Funding Announcements

APS Announces $150,000 Pain Research Grant Program

APS is pleased to announce the launch of its new Sharon S. Keller Chronic Pain Research Grants Program. This grant program is being established to fund research projects that have a high likelihood of leading to new treatments and increased access to or expansion of treatment options for people with chronic pain. The Keller Grant was established by private investor David Keller in memory of his wife who died in 2011 after 25 years of battling cancer, rheumatoid arthritis, chronic musculoskeletal pain, and the side effects of pain medications. Additional contributions to the program have come from more than 35 people who loved and admired Sharon.

The program will award $150,000 up to four 2-year research grants with the purpose of investigating noninvasive interventions with favorable side effect profiles to improve chronic pain management. Projects should be designed to provide novel information regarding treatment efficacy or the mechanisms thereof. Areas of inquiry considered responsive to this grant program include, but are not limited to

• physical treatments for pain (e.g. manual therapy, rehabilitation, brain stimulation)

• psychological treatments for pain (e.g. cognitive-behavioral interventions, neurofeedback)

• complementary and alternative medicine (CAM; e.g. acupuncture, massage therapy)

• coordinated care, including combinations of the above approaches

• community-based interventions and psycho-educational programs that improve access to pain management, especially to underprivileged.

Applications may be submitted online beginning August 15 by visiting https://proposalcentral.altum.com/default.asp?GMID=101 and will be due by 12 am EST on October 15. Eligible applicants must be APS members within 6 years of receiving their doctoral degrees and must not yet have been awarded major National Institutes of Health (NIH) grant or foundation funding. For additional information then please visit www.ampainsoc.org/kellergrant.

Identification and Analysis of Causal Variants: Follow-Up on Genome-Wide Association Studies for Arthritis and Musculoskeletal and Skin Diseases (R21)

This Funding Opportunity Announcement (FOA), issued by the National Institute of Arthritis and Musculoskeletal and Skin Diseases (NIAMS), encourages applicants who aim to characterize the genetic variations in human genomic regions that have been putatively associated with complex diseases relevant to the NIAMS mission and conduct follow-up functional studies of particular genetic variants. The purpose is to accelerate the discovery of causal genes and variants that influence the risk for disease and gain novel insights into the functions of these variants and the mechanisms by which they may contribute to disease. This knowledge will facilitate development of tools for risk prediction and early treatment of disease. The disease-associated regions are primarily those identified by genome-wide association studies (GWAS), although other types of evidence may also inform the rationale for a given study. These studies are expected to be undertaken by a multidisciplinary collaborative effort. This FOA will not support initial discovery GWAS efforts or simple replication of GWAS findings. Awards under this FOA will provide support for personnel, sequencing, genotyping, analyses, and other costs, as justified by the study design. Diseases of interest include, but are not limited to, rheumatoid arthritis, systemic lupus erythematosus, ankylosing spondylitis, gout, scleroderma, juvenile idiopathic arthritis, psoriasis, vitiligo, alopecia areata, osteoporosis, and osteoarthritis. For more information, visit http://grants.nih.gov/grants/guide/pa-files/PAR-12-230.html.

Education

MedScape Pain Learning Center

Through a partnership with MedScape Education, APS is a contributor to the Pain Learning Center, where practitioners interested in managing pain safely and effectively can go for educational programming, interviews with experts, and meeting highlights. Resources such as clinical guidelines, tools, and patient assessment and educational materials are also available.

Submit Your Poster Abstract for the New Orleans Meeting

The Call for Poster Abstracts for the APS 32nd Annual Scientific Meeting in New Orleans, LA, is now available on the APS website. Abstracts can be submitted until 11:59 pm Pacific Time on Monday, November 5.

Please visit the Call for Poster Abstracts page to access the submission requirements and forms.

Members

What is your area of specialty?
I am trained as a pediatric psychologist and a behavioral researcher. My area of specialty includes assessment and management of chronic pain in children and adolescents. I am specifically interested in behavioral interventions, delivery of treatment via the Internet, sleep disturbances, and parent/family factors.

