Education

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.

2014 Call for Poster Abstracts Available Soon

The 2014 Call for Poster Abstracts will be available on the APS website beginning August 15. Please mark your calendar and plan to submit your abstract for consideration as a poster presentation at the 33rd APS Annual Scientific Meeting in Tampa, FL, April 30–May 3, 2014. The deadline for the receipt of all abstracts is November 15. Primary authors will be notified of their abstract’s status in late December.

Members

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.

Summaries

Journal of Pain Highlights

The following highlights summarize selected articles from the Journal of Pain (Volume 14, Number 6).

The Effect of Discussing Pain on Patient-Physician Communication in a Low-Income, Black, Primary Care Patient Population
Stephen G. Henry and Susan Eggly, University of California Davis and Wayne State University

Researchers analyzed 133 video-recorded patient physician visits that included conversations about pain. The setting was a primary-care practice serving a low-income Black population. The objective of the study was to study patient and physician verbal and nonverbal communication and to assess variations in affect and rapport during the visits. The authors also wanted to investigate whether any observed variations were associated with discussions about pain, pain severity, or percentage of time talking about pain. They hypothesized that patients and physicians would display more negative affect and rapport when they spent a higher percentage of time during the visit discussing pain and that patients and physicians would display more negative affect during visits with patients who reported more severe pain.

Given the well-documented connection between the quality of patient-physician relationships and communication, the authors noted it is plausible that frustrations expressed during discussions about pain could adversely affect the quality of communication, the overall doctor-patient relationship, and possibly pain-management outcomes.

Study results revealed that when patients and clinicians discussed pain as opposed to other health topics, the patients showed significantly more of both negative and positive emotions. The authors surmised that patients can experience more intense emotions and greater overall arousal when discussing pain, which translates into higher ratings of both positive and negative affect.

In addition, the authors found that pain discussions were not significantly associated with physician-patient rapport, physician unease, or physicians’ positive engagement. One explanation given is that doctors are not as likely as patients to display their emotions during in-office discussions about pain, due to their training and experience.

Gender Differences in Blood Pressure Related Hypoalgesia in a General Population: The Tromso Study
Roy Bjorkholt Olsen, Stephen Bruehl, Christopher Sivert Nielsen, Leiv Arne Rosseland, Anne Elise Eggen and Audun Stubhaug, University of Tromso, Norway and Oslo University Hospital

Pain and blood pressure (BP) regulation overlap and interact to reflect a homeostatic feedback loop to help maintain stable blood pressure under painful stimuli. This functional interaction produces BP-related hypoalgesia, in which higher pressure levels are associated with reduced pain sensitivity. An important issue raised in prior research is whether BP-related hypoalgesia is gender differentiated. In this study, Norwegian researchers tested for the first time in a large general population of equal gender distribution whether gender moderates BP-related hypoalgesia.

The Tromse 6 Study was performed in 2007 and 2008 as a continuation of the core Tromse Study examining epidemiologic and prospective health problems, symptoms, and chronic diseases. The study began in 1974. For Tromse 6, some 13,000 subjects were evaluated. Participants completed questionnaires covering various health issues, symptoms, and diseases and were given physical examinations. Resting BP was measured, and individuals were given a standard cold-presser to show pain ratings every 9 seconds.

Researchers considered weather BP-related hypoalgesia increased proportionally through the range of extremely low to hypertensive BP levels. Based on previous studies, the authors hypothesized that BP-related hypoalgesia would increase proportionally as BP readings increased and reached the hypertensive level.

Results supported the study hypothesis and showed there was an inverse linear association between resting BP levels and acute pain responses among subjects with resting BP below hypertensive levels. However, the hypertensive subjects showed no further increases in BP, thereby demonstrating a ceiling phenomenon. This suggests that patients with hypertension could be at increased risk for pain-inhibitory failure and potentially subsequent chronic pain conditions following a significant injury. The authors noted this relationship might be consistent with observed epidemiological and clinical associations between chronic pain and hypertension.

The study findings also showed that women displayed significantly more BP-related hypoalgesia than men.

