Treatment

Call for Clinical Centers of Excellence Applications

Deadline: November 30, 2011

Applications are now being accepted online for the APS Clinical Center of Excellence (CCOE) in Pain Management Awards. The CCOE Program annually awards the APS Center of Excellence mark to interdisciplinary healthcare teams who provide the most distinguished, comprehensive, pain care. Pain management programs from across the United States, large and small, rural and urban, community and university-based, are all eligible to apply. Selection of awardees is based on judgment of the quality of services provided and not size or type of program. The 2007 and 2008 CCOE program recipients who have not already received the award for a second time are eligible to apply. Past recipients must provide evidence of sustained excellence and fulfillment of CCOE assessment criteria.

Research

NINR Symposium

In October, the National Institute of Nursing Research (NINR) will hold its 25th Anniversary Concluding Scientific Symposium titled "Bringing Science to Life: A Healthier Tomorrow." The event marks the end of the Institute's 25th anniversary year, which began last fall with a kick-off symposium attended by more than 500 nurses and other healthcare scientists, clinicians, and members of the public. "Bringing Science to Life: A Healthier Tomorrow" will commemorate the contributions that nursing science has made to solving some of America's most important health challenges. The symposium will include keynote and science presentations, a panel discussion, and a guided poster tour.

For more information about the scientific symposium, please visit www.ninr.nih.gov/ahealthiertomorrow. The event is free of charge, but registration is required.

Mayday Fund Announces 2011–2012 Fellows

The Mayday Fund today announced the selection of six experts in pain management to be fellows under The Mayday Pain & Society Fellowship. The new fellows hail from across the United States and Canada, specializing in a wide range of healthcare disciplines, including anesthesiology, healthcare policy, nursing, pediatrics, and pharmacy. Five of the six fellows are APS members.

The fellows will develop skills to advocate and communicate on many of the pain issues they deal with everyday, including the undertreatment of pain, pediatric pain, chronic pain, the treatment of pain with prescription pain medications, disparities in pain treatment, and policies to improve pain care.

The new fellows for 2011–2012 are

• David S. Craig, PharmD BCPS, Clinical Pharmacist Specialist and Residency Director, H. Lee Moffitt Cancer Center & Research Institute (APS member)
• Miriam O. Ezenwa, PhD RN, Assistant Professor and Sickle Cell Scholar, University of Illinois at Chicago, College of Nursing (APS member)
• Denise Harrison, PhD, Chair in Nursing Care of Children, Youth and Families, Children's Hospital of Eastern Ontario and University of Ottawa
• Jennifer N. Stinson, PhD, Clinician Scientist and Assistant Professor, Hospital for Sick Children and University of Toronto (APS member)
• Gregory W. Terman, MD PhD, Professor of Anesthesiology and Pain Medicine and the Graduate Program in Neurobiology and Behavior, University of Washington (APS member)
• Robert Twillman, PhD, Director of Policy and Advocacy, American Academy of Pain Management (APS member)

As part of their training, the new fellows will attend an intensive 4-day workshop in Washington, DC, in October 2011, and work closely with Burness Communications, a public relations firm that works solely with non-profit organizations, primarily in health and science. Fellows will learn how to connect with local and national media, write opinion editorials, develop relationships with university public affairs and government relations leaders, and talk with Members of Congress and other policymakers. For more information on the Mayday Fund and past fellows, please visit www.maydayfellows.org.

Call for Rita Allen Applications

The Rita Allen Foundation (RAF) and APS announce a call for applications for the 2012 Rita Allen Foundation Award in Pain. The call for applications will open November 1. The RAF and APS may award two grants in the amount of $50,000 annually for a period of as many as 3 years to those research proposals demonstrating the greatest merit and potential for success. Applications for the award are due January 17, 2012. Please visit the APS website to apply and to find more information about the award.

