Society

Your Vote, Your Voice: APS Prepares for the 2012 Election

Thank you to those APS members who submitted nominations and a big thank you to the Nominating Committee for choosing a slate of candidates that best represents the diversity and expertise of the APS membership. The candidates are outstanding and dedicated APS members.

Secretary

Directors-at-Large

Three (3) open positions

Nominating Committee—Past Presidents

Three (3) open positions

Nomination Committee—Members-at-Large

Four (4) open positions

The election will open on January 23 using secure online technology. An e-mail invitation will be sent to all voting members with active e-mail addresses. Those without an e-mail address will receive a letter of invitation via the U.S. Postal Service with instructions on how to access the online ballot. Please take the time to add or update your e-mail address on the APS website, or call an APS member services representative for assistance at 847.375.4715.

Voting in the APS annual election is an important and fundamental way to make your voice heard in the society. Thank you in advance for participating in the 2012 election.

Research

Deadline for Rita Allen Applications Extended

New Deadline: February 1

The call for Rita Allen Foundation (RAF) applications is open. 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 February 1. Please visit the APS website for more information about the award and to apply.

NIH Pain Consortium: Centers of Excellence in Pain Education

Altarum Institute and Palladian Partners, an Altarum company, are under a multiyear contract to support 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 Centers of Excellence in Pain Education. CoEPEs will act as hubs for the creation, development, evaluation, integration, promotion, and distribution of pain management curriculum resources and will be leaders for change in the pain management education of health professionals nationwide. Proposals for this research opportunity are due March 5. Visit the Altarum Institute to apply and find additional information on the NIH-CoEPEs website.

Funding Opportunity

National Institute of Arthritis and Musculoskeletal and Skin Diseases (NIAMS) call for applications to establish Multidisciplinary Clinical Research Centers (P60)

The National Institute of Arthritis and Musculoskeletal and Skin Diseases (NIAMS), National Institutes of Health, invites new and renewal applications for Multidisciplinary Clinical Research Centers (MCRCs) in arthritis, musculoskeletal disorders, and/or skin diseases. Each MCRC will be organized around a methodology core. In addition to this core, each center must include a minimum of two highly meritorious clinical projects focused on diseases or conditions within the NIAMS mission. For more information, visit the NIH website.

Scientific Meeting

Top 10 Reasons to Register for the APS meeting in Honolulu

10. If you register by April 5, you save $100 on your conference registration fees. If you register in the month of January, you will be entered into a raffle to win a Hawaiian-themed gift basket and other Hawaii items.
9. 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.
8. There will be the largest number of poster presenters in the past 8 years. More than 400 selected posters will present the best innovations and research in the study and treatment of pain.
7. Any time of year is a good time to visit Oahu. The average temperature is between 75˚F and 85˚F. Did you know Oahu has more than 125 beaches?
6. Attend a special session discussing the relevance of the IOM report, Transforming Pain in America, and the role of APS.
5. Based on past attendee feedback, there will be additional special interest group meeting times offered on Wednesday, May 16, to make it possible to attend more SIG meetings. Visit the meeting site to view the full schedule.
4. Celebrate the APS meeting in beautiful Honolulu with a Hawaiian-themed welcome reception on Wednesday evening in the exhibit hall.
3. Celebrate the 2012 award winners APS recognizes for excellence in the field of pain medicine.
2. Learn about the 2012 Clinical Centers of Excellence in Pain Management Awards recipients.
1. Waikiki is a vibrant center of activity, a destination that showcases the spirit of Aloha to the world. After the meeting sessions have ended for the day, you can 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 nightlife of Waikiki.

Education

Apply for a Young Investigator Travel Award

YI Travel Awards Available for Honolulu

APS is once again inviting young investigators to apply for travel support through the Young Investigator Travel Award Program. Applications are due by January 20 and should be submitted online. Please visit Young Investigators to access more information about the program and download an application.

Documentary Project Confronts Global
Untreated Pain Problem

LIFE Before Death is a documentary project—supported in part by the Mayday Fund and the IASP—comprising a feature film, a 1-hour television program, and 50 short films about the global crisis in untreated pain and the dramatic life changing affect palliative care services can deliver to patients and their families around the world.

Members

Member Spotlight

What is your area of specialty?
I am board certified in pediatric hematology/oncology. My clinical practice and research has largely focused on children, adolescents, and young adults with sickle cell disease.

What initially sparked your interest in working in your field? Briefly describe your career path.
During my fellowship, I began to provide end-of-life care to pediatric oncology patients at a time when survival rates were much lower than they are now. Beginning to practice in an urban medical center with a large African-American community, it became clear that the sickle cell population also had a tremendous need for appropriate symptom management, especially for acute pain. After completing my fellowship, I had an opportunity to join a large NIH-funded multisite natural history study of sickle cell disease. This started me on a career path of clinical research in this disorder which I continue to this day.