Clinical Journal of Pain Highlights

The following highlights summarize selected articles from the Clinical Journal of Pain (Volume 29, Number 7, July Issue).

A Multidimensional Approach to Pain Assessment in Critically Ill Infants During a Painful Procedure
Manon Ranger, C. Celeste Johnston, Janet E. Rennick, Catherine Limperopoulos, Thomas Heldt, and Adre´ J. du Plessis; School of Nursing, McGill University; Montreal Children’s Hospital, McGill University Health Center, Montreal, QC; IWK Health Center, Halifax, NS, Canada; Department of Neurology, Children’s Hospital Boston; Computational Physiology and Clinical Inference Group, Research Laboratory of Electronics, Massachusetts Institute of Technology; Division of Fetal and Transitional Medicine and Division of Diagnostic Imaging and Radiology, Children’s National Medical Center

The ability to accurately extract appropriate infant pain cues from observations is often jeopardized when heavy sedation and muscular blocking agents are administered. This study reports on regional cerebral and systemic hemodynamic changes, as well as behavioral reactions, in critically ill infants with congenital heart disease during a routine painful procedure. Researchers assessed the cerebrovascular and cardiovascular responses to postoperative chest-drain removal by means of continuous near-infrared spectroscopy (NIRS), as well as usual monitoring of heart rate, systemic blood oxygenation, and mean arterial blood pressure. Behavioral reactions were captured through video recordings and rated for pain retrospectively with the Face Leg Activity Cry Consolability (FLACC) pain scale. Differences within patients across phases of the procedure, factors associated with response (sex, age, weight, and medication), and associations between cerebral hemodynamic changes, systemic physiological changes, FLACC pain scores, and specific clinical variables were examined.

Using a multidimensional pain assessment approach, significant cerebral, physiological, and behavioral activity was present in response to a noxious procedure in critically ill infants despite the administration of analgesic treatment. Investigators demonstrated that female infants showed significantly stronger cerebral hemodynamic response and higher pain scores across the events when compared with males. Significant associations between three multidimensional “pain” parameters were not identified. Because average FLACC scores were high and the sedative agent, rather than analgesic treatment, reduced pain ratings significantly, healthcare professionals may be encouraged to question current pain management protocols during chest-drain removal in critically ill infants.

Adding cerebral measurements to a behavioral assessment may complement pain evaluation when there is risk for dampened behaviors (for example, in patients who are highly sedated or paralyzed). These data underscore the need for further investigations of pain responses in noncommunicative patients that combine simultaneous cerebral and behavioral assessment.

Understanding the Information and Service Needs of Young Adults with Chronic Pain Perspectives of Young Adults and Their Providers
Jennifer Stinson, Meghan White, Lisa Isaac, Fiona Campbell, Stephen Brown, Danielle Ruskin, Allan Gordon, Marilyn Galonski, Leah Pink, Norman Buckley, James L. Henry, Chitra Lalloo, and Allia Karim; Departments of Anesthesia and Pain; Child Health Evaluative Sciences, The Hospital for Sick Children; Lawrence S. Bloomberg Faculty of Nursing, University of Toronto; Wasser Pain Management Centre, Mount Sinai Hospital, Toronto and Department of Anesthesia; Department of Psychiatry and Behavioural Neurosciences, McMaster University; and Medical Sciences Program, McMaster University, Hamilton, ON, Canada

Chronic pain (CP) in young adults (YAs) is a common problem. Evidence supporting cognitive-behavioral therapies (CBT) to improve health outcomes in CP is strong, yet integration of these interventions in routine clinical care in primary care settings and specialty pain clinics has been slow. Consequently, the majority of YAs do not receive comprehensive CP education and coping skills training to decrease symptoms and enhance health-related quality of life. This study qualitatively explored the information and service needs of young adults (YAs) with chronic pain to inform the development of a Web-based chronic pain self-management program.

A convenience sample of YAs ages 18 to 29 with chronic pain was recruited from two adult tertiary care multidisciplinary chronic pain clinics in Ontario. Findings uncovered four major themes: pain impact, pain management strategies, barriers to care, and service delivery recommendations. Pain had an impact on social and emotional realms and role functioning, physical functioning, and future vocational and life goals. Pain management strategies included psychological, physical, and pharmacological approaches and development of support systems. Barriers to care were revealed at the patient, healthcare system, and societal levels.

