Funding Announcements

NFL Commits $30 Million Donation to the Foundation for the National Institutes of Health to Support Medical Research

From the National Institutes of Health

Bethesda, MD, September 5, 2012—The Foundation for the National Institutes of Health (FNIH) announces that the National Football League (NFL) has agreed to donate $30 million in support of research on serious medical conditions prominent in athletes and relevant to the general population.

This is the largest philanthropic gift the NFL has given in the league's 92-year history.

With this contribution, the NFL becomes the founding donor to a new Sports and Health Research Program, which will be conducted in collaboration with institutes and centers at the National Institutes of Health (NIH). Specific plans for the research to be undertaken remain to be developed, but potential areas under discussion include chronic traumatic encephalopathy; concussion; understanding the potential relationship between traumatic brain injury and late life neurodegenerative disorders, especially Alzheimer's disease; chronic degenerative joint disease; the transition from acute to chronic pain; sudden cardiac arrest in young athletes; and heat and hydration-related illness and injury. The FNIH hopes to welcome other donors, including additional sports organizations, to the collaboration.

"We are grateful for the NFL's generosity," says Dr. Stephanie James, FNIH acting executive director and CEO. "The research to be funded by this donation will accelerate scientific discovery that will benefit athletes and the general public alike."

"We are looking forward to working with the NFL and other organizations to conduct research on a host of medical conditions affecting athletes," said Dr. Story Landis, director of NIH's National Institute of Neurological Disorders and Stroke. "Findings from this research will provide us with better ways to detect, diagnose, and treat these conditions, and in some cases, even prevent their occurrence."

"We hope this grant will help accelerate the medical community's pursuit of pioneering research to enhance the health of athletes past, present, and future," said Roger Goodell, NFL commissioner. "This research will extend beyond the NFL playing field and benefit athletes at all levels and others, including members of our military."

Read the full press release here.

Call for New APS Grant Open Until October 15

APS is accepting applications for its new Sharon S. Keller Chronic Pain Research Grants program. The program was established by private investor David Keller in memory of his wife who died in 2011 and is supported by others who knew her battle with cancer, rheumatoid arthritis, chronic musculoskeletal pain, and the side effects from pain medicines. The program will award $150,000 in up to four 2-year research grants for eligible APS members who are within 6 years of completing their doctoral degrees toward projects with a high likelihood of leading to new treatments or increased or expanded access to treatment options. Applications are due by 12 am EST on October 15. Further information on the program eligibility and guidelines is available at www.ampainsoc.org/kellergrant.

North American Spine Society Offers 2013 Research Funding

The North American Spine Society (NASS) is offering funding in several categories, including research grants; young investigator grants; nontraditional, nonsurgical treatment grants; clinical traveling; fellowships; research traveling; and fellowships. The deadline for letters of proposal is February 4, 2013; grants (by invitation only), May 6, 2013; and traveling fellowships, May 6, 2013. For details about the general guidelines, the selection process, and how to apply, visit www.spine.org. Please contact Karen James at 630.230.3691 with any questions.

Education

Save the Date for the 2013 APS Annual Scientific Meeting

Join us in the Crescent City for next year's APS 32nd Annual Scientific Meeting May 8–11, 2013. For more information and updates, visit www.APSScientificMeeting.org.

Submit Your Poster Abstract for the New Orleans Meeting

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

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

IASP Interprofessional Curriculum Now Online

During the past 2 years, the International Association for the Study of Pain (IASP) Education Initiatives Working Group has been developing a new interprofessional pain curriculum. An interprofessional pain curriculum provides a common basis for students in different professions to learn the same language as well as gain a basic understanding of important pain mechanisms and major biopsychosocial concepts. Visit the IASP website for more information.

Clinical

Call for APS Clinical Centers of Excellence Applications

Applications are now being accepted online for the APS Clinical Centers of Excellence (CCOE) in Pain Management Awards. The CCOE Program annually awards the APS Center of Excellence mark to interdisciplinary healthcare teams who provide the most distinguished, comprehensive pain care. Pain management programs from across the United States, large and small, rural and urban, community and university-based, are all eligible to apply. Selection of awardees is based on judgment of the quality of services provided and not the size or type of the program.