What initially sparked your interest in working in your field? Briefly describe your career path.
I was introduced to the field of pain by working as a research assistant in the University of California, Los Angeles (UCLA) Pediatric Pain Program under Lonnie Zeltzer, MD, and Debbie Fanurik, PhD, while I was a psychology undergraduate student at UCLA. This introduction sparked a lifelong interest in pain in children. I went on to do my doctoral training in clinical pediatric psychology at Case Western Reserve University, where I continued my research pursuits related to pain in children through the pediatric psychology graduate training program led by Denny Drotar, PhD. I finished my PhD focusing in the area of children's postoperative pain and coping. My introduction to pediatric chronic pain came from my clinical psychology training with child and adolescent patients in different hospital settings in Cleveland and Columbus, OH. I was challenged by these youth who were struggling to cope with painful conditions such as sickle cell disease, cancer, abdominal pain, and burn injuries. These clinical experiences informed my research, leading me to ask relevant research questions about psychological treatment of chronic pain. My career has included developing both research and clinical programs in pediatric pain.

What has been a highlight of your work?
I am especially proud of several areas of my National Institutes of Health (NIH)–funded work that have focused on innovations in treatment for youth with chronic pain. It is important I acknowledge that this work stems from the collective energies of a wonderful interdisciplinary pediatric pain research group I lead at Seattle Children's Research Institute. Because of the lack of available resources in many parts of the world to provide specialized pain care to children with chronic pain, there has been an increasingly recognized need to consider alternative modes of delivering interventions to children and their families. We have developed and tested cognitive behavioral interventions delivered online for youth with chronic pain and their parents, and are currently working to extend these developments to interventions to address comorbid sleep problems. Ultimately, we hope to play a major role in transforming access to evidence-based behavioral pain intervention for children and adolescents with chronic pain.

How has membership in APS been of value to you and your professional development?
APS membership has been an important part of my career. I attended my first APS Annual Scientific Meeting as a postdoctoral fellow and appreciated the opportunities to connect with individuals from multiple disciplines to better understand contemporary issues in the field. Since that time, I have served on different committees within APS. I especially enjoyed serving as chair of the Pain in Infants, Children, and Adolescents special interest group, which allowed me to spend more time focused on broader issues and advocacy for children's pain. Perhaps most important to my continued professional development as a pediatric psychologist and pain researcher has been good fortune over the years to be able to spend time with outstanding mentors, collaborators, and students through APS, which has fueled my passion to better understand how to help children and adolescents in pain.

Summaries

The Journal of Pain Highlights

The following highlights summarize selected articles from August 2012 (volume 13, number 8).

Severe Pain in Sexual Assault Survivors Often Not Treated
Samuel A. McLean, April C. Soward, Lauren E. Ballina, Catherine Rossi, Suzanne Rotolo, Rebecca Wheeler, et al.; University of North Carolina TRYUMPH Research Program, University of North Carolina Department of Anesthesiology, University of North Carolina Department of Emergency Medicine, Cone Health System SANE Program, Inova Fairfax Hospital Forensic Assessment and Consultation Team, Sentara Norfolk Hospital Department of Emergency Medicine, et al.

A majority of sexual assault victims experience severe pain in the early aftermath of the crime but less than one-third of these victims receive pain medications, according to research in The Journal of Pain.

One in five U.S. women experiences a sexual assault in her lifetime. Like other physical trauma, severe acute pain occurs in sexual assault cases. When physical trauma is limited, factors such as stress-induced hyperalgesia may contribute to post-assault pain. Researchers from the University of North Carolina evaluated the distribution and severity of pain in sexual assault victims who presented for medical care from sexual assault nurse examiner (SANE) programs. This was the first prospective study of pain symptoms in the early aftermath of sexual assault.

Female sexual assault survivors 18 years and older who sought a SANE evaluation within 48 hours of the crime were recruited for the study. The subjects were questioned about pain intensity in eight body regions and asked to rate pain severity on a 1-to-10 scale.

