Society

In Memoriam: Robert Addison, 1921–2012

APS Past President Dr. Robert Addison passed away on March 15 following a prolonged illness. Dr. Addison served as APS President from 1989 to 1990. He was a founding member of the Midwest Pain Society (MPS) and served on multiple committees and as the first president of MPS. His work with the MPS was integral in establishing the society in its early years. In 1996 he was awarded the APS Distinguished Service Award for his many contributions to the society. Dr. Addison had a prolific and successful career in pain management. Read his obituary in the Chicago Tribune.

APS Election Results

Thank you to all members who voted in the APS annual election. Congratulations to the newly elected board members and nominating committee.:

Scientific Meeting

Why You Should Attend the APS Meeting

• The APS group rate at the Hilton Hawaiian Village is $199-$239 single/double plus applicable taxes, which is the lowest room rate for an APS meeting since 2008. Also, these discounted room rates will be recognized 3 days before and after the meeting (based on availability) if you are looking to add vacation time to the meeting.
• The largest number of poster presenters in the past 8 years (more than 400) will present the best innovations and research in the study and treatment of pain.
• Anytime of the year is a good time to visit Oahu. The average temperature is between 75°–85° F. And did you know Oahu has more than 125 beaches?
• Attend a special session discussing the relevance of the Institute of Medicine's report Transforming Pain in America and the role of the American Pain Society.
• Based on past attendee feedback, there will be an additional special interest group (SIG) meeting time offered on Wednesday, May 16, to make it possible to attend more SIG meetings. Check out the meeting highlights.
• Celebrate the APS meeting in beautiful Honolulu with a Hawaiian-themed welcome reception on Wednesday evening in the exhibit hall.
• Celebrate the 2012 award winners of excellence in the field of pain management. Learn about the 2012 Clinical Centers of Excellence in Pain Management Awards recipients.
• Waikiki is a vibrant center of activity, a destination that showcases the spirit of Aloha to the world. After meeting sessions have ended for the day, take advantage of exciting land and water activities or stretch your legs climbing Diamond Head. There are numerous restaurants at the Hilton Hawaiian Village or you can check out the night life of Wakiki.

For more information or to register, visit the APS conference site.

SIG Meetings in Honolulu

Are you a member of an APS special interest group (SIG)? Interested in joining a SIG? The APS Scientific Meeting Planning Committee has set aside times for SIG meetings at the meeting in Honolulu. Review the SIG meeting schedule below and plan out your meeting schedule for the best opportunities to learn and network from the best and brightest in pain.

Wednesday, May 16, 2–4 pm

NEW! UNOPPOSED SIG MEETING TIME!

(120) Basic Science

(121) Nursing Issues
The Nursing Issues SIG meeting has been designated for continuing nursing education. Nurses can earn 1 contact hour or 1 pharmacology contact hour. Nurses must attend the SIG meeting and complete the Nursing Issues SIG section of the online evaluation to receive credit.

(122) Measurement of Pain and Its Impact

(123) Pain Rehabilitation

(124) Palliative Care

(125) Psychosocial Research

Thursday, May 17, 4:15–5:15 pm

(126) Advancing the Science of Quality

(127) Clinical Trials

(128) Ethics

(129) Genetics and Pain

(130) Pain and Disparities

(131) Pain Education

(132) Pharmacotherapy

(133) Pain in Sickle Cell Disease

Friday, May 17, 5:30–7:30 pm

(134) Pain in Infants, Children, and Adolescents

Treatment

IOM Relieving Pain in America Update

The estimated number of people living with persistent pain provided in the Institute of Medicine's (IOM's) report, Relieving Pain in America, will be revised from 116 million to 100 million. The IOM has issued the following erratum statement.