The 2007, 2008, and 2009 CCOE program recipients who have not already received the award for a second time are eligible to apply. Past recipients must provide evidence of sustained excellence and fulfillment of CCOE assessment criteria.

APS has recognized 33 Clinical Centers of Excellence since its inception in 2007. This distinction is one of APS's highest honors in the area of clinical treatment. To learn more about the program, past recipients, and how to apply, visit the APS website. The application deadline is November 30.

Summaries

The Journal of Pain Highlights

The following highlights summarize selected articles from September 2012 (volume 13, number 9).

Pain Assessment and Intensity in Hospitalized Children in Canada
Bonnie J. Stevens, Denise Harrison, Judy Rashotte, Janet Yamada, Laura K. Abbott, Geraldine Coburn, Jennifer Stinson, Sylvie Le May, and the CIHR Team in Children's Pain; The Hospital for Sick Children, The University of Toronto, Children's Hospital of Eastern Ontario, University of Ottawa, Murdoch Children's Research Institute, and The University of Melbourne.

Despite the abundance of pain assessment measurement tools, there have been numerous reports of infrequent pain assessment in hospitalized infants and children. In a multisite study, Canadian researchers sought to determine the nature and frequency of pain assessments in children being treated in Canadian pediatric hospitals and to explore the institutional factors that may influence pain assessment practices and pain intensity scores.

Eight university-affiliated pediatric healthcare centers participated in the study. Children were eligible for inclusion if they were younger than 18 and hospitalized for more than 24 hours. The medical charts of 3,840 children were evaluated, and the average per-child number of documented pain assessments was 3.3. However, 60% of the children were assessed with non-validated pain measures. For those whose pain was assessed with a validated tool, 25% had pain scores in the mild range, 22% in the moderate range, and 11% had scores indicating severe pain.

The authors reported that about two-thirds of the children studied had a pain assessment performed within a 24-hour period, which is a significant improvement from previous reports, but the documented pain assessments were described as variable and inconsistent and did not adhere to national accreditation guidelines. Also, there was a wide range of pain intensity scores, and a significant number of children were found to have moderate to severe pain during their hospital stays.

The authors noted that pain assessment scores should be integrated into clinical decision making. Therefore, making pain relief a priority with a healthcare organization is the key challenge for those who advocate good pain assessment. One concern expressed in the study was the widespread use of self-report pain assessments, even in children as young as 5 years. Self-reports are best used in older, verbally competent children.

The Fear Avoidance Model of Chronic Pain: Examination for Pediatric Application
Laura E. Simons and Karen J. Kaczynski; Children's Hospital Boston Perioperative and Pain Medicine Department of Anesthesiology Division of Pain Medicine and Harvard Medical School Department of Psychiatry

The fear avoidance model of chronic pain has been tested extensively in adults. Researchers at Children's Hospital Boston, writing in The Journal of Pain, have undertaken the first examination of the model in children with chronic pain. They hypothesized that it would be a good tool for assessing pediatric pain patients because of its ability to predict pain catastrophizing and pain-related fear.

Three-hundred-fifty children aged 8–17 years enrolled in the study were evaluated for functional disability and depressive symptoms. Children and their parents completed questionnaires independently, which were designed to measure pain-related fear, pain catastrophizing, pain intensity, functional impairments, and depressive symptoms.

The results showed that the fear avoidance model is useful for understanding and predicting functional disabilities in pediatric patients. However, the model provided less guidance for understanding depressive symptoms associated with pain-related fear and catastrophizing in this population. The investigators also found that shorter duration of pain was associated with higher pain ratings among younger children but was not a significant predictor in adolescent patients. Adolescents, however, reported higher levels of functional disability after 1 month than younger subjects. Overall, the findings indicate that fear of pain may play a stronger role in adolescents than younger children, which suggests that focusing on anxiety-related pain responses in adolescents could yield favorable outcomes in helping them resume participation in previously avoided activities.

Regarding treatment implications, the authors reported that results of the study support the use of cognitive behavioral interventions, especially in adolescents with chronic pain, to help reduce pain and associated disability by targeting pain-related fear.

Pain Medicine Highlights

The following highlights summarize selected articles from the August 2012 issue (Volume 13, Issue 8).

