Updates

APS Response to the U.S. Senate Finance Committee Inquiry

The American Pain Society received an inquiry from the U.S. Senate Finance Committee regarding financial support from pharmaceutical companies that manufacture and market opioid analgesic medications. APS will cooperate fully with the members and staff of the U.S. Senate Finance Committee in complying with its request for information.

APS also looks forward to sharing with the Committee its strong advocacy for a sound policy approach to addressing the problem of abuse and diversion of prescription analgesic medications. As advocates for patients and their families, we seek to advance access to a wide range of safe and effective pain treatments, while supporting our need as a society to prevent and control drug abuse.

American Pain Foundation Closes Its Doors

On May 3, the American Pain Foundation (APF) Board of Directors formally voted to close down operations of the foundation. The decision to cease operation was based on economic circumstances. For the official announcement from APF as well as addition information, please visit www.painfoundation.org.

Scientific Meeting

There's Still Time to Preregister for APS Corporate Satellite Symposia

APS will be offering corporate satellite symposia during breakfast, lunch, and dinner hours at the APS Annual Scientific Meeting, May 16–19, in Honolulu, HI. These independently managed symposia are supported by APS’s Corporate Council and have been approved by the APS Scientific Program Committee for presentation as part of the APS satellite symposia program. These symposia are offered free of charge to all meeting registrants, however, seating is limited.

Register for these symposia at APS Satellite Symposia Registration.

Preregistration does not guarantee seating. We do recommend arriving at the symposium location early. If you have any questions regarding registration for these symposia, contact Connie Riefke at 847.375.4397.

Handouts Available to Annual Meeting Attendees

The APS meeting is paperless again this year, and APS will not be distributing a printed copy of the handout syllabus. The session handouts are now available online at www.connect2conferences.com/aps5.

Please visit the meeting proceedings online to view and print handout materials. You can access the handouts by browsing by day or by session type and clicking on the title of a session, and then clicking on the link to the PDF handout that appears beneath each speaker’s name in the faculty listing for that session.

You will be prompted to enter login information to access the handouts. Login information was sent to all registrants in April. Please contact APS at 847.375.4715 if you need assistance logging in to view handouts.

The handout database is available 24 hours a day, 7 days a week.

Accessing the APS Meeting Evaluation System and Obtaining CE Credit

Certificates of continuing education (CE) credit for the 31st Annual Scientific Meeting will be issued upon completion of the online meeting evaluation form. For access to the meeting evaluation, please visit www.ampainsoc.org, click on the Meeting Evaluation link on the home page, and enter your username (found on the second ticket of your badge) and your password. If you have not established a username and password, you will need to do so to access your evaluation form. Please visit the APS registration desk or contact APS Member Services (847.375.4715 or info@ampainsoc.org) to activate your online profile and for additional assistance.

APS encourages all meeting attendees to complete the evaluation, regardless of whether or not credit is being sought.

Research

Funding Opportunity

Collaborative Activities to Promote Research on Integrative Approaches to Symptom Management in Military Populations (Administrative Supplement)

The National Center for Complementary and Alternative Medicine (NCCAM) announces the availability of 1-year administrative supplements for NCCAM-funded grantees to stimulate collaborations for research on integrative approaches to pain and symptom management in military populations. The proposed activities must be within the scope of the peer-reviewed activities specified within the National Institutes of Health parent award. For more information, visit http://grants.nih.gov/grants/guide/pa-files/PA-12-160.html.

IASP Trainee Fellowship Reminder

Applications for the 2012 IASP International Trainee Fellowship funded by the Scan|Design Foundation by Inger & Jens Bruun and the 2012 IASP John J. Bonica Trainee Fellowship are due soon. The International Trainee Fellowship was established in 2006 and supports training in pain research. The fellowship offers a stipend of up to $50,000 for 1 year of training. The John J. Bonica Trainee Fellowship was established in 1998 in honor of the IASP's founder, John J. Bonica, and offers a stipend of up to $50,000 per year for 2 consecutive years (up to $100,000).

To apply for either of these fellowship programs, review the fellowship guidelines and download the application forms from the IASP website. Applications must be completed and returned via e-mail no later than May 15, 2012, to iaspdesk@iasp-pain.org.