"Because of a computational error, the initial publication of the report 'Relieving Pain in America' (2011) contained an erroneous estimate of the number adults who experience pain in the United States. A re-analysis of the study by Tsang and colleagues (2008), as well as the independent assessment by Gaskins and Richards (Appendix C) yields an estimate of approximately 100 million U.S. adults who experience chronic pain and not the 116 million as stated in the original report. The text of the report has been revised to show this corrected estimate."

Furthermore, IOM staff members are undertaking the following steps. They are:

• Changing the online (PDF) version of the report to include the new number (and the footnote erratum at the first place it appears in the report).
• Going through the rest of the report and revising sections accordingly that relate to this correction.
• Inserting an erratum sheet for any books already printed.
• Correcting the website blurb accordingly.
• Revising press releases.
• Preparing and reprinting a new report brief with a revised date. All old report brief's will be discarded.
• Providing the Committee with errata sheets and new PDFs.
• Notifying sponsors and providing them with erratum sheets and new PDFs, etc.

Learn About the 2012 CCOE Award Recipients

The APS Clinical Centers of Excellence (CCOE) in Pain Management Awards program helps advance the quality of pain management in the United States by recognizing and rewarding excellence in quality clinical care. APS announced the winners in last month's APS E-News: Division of Pain Medicine at Stanford University in Palo Alto, CA; Fairview Pain Management Center at University of Minnesota Medical Center in Minneapolis, MN; Comprehensive Pain Center at James A. Haley Veterans' Hospital in Tampa, FL; United Back Care in Redmond, Everett, & Puyallup, WA; and Chronic Pain Rehabilitation Program, Neurological Center for Pain at the Cleveland Clinic in Cleveland, OH. Read about each of our 2012 CCOE recipients.

Research

Genetics and Pain SIG Announces Call for Submissions

Junior Investigator Poster Award

The Genetics and Pain SIG is seeking submissions for the first annual Junior Investigator Poster Award. The purpose of this award is to recognize outstanding work of a junior investigator/trainee conducting research in genetics related to pain. This can include basic, clinical, or translational investigation.

The Poster Award winner will receive a certificate of recognition and will provide a brief 10-minute presentation of their research at the Genetics and Pain SIG meeting to be held at the APS Annual Meeting in Honolulu, HI, on Thursday, May 17, from 4:15–5:15 pm.

Candidates eligible for this award include undergraduates, graduate students, and postdoctoral fellows presenting first-authored posters at the APS annual meeting. Nominations may come from faculty, mentors, and/or colleagues. Self-nominations are also welcomed. Candidates do not need to be a member of the SIG to be nominated, but they must be planning to attend the APS annual meeting in Hawaii. To be considered for the award, please e-mail poster abstract, corresponding number, plus contact information to Barbara Hastie by April 15. Abstracts will be reviewed by a subcommittee of the SIG, and the winner will be notified by April 20.

2012 Young Investigators

APS is pleased to grant Young Investigator Travel Awards to 51 trainees to attend the 2012 Annual Scientific Meeting. These individuals will present their research during designated poster sessions. The APS meeting creates a milieu in which scientists and clinicians can share relevant information from their differing perspectives, frequently leading to advances in science and clinical care. Funding for the 2012 Young Investigator Travel Award Program is made possible by grants from the National Institute of Neurological Disorders and Stroke, National Institute on Aging, National Institute of Diabetes and Digestive and Kidney Diseases, National Institute of Dental and Craniofacial Research, National Institute on Drug Abuse, and the National Center for Complementary and Alternative Medicine.

Education

Sickle Cell Symposium in Hawaii

APS members are invited to attend a symposium on Wednesday, May 16 in Honolulu entitled "Pain in Sickle Cell Disease: Basic and Clinical Sciences." The course has been organized by University of Illinois at Chicago faculty, Z. Jim Wang, PhD; Robert Molokie, MD; and Diana Wilkie, PhD RN FAAN.

The symposium will bring together sickle cell and pain experts to highlight new scientific approaches and technologies in the scientific community's quest for a better understanding of neurobiological mechanisms and proper treatment for pain in sickle cell disease.

