Education

2013 Call for Symposia Closes July 11

APS 32nd Annual Scientific Meeting
May 8–11, 2013
New Orleans, LA

Submit your proposals now for Symposia presentations at the 2013 Annual Scientific Meeting. The submission deadline is July 11.

APS will hold its 32nd Annual Scientific Meeting May 8–11, 2013, in New Orleans, LA. The APS Scientific Program Committee invites the submission of proposals for symposia for presentation during the New Orleans meeting. Symposia sessions are 90 minutes long and consist of a moderator and up to three (3) additional presenters; only one of the presenters can be a non-member of APS. Visit the APS website for a full listing of submission instructions and a list of suggested topics. Don’t miss your opportunity to present new trends, techniques, and therapies in pain research and treatment at next year’s annual meeting.

Mayday Pain and Society Fellowship Deadline Extended to July 2

The Mayday Fund, a New York City foundation dedicated to alleviating the incidence, degree, and consequence of human physical pain, announced that it will extend the deadline for the 2012 Mayday Pain and Society Fellowship: A Media and Policy Initiative to Monday, July 2. The program is designed to equip physicians, nurses, pharmacists, social workers, scientists, policy experts, and legal scholars in pain management with the necessary skills to become effective advocates and spokespeople about pain issues in the United States and Canada.

Developing their communications skills through the Fellowship, the six experts chosen will be poised to move the field forward with their willingness to educate and work with the media, policy makers, advocates, and health and business leaders. Six Fellows are chosen each year, and the Fellowship program runs through March 2013.

Candidates must be accomplished experts, clinicians, or researchers in pain management and be able and willing to devote a significant amount of time to using the skills learned in the Fellowship. They must show an interest in going beyond their professional pursuits to inspire change and make an impact on the pain field. Those interested can apply online at www.MaydayFellows.org.

Research

APS and RAF Announce Scholars in Pain Recipients

APS joins the Rita Allen Foundation (RAF) in recognizing the organizations' collaborative 2012 Scholars in Pain program awardees:

Sarah Ross, PhD
University of Pittsburgh School of Medicine
"Investigating the Neural Circuits of Itch and Pain"

Michael Jankowski, PhD
Cincinnati Children's Hospital Medical Center
"Molecular Mechanisms of Musculoskeletal Pain after Ischemic Tissue Injury"

APS and RAF work together in promoting the scholarship, judging applications, and selecting recipients. Recipients of the award present their final outcomes following the end of their scholarship at a symposia, paper, or poster session at an APS Annual ScientificMeeting.

Candidates for the Rita Allen Award in Pain have completed their training and provided persuasive evidence of distinguished achievement or extraordinary promise in basic science research in pain. Preferred candidates are in the early stages of their careers of appointment at a fully independent faculty level.

The Rita Allen Foundation was established in 1953 and sponsors a Scholars Program that has supported more than 90 scholars over the past 30 years, many of whom have made important advances in medical research. For more information about RAF, please visit www.ampainsoc.org/awards/rita_allen.htm.

APS Announces 2012 Future Leaders in Pain Research Grants Program

The call for applications for the 2012 Future Leaders in Pain Research Grants Program is now open. This year APS will again award at least two grants in the amount of $20,000 each to those research proposals demonstrating the greatest merit and potential for success. This grant program was established to fund research projects of doctorally prepared investigators who have not yet attained NIH RO1 level funding. The program's intent is to encourage research in pain that will add to the body of knowledge, and to allow investigators to develop pilot data that will aid them in securing additional major grant funding. Applications may now be submitted online and will be due by Midnight on July 16.

For more information regarding deadlines, eligibility, topics, and more, please visit Future Leaders in Pain Research Grants on the APS website.

Register for the 2nd ACTTION Scientific Workshop

The agenda and registration information for the 2nd Scientific Workshop of the Analgesic Clinical Trial Translations, Innovations, and Opportunities (ACTTION) public-private partnership are now available on the ACTTION website. The workshop will be held October 24–26 at the U.S. Food and Drug Administration (FDA) White Oak campus in Silver Spring, MD. The theme of the conference is “Preclinical and Clinical Models and Methods for Accelerating Analgesic Drug Discovery and Development” and keynote presentations will be delivered by Drs. Bob Rappaport (FDA), Janet Woodcock (FDA), and Clifford Woolf (Harvard University).

