Scientific Meeting

Register Now for the 2013 APS Meeting

Join us in the Crescent City for the APS 32nd Annual Scientific Meeting May 8–11, 2013. The 32nd Annual Scientific Meeting provides you the opportunity to

• attend a variety of educational sessions featuring interactive workshops and symposia
  
• earn more than 15 hours of continuing education/contact hours; pharmacology hours available for nurses
  
• attend the Clinical and Basic Science Data Blitz featuring innovative and compelling clinical and basic science research
  
• meet with more than 400 poster presenters
  
• network with colleagues at the opening reception in the exhibit hall on Wednesday evening
  
• receive a special conference rate of $239 at the Hilton New Orleans Riverside
  
• back by popular demand, enjoy the sound of the Pain Sensations, APS's house band, in the French Quarter on Thursday night.

Register by March 27, 2013, and receive $100 off the registration fee! To learn more about APS’s Annual Scientific Meeting and to register, visit the 2013 Annual Scientific Meeting website.

Special Meeting Article
Frederick W. L. Kerr Basic Science Research Lecture Spotlight—Jeffrey Mogil, PhD

Please give us a brief description of your area of specialty and what sparked your interest in your field.

Most of my career has been spent studying the genetic mediation of pain and analgesia. My interest was sparked largely by the fact that just as I was starting graduate school, genetic approaches started becoming tractable, and really no one other than Marshall Devor was working on the genetics of pain. For a while, there was very little interest in what I was doing, but after transgenic knockout mice were developed people started becoming quite interested indeed. I've been branching out in recent years, though, with major interests in sex differences in pain, the development of new assays and measures of pain, and in social modulation of pain.

Tell us a little about your session at the APS Annual Scientific Meeting.

I'm going to be talking about my new fascination, the modulation of pain by social factors, and the impact of pain on social interactions. This may sound somewhat old hat, but what's new is that all this work starts with experiments in laboratory mice. Mice do indeed have social lives! In most cases, we have been able to show that the phenomena we are demonstrating in mice can also be observed in people.

What is the one thing you hope people take away from your session?

The title of my talk is "Mice are People Too." By this, I mean to impress people not only with the fact that rodents are capable of much more emotion than we give them credit for, but that people may not be qualitatively distinct in many respects from rodents. Our stress, empathy, and prosociality may be more complicated than that of mice, but it might not be fundamentally different after all. I hope that this work will eventually shed light on social modulation of pain in clinical populations.

What do you look forward to the most at APS’s Annual Scientific Meeting?

Ultimately, I look forward to seeing old friends and colleagues and finding out what they're up to personally and professionally. At this particular meeting, my mother is planning on attending my talk, and I look forward to embarrassing her in front of the audience!

What is the one thing you hope to gain from the APS Annual Scientific Meeting and what impact does it have on your profession?

I've found over the years that the real professional reason to go to meetings like the APS Annual Scientific Meeting is to get a broad sense of trends in the field. What are people excited about? What bandwagon is everyone jumping on? What clinical drug development programs may be in trouble? What new technique is some group using that I've never heard of?

How has your membership in APS been a value to you and your professional development?

I joined APS as a graduate student, largely because of the influence of my graduate advisor, the late John C. Liebeskind. I'll never forget two things he told me about APS. The first was that although I'd be more interested in talking to basic scientists, in fact it was more important to talk to the clinicians; I wouldn't be seeing these people at other meetings (like the Society for Neuroscience), only at APS and the World Pain Congress. The second was that the real action at APS wasn't in the sessions themselves, but in the hallways outside them; the important thing was to meet people. He was right, of course. Some of my most important scientific conversations and collaborations (e.g., with Roger Fillingim) happened in the hallways of the APS meeting.

Funding Announcements

Notice of Intent to Publish the Reissuance of PA-10-006 Mechanisms, Models, Measurement, & Management in Pain Research (R01)

(NOT-NR-13-007)
National Institute of Nursing Research
National Center for Complementary and Alternative Medicine
National Cancer Institute
National Institute on Aging
National Institute of Arthritis and Musculoskeletal and Skin Diseases
Eunice Kennedy Shriver National Institute of Child Health and Human Development
National Institute on Drug Abuse
National Institute of Dental and Craniofacial Research
National Institute of Diabetes and Digestive and Kidney Diseases
National Institute of General Medical Sciences
National Institute of Neurological Disorders and Stroke

Education

Clinical and Basic Science Data Blitz—Request for Submissions

APS announces a request for submissions for the Clinical and Basic Science Data Blitz to be held on Wednesday, May 8, from 6–8 pm in New Orleans, LA, as part of the 32nd Annual Scientific Meeting. Authors are encouraged to submit “hot topics” for presentation during the Blitz; submissions from doctoral students and postdoctoral fellows are encouraged. Selected presenters will have 5 minutes to present data and 5 additional minutes for questions. The blitz will be moderated by Greg Dussor, PhD; Steve George, PT PhD; and David Seminowicz, PhD.