The symposium objectives are to

1. understand the state-of-the-science research related to pain in people with sickle cell anemia
2. recognize the advantages and disadvantages of the different animal models of sickle cell pain
3. discuss the relevance of advances in pain mechanisms to research in animal and human models of sickle cell pain
4. recognize the potential for sickle cell pain to serve as a translational model of nociceptive and neuropathic pain across the patient's life span
5. foster collaborations among sickle cell and pain researchers
6. identify potential collaborations for conducting multisite translational studies.

For more information regarding the symposium and to register, click here or contact Veronica Angulo at 312.996.0470 or vangul1@uic.edu. Space is limited to 75 participants.

Members

What is your area of specialty?
I am a licensed clinical psychologist in the Pain Management Center at Brigham & Women's Hospital and Harvard Medical School, where my research focuses on biobehavioral aspects of acute and chronic pain. In particular, I study individual differences in pain responses and the neurobiological mechanisms by which psychosocial processes shape those individual differences. Some of my current NIH-funded work focuses on the impact of pain-related catastrophizing on neuroendocrine and inflammatory responses to pain, as well as individual differences in central nervous system pain processing and their implications for long-term pain-related outcomes. I am also involved in several studies that use functional neuroimaging techniques to assess the neurobiology of pain-related thoughts and emotions.

What initially sparked your interest in working in your field? Briefly describe your career path.
I studied psychology as an undergraduate at Hamilton College and wrote my thesis in the area of sensory psychophysics. I became interested in sensation and perception, and subsequently attended the University of Alabama at Birmingham, completing a PhD in medical psychology and a master's in public health. During my first year as a graduate student, I joined Roger Fillingim's laboratory and found myself captivated by his infectious enthusiasm for studying individual differences in the experience of pain. I had the pleasure of working with Roger (who is extremely generous with his time and data) on studies of gender, ethnic, and age-related differences in pain perception and pain modulation during my graduate student years. After an internship at Rush University, I completed a postdoctoral fellowship in pain psychology at Johns Hopkins under the direction of Jennifer Haythornthwaite, who was equally generous with her time and expertise and who has inspired many of us in the pain community to investigate the contribution of psychosocial processes to pain-related outcomes. To date, I've had the good fortune to be mentored by two of APS's leading pain psychologists, both of whom have been (and continue to be) fantastic mentors and colleagues. Collectively, my research interests have been largely shaped by these influences of Roger and Jennifer; hence, I recommend that any criticism of my work be routed directly to them.

Is there a particular challenge that you've either overcome or hope to address soon?
An important part of APS's mission is to reduce pain-related suffering; it is my hope that our current lines of research can contribute to that goal by identifying individuals at the greatest risk for persistent pain-related suffering and by helping to refine multidisciplinary interventions to reduce that suffering. Decades of data in a variety of settings suggest that multimodal treatments, potentially delivered by teams of individuals with diverse backgrounds, are likely to be the most effective treatments for persistent pain and pain-related sequelae such as suffering. The complete eradication of chronic pain is probably an unreasonable goal, but a significant reduction in pain-related suffering and disability is a challenge that I hope we can address.

How has membership in APS been of value to you and your professional development?
In my opinion, the society does an excellent job of facilitating the careers of young researchers, and I believe that APS membership has been tremendously valuable to my own professional development. In addition to providing exposure to the latest findings in pain research, APS meetings offer the invaluable opportunity to meet some of the leading researchers in the field. For pain psychologists like myself, the opportunity, as a graduate student or postdoctoral, to meet formally and informally with such successful figures as Frank Keefe, Dennis Turk, Judy Turner, and many others was extremely helpful in illuminating potential career paths. In addition, I was the recipient of an APS Future Leaders in Pain Research small grant, which was immensely helpful in providing pilot data that was eventually used to obtain NIH funding for some of our current work.