Funding Opportunity

NIH Director's Transformative Research Award Program

The Common Fund's National Institutes of Health (NIH) Director's Transformative Research Award initiative, formerly known as the Transformative Research Project (TR01), is created specifically to support exceptionally innovative and/or unconventional research projects that have the potential to create or overturn fundamental paradigms. These projects tend to be inherently risky and may not fare well in conventional NIH review. As compared to the other NIH Director's Awards, the primary emphasis of the Transformative Research Awards initiative is to support research on bold, paradigm-shifting but untested ideas, rather than to support exceptionally creative individuals who wish to pursue new, potentially high-impact research directions. For more information, visit the NIH Common Fund.

Registration Open for 10th IASP Research Symposium

February 7–9, 2012
Miami Beach, FL

The 10th Annual International Association for the Study of Pain (IASP) Research Symposium, "The Genetics of Pain: Science, Medicine, and Drug Development," will be held in Miami, FL. This first-of-a-kind symposium features an exceptional program built from a panel of world-renowned experts in the field of genetic susceptibility to pain. The program is designed to be interactive, with a focus on the genetics of pain (acute and chronic) emphasizing current knowledge, unanswered questions, and emerging concepts related to mechanism-based clinical interventions for persistent pain. Participation is limited to 200 attendees, so be sure to register early. Abstract submission for poster presentations will open soon. Don't miss your opportunity to be a part of this essential conference. Speakers for the symposium include Marshall Devor, Roger Fillingim, Henrik Kehlet, Jorn Lotsch, Bill Maixner, Jeffrey Mogil, Christopher Nielsen, Josef Penninger, Ze'ev Seltzer, and Clifford Woolf.

Complete details on the symposium, including the program, accommodations, abstract/poster submission applications, and registration, are available at the conference website, PainGenetics.org, or for more information, contact the symposium organizers at info@PainGenetics.org.

Education

Submit Your Paper or Poster Abstract!

The Call for Paper & Poster Abstracts for the APS 31st Annual Scientific Meeting in Honolulu, HI, is now open on the APS website. Abstracts can be submitted until 11:59 pm Pacific time on Monday, November 21.

Please visit www.APSScientificMeeting.org and visit Abstracts to access the submission requirements and forms.

Health Psychology Call for Special Series

Health Psychology has placed a call for papers for two special series: (1) Discrimination, Racism, and Health and (2) Disparities in Pain. The editors of Health Psychology are looking for manuscripts that examine the breadth of pain disparities. The journal encourages empirical papers across the lifespan. For more information on the two special series, visit the American Psychological Association.

Society

Election Nominations Open

Do you know a colleague who is motivated, dedicated, and inspired about the future of APS and advancing the knowledge and treatment of pain? Or perhaps you are looking for a new challenge or opportunity for growth. Please consider making a nomination for the APS Board of Directors and/or Nominating Committee. Members are welcome to self-nominate.

The form to nominate potential election candidates is available on the APS website. Open positions for the 2012 APS board are Secretary, three (3) Directors-at-Large, and a seven (7)-member Nominating Committee. Position descriptions, the current list of board and Nominating Committee members, vacancies, and the disciplinary composition and geographic representation of the board are also available on the website. Nominees must be regular APS members. The nominations process will close on November 11, 2011.

Nominating and electing the leadership of APS is an important and fundamental responsibility of all society members. Thank you for your participation!

Revamped APS Scientific Meeting Website

The APS Scientific Meeting website (www.APSScientificMeeting.org) has recently been redesigned. The APS staff worked hard to organize the site to make it easy to use as well as visually appealing. The new site has improved organization and functionality. Information is grouped by end user need: attendees, education, exhibitors, commercial support, proposal and abstract submission, and investigators. Scientific meeting calls to action are better highlighted to make sure you don't miss a deadline! Save the date for the 31st Annual Scientific Meeting May 16–19, 2012, in beautiful Honolulu and check out the recently revamped website at www.APSScientificMeeting.org.