Early Pain Reduction Can Predict Treatment Response: Results of Integrated Efficacy Analyses of a Once-Daily Gastroretentive Formulation of Gabapentin in Patients with Postherpetic Neuralgia
Mark P. Jensen, Ping H. Hsu, and Geertrui F. Vanhove; University of Washington School of Medicine Department of Rehabilitation Medicine and Depomed

Antidepressants, calcium channel α₂-δ ligands (gabapentin and pregabalin), and topical lidocaine are recommended as first-line treatments for patients with neuropathic pain. However, not everyone responds to treatment, and combination therapy is common. Knowledge regarding the ability of early-treatment-response patterns to predict ultimate response may help decrease unnecessary drug exposure and drug costs.

This research was conducted to identify and determine the validity of early-decision criteria following once-daily gastroretentive gabapentin (G-GR) treatment in patients with postherpetic neuralgia (PHN). In two placebo-controlled studies, 279 patients were randomized to 1,800 mg G-GR and 270 patients to placebo with the evening meal; patients underwent a 2-week dose titration followed by 8 weeks of stable dosing and 1 week of dose tapering. Adults with PHN for 6 months and an average baseline Numerical Pain Rating Scale score of 4 were included in the study.

Researchers found a statistically significant association between the early-response category and endpoint response, indicating that the larger the early pain reduction from baseline, the higher the probability of being a responder at week 10. When two early-improvement criteria (10% or higher reduction from baseline and 20% or higher reduction from baseline) at weeks 2–6 were examined as predictors of response at week 10, the estimated sensitivity indicated that these improvement criteria can predict treatment response very accurately. Early response or nonresponse can provide clinical guidance to healthcare providers treating patients with PHN (pain reduction of less than 10% at week 5 of G-GR treatment was the best early predictor of lack of endpoint response). For nonresponding patients, treatment can be modified because continued use of G-GR may not result in an endpoint response. Patients may obtain pain relief with another medication or nonpharmacological treatment and benefit from the potential cost savings of discontinuing treatment with an ineffective therapy.

Effect of Regenerative Injection Therapy on Function and Pain in Patients with Knee Osteoarthritis: A Randomized Crossover Study
Richard Dumais, Catherine Benoit, Alexis Dumais, Lise Babin, Rachel Bordage, Claire de Arcos, Jacques Allard, and Mathieu Bélanger; Vitalité Health Network Dr. Georges-L.-Dumont Regional Hospital, Centre de formation médicale du Nouveau-Brunswick, Dieppe Family Medicine Unit, Université de Sherbrooke Department of Family Medicine, Université de Moncton, Department of Mathematics and Statistics, and Vitalité Health Network Research Centre

This study assessed the effectiveness of regenerative injection therapy (RIT) to relieve pain and restore function in patients with knee osteoarthritis (OA). In this crossover study, participants were randomly assigned to receive either exercise therapy for 32 weeks in combination with RIT during weeks 0, 4, 8, and 12, or RIT alone during weeks 20, 24, 28, and 32. Thirty-six patients with chronic knee OA received RIT comprising injections of 1 cc of 15% dextrose and 0.6% lidocaine in the collateral ligaments; they also received a 5-cc injection of 20% dextrose and 0.5% lidocaine inside the knee joint.

The primary outcome was the Western Ontario and McMaster Universities Osteoarthritis Index of Severity of Osteoarthrosis Symptoms (WOMAC) score (range, 0–96). Following 16 weeks of follow-up, the participants assigned to RIT presented a significant reduction of their osteoarthritis symptoms. WOMAC scores in this group did not continue to change during the last 16 weeks of follow-up when the participants received exercise therapy only. WOMAC scores during the first 16 weeks did not change significantly among the participants receiving exercise therapy only during this period. After 36 weeks, WOMAC scores improved in both groups by 47.3% and 36.2%. The improvement attributable to RIT alone corresponds to a 29.5% decrease in WOMAC scores.

The use of RIT is associated with a marked reduction in symptoms, which was sustained for more than 24 weeks. These results show a meaningful improvement with RIT alone and further improvements with a combination of RIT and exercise. These findings, combined with the low risk, low price, and accessibility of dextrose, make RIT of the knee a viable alternative for the management of knee OA. Further studies should investigate optimal RIT regiments with regard to interval between treatments, concentration of agents, and number of treatments.