To submit your work for consideration, please visit the Data Blitz page of the APS website, download the 2013 Submission Form (doc 34.5 KB), complete all requested information, and email your submission as a Word document to Jennifer Reinard at jreinard@americanpainsociety.org. Please do not submit your work as a PDF document.

Submissions will be accepted through the end of the business day on Monday, March 18, 2013. Primary/presenting authors will be notified of acceptance by the Data Blitz committee in early April. Blitz presenters will be responsible for all costs associated with travel to the Annual Scientific Meeting, including meeting registration.

Member Benefit

Networking opportunities in APS are abundant. These opportunities are available at the Annual Scientific Meeting, in regional activities, committees, task forces, and other informal gatherings.

The Annual Scientific Meeting gives you the opportunity to network by interacting with the best and brightest in pain research. You will be able to connect with colleagues across settings and disciplines at numerous networking events, including special interest group meetings and the opening reception with exhibits and posters. You will also have the chance to discuss your own research and clinical observations as well as meet with more than 400 poster presenters to learn about their work and future research directions.

Summaries

The Journal of Pain Highlights

The following highlights summarize selected articles from February 2013 (Volume 14, Number 2).

Low-Dose Vaporized Cannabis Improves Neuropathic Pain
Wilsey B, Marcotte T, Deutsch R, Gouaux B, Sakai S, Donaghe H; University of California Davis Medical Center, VA Northern California Health Care System

For treating neuropathic pain, currently available medications are marginally effective at best, however, a new study published in The Journal of Pain showed that low-dose, vaporized cannabis can provide significant relief.

Researchers from the University of California Davis Medical Center (UCDMC) compared low-dose (1.29% THC) and medium-dose (3.53% THC) vaporized cannabis to determine if significant analgesic benefits could result without high levels of cognitive side effects. Vaporization avoids respiratory toxins from smoking marijuana. Cannabis can be heated to create active vapors without releasing toxins.

Participants for the study were recruited from the UCDMD Pain Clinic and from newspaper advertisements. Candidates were screened in telephone interviews, and 59 subjects were selected. Several withdrew or were disqualified after medical examinations revealed exclusionary criteria, such as pulmonary disease, cardiovascular disease, or depression. Thirty-nine subjects with persistent neuropathic pain completed the study, which involved several interviews and questionnaires to rate pain intensity. All patients previously had used cannabis as required in the inclusion criteria.

Results of the study showed that both the low and medium doses provided significant pain relief, with an average of 30% reductions in pain intensity compared with placebo. Side effects observed were negligible, based on mood scales. Subjects from the medium-dose group, however, had worse performance and learning and memory evaluations compared with the placebo and low-dose groups.

The authors concluded that low and medium doses of vaporized cannabis could be prescribed for treatment of neuropathic pain and provide clinically significant benefits, however, low doses would cause fewer cognitive and psychological side effects.

Fear of Injury Predicts Self-Reported and Behavioral Impairment in Patients with Chronic Low Back Pain
Thibodeau MA, Fetzner MG, Carleton RN, Kachur SS, Asmundson GJ; University of Regina, Saskatchewan, Canada

Fear of injury directly predicts pain-related anxiety and indirectly predicts self-reported behavioral impairment, according to a Canadian study reported in The Journal of Pain.

Psychologists from the University of Regina in Saskatchewan examined fear of injury as an independent factor contributing to pain-related anxiety and functional impairment in people with disabling low-back pain. They hypothesized that fear of injury may contribute to the maintenance of chronic pain and disability and also amplify the perceived need to avoid behaviors that might be painful.

Seventy-eight patients receiving treatment for chronic low back pain resulting from motor vehicle or workplace accidents were evaluated in the study. They answered several different questionnaires to assess pain anxiety symptoms, anxiety sensitivity, illness/injury sensitivity, and pain intensity. Three measures of functional impairments also were used: physical lifting ability, treatment outcomes, and days absent from treatment.

