Funding Announcements

Clinical Trials and Interventional Studies of Nonpharmacological Approaches to Managing Pain and Comorbid Conditions in U.S. Military Personnel, Veterans, and their Families (R01)

The purpose of this funding opportunity announcement (FOA) is to accelerate clinical trial or interventional research on nonpharmacological approaches to symptom management for pain and associated problems (e.g., post-traumatic stress disorder [PTSD], traumatic brain injury [TBI], depression, anxiety, sleep disturbances, substance abuse) among U.S. military personnel, veterans, and their families. For this FOA, the research population must be active duty personnel or veterans of any branch of the military (e.g., Army, Navy, Marines, Air Force, Coast Guard, the military reserves, National Guard), or their family members. Research related to individuals who are serving or have served in Operation Enduring Freedom (Afghanistan), Operation Iraqi Freedom (Iraq), and Operation New Dawn is of special interest. Applications proposing clinical trial planning or pilot studies should use the companion funding opportunity announcement RFA-AT-14-004 (Pilot and Feasibility Studies). Applications proposing health services research, observational studies, or secondary data analysis should use the companion funding opportunity announcement RFA-AT-14-005 (Health Services and Observational). For more information, visit http://grants.nih.gov/grants/guide/rfa-files/RFA-AT-14-003.html.

Pilot and Feasibility Studies of Non-Pharmacological Approaches to Managing Pain and Comorbid Conditions in U.S. Military Personnel, Veterans, and their Families (R34)

The purpose of this funding opportunity announcement (FOA) is to accelerate clinical trial or interventional research focused on nonpharmacological approaches to symptom management for pain and associated problems (e.g., post-traumatic stress disorder [PTSD], traumatic brain injury [TBI], depression, anxiety, sleep disturbances, substance abuse) among U.S. military personnel, veterans, and their families. For this FOA, research related to all branches of the military (e.g., Army, Navy, Marines, Air Force, Coast Guard, U.S. military reserves, National Guard) and veterans is of interest. Research related to individuals who are serving or have served in Operation Enduring Freedom (Afghanistan), Operation Iraqi Freedom (Iraq), and Operation New Dawn is of special interest. Applications proposing large clinical trial or interventional studies should use companion FOA RFA-AT-14-003 (Clinical Trials and Interventional). Applications proposing health services research, observational studies, or secondary data analysis should use the companion FOA RFA-AT-14-005 (Health Services and Observational). For more information, visit http://grants.nih.gov/grants/guide/rfa-files/RFA-AT-14-004.html.

Comorbid HIV, Chronic Pain, and Substance Use Among Older Adults (R21)

To improve understanding of the intersection of HIV/AIDS and drug abuse, this funding opportunity announcement (FOA) is part of a multipronged 2014 expansion of HIV and AIDS related research within the context of drug and alcohol abuse among understudied populations and in understudied settings that show promise for the development of effective prevention and treatment efforts. In addition to this funding opportunity, others included in the 2014 expansion address HIV/AIDS and substance use among the homeless and unstably housed (RFA-DA-14-009); substance use, HIV, and African-American women and young men who have sex with men (MSM) (RFA-DA-14-010); the integration of substance abuse and HIV prevention and treatment within HIV/AIDS service delivery settings (RFA-DA-14-011), and seek, test, treat, and retain data harmonization coordinating center (RFA-DA-14-007).

For this funding announcement, the National Institute on Drug Abuse (NIDA) invites innovative, exploratory research applications proposing to study the intersection of HIV, chronic pain, and substance use among older adults. Applications could include research to examine risk and protective factors contributing to comorbid HIV, chronic pain, and substance use among older adults; to characterize the adverse medical, mental health, and social consequences associated with comorbid HIV, substance abuse, and chronic pain among older adults; or to develop effective prevention and service delivery approaches and behavioral and pharmacological treatments to address these comorbid conditions in older adults. Research also is encouraged on the role of HIV/AIDS-associated conditions, HIV treatment, or other biobehavioral/social factors in the context of aging, chronic pain, and substance use. A range of research approaches is of interest, including epidemiologic, prevention science, health services, and intervention studies. For more information, visit http://grants.nih.gov/grants/guide/rfa-files/RFA-DA-14-012.html.