Invitation to Participate: Pain Management Knowledge Survey

You are invited to participate in a research study conducted by investigators in the University of Washington's Department of Anesthesiology & Pain Medicine in the School of Medicine and the School of Nursing. The purpose of this study is to conduct research on a brief pain management knowledge survey. If you decide to participate, simply visit https://catalyst.uw.edu/webq/survey/mperrin/158537, record your level of agreement to 12 pain management statements, and then complete several demographic questions about yourself. Your participation is voluntary. No names or other unique identifiers will be collected. If you have any questions about the study please feel free to contact Deb Gordon directly at debrag3@u.washington.edu. Thank you in advance for your time and willingness to participate.

Clinical

APS Clinical Practice Guidelines Committee Seeks Interested Volunteers

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 at cporter@ampainsoc.org by June 8, 2012.

Education

Call for 2013 Symposia Is Open!

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

The Call for Symposia for the 2013 Annual Scientific Meeting is available on the APS website. Please consider submitting a proposal for a symposium session for the 2013 annual meeting.

Visit www.ampainsoc.org to access the submission forms for the Call for Symposia for the 32nd Annual Scientific Meeting. The deadline for all proposals is July 11, 2012.

Corporate Council Members will be invited to submit proposals for Corporate Satellite Symposia in late summer.

The Call for Paper and Poster Abstracts for the 2013 meeting will be available on the APS website beginning August 16. The abstract submission deadline is November 5.

Society

APS SIGs Have a New Communication Tool

APS special interest groups (SIGs) have a new communications tool available—an APS-sponsored Listserv. For participating SIGs, the new Listservs help facilitate a forum for SIG community members to exchange information, ask questions of their peers, collaborate on SIG-related activities and to network.

If you are a member of one of the SIGs listed below, please be sure that you have opted in and subscribed to your new Listserv in order to take part in the conversations and activities. Invitations have been sent via e-mail to participating SIG members, however, not all have opted in.

We encourage you to take advantage of this new communication tool. If you would like to join a SIG or are a part of a SIG and would like to partake in the Listserv please e-mail the APS Listserv Administrator at list@ampainsoc.org. If you are a SIG chair that does not have a listserv and would like to establish one for your SIG, please contact list@ampainsoc.org.

Advancing the Science of Quality
Basic Science
Genetics and Pain
Geriatric Pain
Measurement of Pain and Its Impact
Pain and Disparities
Pain Education
Pain in Infants, Children, and Adolescents
Palliative Care
Pharmacotherapy
Pain in Sickle Cell

Members

What is your area of specialty?
Neuropharmacology and neurobiology of pain

What initially sparked your interest in working in your field? Briefly describe your career path.
I am a pharmacist by training, and have received graduate training in pharmacology. While I was working as a researcher in a natural products research lab in the United Arab Emirates I had to screen several natural products routinely for their potential analgesic activity. During this time, I happened to read several articles on the drawbacks of traditionally used analgesic screening methods, and wanted to develop novel screening methods that have better translational value. I decided to do a postdoctoral training in pain neurobiology during that time and joined the University of Iowa Pain Research Program in 2002. Since then I have developed several translationally relevant preclinical pain models.

What has been a highlight of your work? Perhaps you and your staff are proud of a certain project or accomplishment.
One of my most cited works is the development of a preclinical model for chronic muscle and joint inflammatory pain using high-concentration carrageenan, which was done during my postdoctoral fellowship with Dr. Kathleen Sluka at the University of Iowa. This model has several advantages over the traditionally used CFA model.

Is there a particular challenge that you've either overcome or hope to address soon?
One thing I would like to do is to try to solve the mystery of the unusual analgesic effects of ketorolac. Ketorolac is an NSAID with analgesic activity comparable to certain opioids, and the exact mechanism for this is unknown.

Who is your favorite role model—and why?
Kathleen Sluka at the University of Iowa is my role model. She was my postdoc mentor, and honestly I acquired the real passion for science while working in her lab. I also learned how to balance life and work while working with her.

