Scientific Meeting

APS Annual Meeting Registration Is Open

Join us for the APS 31st Annual Scientific Meeting in Honolulu, HI, May 16–19. Be sure to register by April 5 to save $100! To register, visit APSScientificMeeting.org.

Aloha from Hawaii Lieutenant Governor

Hawaii Lieutenant Governor Brian Schatz welcomes the APS 31st Annual Scientific Meeting attendees to the island of Hawaii in a special video message. We hope you are able to join us for the meeting. For more information, visit APSScientificMeeting.org.

There's Always Something Exciting and New on Oahu

The island of Oahu, known as the Heart of Hawaii, sets the rhythm of the islands with exciting new improvements, changes, and additions on an ongoing basis. Catch a glimpse of the new and dynamic happenings on Oahu for hotels, restaurants, and must-see activities and entertainment.

Society

APS Elections Close February 20! Vote Now!

The election of the APS Board of Directors will close on Monday, February 20, at 11:59 pm (PT). Voting in the APS annual election is an important and fundamental way to make your voice heard in the society. To vote, visit https://eballot4.votenet.com/
ampainsoc/login.cfm. For the listing of candidates, check out the January issue of APS E-News. Thank you in advance for participating in the 2012 election.

APS Announces Its Annual Award Recipients

Each year APS rewards excellence in the field of pain management and research by presenting awards for career achievement, pain scholarship, education and public service, advocacy on behalf of children, outstanding service to APS, and early career achievements. The following 2012 annual achievement award recipients will receive their prestigious awards in May 2012 at the 31st Annual Scientific Meeting.

New APS SIG: Pain in Sickle Cell Disease

The focus of the new APS Pain in Sickle Cell Disease special interest group (SIG) will be to develop a multidisciplinary community of pain researchers—including basic scientists, clinicians, and other health professionals—to increase the knowledge of pain in sickle cell disease and transform clinical practice and public policy to reduce pain-related suffering in children and adults with this disorder. The SIG is chaired by Carlton Dampier, MD CPI, of Emory University and will hold its first meeting in Honolulu on May 16. For more information, visit the Pain in Sickle Cell Disease page. To join the Sickle Cell SIG, send an e-mail to lists@ampainsoc.org.

Research

NIH Pain Consortium: Centers of Excellence in Pain Education

Altarum Institute and Palladian Partners, an Altarum company, are supporting the National Institutes of Health (NIH) Pain Consortium's trans-NIH effort to create Centers of Excellence in Pain Education (CoEPEs). CoEPEs will develop pain management curriculum resources for healthcare professionals that will advance the assessment, diagnosis, and safe treatment of pain. Case-based scenarios will form the backbone of the curriculum resources.

The purpose of this request for proposals is to fund the creation of CoEPEs. The CoEPEs will act as hubs for the creation, development, evaluation, integration, promotion, and distribution of pain management curriculum resources. Proposals are due March 5. For more information, visit the National Institutes of Health Pain Consortium.

NIH Regional Seminars on Program Funding and Grants Administration

Indianapolis, IN, and Washington, DC

NIH is taking its experts on the road in 2012! How would you like the opportunity to meet and discuss grant issues with nearly 35 U.S Department of Health and Human Services and NIH officials and network with others in your field? This program will provides information about the NIH grants process, including such topics as peer review, grant writing for success, pre-award and post-award issues for administrators and investigators, compliance, how to interact electronically with NIH, and how to map your career with NIH. For more information, visit http://grants.nih.gov/grants/guide/notice-files/NOT-OD-12-040.html.

IASP Call for Applications

IASP has a number of funding opportunities. For complete award information, eligibility requirements, and application instructions, visit the IASP website. Application materials are due March 15.

IASP Research Symposium
This yearly program provides up to a maximum of $50,000 for research symposia on topics of interest to basic scientists and clinical researchers. Submit your application now to be considered for funding for a 2013 symposium.

IASP Collaborative Research Grants
These grants encourage and support collaborative, multidisciplinary research between two or more research groups in different countries. Up to three grants of $15,000 each may be awarded.

IASP Developing Countries Collaborative Research Grants
These grants encourage and support collaborative, multidisciplinary research between laboratories in developed and developing countries working on the same topic. Up to two grants of $15,000 each may be awarded.

IASP Research Grants Funded by the Scan|Design Foundation BY INGER & JENS BRUUN
These grants encourage and support collaborative, multidisciplinary research between two or more research groups located in the five Scandinavian countries (Denmark, Finland, Iceland, Norway, and Sweden) and the United States. Investigators must be based in a Scandinavian country and the United States. Two grants of up to $25,000 each are available for either clinical or basic research projects.