APS has played a key role in the ACTTION partnership and is represented by Allan Basbaum, PhD, a Cochair of its Executive Committee. The following individuals are serving as members of the Scientific Workshop Steering Committee: Ralf Baron, Dr med (University of Kiel, Germany), Allan Basbaum, PhD (University of California San Francisco), Robert Dworkin, PhD (University of Rochester), Allison Lin, PhD PharmD (FDA), Frank Porreca, PhD (University of Arizona), Bob Rappaport, MD (FDA), Dennis Turk, PhD (University of Washington), and Clifford Woolf, MD PhD (Harvard University).

Register for the NIH Regional Seminar on Program Funding

It is down to the final weeks to register for the NIH Regional Seminar on Program Funding and Grants Administration in Washington, DC, June 20–22.

Only weeks remain before the final 2012 NIH Regional Seminar on Program Funding and Grants Administration takes place in Washington, DC. This is your opportunity to meet and discuss grant issues with NIH policy officers, grants management, review and program officials, and NIH senior leadership—all in a central location!

For more information, visit http://grants.nih.gov/grants/guide/notice-files/NOT-OD-12-109.html.

Vulvodynia Pre-Application Technical Assistance Webinar Available

The NIH would like to announce the availability of a previously recorded webinar that is intended for individuals planning to submit applications in response to a series of funding opportunity announcements entitled, "Vulvodynia—Systematic, Epidemiologic, Etiologic or Therapeutic Studies" [PAR-10-190 (R01), PAR-10-191 (R03) and PAR-10-192 (R21)]. Access this webinar at https://webmeeting.nih.gov/p12267747/. For more information, visit the NIH website at http://grants.nih.gov/grants/guide/notice-files/NOT-HD-12-019.html.

Society

APS CPG Committee Seeks Interested Volunteers—Deadline Extended

APS members rate the clinical practice guidelines (CPG) program among the five most important initiatives the society supports. The evidence-based guidelines that APS has produced are recognized for their high quality and wide dissemination to specialists and primary care clinicians, payers, and policy makers. The society has developed six guidelines to date, covering cancer, arthritis, low back pain, fibromyalgia, sickle cell, and use of opioids for chronic pain. New guidelines are in development for acute postoperative pain and methadone safety.

The CPG Committee is the liaison between the board and the guidelines program. The committee provides oversight of policies, methodologies, and ethical standards for guideline development; advises the director of the guidelines program; proposes topics for guideline development; recommends panel chairs and members; assesses guideline impact; and seeks funding opportunities.

The committee conducts its work by conference call and at an annual committee meeting held in conjunction with the APS Annual Scientific Meeting. At this time, the committee would like to expand and diversify its membership, hoping to add members from pharmacology, psychology/psychiatry, and surgery, among others.

Interested volunteers should submit a curriculum vitae and a letter of interest to Cynthia Porter by June 30, 2012.

Scientific Meeting

A Successful APS Meeting in Honolulu

APS enjoyed a successful scientific meeting in Honolulu, HI, May 16–19. The APS 2012 achievement awards and the Clinical Centers of Excellence in Pain Management awards were presented at the President's Reception. Conference attendance totaled more than 1,300 with attendees and exhibitors this year. The meeting offered 1 keynote address, 3 plenary lectures, 2 award lectures, 1 Global Year Against Pain lecture, 1 special session on the IOM report, 28 symposia, 3 workshops, and nearly 400 poster presentations giving attendees a wide variety of educational opportunities.

Attendees took in plenary lectures from various APS award winners on a range of important pain-related topics. Daniel Carr, MD, presented "Evolving Models of Health Care Delivery" to attendees in the keynote address. A plenary lecture entitled "The Body in Mind—Disruption and Treatment of Cortical Body Maps in People with Chronic Pain" presented by G. Lorimer Moseley, PhD, focused on the brain's mapping of the body and its physical and psychological integrity. David Dodick, MD, presented the Global Year Against Pain lecture on "Migraine: Pathophysiology and Emerging Therapies" on the last day of the meeting.

Members

What is your area of specialty?
I am trained as a physical therapist and a neuroscientist. My area of specialty and research is in musculoskeletal pain mechanisms and effectiveness of nonpharmacological treatments for musculoskeletal pain.