Education

Call for Poster Abstracts

The American Pain Society invites the submission of abstracts for poster presentation at the 33rd Annual Scientific Meeting, April 30–May 3, 2014 in Tampa, FL. The Call for Poster Abstracts will be available on the APS website August 15–November 15, 2013. Please visit the APS website for a full set of instructions and to access the submission system.

Annual Scientific Meeting Attendees, Receive Your CE Credit

APS encourages all annual scientific meeting (ASM) attendees to complete the online meeting evaluation form regardless of whether credit is being sought. Certificates of continuing education credit will be issued upon completion of the evaluation form. Please visit the evaluations page to access the meeting evaluation.

You will need to enter your username (which can be found on the second ticket of your name badge) and your password. If you are not a member of APS, did not register online for the annual meeting, or otherwise have not established a username and password, you will need to do so to access your evaluation form. Please contact APS Member Services at 847.375.4715 to activate your online profile.

If you attended the “Risk Evaluation and Mitigation Strategies (REMS) for Extended-Release and Long-Acting Opioids: Achieving Safe Use While Improving Patient Care” course on Saturday, May 11, you will have access to the evaluation form for the course upon logging into the meeting evaluation system.

Members

Member Spotlight: Arian Nachat, MD FABEM FABHPM

Arian Nachat, MD FABEM FABHPM
APS Complementary and Alternative Medicine SIG Chair
Integrated Pain Management Lead
Kaiser Walnut Creek
Walnut Creek, California

I am board certified in emergency medicine, and hospice and palliative medicine, and trained in Traditional Chinese Medicine. My interest in CAM modalities started in medical school, when I took an elective course in integrative medicine. I found it fascinating that there were Western medical conditions that could be treated with CAM with improved patient satisfaction and outcomes.

We, as allopathic providers, struggle with a myriad of Western medical conditions that cause our patients great frustration and loss of quality of life that can be co-managed using an integrative approach that combines the best of both allopathic and complementary medicine.

In the past 3 years, I have been the director of an acute inpatient integrative pain management team at Kaiser Permanente in Walnut Creek. Our team consists of physician, clinical nurse specialist, pharmacist, and acupuncturist providers. We evaluate patients from a comprehensive vantage point and offer both allopathic medication optimization and Eastern treatment modalities. We also have a group of volunteer providers who perform guided meditation, reike, massage therapy, bodywork, qigong, and healing touch. In our retrospective administrative reviews, we have found that our patients use less narcotics, stay in the hospital for less time, and return to a more functional life faster compared to patients who do not receive these types of treatments. We are the only such inpatient program in the United States at this time.

My goal in joining APS and becoming a chair for the CAM SIG is to further the education and understanding of how to safely, in an evidence-based model, integrate the best of these worlds to improve pain management and healthcare delivery.

Member Benefit: The Journal of Pain

Have you taken advantage of the exceptional intellectual content in The Journal of Pain, APS' official journal? Designed to provide a forum for scholarly presentation and commentaries on issues and controversies, JOP is published 12 times per year and is cited in Index Medicus^®.

The articles published in JOP are original and related to all aspects of pain, including the following:

• Clinical and basic research
• Patient care
• Education
• Health policy

An excellent reason for APS members to publish in JOP is that necessary color figures appearing in member-authored articles are printed at no cost to the authors—resulting in a savings of almost $1,000. For more information, please visit the JOP website. Members can view highlights from past issues and more information about submissions on the APS website.

JOP’s impact factor continues to rise every year, making it the second-ranked pain journal in the world. The impact factor currently stands at 4.926 (©2011 Journal Citation Reports^®).

As an APS member, you now can fully access JOP online when you use your APS member login on the APS website. This feature saves you the extra step of having to log in to multiple sites and provides access directly from the APS website. Simply log in to the APS members only area with your APS member password and click “Journal of Pain” under Publications. If you have questions, contact APS Member Services at 847.375.4715.

Summaries

The Journal of Pain Highlights

The following highlights summarize selected articles from The Journal of Pain (Volume 14, Number 7, August Issue).