Results showed that the majority of sexual assault victims experienced severe or moderate pain in the early aftermath of the attacks. In more than half of the women, pain was reported in four or more body regions. Less than one-third of the victims said they were treated with pain medications. The authors concluded that pain in the aftermath of sexual assault not only occurs from physical trauma, but might also be a neurobiological complication caused by stress from the frightening experience.

The authors recommended that acute pain caused by sexual assault should be identified and treated promptly to reduce immediate suffering and to help improve psychological outcomes. Attending clinicians should conduct pain evaluations and treat with nonsteroidal anti-inflammatory drugs or opioid medications. Also, pain education for SANE program nurses and others who provide care to victims should emphasize that pain is common after sexual assault.

Study Shows U.S. Chronic Pain Costs Up to $635 Billion
Darrell J. Gaskin and Patrick Richard; Hopkins Center for Health Disparities Solutions, Johns Hopkins Department of Health Policy and Management, Johns Hopkins University Bloomberg School of Public Health, and Uniformed Services University of the Health Sciences Department of Preventive Medicine and Biometrics

Health economists from Johns Hopkins University writing in The Journal of Pain reported the annual cost of chronic pain is as high as $635 billion a year, more than the annual costs each for cancer, heart disease, and diabetes.

Previous studies have not provided a comprehensive analysis of the impact on healthcare and labor markets associated with people with chronic pain. The Johns Hopkins researchers estimated the annual economic costs of chronic pain in the United States by assessing incremental costs of health care due to pain and the indirect costs of lower productivity resulting from pain. They compared the costs of health care of persons with chronic pain with those who do not report chronic pain.

Data from the 2008 Medical Expenditure Panel Survey was used to gauge the economic burden of pain in the United States. The sample included 20,214 individuals 18 years and older to represent 210.7 million U.S. adults.

The authors defined persons with pain as those who have pain that limits their ability to work, are diagnosed with joint pain or arthritis, or have a disability that limits capacity for work. To measure indirect costs, they used a model to predict healthcare costs of persons with pain and subtracted predicted healthcare costs of people with no pain. The impact of incremental costs of selected pain conditions were calculated for various payers of healthcare services.

Results showed that mean healthcare expenditures for adults were $4,475. Prevalence estimates for pain conditions were 10% for moderate pain, 11% for severe pain, 33% for joint pain, 25% for arthritis, and 12% for functional disability. Persons with moderate pain had healthcare expenditures $4,516 higher than someone with no pain, and individuals with severe pain had costs $3,210 higher than those with moderate pain. Similar differences were found for other pain conditions compared with persons without these conditions: $4,048 higher for joint pain, $5,838 for arthritis, and $9,680 for functional disabilities.

In addition, adults with pain reported missing more days of work than people without pain. Pain also negatively impacted two other components of productivity: number of annual hours worked and hourly wages.

Based on their analysis of the data, the authors determined that the total cost for pain in the United States ranged from $560 billion to $635 billion. Total incremental costs of health care due to pain ranged from $261 billion to $300 billion, and the value of lost productivity ranged from $299 billion to $334 billion. Compared with other major disease conditions, the per-person cost of pain is lower but the total cost is higher.

The authors noted their conclusions are conservative because the analysis did not consider the costs of pain or institutionalized and non-civilian populations, for persons under 18, or for caregivers.

Clinical Journal of Pain Highlights

The following highlights summarize selected articles from the July/August 2012 issue (volume 28, issue 6).

Systematic Review of the Quality and Generalizability of Studies on the Effects of Opioids on Driving and Cognitive/Psychomotor Performance
Angela Mailis-Gagnon, Shehnaz Fatima Lakha, Andrea Furlan, Keith Nicholson, Balaji Yegneswaran, and Rainer Sabatowski; Comprehensive Pain Program Toronto Western Hospital Krembil Neuroscience Center, Institute for Work and Health University of Toronto Division of Physiatry Department of Medicine Toronto Rehabilitation Institute, and Comprehensive Pain Center Carl Gustav Carus University Hospital at Dresden University of Technology

The effects of opioids on driving performance have been much debated. The varied results in the current literature with regard to opioids and driving may be attributable to pain severity, combinations of medications, sleep disturbance and fatigue, comorbid psychiatric and psychological disorders, or other factors. It has been suggested that untreated pain by itself may pose higher risk to cognitive function than opioids, and that driving ability improves once pain is treated. Cognitive/psychomotor functions were assessed using psychological tests, a driving simulator, or an on-road driving test for subjects featured in previous studies.