How has membership in APS been of value to you and your professional development?
APS membership has immensely helped me to form a network of scientists in my area of research interest. APS has also helped me to develop professionally by giving me opportunity to serve in its committees such as ethics committee, scientific program committee, etc., and also to serve as the editorial member of The Journal of Pain.

Summaries

The Journal of Pain Highlights

The following highlights summarize selected articles from May 2012 (volume 13, number 5).

Nabiximols for Opioid-Treated Cancer Patients with Poorly Controlled Chronic Pain: A Randomized, Placebo-Controlled, Graded-Dose Trial
Russell K. Portenoy, Elena Doina Ganae-Motan, Silvia Allende, Ronald Yanagihara, Lauren Shaiova, Sharon Weinstein, et al.; Beth Israel Medical Center, Hospital Sf. Ioan cel Nou, National Cancer Institute of Mexico, Hazel Hawkins Hospital, Metropolitan Hospital Center, Huntsman Cancer Institute, et al.

An investigational cannabinoid therapy helped provide effective analgesia when used as an adjuvant medication for cancer patients with pain that responded poorly to opioids, according to results of a multicenter trial reported in The Journal of Pain.

While opioid therapy is the mainstay treatment for cancer pain in patients with advanced disease, a substantial minority experience pain that cannot be adequately controlled at safe and tolerable doses. The most common treatment approach is coadministration of another analgesic. Cannabinoids are being analyzed as potential adjuvant analgesics. In this randomized multicenter study, nabiximols, a cannabinoid delivered as an oral mucosal spray, was studied to obtain information about the dose response for analgesia and safety in a population with pain not adequately controlled with an opioid.

Patients were eligible to participate in the study if they had active cancer and chronic pain that was moderate to severe despite taking opioids. The study timeline was a 5- to 14-day baseline period, 5 weeks titration and treatment, and a poststudy visit after 2 weeks. Every day, patients responded to questions to rate their pain, gauge their sleep quality, and determine how many sprays of the nabiximols they were taking.

Results of the study showed that nabiximols has analgesic efficacy when used as an add-on therapy for cancer patients with pain not controlled by an opioid alone. In the low-dose nabiximols group, there was a 25% improvement in pain compared with baseline. However, there was no analgesic effect in the high-dose group and the high dose was not well tolerated. Just 66% of subjects in that group finished the study. The authors concluded that nabiximols in a tolerable dose range may offer analgesic benefits to very ill cancer patients with refractory pain.

Associations Between Pro- and Anti-Inflammatory Cytokine Genes and Breast Pain in Women Prior to Breast Cancer Surgery
Birha McCann, Christine Miaskowski, Theresa Koetters, Christina Baggott, Claudia West, Jon D. Levine, et al.; University of California–San Francisco and Redwood Regional Oncology Group

Though postoperative breast cancer pain has been examined extensively, few studies have been published about preoperative breast cancer pain. Researchers from the University of California–San Francisco studied a sample of women scheduled for breast cancer surgery and sought to determine the occurrence rate for preoperative breast pain, describe characteristics of the pain, evaluate the demographic and clinical variation in the women with preoperative pain, and assess the role of pro- and anti-inflammatory cytokine genes. This is the first study to describe the characteristics of preoperative breast pain in a sample of women prior to breast cancer surgery, and to evaluate for genetic variations in pro- and anti-inflammatory genes in women who did and did not report pain. The analysis was part of a larger study on neuropathic pain and lymphedema in women who had breast cancer surgery

Patients answered questionnaires designed to evaluate overall functional status, comorbid medical conditions, and pain characteristics. All patients were given genotype tests. Three hundred ninety-eight women participated.

Women who reported presurgical pain were younger and had poorer functional status than the non-pain group. Also, a higher percentage of non-white women reported pain, and a potential reason cited is that more of the non-white women in the sample were diagnosed with advanced disease. Possible contributors to presurgical breast pain are tissue injury or nerve damage, inflammation associated with tumor growth, and the number of biopsies performed. Women in the pain group had a significantly higher number of biopsies. Further, the pain qualities reported by women with presurgical breast pain were nociceptive and not neuropathic, which suggest that differences in inflammatory responses could be influencing presurgical breast pain development.