Results of the study showed that fear of injury likely leads to pain-related anxiety by causing catastrophic interpretations of pain and how it could be indicative of an injury. Such appraisals, according to the authors, could lead to pain-related anxiety. Also, individuals with greater fear of injury may be able to cope with single instances of pain but worry that their pain predicts injury that could lengthen or worsen their chronic pain condition.

The authors noted that their study is the first attempt at testing fear of injury within contemporary theories of chronic pain, and their findings support chronic pain interventions to improve pain-related anxiety as a way to reduce functional impairment.

u-Opioid Receptor Gene A118G Polymorphism Predicts Pain Recovery After Sexual Assault
Ballina L, et al, University of North Carolina, Chapel Hill

One in five U.S. women are sexually assaulted in their lifetimes and more than half experience severe pain during the week following an attack. A study published in The Journal of Pain showed that the presence of a genetic variant could significantly reduce pain severity associated with assault.

Previous studies have reported that sexual assault victims who report having severe pain across multiple body regions are experiencing stress-induced hyperalgesia, resulting from release of endogenous opioids. An initial period of analgesia is followed by delayed onset of persistent and widespread hyperalgesia. Gene variants have been associated with the u-opioid receptor and the most common variant is the single nucleotide polymorphism (SNP) A118G. Individuals with one or more copies of the variant gene (allele) at the A118G have shown poor analgesic response to opioids.

A research team at the University of North Carolina hypothesized that that activation of u-opioid receptors causes stress induced hyperalgesia after a sexual assault and survivors with one or more copies of the variant gene at the A118G receptor would experience less receptor-mediated hyperalgesia and less pain in the initial weeks following the assault.

Women 18 years and older presenting for treatment by sexual assault nurse examiners working in 10 different health systems were recruited for the study. The women were interviewed after 1 week and 6 weeks for evaluation of their pain symptoms. Genotyping was performed on all 52 study participants. The gene variant was found in 12 women (23%) and all were Caucasian.

The study results showed that the women with the gene variant resulting in reduced response to u-opioid receptor binding had clinically relevant reductions in pain severity. The findings suggest that women with one or more alleles at A118G may experience both a reduced analgesic response to endogenous opioids and a reduction in delayed-onset, more long-lasting opioid mediated hyperalgesia. The finding suggests that endogenous opioid-mediated hyperalgesia may contribute to pain symptoms after sexual assault.

Pregabalin Suppresses Nociceptive Behavior and Central Sensitization in a Rat Trigeminal Neuropathic Pain Model
Cao Y, Wang H, Chiang CY, Dostrovsky J, Sessie B; Peking University, China; University of Toronto, Ontario, Canada

A team of scientists from Peking University in China tested male rats to determine whether the drug pregabalin affects nociceptive behavior and central sensitization in a neuropathic pain model. Neuropathic pain was induced by performing partial infraorbital nerve transections.

Behavioral assessments were performed before administration of pregabalin and afterward at intervals of 30, 60, 120, and 180 minutes.

Results showed that pregabalin significantly reversed the reduced mechanical withdrawal thresholds in the rats. The action was dose dependent. Also, pregabalin attenuated the central sensitization of the neurons, as reflected in reversal of the reduced activation threshold, increased responses to pinching pressure, and enhanced stimulus-response function. The authors noted this is the first study documenting that pregabalin attenuates mechanical allodynia and central sensitization characteristics of neuropathic pain. The findings support clinical use of pregabalin for treating craniofacial neuropathic pain.

Pain Medicine Highlights

The following highlights summarize selected articles from Pain Medicine (Volume 14, Number 1, January Issue).

Preliminary Validation of the Defense and Veterans Pain Rating Scale (DVPRS) in a Military Population
Buckenmaier C, Galloway K, Polomano R, McDuffie M, Kwon N, and Gallagher R; Walter Reed National Military Medical Center, Uniformed Services University of the Health Sciences

The lack of standardized pain assessment and documentation practices both in military and Veterans Health Administration (VHA) healthcare settings present numerous challenges for pain care practitioners. These populations are often highly transient, seeking care in multiple healthcare settings and geographic areas.

In 2008, the Army Surgeon General charged a Pain Management Task Force (PMTF) to examine pain assessment practices across military and VHA settings and proposed recommendations to implement a standardized Department of Defense (DoD) and VHA approach to pain management for service members, their families, and veterans. The Office of the Army Surgeon General published the PMTF’s report in 2010. A key finding was the determination that a universal DoD- and VHA-integrated comprehensive patient-reported pain assessment tool was needed. The capacity to easily measure and track multiple dimensions of pain in routine practice was given high priority, and the PMTF developed an integrated pain scale, the Defense and Veterans Pain Rating Scale (DVPRS).