Severity of Acute Low Back Pain Predicts Development of Chronic Low Back Pain
Paul Campbell, Nadine E. Foster, Elaine Thomas and Kate M. Dunn, Arthritis Research Primary Care Centre, Keele University, Keele, Staffordshire, United Kingdom

Up to 70% of us will experience low back pain in our lifetimes and many will progress to long term chronic low back pain. Research reported in The Journal of Pain shows that high pain intensity at onset is predictive of future pain and disability, even after 5 years.

Researchers with the Arthritis Research U.K. Primary Care Centre evaluated 488 primary care practice patients who sought treatment for low-back pain. The intent of the study was to determine which prognostic factors best predict poor pain and disability outcomes 5 years later, and compare these factors with short-term outcomes at 6 month follow-up. Study subjects were mailed questionnaires soon after their physician visits and were surveyed after 6 months and at 5 years. Pain and disability were measured using the Chronic Pain Grade, a seven-item chronic pain assessment tool.

Potential predictive factors were organized in four categories: demographic, physical, psychological, and occupational. After 6 months, the results showed that baseline pain intensity was associated with a 12% higher risk for developing chronic low back pain and patient beliefs that pain would persist conveyed a 4% risk increase. After 5 years, baseline pain intensity yielded a 9% increased risk for chronic pain, while believing that pain would persist had increased the risk by 6%.

The authors noted that their research confirms previous studies concluding that baseline pain intensity is a key predictor of future pain and disability. This study, however, is the first to demonstrate this association over a long period of time.

Clinically, the study confirms that effective pain relief in the initial management of low-back pain has implications for long-term improvement. Also, patient beliefs that pain will persist a long time can predict progression to clinically significant low-back pain independent of a wide range of other prognostic factors.

Anxiety and Pain Magnification at the Time of Surgery Predict the Development of Chronic Post-Surgical Pain
Anne Masselin Dubois, Nadine Attal, Dominique Fletcher, Christian Jayr, Aline Albi, Jacques Fermanian, Didier Bouhassira and Sophie Baudic Hopital Ambroise Paré and Université Versailles-Saint Quentin

When post-surgical pain becomes chronic pain, the causes could be related to the type of surgery performed or from common psychological factors considered to be predictive of chronic post-op pain, such as anxiety, depression, and pain catastrophizing. French researchers assessed the predictive value of these factors in patients who had two different types of surgery: total knee arthroplasty (TKA) and breast cancer surgery.

The study compared the extent to which anxiety and depression predicted the prevalence and intensity of chronic post-operative pain 3 months following surgery. They hypothesized that, despite differences in the two surgical procedures, there would be common affective or cognitive risk factors for progression to chronic post-surgical pain.

For the study, patients scheduled for total TKA and mastectomy or lumpectomy filled out questionnaires 1 month ahead of surgery to provide demographic information and baseline ratings of anxiety or pain catastrophizing. On the day before surgery, patients were questioned in person about their pain status and intensity, anxiety levels, and depression. Two days after surgery, the questions focused on pain status and patients subsequently were mailed surveys to rate their pain at 3, 6, and 12 months following surgery. The article reported on the data obtained after 2 days and at 3 months.

Results showed that state anxiety is predictive of clinically meaningful post-surgical pain after 3 months while pain magnification, an element of pain catastrophizing, predicts higher pain-intensity levels.

PAIN Highlights

The following highlights summarize selected articles from PAIN (Volume 154, Number 8, August Issue).

Pain Modality- and Sex-Specific Effects of COMT Genetic Functional Variants
Inna Belfer, Samantha K. Segall, William R. Lariviere, Shad B. Smith, Feng Dai, Gary D. Slade, Naim U. Rashid, Jeffrey S. Mogil, Claudia M. Campbell, Robert R. Edwards, Qian Liu, Eric Bair, William Maixner, and Luda Diatchenko; Department of Anesthesiology, University of Pittsburgh, Pittsburgh, Pennsylvania; Center for Neurosensory Disorders, University of North Carolina at Chapel Hill; Yale Center for Analytical Sciences, New Haven, Connecticut; Department of Psychology and Alan Edwards Centre for Research on Pain, McGill University, Montreal, QC, Canada; Johns Hopkins University School of Medicine, Baltimore; Pain Management Center, Brigham and Women’s Hospital, Chestnut Hill, Massachusetts; Department of Biostatistics, University of North Carolina at Chapel Hill

Catechol-O-methyltransferase (COMT), an enzyme that degrades catecholamines including epinephrine, norepinephrine, and dopamine, represents a critical protein that contributes to a variety of diverse biological systems including pain perception, mood, cognition, and response to both physical and emotional stressors. About a decade ago, researchers reported on a COMT common, functional, single nucleotide polymorphism, Val158Met, that modulated brain responses to pain in healthy volunteers.