What initially sparked your interest in working in your field? Briefly describe your career path.
After graduating from college and practicing as a physical therapist, it became clear that gaining a better understanding of chronic musculoskeletal pain could only enhance therapy. I therefore went back to get a PhD in anatomy and neuroscience at the University of Texas in Galveston working with Drs. Karin High and Bill Willis. The excitement and passion they brought to their work inspired me to continue to build a research career focusing on blending the neuroscience of pain with physical therapy pain management. My patients with chronic pain have always served as an inspiration to better understand the underlying mechanisms of chronic pain conditions with a hope that we can improve their outcome.

What has been a highlight of your work? Perhaps you and your staff are proud of a certain project or accomplishment.
Our laboratory and research team has had many accomplishments over the years. We are most proud of our ability to translate clinical problems into the basic science laboratory where we have developed animal models to study chronic muscle pain, exercise-induced pain, exercise-induced analgesia, and TENS-induced analgesia. Using the findings from animal models we have been able to translate findings examining mechanisms and efficacy of nonpharmacological treatments in chronic pain populations.

Is there a particular challenge that you've either overcome or hope to address soon?
Although we have made significant progress in understanding the mechanisms of acute and chronic pain, there is still a significant mystery involving the underlying neurobiology of the transition from an acute pain condition to a chronic pain condition. My laboratory is actively pursuing the underlying mechanisms for why a small percentage of people with acute pain develop chronic debilitating pain.

Who is your favorite role model—and why?
So many people have served as role models for my professional career over the years. During my PhD and postdoctoral years both Karin High and Bill Willis were excellent mentors. They taught me to always ask questions and think outside the box. Dr. Jerry Gebhart served as a mentor early in my career when I began my first faculty position. His commitment to the APS and IASP inspired me to become more actively involved in these organizations. Lastly, my father taught me that there was nothing I couldn't do and to always learn everything you can about your profession even if it was not directly related to your immediate work.

How has membership in APS been of value to you and your professional development?
Early in my career I was given the opportunity to present my research and organize symposia. Since then I have had the opportunity to serve on the board and numerous committees within the society. Membership in the APS has allowed me to meet colleagues not only in the neurosciences but in many disciplines. These interactions have been invaluable to building a knowledge base and expanding my research focus. I have been a member since I was a graduate student and have made incredible friends within APS.

Review

Atlas of Image-Guided Intervention

Rathmell, J.P. Atlas of Image-Guided Intervention, 2nd Edition. Philadelphia, Lippincott, Williams and Wilkins, 2012. Hardcover, 210 pages. ISBN 978-1-60831-704-2. $147.50

Published 7 years after the first edition, this beautiful volume continues the tradition of excellence established in Rathmell's earlier work. The illustrations are superb, the quality of printing and binding superior, and the narrative content carefully edited. The selection of procedures is, as the author indicates, arbitrary and based upon what he most often performs. Like most good cook books, the directions for performing the procedure are clear, but the outcomes in terms of patient relief of symptoms are not discussed. In some chapters there is a brief reference to the evidence-based outcomes as reported in standard guidelines. This is a good source for those just learning how to do interventional pain management; there are some references in each chapter, but they are by no means definitive. There are many competitive atlases for interventional pain management; some have a broader scope and more information about each intervention, some have less. This volume is a good resource for the neophyte.

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 June 2012 (volume 13, number 6).

Study Shows Physiological Markers for Neonate Pain
Laurel Slater, Yayesh Asmerom, Danilo S. Boskovic, Khaled Bahjri, Megan S. Plank, Katherine R. Angeles, et al; Loma Linda University School of Medicine

There was a time when a belief was widely held that premature neonates did not perceive pain. That assumption, of course, has long been refuted. However, the assessment of neonate pain continues to be a challenge. Current measurements tend to rely on inexact behavioral markers, such as alertness and ability to react expressively to pain sensations. Researchers at Loma Linda University, however, reported in The Journal of Pain that there is a significant relationship between procedural pain and detectable oxidative stress in neonates.

An approach involving measurement of systemic biochemical reactions to pain offers the benefit of providing an objective method for measuring pain in premature neonates. Exposure to painful procedures often results in reductions in oxygen saturations and tachycardia, but few studies have quantified the effects of increased pain oxygen consumption. No studies have examined the relationship between pain scores that reflect behavioral and physiological markers of pain and plasma markers of ATP utilization and oxidative stress. In this study, 80 preterm neonates were evaluated. In about half, tape was taken off the skin following removal of catheters, and they were evaluated for oxidative stress by measuring uric acid and malondialdehyde (MDA) concentration in plasma before and after the procedure. These subjects were compared with a control group not experiencing tape removal. Pain scores were assessed using the Premature Infant Pain Profile.