Reviews

Clinical Hypnosis for Pain Control

Next comes a review of the science behind hypnosis and pain control; this is followed by clinical research on hypnosis as a treatment modality for pain. Several chapters discuss Erickson's approach, which involves managing acute pain and hospital-based pain control. The final chapter covers hypnosis in chronic pain patients. There are numerous examples of scripts for inducing hypnosis in different types of patients. Patterson has played a large role in the development of virtual reality hypnosis for burn patients and this subject is particularly well covered in the text, but throughout the book the author's personal experiences with pain patients serve as the backbone for his strategies and assessments of outcomes. I particularly recommend this book for pain experts who wish to expand their therapeutic strategies to include hypnosis.

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

The Journal of Pain Highlights

The following highlights summarize selected articles from April 2012 (volume 13, number 4).

Predictors of Clinical Pain in Fibromyalgia: Examining the Role of Sleep
Ryan J. Anderson, Christina S. McCrae, Roland Staud, Richard B. Berry, and Michael E. Robinson; University of Florida

Patients coping with the complex pain disorder fibromyalgia often have difficulty sleeping, and a new study published in The Journal of Pain reports that despite negative quality of life implications, poor sleep is not a significant predictor of fibromyalgia pain intensity and duration.

The complexity of the pain disorder is rooted in the variable, patient-to-patient, influence of physical, psychological, social factors that contribute to clinical pain, but their influence often is difficult to understand. Previous research has shown that variables such as negative mood and the number of localized pain areas are significant predictors of clinical pain in fibromyalgia patients.

Many fibromyalgia patients complain about poor sleep, and studies have shown that interrupted sleep experienced by individuals with other pain conditions is predictive of next day clinical pain. Also, sleep duration has been shown to predict clinical pain in healthy adults. For this study, a research team from the University of Florida hypothesized that decreased total sleep time would predict higher clinical pain in a sample of patients with fibromyalgia.

Seventy-four adults with fibromyalgia were recruited for the study and observed for 14 days. Subjects rated their clinical pain every evening and completed sleep diaries describing the previous night’s sleep.

Results of the analysis showed that four sleep measures evaluated in the study failed to significantly predict clinical pain. The authors noted that the effects of impaired sleep, such as fatigue and inactivity, may play more significant roles in clinical pain than measures of sleep duration or insomnia.

Hyperalgesia and Heroin Dependent Patients and the Effects of Opioid Substitution Therapy
Peggy Compton, Catherine P. Canamar, Maureen Hillhouse, and Walter Ling; University of California, Los Angeles

Patients with addiction disorders who take methadone or other opioid medications for pain will experience heightened sensitivity to pain, known as hyperalgesia, and new research published in The Journal of Pain shows that the condition does not improve over the course of treatment.

Managing pain in heroin-abusing patients poses challenges for clinicians because they present for treatment in a hyperalgesic state and maintenance therapy with either methadone or buprenorphine that does not change their pain responses. Opioid medications not only provide rapid pain relief but also induce hyperalgesia, which has been suggested to contribute to opioid tolerance. Previous research has shown that patients taking methadone for heroin addiction are significantly more sensitive to pain than drug-free individuals.

For this study, researchers from UCLA compared the pain responses of treatment seeking, heroin-addicted patients to a non-drug control group using experimental pain stimuli. They sought to determine how hyperalgesia might change as a patient moves from heroin abuse to stabilization and eventually to maintenance of a pain treatment opioid.

Eighty-two heroin-addicted subjects and a drug-free control group participated in the study. Those who were abusing heroin were given either methadone or buprenorphine. The cold pressor test and electrical stimulation were administered to measure pain responses.

Results showed that maintenance therapy with either methadone or buprenorphine for hyperalgesic heroin-dependent individuals did not significantly change or worsen their pain responses. Based on these findings, the authors recommend that clinicians consider the potential impact of opioid-induced hyperalgesia associated with opiate addiction disorders when treating patients who use opiates legitimately or illicitly.