Advocacy

APS Members Among Researchers Appointed to IPRCC

On Monday, February 13, the NIH announced appointments to the Interagency Pain Research Coordinating Committee (IPRCC). The committee was authorized by the Affordable Care Act to identify critical gaps in basic and clinical research on the symptoms, causes, and treatment of pain and will recommend federal research programs in these areas. The focus will be to coordinate pain research activities across the federal government with the goals of stimulating pain research collaboration, fully leveraging the government resources dedicated to supporting pain research, and providing an important avenue for public involvement. The committee will develop a report on scientific advances in the diagnosis, prevention, and treatment of chronic and acute pain.

Committee appointments include representatives of seven federal government organizations that deal with pain research and patient care, biomedical researchers, and representatives from nonprofit public advocacy organizations. APS member researchers appointed to the committee include

• Ronald Dubner, DDS PhD, professor at the University of Maryland School of Dentistry. Dr. Dubner was previously president of APS and remains active as an APS representative to the Pain Care Coalition.
• Carmen R. Green, MD, professor of anesthesiology, obstetrics and gynecology, and health management and policy at the University of Michigan's Schools of Medicine and Public Health. Dr. Green is the chair of the Public Policy Committee.
• Tamara Liller, President of the National Fibromyalgia Partnership.
• Sean Mackey, MD PhD, is chief of the pain management division and associate professor of anesthesiology, neurosciences, and neurology at Stanford University School of Medicine.
• Christine A. Miaskowski, PhD RN, is an American Cancer Society clinical research professor and the associate dean for academic affairs at the University of California, San Francisco School of Nursing. Dr. Miaskowski served as APS president in 2002–2003.

The committee, under the chairmanship of Dr. Story Landis, will hold its first meeting on March 27. For more information, visit the NIH website.

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 new 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 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 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 please contact Veronica Angulo at 312.996.0470 or vangul1@uic.edu. Space is limited to 75 participants.

Members

What initially sparked your interest in working in your field? Briefly describe your career path.
I initially trained in pediatrics and then in pediatric hematology/oncology. In the "dark ages" of the early 1980s, we would use force to hold kids down for their diagnostic and therapeutic procedures. This seemed unacceptably traumatic, so I began to work with a friend and colleague, Neil Schechter, on developing ways to alleviate pain and suffering during these procedures. As pediatricians, we began a small pain management program at the University of Connecticut. I then made the leap and retrained in anesthesiology so that I could dedicate myself in a more focused way to pain management.

What has been a highlight of your work?
I am most proud of the comprehensive pain management services that we have developed at Children's Hospital of Wisconsin and the Medical College of Wisconsin. We transformed our organizations at multiple levels to prioritize and systematically prevent and treat pain in children. Our recent recognition as a Clinical Center of Excellence by APS is certainly one of the moments in my career that I am most proud of.

Is there a particular challenge that you've either overcome or hope to address soon?
The biggest challenge I think we face is that with shrinking healthcare dollars, efforts in "soft" areas like pain management are starting to be impacted by fiscal pruning. Most healthcare organizations do not yet truly recognize the implications of poorly managed pain or that untreated pain can become a chronic pain disease, so I fear that support for various aspects of pain programs will wither.

Who is your role model?
My role model is a nonmedical world leader of the socially engaged Buddhist movement, Thich Nhat Hanh. Through his teachings on peace, global responsibility of the individual, and social consciousness accomplished largely through the practice of mindfulness in everyday life, I have learned to be a better physician, educator, scientist, and family member.

How has membership in APS been of value to you and your professional development?
APS is the champion of pain management, research, and education in the United States. It has offered me countless opportunities to network, learn, and promote pain management as a palpable healthcare priority.

Summaries

Chronic pain patients taking opioid analgesics who are not substance dependent or addicted can frequently experience cravings to take more medication, but this behavior is not associated with pain levels or spikes in pain intensity, according to research reported in The Journal of Pain.

Researchers from Harvard Medical School studied drug craving in 62 pain patients prescribed opioids who were at low or high risk for opioid medication misuse. There is no definitive evidence that craving is indicative of drug addiction, since patients who are not addicted have reported drug cravings.

The purpose of the study was to evaluate self reports of cravings to determine if craving is associated with the desire to take more opioids—preoccupations with the next scheduled dose and mood changes. They also hypothesized that craving reports would be reduced through frequent patient monitoring and motivational counseling.