The data showed there was a significant relationship between procedural pain and MDA, which is a well-accepted marker of oxidative stress. There were increases in MDA in preterm neonates exposed to the single painful procedure and not in the control group. Since premature neonates undergo several painful procedures a day, the researchers concluded that if exposure to multiple painful procedures is shown to contribute to oxidative stress, biochemical markers might be useful in evaluating mechanism-based interventions that could decrease adverse effects of painful procedures.

Non-Evoked, Ongoing Pain Revealed in Mice with Tissue or Nerve Injury
Ying He, Xuebi Tian, Xiaoyu Hu, Frank Porrecam, and Zaijie Jim Wang; University of Illinois and University of Arizona Health Science Center

Scientists from the University of Illinois and the University of Arizona Health Science Center reported in The Journal of Pain that mice experience non-evoked ongoing pain following tissue or nerve injury. The study tested the hypothesis that negative reinforcement can be used to unmask the presence of pain in injured mice. Specifically, the researchers determined whether spinal administration of drugs that do not produce conditioned place preference (CPP) in naïve mice would do so in injured mice.

Drugs selected for the study were clonidine, lidocaine, and adenosine, which do not produce rewarding properties in naïve mice, but produce robust CPP in those with ongoing tissue injury. As expected, the drugs given spinally blocked evoked hypersensitivity in the injured mice. The data showed that injured mice do experience non-evoked ongoing pain and relief is achieved through rewards from negative reinforcement.

The conclusions are consistent with the human experience that pain is aversive and produces strong motivational desire to seek relief. These findings could help facilitate discovery of analgesic drugs for spontaneous or ongoing pain in patients with chronic pain conditions.

PAIN Highlights

The following highlights summarize selected articles from May 2012 (volume 153, issue 5).

Warmth is Analgesic in Healthy Newborns
Larry Gray, Colleen W. Lang, and Stephen W. Porges; University of Chicago Comer Children's Hospital and University of Illinois at Chicago

Healthy normal newborns experience pain as part of routine newborn care. This pain occurs in response to invasive procedures such as blood sampling, vaccinations, vitamin K injections, or circumcision. Preventing pain in newborns is increasingly viewed as a professional imperative and an ethical expectation. Untreated pain has detrimental consequences including increased pain sensitivity in later childhood.

The purpose of this study was to explore the analgesic properties of applied warmth compared to the currently used analgesic techniques of sucrose taste and suckling (pacifier). The authors hypothesized that external warmth would protect infants against minor procedural pain. The authors compared infants receiving radiant warmth (experimental group) during a painful hepatitis B vaccination to those receiving either sucrose taste or pacifier suckling.

Warmer infants cried significantly less than sucrose taste or pacifier-suckling infants after vaccination. Heart rate patterns reflected this analgesia.

Providing natural warmth to newborn infants during a painful procedure decreases the crying and grimacing that accompany the pain of a vaccination. Infant warmers are universally available in hospitals, so this warming treatment is natural, easy, and performed more effectively than the currently used analgesic treatments of sucrose taste or pacifier suckling.

More Educated Emergency Department Patients Are Less Likely to Receive Opioids for Acute Pain
Timothy F. Platts-Mills, Katie M. Hunold, Andrey V. Bortsov, April C. Soward, David A. Peak, Jeffrey S. Jones, et al.; University of North Carolina, Massachusetts General Hospital, Spectrum Health—Butterworth Campus, William Beaumont Hospital, North Shore University Hospital, St. Joseph Mercy Hospital, University of Florida, and Baystate Medical Center

Little has been known about the characteristics that differentiate patients in pain who receive opioids from those who do not receive these drugs. The emergency department (ED) may be a particularly useful venue in which to examine the influence of socioeconomic characteristics on patient health outcomes because patients and physicians usually are meeting for the first time.

The purpose of this study was to examine the effect of patient education and income on ED opioid prescribing using data obtained from a large prospective study of European Americans presenting to the ED after a minor motor vehicle collision. Patient education and income were obtained via patient self-report during the research interview. Patient pain severity was assessed using a 0-to-10 verbal numerical rating scale.