PAIN Highlights

The following highlights summarize selected articles from March 2012 (volume 153, issue 3).

A Systematic Literature Review of 10 Years of Research on Sex/Gender and Experimental Pain Perception—Part 1: Are There Really Differences Between Women and Men?
Mélanie Racine, Yannick Tousignant-Laflamme, Lorie A. Kloda, Dominique Dion, Gilles Dupuis, and Manon Choinière; Université du Québec à Montréal, Université de Montréal, and Montreal Heart Institute

For many years women were commonly excluded from preclinical and clinical studies because of their greater biological complexity. In 1990 the National Institutes of Health introduced a policy requiring that women commonly be part of medical and behavioral research.

The objectives of the present systematic review were to summarize and critically appraise the results of 10 years of research on sex/gender differences in response to experimentally induced pain in healthy humans (employing high-quality methodology) and to synthesize the literature on the role of various biopsychosocial factors that may contribute to sex/gender differences in pain sensitivity.

This review revealed that 10 years of laboratory research have not been successful in producing a clear and consistent pattern of sex differences in human pain sensitivity, even with the use of deep, tonic, long-lasting stimuli that are known to better mimic clinical pain. The retrieved studies suggest that women and men have comparable detection thresholds for cold pain and ischemic pain (IP), although pressure pain thresholds are lower in women. There is strong scientific evidence that women tolerate less pressure and thermal pain (cold and heat) than their male counterparts, but this is not the case for tolerance to IP, which is comparable in both sexes.

These observations contradict the main conclusions of previous review papers that state women have greater pain responsiveness than men for most pain modalities in the laboratory setting.

A Systematic Literature Review of 10 Years of Research on Sex/Gender and Pain Perception—Part 2: Do Biopsychosocial Factors Alter Pain Sensitivity Differently in Women and Men?
Mélanie Racine, Yannick Tousignant-Laflamme, Lorie A. Kloda, Dominique Dion, Gilles Dupuis, and Manon Choinière; Université du Québec à Montréal, Université de Montréal, and Montreal Heart Institute

Between 1998 and 2008, more than 125 laboratory studies examined the role of various biopsychosocial factors in sex/gender differences in experimentally induced pain perception. This article provides a comprehensive, rigorous, and critical summary of this research.

The results presented in this review reveal that the involvement of hormonal and physiological factors contributing to the differences in pain sensitivity between healthy women and men is either inconsistent or absent. Some studies suggest that temporal summation, allodynia, and secondary hyperalgesia may be more pronounced in women than in men. The evidence to support less-efficient endogenous pain inhibitory systems in women is mixed and does not necessarily apply to all pain modalities. With regard to psychological factors, depression may not mediate sex differences in pain perception, while the role of anxiety is ambiguous. Cognitive and social factors appear to partly explain some sex-related differences. Individual history also may influence female pain responses.

This review suggests that pain sensitivity in healthy women and men can be altered by biopsychosocial factors. Although some areas remain understudied in this field of research, there is a need to assess and improve the ecological validity of findings from laboratory studies on healthy subjects, and perhaps a change of paradigm needs to be considered at this point to better understand the factors and mechanisms that influence the experience of women and men with acute or chronic pain.

Clinical Journal of Pain Highlights

The following highlights summarize selected articles from the March/April 2012 issue (volume 28, issue 3).

Thermal Detection and Pain Thresholds but Not Pressure Pain Thresholds Are Correlated With Psychological Factors in Women with Chronic Whiplash-Associated Pain
Mia Wallin, Gunilla Liedberg, Björn Börsbo, and Björn Gerdle; University of Linköping, and University Hospital of Linköping

Whiplash-associated disorders (WAD) have been associated with sensory disturbances such as hypersensitivity or hypoesthesia. Among patients with acute WAD, 40%–50% have neck pain after 1 year. A growing body of evidence has identified pain intensity, clinical findings (i.e., WAD grade), and, to some extent, psychological factors as possible risk factors for WAD chronicity.