Using both animal and human genetic studies, the present investigators demonstrated that the impact of COMT on pain substantially depends on the modality of the noxious stimulus and an individual’s sex. Data from the Heritability of Nociception Project, which are publicly available on the Jackson Laboratory’s Mouse Phenome Database website, were used as source data for the findings reported in this study.

Researchers found that the effects of COMT functional variation in mice are modality specific. Spontaneous inflammatory nociception and thermal nociception behaviors were most correlated with the presence of the B2 SINE transposon insertion residing in the 30UTR mRNA region. Similarly, in humans, COMT functional haplotypes were associated with thermal pain perception and with capsaicin-induced pain. Furthermore, COMT genetic variations contributed to pain behaviors in mice and pain ratings in humans in a sex-specific manner. The ancestral COMT variant, without a B2 SINE insertion, was more strongly associated with sensitivity to capsaicin in female versus male mice. In humans, the haplotype coding for low COMT activity increased capsaicin-induced pain perception in women, but not in men. These findings have a number of practical implications. First, modality and gender specificity of COMT effects should be considered in clinical settings when novel COMT-dependent analgesics, such as propranolol, are tested. These considerations may be relevant not only for pain research, but also for other complex traits and conditions influenced by COMT genetic variation, such as cognitive function or depression.

Motor and Parietal Cortex Stimulation for Phantom Limb Pain and Sensations
Nadia Bolognini, Elena Olgiati, Angelo Maravita, Francesco Ferraro, and Felipe Fregni; Department of Psychology, University of Milano-Bicocca, Milano, Italy; Neuropsychological Laboratory, IRCCS Istituto Auxologico Italiano, Milano, Italy; Department of Rehabilitation, Azienda Ospedaliera Carlo Poma, Mantova, Italy; Laboratory of Neuromodulation, Spaulding Rehabilitation Hospital, Harvard Medical School, Boston

Phantom limb pain (PLP) is a neuropathic pain syndrome characterized by pain experienced in an amputated limb. Although the mechanisms underlying PLP are not fully understood, the emerging view is that PLP may be linked directly to a maladaptive plastic reorganization of the cortex.

PLP remains a challenging condition to treat because it is commonly refractory to classical pharmacological and surgical treatment approaches. In two double-blind, sham-controlled experiments, investigators explored whether transcranial direct current stimulation (tDCS), modulation of cortical excitability in the primary motor cortex (M1), and posterior parietal cortex (PPC) can reduce PLP in chronic lower-limb or upper-limb amputees. They also measured the differential effectiveness of tDCS on stump pain, nonpainful phantom sensations, and telescoping to evaluate the relationship between cortical excitability in M1 and PPC and different types of pain (PLP versus stump pain) and nonpainful phantom experiences.

Anodal tDCS of M1 induced a selective short-lasting decrease of PLP, whereas cathodal tDCS of PPC induced a selective short-lasting decrease of nonpainful phantom sensations; stump pain and telescoping were not affected by parietal or motor tDCS. These findings demonstrate that painful and nonpainful phantom limb sensations are dissociable phenomena. PLP is associated primarily with cortical excitability shifts in the sensorimotor network; increasing excitability in this system by anodal tDCS has an antalgic effect on PLP. Conversely, nonpainful phantom sensations are associated with a hyperexcitation of PPC that can be normalized by cathodal tDCS.

This evidence highlights two original findings: First, PLP can be reduced by anodal tDCS of M1; second, painful and nonpainful phantom sensations are dissociable phenomena mediated by discrete cortical areas. Further studies using neurophysiological measures to assess the impact of the combination of neuropsychotropics and tDCS may provide insight concerning the specific effects of drugs and tDCS on PLP.