After analyzing the genotyping data, the authors concluded that preoperative breast pain involves an inflammatory process; this information may help identify women who are at risk for preoperative breast pain. Further research is needed to determine if preoperative breast pain influences the severity of postoperative pain and development of chronic pain after breast cancer surgery.

PAIN Highlights

The following highlights summarize selected articles from April 2012 (volume 153, issue 4).

Pain, Affective Symptoms, and Cognitive Deficits in Patients with Cerebral Dopamine Dysfunction
Johanna M. Jarcho, Emeran A. Mayer, Ziyue Karen Jiang, Natasha A. Feier, and Edythe D. London; National Institute of Mental Health and University of California, Los Angeles

Individual differences in sensitivity to pain and the capacity to recruit endogenous antinociceptive systems to counteract noxious stimuli reflect natural variability in central pain-processing systems. Although it is well established that endogenous opioids play a key role in modulating these systems, emerging research implicates central dopamine (DA) signaling as another important modulator of pain perception.

Considerable evidence supports the role of the DA system in altered pain sensitivity of patients with chronic central nervous system disorders, such as disorders of mood and anxiety, substance abuse, Parkinson’s disease, and schizophrenia. Because genetically determined variations in several DA-dependent brain-based systems (including outcome predictions, attention, and engagement of endogenous pain modulations systems) appear to mediate variations in pain sensitivity and chronic pain prevalence across several clinical disorders, these DA-dependent signaling systems can be considered as general endophenotypes of chronic pain symptoms.

Altered pain sensitivity among patients with DA-based disorders can have important implications for management and treatment outcomes. The possible role of altered DA signaling mechanisms in persistent pain disorders introduces the possibility of novel treatment approaches for chronic pain syndromes.

A better understanding of the role of the DA signaling system in the development and expression of chronic pain may warrant formal evaluation of novel, atypical antipsychotic drugs as primary or adjuvant therapies.

Is Treatment of Postherpetic Neuralgia in the Community Consistent with Evidence-Based Recommendations?
Robert H. Dworkin, Christopher J. Panarites, Edward P. Armstrong, Daniel C. Malone, and Sissi V. Pham; University of Rochester School of Medicine and Dentistry, Abbott Vascular, University of Arizona, Strategic Therapeutics LLC, and Sissi Pham Consulting Inc.

Postherpetic neuralgia (PHN) is a chronic peripheral neuropathic pain condition that can develop following a herpes zoster infection. Patients with PHN often experience substantial adverse effects on their health-related quality of life, including physical and emotional functioning and sleep. Recent data suggest the incidence of herpes zoster is increasing, although the explanation is unknown. This increase will lead to an increase in PHN, which will necessitate the development of improved treatments and preventive interventions to meet this pressing public health need.

U.S. healthcare claims were used to identify patients with a PHN diagnosis. The initial pharmacological treatments and changes to these treatment regimens were categorized according to the recommendations from the International Association for the Study of Pain's special interest group on neuropathic pain for first-, second-, and third-line treatment of neuropathic pain. Results indicated that the treatment of PHN was only partially consistent with these treatment recommendations. Of patients with PHN who were not already on a specified treatment, 70% began treatment with either a first-, second-, or third-line treatment or a not-recommended treatment, and 30% did not begin treatment with any of these medications. Only one-quarter of patients began treatment with a first-line medication. These results suggest that a considerable number of patients with PHN in the community are not receiving evidence-based treatment.

Considering the ease of diagnosing PHN in clinical practice, it is possible the percentage of patients not receiving evidence-based treatment is even higher for neuropathic pain conditions that are more difficult to diagnose such as radiculopathies and traumatic nerve lesions. This study suggests that many patients with PHN and other neuropathic pain conditions may achieve better pain relief if their treatment is more consistent with evidence-based recommendations for first- and second-line treatment.