PAIN Highlights

The following highlights summarize selected articles from September 2012 (Volume 153, Issue 9).

Electrocortical Evidence for Preferential Processing of Dynamic Pain Expressions Compared to Other Emotional Expressions
Philipp Reicherts, Matthias J. Wieser, Antje B.M. Gerdes, Katja U. Likowski, Peter Weyers, Andreas Mühlberger, and Paul Pauli; University of Würzburg Department of Psychology, Clinical Psychology, Biological Psychology, and Psychotherapy, and University of Mannheim Department of Psychology and Biological and Clinical Psychology

The experience of pain is reliably accompanied by distinct facial expressions that signal a state of distress and serve as social communication. People who are unable to verbalize pain accurately benefit from correct identification of their pain expressions. Despite the high evolutionary relevance of facial pain expressions, research on neurophysiological correlates of their processing is rather scarce.

In the present study, 23 participants viewed short video clips of neutral, emotional (joy, fear), and painful facial expressions while affective ratings, event-related brain responses, and facial electromyography (EMG) were recorded. An emotion recognition task indicated that participants accurately decoded all presented facial expressions. EMG analysis suggests a distinct pattern of facial response detected in response to happy faces only. This study's researchers used dynamic facial expression because dynamic, compared to static stimuli, are found to increase facial responses in participants and potentially augment the representation of specific pain face movements. However, emotion-modulated late-positive potentials revealed a differential processing of pain expressions compared to other facial expressions, including fear. Moreover, pain faces were rated as most negative and highly arousing.

Results suggest a general processing bias in favor of pain expressions, further underscore the salience of facial pain expressions, and support the notion of a putative bias for the preferential processing of pain-associated cues and behaviors in healthy subjects. A better understanding of mechanisms underlying the perception and evaluation of facial pain expressions will be crucial to advance knowledge about the processing of pain-related information in general.

Obesity Is a Risk Factor for Musculoskeletal Pain in Adolescents: Findings from a Population-Based Cohort
Kevin C. Deere, Jacqui Clinch, Kate Holliday, John McBeth, Esther M. Crawley, Adrian Sayers, Shea Palmer, Rita Doerner, Emma M. Clark, and Jon H. Tobias; University of Bristol School of Clinical Sciences Musculoskeletal Research Unit, Southmead Hospital Avon Orthopaedic Centre, Bristol Royal Hospital for Children Department of Paediatric Rheumatology, Manchester University Arthritis Research UK Epidemiology Unit, University of Bristol School of Social and Community Medicine Centre for Child and Adolescent Health, University of the West of England Faculty of Health and Life Sciences, and University of Bristol School of Social and Community Medicine

Obesity is a risk factor for fibromyalgia in adults, but whether a similar relationship exists in children is uncertain. This study examined whether obesity is associated with reporting of musculoskeletal pain, including chronic regional pain (CRP) and chronic widespread pain, in adolescents in a population-based setting.

A pain questionnaire was administered to offspring of the Avon Longitudinal Study of Parents and Children (ALSPAC) at age 17; the questionnaire assessed site, duration, and pain intensity, from which participants with different types of musculoskeletal pain were identified. Relationships between obesity and pain were examined by calculating odds ratios stratified by gender and adjusted for socioeconomic status as reflected by level of maternal education.

Obese adolescents were more likely to report musculoskeletal pain, including knee pain and CRP. Moreover, obese adolescents with knee pain and CRP had relatively high pain scores, suggesting a more severe phenotype with worse prognosis.

Obesity was associated with the occurrence and severity of several musculoskeletal pain phenotypes, including knee pain and CRP, in adolescents from the ALSPAC cohort. These findings suggest that obesity may represent an important risk factor for the occurrence and persistence of clinically relevant musculoskeletal pain in young adults.