The DVPRS was designed to enhance the existing numeric rating scale (NRS) with visual cues and word descriptors to anchor pain ratings with perceptual experiences and limitations imposed by pain. Supplemental questions on general activity, sleep, mood, and level of stress were added to help quantify the impact of pain on these experiences. This article presents preliminary validation data from a convenience sample of 350 inpatient and outpatient military service members at Walter Reed Army Medical Center.

The DVPRS demonstrated acceptable reliability and validity and has important implications for standardizing pain assessment practices throughout military and veteran healthcare settings, improving screening practices to identify risk for pain-related issues, and providing a minimum set of patient-reported outcomes for communication and documentation across transitions of care. Strong consensus among PMTF members favored the use of an integrated pain intensity measure with an NRS, associated depictions of faces, word descriptor anchors, and pain level categories to enhance common criteria for evaluating pain and demonstrating outcomes of care.

Perhaps the most important aspect of the DVPRS and its proposed general adoption by the DoD and VHA is the consistency of data that standardization of “pain questions” brings to integrated electronic health records. A uniform minimum pain data set would allow comparisons and outcomes tracking currently not possible with existing clinical pain assessment practices. These results support further examination of this scale for military service members with acute and chronic pain.

A Feasibility Study of Transdermal Buprenorphine Versus Transdermal Fentanyl in the Long-Term Management of Persistent Non-Cancer Pain
Mitra F, Chowdhury S, Shelley M, Williams G; The Townsville Pain Management Clinic

Buprenorphine and fentanyl transdermal patches are considered equally efficacious in managing persistent pain. This study sought to compare prospectively the long-term efficacy, acceptability, and side effects of both of these patches in patients with persistent nonmalignant pain and lay the groundwork for a larger multicenter study with which such efficacy and safety outcomes of the two medications can be adequately assessed.

Forty-six adults (age range, 22–80 years) with nonmalignant persistent pain participated in this 12-month study. Participants were opioid-naïve, having pain for the greater part of the day and night, and appropriate for treatment with transdermal patches. After initial assessment, they were randomly allocated to either buprenorphine (TDB) or fentanyl (TDF) patch treatment and then titrated to optimal doses of medication.

Participants showed a similar trend in improvement of pain intensity, physical activity, sleep, and mood throughout the study. Significant relief in pain intensity was achieved for the initial 6 months, and the effects stabilized throughout the remainder of the study in both groups. There were no significant group differences over time. However, a higher equipotent dose of fentanyl was required for comparable pain relief. Throughout the study, TDF participants experienced more side effects than the TDB group.

World Health Organization Guidelines for cancer palliative treatment have recommended rotation of opioids to ease adverse effects and improve tolerance. The clinical observations noted in this study found that switching of patches could benefit patients with nonmalignant pain in terms of side effects and tolerance.

PAIN Highlights

The following highlights summarize selected articles from Pain (Volume 154, Number 2, February Issue).

Impact of Being Primed with Social Deception Upon Observer Responses to Others’ Pain
De Ruddere L, Goubert L, Vervoort T, Kappesser J, Crombez G; Ghent University, Belgium

This study examined whether priming with social deception affects responses (pain estimates, self-reported sympathy, inclination to help) towards others’ pain, and whether the priming effect is mediated by patient valence (positive/negative), as indicated by participants.

First, 55 participants took part in an “independent” delayed memory study in which they read either a neutral text about the use of the healthcare system (neutral condition) or a text about its misuse (social deception condition). Second, participants watched videos of patients with pain performing pain-inducing activities. Participants rated the patients’ pain, the sympathy they felt for the patients, and the inclination to help them. Third, participants re-estimated patients’ pain when patients’ self-report of pain was provided. Fourth, pictures of the patients were shown and participants indicated patient valence as positive or negative.

Results revealed no direct effect of priming with social deception. However, priming with social deception was related to less-positive ratings of patient valence, which in turn contributed to lower ratings of pain and sympathy and to a larger discrepancy between patients’ pain ratings and those of participants. The findings indicate that observers attribute less pain, feel less sympathy, and are less likely to take patients’ self-reported pain intensity into account when patients are evaluated less positively, which is likely to occur when a cognitive scheme of social deception is primed.