Participants unanimously felt that a Web-based program would be an acceptable means to help improve access to services and meet the need for more information about chronic pain, strategies to manage pain symptoms, and social support to address the unique developmental needs of YAs.

Many YA participants expressed ambivalent feelings toward pharmacological therapy; their desire for pain relief mingled with concern about adverse effects and the possibility of addiction. YAs also stated that current CP management programs were tailored more to older adults with CP and did not meet their unique developmental needs. Healthcare providers stressed the importance of discussing issues targeted to this age group, such as sexual relationships.

Participants offered a range of suggestions to inform the design and development of a Web-based self-management program to meet the unique needs of YAs with CP. Healthcare providers indicated that meeting the unique information needs of this group would go a long way toward improving clinician-patient communication and patient engagement in decision making.

PAIN Highlights

The following highlights summarize selected articles from PAIN (Volume 154, Number 7, July Issue).

Effects of Motion Style Acupuncture Treatment in Acute Low Back Pain Patients with Severe Disability: A Multicenter, Randomized, Controlled, Comparative Effectiveness Trial
Joon-Shik Shin, In-Hyuk Ha, Jinho Lee, Youngkwon Choi, Me-riong Kim, Byoung-Yoon Park, Byung-Cheul Shin, and Myeong Soo Lee; Jaseng Medical Foundation, Jaseng Hospital of Korean Medicine, Seoul, Republic of Korea; Division of Clinical Medicine, School of Korean Medicine, Pusan National University, Yangsan, Republic of Korea; Medical Research Division, Korea Institute of Oriental Medicine, Daejeon, Republic of Korea

Motion style acupuncture treatment (MSAT) is a relatively novel acupuncture method that is being used increasingly in South Korea. It is similar to traditional acupuncture in that needles are inserted at specific acupuncture points, but it is unique because it necessitates passive or active movement of the patient’s body while acupuncture needles are retained. This study was designed to examine the effects of MSAT on patients with acute low-back pain (aLBP) who have severe disabilities.

Numerical rating scale (NRS) rankings of low-back pain, the primary outcome measure for the MSAT group, were more positive among MSAT participants than injection group participants at 30 minutes. This difference was maintained at 2 and 4 weeks but it gradually decreased, with no significant difference at 24 weeks. Whereas NRS rankings of leg pain in the MSAT group showed a significant decrease 30 minutes after treatment, the injection group did not experience this decrease in pain. Both groups presented with a significant pain decrease at 2 and 4 weeks, and at 24 weeks the injection group showed a greater reduction in pain. The MSAT group showed a more significant difference than the injection group at 30 minutes and at 2 and 4 weeks, but not at 24 weeks. Furthermore, the MSAT group showed a significant difference in straight-leg raising (SLR) at 30 minutes.

This study demonstrated that MSAT was more effective for pain and function in patients with aLBP with severe disability in the short term and for up to 4 weeks versus conventional NSAID injection. These results suggest that MSAT has superior effects on pain and functional status, as demonstrated by the NRS rankings of LBP and leg pain, Oswestry Disability Index scores, lumbar range of motion, and range of SLR.

Because the setting was a Korean hospital, it is possible that patients were more likely to favor acupuncture. Additional studies comparing MSAT with traditional acupuncture and investigations of post-MSAT MRI follow-up of patients experiencing severe disability attributable to acute disc herniation will shed more light on this topic.