What has been a highlight of your work?
My research has focused on patient-reported outcomes, and was the first to describe validation of pain questionnaires in children with sickle cell pain, and to describe the much larger burden of pain cared for in the home setting rather than in the hospital as traditionally viewed.

Is there a particular challenge that you've either overcome or hope to address soon?
I hope to develop multisite collaborative studies to characterize chronic pain in this disorder, which has become a major clinical problem.

How has membership in APS been of value to you and your professional development?
I joined APS early in my research career and the information and networking from my involvement with APS has been instrumental in the conduct of my research. I see the recent creation of a Special Interest Group within APS for Sickle Cell Disease Pain that I will chair as the opportunity to bring our hematology and pain communities together to share their respective expertise and hopefully accelerate the pace of research and improve the treatment of pain in this complex disorder.

Summaries

Women aged 50 and older who experience worsening pain as they get older also have elevated risk for depression, obesity, and declining physical function, according to research reported in The Journal of Pain.

Persistent pain complaints are common among women at midlife or older, according to published studies that have shown pain prevalence in this population is as high as 70%. Researchers from the Fred Hutchinson Cancer Center in Seattle, WA, sought to identify the psychosocial, demographic, and clinical factors that can predict changes in pain and functioning among postmenopausal women with recurrent pain conditions.

Data was examined from the Women's Health Initiative Observational Study Cohort, a national study that followed more than 93,000 women aged 50–79 for up to 12 years. Of the women enrolled in the national study, some 68,000 met the criteria for recurrent pain.

The researchers found that recurrent pain was reported by 75% of the study participants and 40% said their pain was worse after 3 years compared with baseline levels. Also, women taking opioid pain medications were more likely to report lack of improvement in pain relief and worsened physical functioning after 3 years. With regard to depression, a positive screen for depression at baseline was associated with worsening pain at year 3.

In summary, several conditions were found to be associated with worsening pain and physical function over the 3-year period, including elevated body mass index reflecting excess weight and obesity, depression, and higher medical comorbidities. The authors concluded their findings support prior recommendations advising doctors to screen and treat for depression in women with recurrent pain conditions and to pay close attention to weight management. In addition, clinicians should be aware that pain patients with declining physical function are at risk for worsening pain over time.

Sensory Pain Qualities in Neuropathic Pain
Sean Mackey, Ian Carroll, Birol Emir, T. Kevin Murphy, Ed Whalen, and Levent Dumenci; Stanford University, Pfizer Global Pharmaceuticals, and Virginia Commonwealth University

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.

Stanford University researchers studied some 2,500 patients with diabetic peripheral neuropathy (DPN) and postherpetic neuralgia (PHN). They were divided into two groups: one treated with pregabalin and the other with placebo. The intent of the study was to measure the association of different pain sensations with pain mechanisms. They assumed that improved understanding of this relationship can advance knowledge of the causes of different pain conditions and help physicians determine their treatment options.

In a previous study of 71 patients, the team used a two-factor model of neuropathic pain in which the first factor was stabbing pain and the second was heavy, gnawing, and aching pain. Patients with high levels of heavy pain had significantly greater reduction in pain intensity from intravenous lidocaine.

Results of the large cohort study confirmed that the sensory pain qualities of individuals with neuropathic pain conditions, DPN and PHN, exhibit a two-factor model of pain—stabbing pain and heavy pain. The authors concluded these pain descriptors might allow clinicians to better differentiate related neuropathic pain conditions and help guide physicians toward the most effective therapies.

PAIN Highlights

The following highlights summarize selected articles from December 2011 (volume 152, issue 12).

Within rural populations, the debilitating nature of chronic pain is amplified by structural barriers such as fewer economic resources, geographical isolation, and reduced access to quality medical care. The demographic makeup of some rural populations (low socioeconomic status [SES] and low literacy) corresponds with elevated risk for poor pain-related outcomes.

Cognitive behavioral therapies (CBT) are efficacious for an array of chronic pain conditions. However, the literature is based primarily on urban (white) samples. This study's authors conducted a randomized controlled trial within a low-SES, rural chronic pain population in Alabama, examining the feasibility, tolerability, acceptability, and efficacy of group CBT compared with a group education intervention (EDU). They hypothesized that although both interventions would elicit short- and long-term improvement across pain-related outcomes, the cognitively focused CBT protocol would uniquely influence pain catastrophizing.

Results indicated significantly more dropouts occurred in CBT. Intention-to-treat analyses showed that participants in both conditions reported significant improvement across pain-related outcomes, and a nonsignificant trend was found for depressed mood to improve more with CBT than with EDU. CBT produced greater gains on cognitive and effect variables than EDU. Treatment gains were maintained at 6-month follow-up.

This community-based randomized controlled trial found that adapted, culturally sensitive psychosocial interventions for chronic pain represent viable treatment options within underserved, low-SES, minority chronic pain populations. Although both the CBT and EDU approach were associated with short- and long-term improvements on pain-related outcomes, the cognitively focused CBT protocol resulted in unique cognitive and effective changes. Still, a higher dropout rate occurred in CBT, suggesting further adaptations may be necessary to reduce the cognitive load of the treatment protocol.