Members

What is your area of specialty?
My research addresses how individuals cope with pain and injury. Specifically, I study cognitive, emotional, and behavioral responses to pain that may contribute to disability or facilitate positive adjustment. I examine constructs such as pain-related fear, catastrophizing, and perceptions of injustice among pain sufferers in both clinical settings and using laboratory paradigms. In addition, I am broadly interested in interpersonal processes in the context of pain and illness—specifically, how individuals communicate their pain and how this is perceived in their social environment, for instance, by their treatment providers.

What initially sparked your interest in working in your field? Briefly describe your career path.
As an undergraduate at Fordham University, I was quite interested in pediatric psychology and was able to volunteer in pediatric units throughout NYC. As part of that experience, I first encountered patients with sickle cell disease and was drawn to the way different people conceptualize and communicate their pain, as well as their variable functional outcomes. This steered me toward the study of pain specifically, and I was able to participate in research at the Pain and Palliative Care Unit of Beth Israel Medical Center, with greater focus on chronic musculoskeletal pain. I then looked specifically for graduate, residency, and postdoctoral programs that would provide me with the tools to examine and intervene on the chronic and acute pain experience.

What has been a highlight of your work?
The true highlight of my clinical and academic career has been the variety of settings and populations with which I have had experience. I have worked in New York City and subsequently in rural Appalachia, Seattle, Quebec, and Belgium. Now I am in Texas. Each place has allowed me to integrate into a unique clinical, academic, and local culture, and in each place I've been lucky enough to meet people who have contributed to my personal and intellectual growth.

Is there a particular challenge that you've either overcome or hope to address soon?
My upcoming challenge is to extend my research further into the clinical domain by developing interventions based on our more basic laboratory and clinical findings. The idea of surrendering complete experimental control to the real world is slightly unnerving but also quite exciting.

Who is your favorite role model—and why?
I have been very lucky to have doctoral and postdoctoral mentors who have each exemplified passion for their research as well as rigor and efficiency in the scientific process. More importantly, they have not been afraid of exploring new ideas at the risk of failure. I look to maintain that kind of implicit excitement and discipline about my own work in the face of inevitable challenges.

How has membership in APS been of value to you and your professional development?
Participation in APS makes me feel like I am part of a larger community working toward the same goal. In this sense, APS membership serves to consolidate my own sense of professional identity and purpose. APS also serves as a valuable information resource, highlighting essential empirical, clinical, and political developments that may have an impact on my own work. In turn, this provides me with a sense of momentum in the field, fueling my own excitement and creativity and helping me to communicate the relevance of our work to my students and collaborators.

Society

Member Benefit: Special Interest Groups (SIGs)

Have you joined a SIG yet? Each multidisciplinary APS SIG provides a forum for specialized member interaction and allows members with like interests and issues to easily collaborate with each other to develop an extended network of resources and information. Participation in one or more SIGs is open to all members, regardless of discipline. SIGs meet yearly at the APS Annual Scientific Meeting.

Click here for a current list of APS SIGs and more information. APS welcomes the formation of new SIGs. The procedure for doing so is on the APS website. If you are interested in joining any of the SIGs, contact the APS national office by e-mail.

New Value Summary Chart

APS has taken some important actions on behalf of our members to date in 2012. Click here to see a chart illustrating the value of APS membership.

In the Media

Advances Against Chronic Pain (U.S. News and World Report)

FDA Approves Wider Use for J&J; Nucynta ER Pain Drug (MSNBC)

Coming Soon: Pot Chewing Gum? (Fox News)

New Attack on Pain (The Melbourne Newsroom)

Researchers Identify Which Sensory Nerve Cells Contribute to Chronic Nerve Pain (University of Bristol)

First fMRI Data Results Elucidate Mechanics of Fibro Drug (Pain Medicine News)

FDA Warns of Possible Risk for C. difficile–Associated Diarrhea with PPI Use (Pain Medicine News)

Reformulated Oxycodone Product Appears to Reduce Abuse and Misuse (Pain Medicine News)

Study Could Lead to Better Ways of Treating Pain, Memory Loss (Medical News Today)

RF Ablation Provides Durable Relief of Sacroiliac Joint Pain (Anesthesiology News)

Scientists Can Now Block Heroin, Morphine Addiction (ScienceDaily)

Newly Discovered Scaffold Supports Turning Pain Off (ScienceDaily)

Nerve Transfer Surgery Success (ScienceDaily)

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.