The objective of this systematic review was to assess the quality of studies and to revisit the question of whether patients who take stable opioids are safe to drive. The authors searched various literature databases, reference lists of retrieved articles, and narrative reviews for studies on patients with chronic cancer and noncancer pain who were taking opioids.

The authors included 35 studies (representing 2,044 patients and 1,994 controls). The amount and dosage of opioids varied largely among studies. Findings suggest that certain patients on pharmacologically stable dosages of opioids are able to drive provided they (a) are not taking coprescriptions or other substances, such as alcohol and illicit drugs, that may exert significant central nervous system effects; (b) do not experience high levels of pain; (c) lack a substantial sleep disorder or daytime somnolence; and (d) do not have significant depression, an anxiety disorder, or other diagnosable psychiatric conditions. Unfortunately, the level of "stable" opioids that may be considered safe for driving remains unknown, as studies comparing cognitive function or driving performance of patients with chronic pain taking moderate versus high doses of opioids do not exist. A word of caution: Systematic reviews such as this study attempt to guide evidence-based medical practice. However, these authors stress that prescribing physicians ultimately must retain and exercise judgment, and that each patient should be considered individually.

Fear-Avoidance Model of Chronic Pain: The Next Generation
Geert Crombez, Christopher Eccleston, Stefaan Van Damme, Johan W. S. Vlaeyen, and Paul Karoly; Ghent University Department of Experimental-Clinical and Health Psychology, University of Leuven Department of Psychology Research Group on Health University of Bath Centre for Pain Research, Maastricht University Department of Clinical Psychological Science, and Arizona State University

The fear-avoidance (FA) model of chronic pain describes the ways in which people who experience acute pain may become trapped in a vicious circle of chronic disability and suffering. Fortunately, a biopsychosocial perspective is emerging that views the origins of pain and suffering as complex and multifactorial. This perspective takes into consideration not only biomedical variables but also psychological and social variables. An important scientific and clinical endeavor is to identify variables that account for the initiation, exacerbation, waning, and maintenance of pain and suffering. The authors proposed to extend the FA model by adopting a motivational perspective on chronic pain and disability.

Three key challenges call for a next generation of the FA model, according to this perspective. First, the current FA model has its roots in psychopathology, and investigators must find a way to account for findings that do not easily fit within such a framework. Second, the FA model does not address the dynamics and complexities of disability and functional recovery. Third, the FA model does not incorporate the idea that pain-related fear and avoidance occur in the context of multiple and often competing personal goals.

To address these three key challenges, the authors believe the next generation of the FA model needs to more explicitly adopt a motivational perspective that is built around the organizing powers of goals and self-regulatory processes. Using this framework, the FA model is recast as capturing the persistent but futile attempts to solve pain-related problems to protect and restore life goals.

PAIN Highlights

The following highlights summarize selected articles from August 2012 (volume 153, issue 8).

Acupuncture as an Adjunctive Therapy to Pharmacological Treatment in Patients with Chronic Pain Due to Osteoarthritis of the Knee: A Three-Armed, Randomized, Placebo-Controlled Trial
Christos I. Mavrommatis, Eriphili Argyra, Athina Vadalouka, and Dimitrios G. Vasilakos; General Hospital of Athens Rheumatology Department, Aretaieion University Hospital of Athens Pain and Palliative Care Center Department of Anaesthesiology, and University Hospital of Thessaloniki Department of Anaesthesiology and Intensive Care

The role of acupuncture in the treatment of osteoarthritis of the knee is controversial, and there are few published studies on this topic. The aim of this study was to analyze the efficacy of acupuncture as adjunctive therapy to pharmacological treatment of knee osteoarthritis for pain relief and stiffness reduction and to improve physical functioning and quality of life.