Pain Medicine Highlights

The following highlights summarize selected articles from Pain Medicine (Volume 14, Number 7, July Issue).

Effects of Low-Dose IV Ketamine on Peripheral and Central Pain from Major Limb Injuries Sustained in Combat
Rosemary C. Polomano, Chester C. Buckenmaier III, Kyung H. Kwon, Alexandra L. Hanlon, Christine Rupprecht, Cynthia Goldberg, and Rollin M. Gallagher; Department of Biobehavioral Health Sciences, University of Pennsylvania School of Nursing, Philadelphia; Departments of Anesthesiology and Critical Care (Secondary) and Psychiatry and Anesthesiology and Critical Care, University of Pennsylvania Perelman School of Medicine, Philadelphia; Pain Management, Veterans Health System, Philadelphia; Pain Policy Research and Primary Care, Penn Pain Medicine, Philadelphia; Defense and Veterans Center for Integrative Pain Management, Rockville, Maryland; Department of Anesthesiology, Uniformed Services University of the Health Sciences, Bethesda, Maryland; Orthopedic Trauma & Physical Medicine and Rehabilitation, Walter Reed National Military Medical Center, Bethesda, Maryland; Inova Mount Vernon Hospital Pain Service, Alexandria, Virginia

Low-dose ketamine has been routinely administered as part of multimodal analgesia to treat acute and chronic pain experienced by injured service members in the Afghanistan and Iraq wars who sustained major polytrauma such as multiple limb trauma and amputations. At Walter Reed Army Medical Center (now closed), Washington, DC, and the newly established Walter Reed National Military Medical Center, Bethesda, MD, low-dose ketamine infusion was often added to multimodal analgesic regimens to maximize analgesia in particularly challenging patients with pain.

Few studies have systematically evaluated the short-term outcomes associated with low-dose ketamine infusions to treat neuropathic pain resulting from major limb injuries sustained in combat. The primary aim of this investigation was to examine patterns in short-term, patient-reported pain when continuous low-dose intravenous (IV) ketamine infusions were added to individualized standard multimodal analgesia regimens in a cohort of combat-wounded service members with major limb injuries and neuropathic pain. A secondary aim was to demonstrate the effectiveness, safety, and tolerability of continuous low-dose IV ketamine (doses of 120 mcg/kg/h or less) over 3 consecutive days on general care units.

A retrospective review of hospital and acute pain service (APS) records was conducted on a cohort of 19 hospitalized patients who met inclusion criteria. In this case series, investigators describe patterns in pain outcomes associated with low-dose IV ketamine infusions in a cohort of patients also treated with standard pain regimens. Over the course of therapy, there was a significant reduction in present pain intensity, and a better response was observed in those with higher baseline worst pain intensity (WPI) and lower global pain relief (GPR) scores after the first day of therapy. GPR scores for patients reporting “good” to “complete” GPR following the initial 24-hour dose remained unchanged. Investigators were not able to detect differential responses in patients with and without phantom limb pain (PLP); however, over time, patients without PLP showed improvements in WPI.

From a clinical perspective, perhaps the most important finding in this cohort was improvement in perceptions of GPR with the addition of ketamine for patients already exposed to significant doses of opioids and complex adjunct pain regimens. This study also demonstrated that patients receiving low-dose IV ketamine can be safely treated on general units with active APS involvement and oversight. More case reports and retrospective or prospective investigations are needed to examine the effects of dose manipulations (e.g., higher doses) on pain responses and adverse events (e.g., hypotension).

Hypnosis for Treatment of HIV Neuropathic Pain: A Preliminary Report
David Dorfman, Mary Catherine George, Julie Schnur, David M. Simpson, George Davidson, and Guy Montgomery; Departments of Psychiatry, Neurology, and Oncological Sciences, Icahn School of Medicine at Mount Sinai, New York

Painful HIV distal sensory polyneuropathy (HIVDSP) is the most common nervous system disorder among patients with HIV. The symptoms adversely affect patients’ quality of life and often diminish their capacity for independent self-care. It affects at least 29% of patients with HIV, and some estimates are as high as 62%. The disorder is caused by the virus itself through a not-yet-understood mechanism, as well as by the neurotoxicity of certain drugs used to treat HIV. No interventions have been shown consistently effective in treating the disorder. The purpose of the present study was to determine whether hypnosis could be a useful intervention in the management of painful HIVDSP.