These results support previous research demonstrating the crucial role of observers’ evaluation in terms of patient valence in observer responses toward people in pain. Taking the pain of less-positively evaluated patients less seriously may have detrimental consequences for patients because lower pain estimates may lead to inadequate pain management, and less sympathy may lead to less helping behavior. Diminished consideration of pain report may make patients with pain feel as though they are not believed and are misunderstood, which also can influence treatment outcomes.

Hypertension Prevalence and Diminished Blood Pressure-Related Hypoalgesia in Individuals Reporting Chronic Pain in a General Population: The Tromsø Study
Bjørkholt Olsen R, Bruehl S, Sivert Nielsen C, Rosseland L, Eggen AE, Stubhaug A; Oslo University Hospital, Norway

Systems modulating pain and blood pressure (BP) overlap physiologically and interact functionally. These interactions seem to reflect a homeostatic feedback loop that serves to maintain stable BP in the context of noxious stimuli. One result of these functional interactions is the phenomenon of BP-related hypoalgesia, in which higher resting BP levels are reliably associated with reduced acute pain sensitivity.

A standardized laboratory pain testing protocol was incorporated as part of a large ongoing epidemiological study in which resting BP levels and chronic pain and hypertension status were assessed. It was hypothesized that a higher resting BP would be associated with lower acute pain sensitivity among patients without chronic pain, but that this association would be significantly weaker among those reporting chronic pain. Researchers further hypothesized that prevalence of hypertension would be significantly higher among individuals reporting chronic pain than among individuals reporting no chronic pain.

Results supported study hypotheses. The subsample of those reporting no chronic pain displayed significant BP-related hypoalgesia. Moreover, consistent with previous laboratory studies targeting specific chronic pain diagnostic groups, those reporting chronic pain in any body region displayed BP-related hypoalgesia that was significantly smaller in magnitude (by approximately half) than the hypoalgesia observed in the subsample free of chronic pain. The results indicate a 5.5% higher prevalence of hypertension among patients with chronic pain than among those not reporting chronic pain. Although the absolute magnitude of this increased risk might not seem large, at the population level, the number of people affected would not be trivial.

This study and previous epidemiological studies suggest that chronic pain may be an underrecognized contributor to onset and maintenance of hypertension. As a silent disease not traditionally associated with chronic pain, hypertension is unlikely to be a treatment target in the pain clinic setting. Conversely, cardiology or internal medicine physicians most likely to treat hypertension might not appreciate the role that chronic pain could be playing in cardiac health. Improved recognition of connections between chronic pain and hypertension could lead to more timely diagnosis and treatment of hypertension in the large segment of the population (up to 30%) that will eventually experience chronic pain.

Society

Board/SIG Updates

The Pain Assessment SIG requests that APS members take their short survey.

The goal of this brief survey is to obtain information about the status of pain assessment in current clinical practice, which should inform us about the future research and educational needs.

We estimate that this survey will take 5–10 minutes to complete and we want to thank you in advance for taking the time to help the APS gather this data. By completing this survey, you agree to the use of the compiled data for an overall report on this topic. The survey is anonymous and no individual data will be used for any other purpose.

News from Regional Societies

Save the Date! The Midwest Pain Society (MPS) will hold their 2013 meeting October 25–26. MPS is now accepting applications for the Addison Blonsky Grant, which will be awarded in the fall of 2013. Any questions can be directed to Steven Krause at KRAUSES@ccf.org.

For more information on all of APS’s Regional Societies, please visit the Regional Societies Page of Americanpainsociety.org.

In the Media

FDA Panel Votes for Tighter Controls on Vicodin (MedPage Today)

CDC Restates Prohibition Against Reuse Of Single-Dose Vials (Pain Medicine News)

Joint Commission Urges Safer Use of Opioids in Hospitals (Pain Medicine News)

Saline Preinjection Increases Size of RF Lesions (Anesthesiology News)

New Research Sheds Light on Opioid Resistance (Anesthesiology News)

No Proof Drugs Ease Kids' Migraines: Study (US News & World Report)

Brain Scans Show Doctors Feel Their Patients' Pain–And Their Relief (Medical News Today)

Children Treated With Common Anti-Fever Medications At Increased Risk For Kidney Injury (Medical News Today)

Men Taking Long-Acting Chronic Pain Meds Five Times More Likely to Have Low Testosterone Levels (Science News)

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.