Social Information Processing in Adolescents with Chronic Pain: My Friends Don't Really Understand Me
Paula A. Forgeron, Patrick McGrath, Bonnie Stevens, Joan Evans, Bruce Dick, Allen Finley, and Torie Carlson; Dalhouise University, IWK Health Centre, University of Toronto/Hospital for Sick Children, University of Alberta/Alberta Children's Hospital, and University of Calgary/Alberta Children's Hospital

Adolescents with chronic pain are at risk for impairment in their friendships. They miss out on leisure activities, have increased school absence, may have fewer friends, are at an increased risk for victimization, and may be perceived by peers as less likeable. To help determine the source of these problems, the Social Information Processing (SIP) Model was adapted using narrative vignettes to determine if adolescents with chronic pain interpret friendship interactions differently in terms of supportive and nonsupportive behaviors compared to healthy peers.

Among the 107 participating adolescents, all had daily pain and 45 subjects were included in the chronic pain group. Participants with chronic pain rated nonsupportive vignettes more negatively than healthy controls and indicated they would enact supportive behaviors toward the chronic pain character more often if they were the healthy character. Chronic pain explained 6.5% of variance in ratings of nonsupportive vignettes and 10.1% of the variance in supportive behavior selections.

Chronic pain was significantly associated with ratings on both intent and outcome attributions of nonsupportive vignettes. Participants with chronic pain rated behaviors of the healthy friend in nonsupportive vignettes as more negative than controls. When adolescents with chronic pain are faced with a potentially nonsupportive social situation, they may appraise these situations quickly due to stored memories of other nonsupportive reactions.

Differences in social information processing exist between adolescents with chronic pain and healthy peers. This study sheds light on some of the SIP steps associated with these differences and the broad types of social situations in which these differences may occur. Strategies are needed that will help adolescents with chronic pain take control in social situations so they feel supported by close friends.

Financial relationships among the biomedical industries, physicians, and professional medical associations (PMAs) can be professional, ethical, and mutually beneficial and can lead to improved medical care. However, such relationships present conflicts of interest (COIs). One of the greatest concerns regarding COI is continuing medical education (CME) because industry funds 40%–60% of CME. COIs have the potential to bias physicians, educators, and PMA leaders. These conflicts lead to potential CME bias that can influence physicians' practice patterns and patient care.

Physicians generally are aware of the potential for bias when industry contributes funding for CME, but they often cannot detect the bias. Most physicians believe they can resist the influence of their conflicts, but compelling research has demonstrated otherwise.

Two methods can manage COI: divestment and disclosure. A divestment strategy calls for a physician to be completely free of financial relationships with industry. This author contends that some PMAs may need to increase dues to cover their operating costs. He or she writes that educators should be free of all ties to industry and PMAs should refrain from selling rights to market (except perhaps for exhibit halls and journal ads). Examples are cited that demonstrate such an approach is possible while allowing PMAs to continue to fund their missions.

Patient-Controlled Intrathecal Analgesia for the Management of Breakthrough Cancer Pain: A Retrospective Review and Commentary
Shane E. Brogan and Natalie Winter; University of Utah

In recent years the pain community has increasingly recognized breakthrough pain as an important clinical challenge that negatively influences quality of life. Intrathecal therapy (ITT) via an implanted pump has become an accepted practice for the treatment of refractory cancer pain by allowing the infusion of opioids and adjuncts directly to the neuraxis. Until recently, breakthrough pain required ongoing use of oral or transmucosal opioids. An implanted pump manufacturer has introduced a handheld device to bolus additional medication for breakthrough pain. This review article's authors hypothesized that patient-controlled intrathecal analgesia (PCIA) for the treatment of breakthrough cancer pain would reduce the need for breakthrough opioids and improve patient perception of pain.

After initiation of ITT with PCIA, 50% of patients had discontinued all nonintrathecal opioids at follow-up, and 46% of the patients on breakthrough medications no longer required their use. At follow-up there was a significant reduction in total nonintrathecal opioid use. There also was a significant difference between mean numerical rating scores (NRS) for pain at follow-up—6.5 versus 3.1 pre-ITT (P < 0.001). Among patients, 65% reported their pain as severe (NRS of 7 or higher) before receiving ITT; this decreased to 3% at follow-up. Before ITT, 13% reported mild pain; this increased to 60% at follow-up.

This data has the potential to encourage best-practices dialogue among physicians who manage cancer pain via the intrathecal route.

In the Media

Chronic Pain in Kids (Fox News—video)

State: Few Doctors Monitor Drug Database (Newsday)

Neck Pain? Skip the Pills, Just Stretch Like a Chicken (Wall Street Journal)

Recalled Excedrin May Contain Powerful Pain Killers (The Washington Post—video)

Senator Warns FDA on Danger of Newest Painkillers (ABC News/AP)

FDA Issues Public Health Advisory on Certain Pain Meds (Medscape—requires free log in)

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.