Consequently, both primary care and tertiary care clinics are increasingly faced with the complex clinical calculus of managing pain, opioid withdrawal, and the mental health of patients being tapered off long-term opioid therapy. Our goal is to discuss the empirical bases and practical challenges of tapering patients with chronic pain off opioids. We will approach this from the perspective of inpatient chronic pain rehabilitation and outpatient pain management. Special attention will be paid to the psychosocial characteristics that contribute to different responses to opioid taper, as well as the potential utility of psychosocial treatments over the course of an opioid taper. Learning Objectives 1) Present an overview of the current opioid epidemic, how it has altered pain management practices, and the current challenges facing physicians and other health care providers when treating patients on longstanding opioid therapy regimens. 2) Describe the evidence for psychosocial therapies as adjuncts and/or alternatives to pharmacological approaches to opioid taper in patients with chronic pain. 3) Describe the similarities and differences between inpatient and outpatient opioid taper.

This SIG meeting offers 1.0 hour of CE credit.

The SIG business meeting will serve as a forum to discuss the future of the SIG and feedback on the SIG’s scientific pre-con, the APS Conference on Analgesic Trials (Sunday March 4).Pain Education

Explore advances in pain education across the learning continuum (UME, GME, CME/MOC/MOC, IPE). – Review teaching modalities used in pain education – Analyze the use of competency-based medical education in pain medicine – Appraise contemporary research on pain education

This session will serve as the primary care SIG’s annual meeting. In addition to conducting annual business, we will have two brief talks of interest to our SIG members: 1. Six Building Blocks, 2. Pain in Primary Care Update.

This SIG meeting offers 1.0 hour of CE credit.

The Basic Science SIG meeting will feature two talks by recipients of the Future Leaders in Pain Research Award. Agenda items include a brief discussion of how pain scientists can better interact with government and media, and opening the floor for nominations for the 2018 incoming SIG Co-Chair.

Existing treatments for chronic pain produce meaningful therapeutic benefit for only a minority of patients, and we have limited ability to predict which patients will benefit from which treatments. Current approaches to pain assessment and diagnosis provide little information regarding the mechanisms underlying patients’ pain. Because pain treatments target underlying mechanisms, this represents a major barrier to improving clinical outcomes. Thus, mechanism-based approaches to pain assessment have the potential to enhance treatment outcomes by better matching patients to the appropriate treatments. This session will explore the topic of mechanism-based pain assessment. First, the multiple categories of pain mechanisms will be described. Then, several examples of strategies available for mechanism-based pain assessment will be provided, including systematic measurement of pain characteristics, symptom-based clustering of patients, and quantitative sensory testing. Emerging evidence will be reviewed suggesting that these methods may enhance patient phenotyping leading to improved prediction of treatment outcomes. The session will conclude with clinical recommendations and some possible directions for possible research.

Safe and effective non-pharmacologic treatments that have strong and sustained effects are urgently needed for the proper management of widespread chronic pain with strong centralized components. The speaker will discuss how a novel approach to exercise – neuromuscular training, derived from injury prevention research and focusing on improving body biomechanics and movement competence can be used in combination with coping skills training to reduce pain and disability in juvenile fibromyalgia syndrome (JFM). The Fibromyalgia Integrative Training for Teens (FIT for Teens) program potentially has stronger effects on pain and disability in JFM than previously studied non-pharmacologic treatments. Results show strong improvements in self-reported pain and disability after treatment. Moreover, objectively measured improvements are seen in physical ability using technologically advanced methods including 3-dimensional motion capture of movement biomechanics. The potential for incorporation of technological advancements such as motion capture and virtual reality into behavioral treatments for centralized musculoskeletal pain will be discussed. Finally, treatment studies of this type cane be used to probe the underlying brain mechanisms of centralized pain and its treatment and point the way for exciting new research directions in pain management.

Medical Marijuana is viable now in over 25 states. Many of these states allow medical marijuana use for children under 18 years of age. There is limited experience and loads of controversy regarding the use of medical marijuana in children and adolescents. The Pediatric SIG will host a vigorous debate regarding the use of cannabinoids in youth.

VA and DoD have focused on modifying opioid prescribing practices for chronic pain. Efforts have addressed changes to opioid dosing and alternatives to opioid therapy, among others. Three VA researchers will discuss cutting edge research focused on modifying opioid therapy for veterans and non-veterans with chronic pain. Research will describe outcomes from a recently completed 2 site (VA, Kaiser Permanente) prospective cohort study examining opioid dose escalation among patients with chronic pain. Results will be discussed from a retrospective study using VA administrative data to characterize 12-month trajectories of pain intensity following discontinuation of long-term opioid therapy, in which 4 distinct trajectory sub-groups were identified. Patient correlates of sub-group membership will be presented. Finally, another large cohort study (N>5 million veterans) using administrative data that examined the effect of use of complementary and integrative health (CIH) interventions (e.g., acupuncture, yoga, meditation) on reducing opioid initiation, dose, or duration in veterans with musculoskeletal diagnoses and PTSD. These studies highlight important research, clinical, and policy implications for opioid management of patients with chronic pain.

This SIG meeting offers 1.0 hour of CE credit.

This CE event is a joint meeting of the Ethics & Pain Rehabilitation SIGs to address the growing gap between best practices for chronic pain management and the public’s knowledge and access to these services. Policy and practice issues will be discussed in implementing biopsychosocial approaches to pain management. CEUs provided to attendees.

This SIG meeting offers 1.0 hour of CE credit.

The Science of Integrative Pain Management Wondering about the evidence base for integrative pain management? Attend the CAM SIG meeting and learn about the scientific evidence behind integrative medicine approaches to help manage pain. These modalities include acupuncture, aromatherapy, biofeedback, chelation, breathing exercises, diet-based therapy, energy healing therapy (Reiki), guided imagery, hypnosis, massage, meditation, mind-body exercises (yoga, tai chi, and qi gong), music therapy, supplementation and nutraceuticals, and pet therapy.

Chronic pain is a major public health problem in the US, unequally borne by those with income and ethnic minorities. Treatment, when available, is biomedical, expensive, and fraught with undesirable side effects. Pain self-management treatments show promise as adjuncts or alternatives, but are usually unavailable to individuals with low socioeconomic status, and have not been adapted to their education or literacy levels. This lecture presents the rationale for adapting and simplifying pain self-management treatments for individuals with chronic pain and chronic illness, explains the process of making such adaptations, examines the efficacy of these simplified treatments, and discusses the opportunities and challenges of implementing such programs in low-resourced settings.