Reviews

Cancer Pain

Each chapter is fully referenced, and the illustrations are superb and add to the written material. I see this book as a summary of recent developments and a compendium of suggestions for future research. It is not comprehensive on the clinical problems of cancer and related pains, and the material is not presented in a way that facilitates improvements in care. The major problem of pain in those who have survived cancer is not addressed. The final chapter addresses an important area: pain management in developing countries, but none of the prior chapters even consider issues relevant to this arena. For a timely review of some important issues in cancer pain management, this book is superb, but its contents are highly selected and do not cover many of the issues that are troubling in the management of pain associated with cancer.

Reviewed by John D. Loeser, MD. Dr. Loeser is professor emeritus of neurological surgery and anesthesiology and pain medicine at the University of Washington.

Summaries

Chronic pain in adolescents is a risk factor for suicide ideation, according to new research reported in The Journal of Pain. Researchers from the University of North Carolina, Duke University, and Lehman College in New York analyzed data from the 9,970-person National Longitudinal Study of Adolescent Health. They examined the link of chronic pain with increased risk for suicide ideation and suicide attempt, and also assessed the relationship of pain, comorbid depression, and suicide ideation.

Previous studies in adults have shown that suffering from chronic pain can be severe enough to prompt patients to contemplate suicide. Suicide is a major cause of death among adolescents. In 2009, 14% of adolescents polled had seriously considered suicide and 6 percent attempted it. This is the first study to associate chronic pain with suicide ideation and attempt in this population. The authors noted that recognizing the sources of increased risk for suicide in adolescents and offering appropriate care can make a difference in saving lives.

Subjects who said they experience pain once week for at least 12 months were evaluated in the study. In adolescents, headache was reported as the most commonly reported pain problem. For the study, suicide ideation and attempt were measured by asking subjects: "During the past 12 months, did you ever seriously think about committing suicide?" and "During the past 12 months, how many times did you attempt suicide?" Depression was measured by answers to questions on a widely used depression measurement scale.

The researchers found that, similar to adults, self-reported pain was associated with increased risk of suicide ideation in adolescents and did not vary as a function of age or gender. Also, suicide attempts by adolescents with chronic pain were largely associated with depression, which is common in chronic pain patients. Therefore, comorbid depression may further increase the risk of suicide attempts in adolescents with chronic pain.

The authors advised clinicians they should be alert to possible suicide ideation and attempt in adolescents with chronic pain and aggressively treat comorbid psychiatric disorders.

Activity Patterns in Chronic Pain: Underlying Dimensions and Associations with Disability and Depressed Mood
Hanne P.J. Kindermans, Jeffrey Roelofs, Marielle E.J.B. Goossens, Ivan P.J. Huijnen, Jeanine A. Verbunt, Johan W.S. Vlaeyen, Maastricht University, The Netherlands

Activity patterns in chronic pain patients, such as avoidance behavior and persistence, play an important role in the development and perpetuation of chronic pain, according to research reported in The Journal of Pain.

The aim of this study, conducted by Dutch researchers, was to identify activity patterns of patients with chronic pain and determine which types of behavior are linked with pain-related disability and depression. The authors hypothesized that activity patterns characterized by avoidance and persistence behavior would correlate with disability and depressive symptoms.

Avoidance behavior is characterized by fear of movement and pain catastrophizing, and the resulting inactivity can be disabling. Numerous studies have confirmed the detrimental impact of avoidance behavior in fostering disability and depression. Activity persistence is characterized by higher levels of activity that can be detrimental from overuse. Some studies, however, have found that activity persistence is associated with lower levels of disability because active patients feel less disabled.

Study participants (132) were selected if they suffered from musculoskeletal pain for longer than 3 months. They completed questionnaires covering patterns of activity, behavioral responses to illness, chronic pain coping, depression and pain disability.