Patients in the study were seen monthly, completed electronic diaries, were given urine drug tests, and had monthly contact with their physicians.

The results showed that pain patients taking opioids who are not dependent or addicted, according to accepted measurements, do experience drug cravings. Further, levels of craving were only weakly associated with current levels of pain or average pain over 24 hours. The authors concluded that craving is a mental experience distinct from pain itself. Also, the results show that craving is a common experience with opioid therapy and may or may not be related to substance abuse disorders and higher risks for drug misuse.

The authors noted that further studies are needed to determine if craving is a useful indicator for eventual development of drug dependence or addiction, and added that craving could reflect drug withdrawal in between medication doses.

The Association Between Race and Neighborhood Socioeconomic Status in Younger Black and White Adults with Chronic Pain
Carmen R. Green and Tamera Hart-Johnson, University of Michigan Medical School

Although pain intensity normally is the primary characteristic studied in trials for pain therapeutics, a new study published in The Journal of Pain shows that other pain qualities, such as location, timing, and interference with activities, could be associated with specific pain mechanisms and may shed light on potential treatment responses.

As racial and ethnic diversity increases in the United States along with a higher prevalence of chronic pain, there is ongoing debate regarding the impact of race and socioeconomic status (SES) in creating health disparities, especially in pain treatment outcomes. Researchers from the University of Michigan continued their ongoing work in studying racial and ethnic health disparities with publication in The Journal of Pain of the first study to examine the role of race and neighborhood SES in young black and white adults with chronic pain.

The researchers reviewed data from a tertiary care pain center for a sample of 3,730 adults ages 18–49 with chronic pain. They hypothesized there would be significant racial differences in pain-related outcomes, that a substantial portion of the racial differences could be explained by neighborhood SES, and that race and SES play different roles in emotional and physical health and pain outcomes.

Results of the analysis showed that the black patients in the study sample had increased pain, pain-related disability and depression than whites. Also, black race was associated with lower neighborhood SES, however, better neighborhood SES was not protective for young blacks with chronic pain as it was for whites. This, according to the authors, confirms that race plays an important role in pain-related outcomes for young adults.

Back problems are a highly prevalent health condition, with some international studies estimating that up to 70% of people will experience back problems at some stage in their life. Those with the condition have a significantly higher chance of retiring early from the workforce and in greater numbers than for any other condition. This article investigates the influence of early retirement resulting from back problems on the wealth of Australians 45–64 years old.

People who retire from the labor force early because of back problems face long-term financial disadvantages compared with those who are able to remain in full-time employment. Those outside of the labor force will accumulate significantly less wealth by the time they reach the traditional retirement age of 65 and have a corresponding lower annuity income available to them to finance their retirement.

Compared with those who retire early because of conditions such as cardiovascular disease, depression, or other mental health problems, more than twice as many people retire early because of back problems; these people are predicted to have no savings by the time they reach age 65. Retiring early due to back problems will leave those who manage to accumulate some savings with as little as $3,708 for women and $5,038 for men.

The adoption of cost-effective back-problem interventions and practices may contribute to extending labor force participation and help prevent the costs of lower wealth assets associated with early retirement.

Sex-Related Differences of Patient-Controlled Epidural Analgesia for Postoperative Pain
Alexander Schnabel, Daniel M. Poepping, Joachim Gerss, Peter K. Zahn, and Esther M. Pogatzki-Zahn; University Hospital of Muenster and Ruhr University Bochum

Evidence showing that gender is an important factor in pain modulation is increasing; data are rare, however, with regard to perioperative regional analgesia. The aim of this analysis was to assess gender-related differences in pain ratings, analgesic consumption, and adverse events in a large group of patients treated with patient-controlled epidural analgesia (PCEA) after major surgery.

Data from 14,988 adult patients (6,506 women and 8,482 men) receiving a PCEA between January 1998 and December 2009 were examined. Postoperative pain scores during rest and movement were nearly equal between men and women. However, women showed lower total PCEA consumption consistently throughout the 5-day observation period. Total PCEA consumption did not interact with surgical site (abdomen, thorax, extremity) or age but was influenced by body mass index and vomiting.

Subgroup analysis showed that sex difference in patients receiving PCEA is independent of the type of surgery. This is relevant because procedure-specific aspects were recently included in several acute pain guidelines and recommendations. However, the authors showed that age is a factor influencing gender-related differences in postoperative pain ratings. While young men reported comparable or slightly higher mean pain scores compared with women, middle-aged women reported significantly more pain than men throughout the observation period. Middle-age women receiving morphine in the early postoperative period had higher pain scores compared with men. However, in contrast to our results, younger women and men (18–49 years) showed an even larger difference if they received morphine.