Thirty-six volunteers with HIVDSP received three weekly training sessions in self-hypnosis. Participants were followed for pain and its sequelae for 7 weeks before the intervention, and for 7 weeks postintervention. Participants remained on the same standard-of-care pain regimen for the entire 17 weeks of the protocol. The primary outcome measure was the Short Form McGill Pain Questionnaire scale total pain score. Other outcome measures assessed changes in affective state and quality of life.

The results of this study furnish preliminary evidence that hypnosis is an effective treatment for painful HIVDSP. There was a reduction in participants’ pain levels and improvement in their quality of life. Participants with elevated levels of depression-related symptoms also experienced a reduction in these symptoms. These benefits were durable for at least 7 weeks following the intervention and occurred regardless of whether participants were taking pain medications. These findings are of particular interest for two reasons: first, little evidence speaks to the effectiveness of pharmacological interventions for painful HIVDSP. Second, the bulk of the literature addressing the effectiveness of hypnosis in pain management has concentrated on acute rather than chronic pain.

Among the 26 participants whose conditions improved, mean pain reduction was 44%. The investigators concluded that brief hypnosis interventions hold promise as a useful and well-tolerated tool to manage painful HIVDSP, and further investigation is warranted.

Research

APS Announces 2014 Sharon S. Keller Chronic Pain Research Grants Program: Call for Letters of Intent Opens September 3

The call for letters of intent (LOIs) opens September 3 for the 2014 Sharon S. Keller Chronic Pain Research grant program. This year APS again will award as many as four grants in the amount of $35,000 each to pain research proposals demonstrating the greatest merit and potential for success. Interested applicants should submit a required 1-page LOI briefly describing the aims and methods of their proposed research. LOIs will undergo review to determine their responsiveness to this request. Only approved LOIs will be invited to submit a full application.

The Sharon S. Keller Chronic Pain Research grant program was established in 2013 to fund research projects that have a high likelihood of leading to new treatments and to increased access to or expanded treatment options for people with chronic pain. LOI submission will be open Tuesday, September 3, through midnight September 30.

For more information regarding deadlines, eligibility, topics, and more, please visit Sharon S. Keller Chronic Pain Research Program on the APS website.

Call for Applications for the 2014 Clinical Centers of Excellence Program Opens September 2

The call for applications for the 2014 APS Clinical Centers of Excellence (CCOE) in Pain Management Awards will open on Monday, September 2. The CCOE Program annually awards the APS Center of Excellence designation to interdisciplinary healthcare teams that provide the most distinguished, comprehensive pain care. Pain management programs from across the United States, small and large, 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, not the size or type of the program.

CCOE program recipients from 2007–2010 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 35 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 CCOE webpage.

APS Members Will Present at PAINWeek

For the second year in a row, several APS members will be present at PAINWeek, September 4–7, to share their expertise. APS will host a full-day pain track entitled New Developments in Evidence-Based Pain Assessment and Treatment and a special 3-hour session, “ER/LA Opioid REMS: Achieving Safe Use While Improving Patient Care.”

In addition, APS will host an exhibit meant to inform this audience of our work and foundational principles of science-grounded, evidence-based, interdisciplinary pain care. Those staffing the exhibit will distribute informational facts about APS, The Journal of Pain, an annual scientific meeting announcement, clinical practice guideline references, and membership information.

Held in Las Vegas each September, with approximately 2,000 attendees, PAINWeek is the largest U.S. pain conference for primary care clinicians.

Important Dates

Call for 2014 Poster Abstracts

Opens Thursday, August 15
More information

Clinical Centers of Excellence Award Program

Opens Monday, September 2
More information

Sharon S. Keller Chronic Pain and Research Program

LOI Process Opens Tuesday, September 3
More information

Sharon S. Keller Chronic Pain and Research Program

LOI Deadline: Monday, September 30
More information

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@americanpainsociety.org for consideration.