The efficacy of acupuncture as an adjunctive therapy to pharmacological treatment of chronic knee osteoarthritis pain was studied with a three-armed, single-blinded, randomized, sham-controlled trial. A total of 120 patients with knee osteoarthritis were randomly allocated to three groups: Group I was treated with acupuncture and etoricoxib, Group II with sham acupuncture and etoricoxib, and Group III with etoricoxib only.

Patients with knee osteoarthritis who underwent acupuncture plus pharmacological treatment had significantly better function and less pain after 8 weeks compared with patients subjected to sham acupuncture plus pharmacological treatment or pharmacological treatment alone. The differences between the acupuncture and sham acupuncture or pharmacological groups remained significant during follow up and for 4 weeks after the 8-week treatment period ended.

Analgesic Tolerance Without Demonstrable Opioid-Induced Hyperalgesia: A Double-Blinded, Randomized, Placebo-Controlled Trial of Sustained-Release Morphine for Treatment of Chronic Nonradicular Low-Back Pain
Larry F. Chu, Nicole D'Arcy, Caitlin Brady, Abigail Kathleen Zamora, Chelsea Anne Young, et al.; Stanford University School of Medicine Department of Anesthesia

There is a dearth of high-quality clinical evidence demonstrating analgesic efficacy and the rate of complications associated with chronic opioid use for the treatment of chronic nonradicular low-back pain. Despite its success in acute settings, long-term use of opioid pain medications may be accompanied by waning levels of analgesic response not readily attributable to advancing underlying disease, necessitating dosage escalation to attain pain relief.

Analgesic tolerance and, more recently, opioid-induced hyperalgesia have been invoked to explain such declines in opioid effectiveness over time. Because both phenomena result in inadequate analgesia, they are difficult to distinguish in a clinical setting.

Patients with otherwise uncomplicated low-back pain were titrated to comfort or dose-limiting side effects in a prospective, randomized, double-blinded, placebo-controlled clinical trial using sustained-release morphine or weight-matched placebo capsules for 1 month. A total of 103 patients completed the study, with an average end titration dose of 78 mg morphine/d. After 1 month, the morphine-treated patients developed tolerance to the analgesic effects of remifentanil but did not develop opioid-induced hyperalgesia. On average, these patients experienced a 42% reduction in analgesic potency. The morphine-treated patients experienced clinically relevant improvements in pain relief, as shown by a 44% reduction in average visual analog scale pain levels and a 31% improvement in functional ability. The differences in visual analog scale pain levels (P = 0.003) and self-reported disability (P = 0.03) between both treatment groups were statistically significant. After 1 month of oral morphine therapy, patients with chronic low-back pain developed tolerance but not opioid-induced hyperalgesia. Improvements in pain and functional ability were observed. This study provides evidence for the development of tolerance and absence of opioid-induced hyperalgesia after 1 month of chronic opioid therapy.

Society

Member Benefit: Color JOP Images Printed Free

An excellent reason for APS members to publish in The Journal of Pain, the second-ranked pain journal worldwide, is that necessary color figures appearing in member-authored articles are printed at no cost to the authors. The Journal of Pain publishes original articles related to all aspects of pain and pain management and welcomes submissions from clinical and basic researchers, medical specialists, psychologists, nurses, physical therapists, social workers, and workers in related fields. For more information, please visit www.jpain.org/authorinfo.

In the Media

UTMB Scientist Receives Grant from NINDS to Study Relationship Between Pain and Higher Brain Functions (EurekAlert)

Years in the Making, REMS Approved for Long-Acting, Extended-Release Opioids (Pain Medicine News)

Opiates' Side Effects Rooted in Patients' Genetics (Medical News Today)

OxyContin Trial Planned for Kids (The Wall Street Journal)

Does Palliative Care Belong in the ER? (Reuters Health)

Senate Finance Committee Investigates Rise in Prescription Opioid Abuse (Pain Medicine News)

Florida Pain Patients: Drug Enforcement Has Gone Too Far (WFSU)

Physicians More Cautious About Prescribing Strong Painkillers (Medical News Today)

Women With Vulvodynia At Much Higher Risk For Other Chronic Pain Conditions (Medical News Today)

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.