Opioid Use Among Low Back Pain Patients in Primary Care: Is Opioid Prescription Associated with Disability at 6-Month Follow-Up?
Julie Ashworth, Daniel J. Green, Kate M. Dunn, and Kelvin P. Jordan; Arthritis Research UK Primary Care Centre, Keele University, Staffordshire, UK; IMPACT Community Pain Service, Staffordshire & Stoke-on-Trent Partnership Trust, Staffordshire, UK; University Hospital of North Staffordshire, Stoke-on-Trent, Staffordshire, UK

This study sought to assess the relationship between opioid prescribing at baseline and self-reported disability, as measured by the Roland and Morris Disability Questionnaire (RMDQ) at 6-month follow-up in a United Kingdom population of primary care consulters with low-back pain (LBP). A total of 715 participants from a prospective cohort study who gave consent for review of medical and prescribing records and completed baseline and 6-month follow-up questionnaires were included. The primary outcome was RMDQ disability at 6 months. In the final multivariable analysis, opioid prescription at baseline (32.7%) was significantly associated with higher disability at 6-month follow-up, but the magnitude of this effect was small, with a mean RMDQ score 1.18 points higher among those prescribed opioids. These findings indicate that even after adjusting for a substantial number of potential confounders, opioids were associated with slightly worse functioning in patients with back pain at 6-month follow-up.

Self-efficacy scores were lower in the higher-dose groups. Those prescribed opioids were also significantly more likely to receive a nonsteroidal anti-inflammatory drug prescription and had significantly higher comorbidity scores, with the highest comorbidity scores in the high-dose group. The number of women receiving an opioid prescription was significantly higher than the number of men, particularly in the higher-dose groups. Across the study population, self-reported disability, pain, self-efficacy, anxiety, and depression improved during the 6-month follow-up period; the degree of improvement was similar for those who were prescribed opioids during the baseline period and those who were not.

These findings indicate that even after adjusting for a large number of covariates, receipt of an opioid prescription did not improve functional outcome from LBP. It is possible that patient preference for or against treatment with prescribed opioid analgesics is associated with other differences in patient behavior in the presence of LBP, and that such differences may, in turn, influence disability. This study found that opioids were commonly prescribed for patients with LBP, yet there is little evidence that this is a useful therapeutic strategy.

Research

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

The call for letters of intent (LOIs) for the 2014 Sharon S. Keller Chronic Pain Research Grants Program opens September 3. This year APS will again award up to 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 increased access to or expanded treatment options for people with chronic pain. LOI submission will be open 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.

Society

APS Headquarters Is Moving to Chicago

APS and its management firm, Association Management Center (AMC), will be relocating its offices and client headquarters in August. AMC embarked upon a search for new office space in 2012 after outgrowing its current location in Glenview, IL, after nearly 18 years.

The new office is located in the O’Hare Plaza office complex, which is less than 5 miles from O’Hare International Airport. This location offers more convenience, flexibility, and efficiency for staff and volunteer leaders.

AMC will close at noon on Thursday, August 1 and will reopen in the new location on Monday, August 5. APS’s call center, online store, and members-only pages will be down temporarily during this time. APS’s phone, fax numbers, and e-mail addresses will not change, but our new address will be as follows:

American Pain Society
8735 W. Higgins Road, Suite 300
Chicago, IL 60631

Questions regarding the move can be sent to info@americanpainsociety.org or by calling 847.375.4715.

Call for APS Award Nominations

Every year at its Annual Scientific Meeting, APS rewards excellence in the field of pain management and research by presenting awards for career achievement, pain scholarship, education and public service, advocacy on behalf of children, outstanding service to APS, and early-career achievements.

Applications for the 2014 APS annual achievement awards are now open and will close at midnight on August 1. Award winners will be announced in September 2013 and will be honored at the President’s Recognition Reception at the 33rd Annual Scientific Meeting April 30–May 3, 2014, in Tampa, FL.

To make one or more award nominations, please visit the APS website and complete the electronic nomination form. Please be sure to include all of the requested information. All nominations should be completed online by August 1. Please contact Amanda Pairitz at the APS office at apairitz@americanpainsociety.org with any questions.

Save the Date for APS's 2014 Annual Scientific Meeting

APS 33rd Annual Scientific Meeting
April 30–May 3, 2014
Tampa Convention Center
Tampa, FL

Attend APS’s 33rd Annual Scientific Meeting to

• discover the latest in basic science and clinical research
  
• experience a unique multidisciplinary forum for sharing advances and standards in evidence-based pain research and treatment
  
• discuss new trends, techniques, therapies, and diagnostic procedures.

For more information visit www.apsscientificmeeting.org.

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.

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.