Results showed that two types of avoidance behavior, pain avoidance (behavior to minimize or prevent a pain experience) and activity avoidance, were related to higher levels of disability and depressive symptoms. Moreover, excessive persistence and pacing were also associated with more disability and depression. In contrast, task persistence (focusing on getting the job done) was related to lower levels of pain-related disability.

The authors concluded that clinicians should increase their understanding of pain patient activity patterns to help improve therapeutic outcomes. For example, patients showing high levels of excessive persistence could benefit from cognitive-behavioral therapies that are used successfully to treat obsessive compulsive disorder.

PAIN Highlights

The following highlights summarize selected articles from September 2011 (volume 152, issue 9).

This was the first large-scale study of the prevalence, severity, impact, and treatment of chronic pain in people with an intellectual disability (ID). Questionnaires were distributed to primary caregivers of community-dwelling adults with an ID to gather data on demographics, general health, nature of pain, impact of pain, treatment, and health-related decision making. The 753 responding caregivers reported that 15.4% of this sample had been experiencing chronic pain for an average of 6.3 years. More women than men were reported to experience chronic pain. Age, communication ability, and level of ID were not found to be associated with the presence of pain. However, pain was associated with cerebral palsy, physical disability, and reports of challenging behavior.

A significant proportion of people with chronic pain also experienced limitations in daily living. More than 80% of service users were receiving some form of treatment for their pain, with most seeing a family physician and using analgesics as the primary form of pain treatment.

Although this study provides foundational data, it highlights the possibility that chronic pain may be underrecognized in people with an ID. The relatively low rate of depression reported by caregivers and the absence of awareness of suicidal ideation emphasizes that greater attention needs to be given to the accurate assessment of pain and its comorbid problems.

Dysmenorrhoea Is Associated with Central Changes in Otherwise Healthy Women
Katy Vincent, Catherine Warnaby, Charlotte J. Stagg, Jane Moore, Stephen Kennedy, and Irene Tracey; University of Oxford

Patients with chronic pain conditions demonstrate altered central processing of experimental noxious stimuli, dysfunction of the hypothalamic-pituitary-adrenal axis (HPA), and reduced quality of life. Dysmenorrhoea is not considered a chronic pain condition but is associated with enhanced behavioral responses to experimental noxious stimuli.

Researchers used behavioral measures, functional magnetic resonance imaging, and serum steroid hormone levels to investigate the response to experimental thermal stimuli in otherwise healthy women with and without dysmenorrhoea. Women with dysmenorrhoea reported increased pain in response to noxious stimulation of the arm and abdomen throughout the menstrual cycle; no menstrual cycle effect was observed in either group.

During menstruation, deactivation of brain regions in response to noxious stimulation was observed in control women but not in women with dysmenorrhoea. In addition, women with dysmenorrhoea reported significantly lower physical, but not mental, quality of life. Many features of chronic pain conditions are also seen in women with dysmenorrhoea; specifically, a reduction in quality of life, HPA suppression, and alterations in the central processing of experimental noxious stimuli. These findings indicate the potential importance of early and adequate treatment of dysmenorrhoea.

Dysmenorrhoea is not routinely considered as a chronic pain condition and is excluded from both the British and American definitions of chronic pelvic pain (CPP); however, it is a frequent comorbid symptom in women with CPP.

These data support the idea that central changes occur secondary to pain. Such changes could predispose this group of women to developing a chronic pain condition after a relatively minor insult and contribute to the gender differences observed in the prevalence of chronic pain conditions. In light of the normal psychological profiles of these women and the negative connotations associated with the label of a chronic pain syndrome, it is difficult to know whether these data should be considered supportive evidence for a reclassification of dysmenorrhoea as a chronic pain condition or inclusion within the definition of CPP.

This study sought to identify predictive factors requiring high-dose transdermal fentanyl in opioid switching from oral morphine or oxycodone to transdermal fentanyl in patients with cancer pain. Researchers used a statistical approach to identify factors predicting a need for higher-dose transdermal fentanyl in opioid switching from oral morphine or oxycodone in patients with cancer pain.