The aim of this explorative study of women with chronic WAD and healthy pain-free controls (CON) was to investigate whether differences exist in (1) pain intensity and not direct pain-related symptoms; (2) detection and pain thresholds of thermal stimuli and pressure within, near, and remote to the primary pain area (neck and shoulders); and (3) correlation patterns of quantitative sensory testing and pressure pain threshold (PPT) variables, pain aspects, and psychological variables.

For subjects with WAD, but not CONs, multivariate correlations existed between quantitative sensory testing and PPT variables, habitual pain, and psychological factors. In WAD, habitual pain intensity aspects were the strongest predictors for PPT, and psychological variables were the strongest predictors for cold and heat pain thresholds, whereas both pain intensity and psychological factors were relatively equal in importance as predictors of cold and heat detection thresholds. The relative importance of habitual pain intensity and psychological distress with respect to the investigated detection and pain thresholds differed in WAD. These authors suggest that when interpreting results related to detection and pain thresholds, use of a biopsychosocial model is important.

Adherence to a Community-Based Exercise Program Is a Strong Predictor of Improved Back Pain Status in Older Adults: An Observational Study
Gregory E. Hicks, Francesco Benvenuti, Valentino Fiaschi, Bruna Lombardi, Luciana Segenni, Mary Stuart, Ingrid Pretzer-Aboff, Gensini Gianfranco, and Claudio Macchi; Delaware Rehabilitation Institute, University of Delaware, University of Maryland–Baltimore County, Azienda Unità Sanitaria Locale 11 di Empoli, Azienda Unità Sanitaria Locale 7 di Siena, Azienda Unità Sanitaria Locale 4 di Prato, Azienda Unità Sanitaria Locale 5 di Pisa, University of Florence, and Don Carlo Gnocchi Foundationy

It has been hypothesized that a reduction in physical activity secondary to pain is one of the main reasons for the functional consequences seen among older adults with back pain. This observational cohort study was conducted to identify factors that predict improved pain status among older adults with chronic back pain who participated in the Adaptive Physical Activity (APA) Program.

This study followed 392 older adults (ages 50–88) with chronic back pain who participated in the APA for 12 months. APA was a community-based group exercise program that subjects attended for 1 hour twice weekly in local gyms.

Participation in the APA program was associated with improved back pain status among those who were most adherent to the exercise program. More than 60% of the sample reported improvement in their back pain status at the 12-month follow-up interview. The strongest predictor of improvement was regular participation in the exercise program. This finding is consistent with the concept that regular exercise in patients with chronic back pain can reduce pain, prevent recurrence, and reduce disability. Supervised exercise programs were more effective than nonsupervised programs, perhaps owing to increased adherence. Finally, higher frequency of exercise (at least 20 hours) throughout the course of the intervention were also found to be more effective in improving outcomes.

For participants who attended more than 75% of all exercise sessions for the entire 12-month period, the odds of improved back pain status were increased nearly 14-fold. This finding strongly advocates for the notion that older adults with chronic pain can see improvements in their pain if they are actively engaged in exercise.

In the Media

Opioid Use for Abdominal Pain Sees Recent Spike (Anesthesiology News)

Opioids May Play Role in Cancer Growth (ABC News)

5 Ways to Manage Fibromyalgia (Fox News)

Redheads and Pain: Study Seeks to Confirm a Link (Huffington Post)

Study: Veterans with PTSD Are More Likely to Get Addictive Pain Med Prescriptions (CBS News)

Panel Backs Continued Testing of Pain Drugs (Wall Street Journal)

FDA, IOM Point to Need to Ramp Up Development of Abuse-Resistant and Novel Nonopioid Pain Meds (Genetic Engineering & Biotechnology News)

Call for Submissions

Do you have a topic that is relevant to APS members? 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.