In this observational study, patients with the highest educational attainment were much less likely to receive opioids than patients with the lowest educational attainment. Even after adjusting for age, sex, income, and pain severity, patients with the highest educational attainment were three times less likely to receive opioids than patients with the lowest education attainment. Patients with higher educational attainment had lower pain severity, appeared less distressed, and reported less sense of life threat than patients with lower educational attainment.

These results suggest that patient educational attainment has a stronger influence on ED opioid prescribing than does patient income. Educational attainment may also have more influence than income on factors such as patient understanding of their condition and self-efficacy regarding recovery. Further studies are needed to replicate this association in other common pain conditions for which ED patients seek care.

Clinical Journal of Pain Highlights

The following highlights summarize selected articles from the June 2012 issue (volume 28, issue 5).

A Multi-Institutional Study Analyzing Effect of Prophylactic Medication for Prevention of Opioid-Induced Gastrointestinal Dysfunction
Masashi Ishihara, Hiroaki Ikesue, Hisashi Matsunaga, Katsuya Suemaru, Kiyoyuki Kitaichi, Kimitaka Suetsugu, et al.; Gifu University Hospital, Kyushu University Hospital, Okayama University Hospital, and Ehime University Hospital

The aim of this study was to evaluate the effectiveness of prophylactic treatment with laxatives and antiemetics on the incidence of gastrointestinal adverse reactions such as constipation, nausea, and vomiting in patients with cancer who received oral opioid analgesics for the first time.

A multi-institutional retrospective study was carried out in which 619 eligible hospitalized patients receiving oral opioid analgesics for cancer pain were enrolled from 35 medical institutions. The primary endpoint was the incidence of opioid-induced side effects in patients receiving prophylactic medication.

The incidence of constipation was significantly lower in patients receiving laxatives, including magnesium oxide, as premedication than in those who did not take laxatives (34% vs. 55%). However, the incidence of nausea or vomiting was similar regardless of prophylactic medication with dopamine D2 blockers. Among laxatives, magnesium oxide at doses exceeding 1,000 mg/d was found to be most effective in preventing constipation.

It has been demonstrated that tolerance to morphine-induced constipation rarely develops; consequently, laxatives may be required as long as opioid analgesics are used.

Evaluation of a Preoperative Pain Score in Response to Pressure as a Marker of Postoperative Pain and Drugs Consumption in Surgical Thyroidectomy
Rocco Rago, Francesco Forfori, Gabriele Materazzi, Antonio Abramo, Michele Collareta, Paolo Miccoli, et al.; U.O. Anestesia e Rianimazione IV Universitaria and U.O. Chirurgia Generale II, Università Degli Studi di Pisa

The visual analog scale (VAS) is one of the most used scales for evaluating postoperative pain worldwide, especially in adult patients and for all degrees of pain. However, some researchers have voiced doubt about the scale's reliability among elderly patients, very young people, and those with mild to moderate cognitive impairment.

The adequacy of postoperative pain control is one of the most important factors in determining when a patient can be safely discharged from an outpatient facility. The prescription of analgesic drugs is usually started at a VAS score of 3 or 4. In this prospective study authors evaluated the sensitivity and specificity of preoperative pain assessment using the VAS in response to tourniquet-induced pain to predict postoperative pain and analgesic drug consumption in patients scheduled for total thyroidectomy in a day surgery unit.

The results of this study confirm that the VAS can be considered predictive for pain and postoperative analgesic requests in thyroid surgery; moreover, the mathematical and statistical model used for this study confirms that a VAS value of 3 can be eligible as a cutoff for analgesia treatment and admission to day surgery. This study provides further discussion on the use and significance of the VAS, especially regarding a new approach to include the VAS among inclusion criteria for admission to day surgery units and to gauge patient satisfaction.

In the Media

Osteoporosis Drugs Linked to Rare Fractures (Wall Street Journal)

Cure Pain Instantly (Men’s Health)

Pain Meds Linked to Lower Risk for Skin Cancer (MedPage Today)

Doctor Shopping: States Cracking Down On Prescription Drug Abuse (Huffington Post)

What Do You Know: Antidepressants Relieve Arthritis Pain (The Atlantic)

Prescription Drug Abuse Can Be Stemmed With Innovation, Not Restriction (Forbes)

Data Shows Rise in NYC Painkiller Prescriptions (Businessweek)

Pain Pills Add Cost and Delays to Job Injuries (New York Times)

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.