Participants were 76 hospitalized patients with terminal cancer who underwent opioid switching from oxycodone or morphine sustained-release tablet to transdermal fentanyl between January 2009 and June 2010. The conversion dose was calculated as transdermal fentanyl (25 μg/h)/oral morphine (60 mg) or oxycodone (40 mg) = 1. The response evaluated was the dose conversion ratio. Evaluated predictors were factors potentially influencing pain.

This study indicates that breast cancer, total protein, alanine aminotransferase, advanced age, and male gender are significant predictors of a need for higher-dose transdermal fentanyl in opioid switching. This research was conducted with the realization that identifying predictive factors requiring high-dose transdermal fentanyl in opioid switching from oral morphine or oxycodone to transdermal fentanyl in patients with cancer pain would help to establish evidence-based medicine for better treatment of cancer pain.

The statistical identification of predictors for higher-dose transdermal fentanyl in opioid switching is considered likely to contribute to the establishment of evidence-based medicine in pain relief and palliative care.

The Discriminative Validity of "Nociceptive," "Peripheral Neuropathic," and "Central Sensitization" as Mechanisms-Based Classifications of Musculoskeletal Pain
Keith M. Smart, Catherine Blake, Anthony Staines, and Catherine Doody; St. Vincent's University Hospital, University College Dublin, and Dublin City University

Empirical evidence of discriminative validity is required to justify the use of mechanisms-based classifications of musculoskeletal pain in clinical practice. The purpose of this study was to evaluate the discriminative validity of mechanisms-based classifications of pain by identifying discriminatory clusters of clinical criteria predictive of nociceptive, peripheral neuropathic, and central sensitization pain in patients with low-back (± leg) pain disorders. For the purpose of this study, discriminative validity was defined as the extent to which the categories of a classification system can differentiate between those with and without the disorder.

This study was a cross-sectional, between-patients design using the extreme-groups method. Four hundred sixty-four patients with low-back (± leg) pain were assessed using a standardized assessment protocol. After each assessment, patients' pain was assigned a mechanisms-based classification.

Findings from this study suggest that relatively few symptoms and signs may be required to distinguish between pain types. Differentiating between the dominant mechanisms assumed to underlie patients' pain may be important clinically because it may have a direct impact on clinical decision making. However, the predictive and prescriptive validity of mechanisms-based classifications of pain requires further empirical evaluation.

By identifying a discriminatory cluster of symptoms and signs predictive of nociceptive, peripheral neuropathic, and central sensitization pain, this study provides some preliminary discriminative validity evidence for mechanisms-based classifications of musculoskeletal pain. Classification system validation requires the accumulation of validity evidence before its use in clinical practice can be recommended. Further studies are required to evaluate the construct and criterion validity of mechanisms-based classifications of musculoskeletal pain.

In the Media

Abuse of Xanax Leads a Clinic to Halt Supply (New York Times)

Researchers Developing Tool to Precisely Measure Pain (Vancouver Sun)

Study Reveals Laughter Really is the Best Medicine (BBC News)

Drug Deaths Now Outnumber Traffic Fatalities in U.S., Data Show·(Los Angeles Times)

Feeling Pain? The Computer Can Tell (Reuters)

How Your Harsh Reaction to Horseradish May Lead to New Pain-Managing Medicines (Washington Post)

Florida Shutting 'Pill Mill' Clinics (New York Times)

Column: Pain Management: Education Is key (USA Today)

Call for Submissions

Do you have a topic that is relevant to the APS member? Is there a member who is doing work that APS should spotlight? Is there a funding opportunity APS members need to know about? Please submit stories, events, and more to enews@ampainsoc.org for consideration.

Visit the APS Career Center for positions available in the study and treatment of pain.