Pain Medicine Highlights

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

A Quantitative Review of Ethnic Group Differences in Experimental Pain Response: Do Biology, Psychology, and Culture Matter?
Bridgett Rahim-Williams, Joseph L. Riley III, Ameenah K. K. Williams, and Roger B. Fillingim; University of Florida, University of Florida College of Dentistry, and University of Maryland

Although there is no consensus regarding underlying mechanisms, ethnic group differences inevitably reflect a holistic influence of biological, social, cultural, and psychological factors—the biopsychosociocultural model of pain. To elucidate these mystifying, yet integrated mechanisms, researchers undertook both clinical and experimental pain studies to document the pain experience.

A systematic literature review (1944–2011) and analysis of studies using experimental pain stimuli to assess pain sensitivity across multiple ethnic groups was conducted. Researchers calculated effect sizes and identified ethnic/racial group categories and pain regarding biopsychosociocultural factors contributing to ethnic/racial group differences. The majority of studies included comparisons between African Americans (AAs) and non-Hispanic Whites (NHWs). There were consistent moderate to large effect sizes for pain tolerance across multiple stimulus modalities; AAs demonstrated lower pain tolerance. Effect sizes were small to moderate across ethnic groups for pain threshold. A subset of studies comparing NHWs and other ethnic groups showed a variable range of effect sizes for pain threshold and tolerance.

Although experimental pain does not fully duplicate the sensory and affective qualities that characterize clinical pain, ethnic differences in experimental pain sensitivity may contribute to ethnic differences in the experience of clinical pain. Evaluating ethnic differences in experimental pain models may not only provide information about underlying mechanisms, but may also predict or explain group differences in clinical pain. Research that continues to identify and elucidate mechanisms underlying ethnic group differences will lead the way in advancing knowledge and science with the ultimate translational goal of reducing ethnic disparities in pain and improving pain management for all.

Occipital Nerve Pulsed Radiofrequency Treatment: A Multi-Center Study Evaluating Predictors of Outcome
Julie H. Y. Huang, Samuel M. Galvagno Jr., Mariam Hameed, Indy Wilkinson, Michael A. Erdek, Amit Patel, Chester Buckenmaier III, Jason Rosenberg, and Steven P. Cohen

Occipital neuralgia (ON) is a challenging condition for which there is no reference standard for treatment. The diagnosis of ON is complicated by the fact that other headache syndromes such as posttraumatic, cervicogenic, and migraine may also present with occipital pain that responds to nerve blocks. The absence of any minimally invasive, reliable, long-term treatment for ON has led to growing interest in pulsed radiofrequency (PRF). PRF alleviates pain primarily via the induction of a low-intensity electrical field around sensory nerves.

The purpose of this study was to evaluate pulsed radiofrequency (PRF) for ON and to determine whether any demographic, clinical, or treatment characteristics are associated with success.

A retrospective data analysis was conducted in 102 subjects evaluating the effect of myriad factors on treatment success. Patients with a primary diagnosis of ON (102) were treated with PRF of the greater and/or lesser occipital nerve. A positive primary outcome was predefined as at least 50% pain relief lasting at least 3 months. The secondary outcome measure was procedural satisfaction. Fifty-one percent of patients experienced at least 50% pain relief and satisfaction with treatment lasting at least 3 months. Variables associated with a positive outcome included a traumatic inciting event, lower diagnostic block volumes, and employment of multiple rounds of PRF. Although this success rate may be perceived by some as inadequate, the results can be viewed from the perspective that these patients already had failed multiple conservative and interventional treatment modalities and were at high risk for treatment failure.

These results demonstrate that PRF may provide significant intermediate-term pain relief to a substantial percentage of patients with refractory ON. Selecting appropriate candidates based on clinical characteristics (i.e., neuropathic pain limited to the distribution of the occipital nerves) and optimizing diagnostic accuracy (i.e., maximizing the specificity of diagnostic occipital nerve blocks by reducing injectate volume) and treatment considerations may further improve success rates.

In the Media

Senate Inquiry Into Painkiller Makers' Ties (New York Times)

Concern Raised Over Painkiller's Use in Sports (NY Times)

Chronic Pain Rates Shoot Up Until Americans Reach Late 50s (Gallup)

Fatigue Not a Factor in Fibromyalgia Pain, Study Says (U.S. News and World Report)

Perceptions 'Can Make Pain Worse' (BBC)

Mind Tricks May Help Arthritic Pain (BBC)

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.