Women seem to be at higher risk for insufficient pain relief, presumably because of an (indirect) avoidance of analgesics. A consequence of this research might be introduction of an opioid-free PCEA solution for women at high risk for nausea and vomiting.

Clinical Journal of Pain Highlights

Risk assessment and stratification has become an important aspect of prescribing opioids to patients with chronic pain. Little empirical data are available on the sensitivity and specificity of commonly used risk assessment tools, however. This article describes two studies that compare the prediction capabilities of various risk assessment tools.

The first study presents data on patients at a pain practice whose treatment with opioids was stopped due to their engagement in aberrant drug-related behavior. Patients were assessed with the Screener and Opioid Assessment for Patients with Pain–Revised (SOAPP-R), the Pain Medication Questionnaire, the Opioid Risk Tool, and a clinical interview. A second study compared the risk assessment measures, SOAPP-R, Pain Medication Questionnaire, Opioid Risk Tool, and a clinical interview. Data were gathered on whether patients had engaged in aberrant drug-related behavior at 6-month follow-up.

Significant differences in the measures were found. Accuracy did not appear to be a function of the type of aberrant drug-related behavior patients engaged in for any of the measures. The clinical interview showed the best sensitivity of the four risk measures in predicting risk. The SOAPP-R showed the best sensitivity of the self-report measures.

The data presented here suggest that the written measures may be less accurate, owing to some overall characteristic of the measures. It does not appear there is a specific type of patient or behavior the written measures fail to predict in comparison with the clinical interview, but these measures lag in predicting all types of medication misuse and aberrant behavior.

The field of pain management may not have a single "best" risk assessment measure, but it instead has the "best" risk measures depending on the patient population being assessed, the base rate of opioid misuse in the population, and the resources at hand.

NGX-4010, a Capsaicin 8% Dermal Patch, Administered Alone or in Combination with Systemic Neuropathic Pain Medications, Reduces Pain in Patients with Postherpetic Neuralgia
Gordon A. Irving, Miroslav Backonja, Richard Rauck, Lynn R. Webster, Jeffrey K. Tobias, and Geertrui F. Vanhove; Swedish Pain Center, University of Wisconsin–Madison, The Center for Clinical Research, and Lifetree Clinical Research and Pain Clinic

Analyses of integrated data from four controlled postherpetic neuralgia studies evaluated the effect of NGX-4010, a capsaicin 8% patch, administered alone or together with systemic neuropathic pain medications.

Patients recorded their average pain for the past 24 hours daily for 12 weeks using an 11-point numeric pain rating scale (NPRS). Efficacy assessment included the percentage NPRS score reduction from baseline during weeks 2–8 and 2–12, the proportion of patients responding during weeks 2–8 and 2–12, and the Patient Global Impression of Change at weeks 8 and 12.

A single 60-minute NGX-4010 application significantly reduced NPRS scores versus control regardless of concomitant systemic neuropathic pain medication use. NGX-4010 patients not using systemic neuropathic pain medication reported a greater reduction in mean percentage change from baseline (–36.5%) compared with NGX-4010 patients who were using systemic neuropathic pain medications (–26.1%).

These integrated analyses demonstrate that a single 60-minute application of NGX-4010 can provide pain relief that is maintained for up to 12 weeks in patients with postherpetic neuralgia. Pain scores began declining as early as day 1 after treatment and were significantly lower than control by day 3 after patch application. This reduction continued over the 12-week trial period. Compared with control patients, significantly more patients treated with the NGX-4010 patch had a clinically meaningful reduction in pain (≥ 30% reduction in NPRS score) or felt much or very much improved. These results may suggest that patients already taking systemic neuropathic pain medications have more treatment-resistant pain or that each additional pain medication has an additive but smaller effect than the preceding medication.

In the Media

Young Children Exposed to Anesthesia Multiple Times Show Elevated Rates of ADHD (Mayo Clinic)

Know Concentration Before Giving Acetaminophen to Infants (FDA Consumer Updates)

Alternative Therapies Offer Arthritis Pain Relief (ABC News)

Study: Obese People Are in Pain More Often, Even if They Are Healthy (WebMD)

Why Do Cardiologists Often Pass Up Safe, Low-Tech Treatments for Chest Pain (Washington Post)

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.