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EducationCall for Poster AbstractsThe 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. MembersMember Spotlight: Beth Darnall![]() Beth Darnall How has membership in APS been of value to you and your professional development? I am also indebted to APS for catalyzing my pain research career. In 2006 I was awarded a "Future Leaders in Pain Research" grant from APS. I cannot overemphasize the importance of this seed grant and how it transformed my future. I continue to study the concepts of my early APS-funded research—a main current empirical focus examines the immune, sensory perception, and neural correlates of catastrophizing. What is your area of specialty? What has been a highlight of your work? Are you and your staff especially proud of a particular project or accomplishment? In addition, before leaving Oregon for California I served as the 2012 president of the Pain Society of Oregon. This was a tremendous honor. At the time I was elected, the PSO was the only multidisciplinary state pain organization in the United States. Happily, Washington state has now joined the ranks! What initially sparked your interest in working in your field? Briefly describe your career path. Who is your favorite role model and why? Member Benefit: Journal AppNew JOP App The Journal of Pain iPad® edition allows you to get the content you need, where and when you need it. No more waiting until you're online, and no more keeping your print copy handy. You can
Download this exciting new member benefit today. SummariesThe Journal of Pain HighlightsThe following highlights summarize selected articles from The Journal of Pain (Volume 14, Number 9, October Issue). ![]() Persistent Postmastectomy Pain in Breast Cancer Survivors: Analysis of Clinical, Demographic, and Psychological Factors More than 40% of the 200,000 women in the United States diagnosed with breast cancer every year undergo surgery. Although treatment advances have significantly reduced mortality from breast cancer, persistent postmastectomy pain is rated by survivors as their most troubling symptom. Researchers from the University of Pittsburgh evaluated 611 women who had undergone a total or partial mastectomy and were treated with chemotherapy, radiation, or hormone therapy. The objective of the study was to determine which factors, such as demographics, tumor size, pain severity, treatments, stress, and psychological factors, contribute to postmastectomy pain. According to the authors, previous research has provided little consensus regarding the most important determinants of pain following mastectomy. Earlier studies had small sample sizes and focused on just one group of variables. In this study, the authors used a much larger sample, which allowed them to study a large number of variables at the same time. Results of this study showed, in accordance with some previous research, that there was no evidence of linkage between the type of mastectomy performed, tumor size, or the occurrence of treatment side effects and the development of postmastectomy pain. However, psychosocial variables were found to be important predictors. Specifically, anxiety, depression, impaired sleep, somatization, and catastrophizing each were independently related to the development of persistent postmastectomy pain. Motives for Medical Misuse of Prescription Opioids Among Adolescents Misuse of prescription opioids among adolescents and young adult has generated significant media coverage, but less attention has been given to differentiating the underlying motives for opioid misuse. Medical misuse is defined as use of a prescribed opioid medication in a manner not intended by the prescriber. Nonmedical misuse is use of someone else’s prescription drugs. Previous studies have shown the majority of adolescents who are prescribed opioids use them properly. But there are subgroups of adolescents who do not. The objectives of this study were to determine past-year prevalence of motives for medical misuse of prescription opioids among adolescents in two school districts in Detroit, and to assess the associations of motives for medical misuse with gender, race, ethnicity, substance abuse, and diversion behaviors. For this study, nearly 3,000 adolescents were surveyed in 2011 and 2012. The authors reported that pain relief was the most prevalent motive for medical misuse of opioids among adolescents. This factor alone motivated 4 in 5 adolescents who misused their prescribed pain medications. Further, the number of individuals who misused opioids nonmedically was 3 times greater than those who reported past-year medical misuse. Although the majority of medical misusers said they were motivated by their need for pain relief, 47% of nonmedical misusers and 30% of medical misusers said they were also motivated by non-pain relief choices, such as wanting to get high. The study showed that females were almost twice as likely as males to report past-year medical misuse of opioids, but there were no gender differences seen in the prevalence of motives. African Americans were more likely than whites to medically misuse opioids, and 3 in 4 said they were motivated by pain relief. The authors noted that racial differences observed in this study could be related to inadequate pain management, poor communication, insufficient opioid availability, and underprescribing among black patients. Also, the researchers reported that neither medical misuse nor the motive to relieve pain were associated with an increased risk for substance abuse. However, medical misuse for non-pain relief motives was linked with significantly greater probability for substance abuse. Overall, the findings of this study indicate a need for close monitoring of opioid medications among adolescents and underscore the importance of detecting unusual patterns of opioid medication use. Pain Medicine HighlightsThe following highlights summarize selected articles from Pain Medicine (Volume 14, Number 9, September Issue). ![]() Effect of Sacrum-Perineum Heat Therapy on Active Phase Labor Pain and Client Satisfaction: A Randomized, Controlled Trial Study The ability to reduce labor pain is one of the most important aspects of obstetric care. Heat therapy, typically applied to a woman’s back, lower abdomen, groin, or perineum during the last stage of labor, is a pain relief method that does not require highly skilled care. This study was designed to test the hypothesis that heat therapy on the perineum-sacrum during labor would reduce pain and increase mothers’ satisfaction with the birth experience. Because heat dilates blood vessels and raises blood flow, it can influence the transmission of pain impulses and can increase collagen elasticity. A rise in local blood circulation can reduce metabolites that activate nociceptors, and heat can also reduce swelling, thus relieving pressure on local nociceptive endings. This may also activate the release of endogenous opiates through placebo-type mechanisms. Sixty primiparous women ages 18 to 35 years old were randomly assigned to heat therapy and control groups. Pain and satisfaction scores were measured using a visual analog scale. Pain scores were recorded by the investigator every 30 minutes until dilation reached 8 cm. During these periods, the subjects were asked to inform the investigator to replace the towel when it became cold. The mean satisfaction score in the heat therapy group was significantly higher than in the control group. Pain scores reported by subjects in the group receiving sacrum-perineum heat therapy were lower than pain scores of the women in the control group 60, 90, and 120 minutes after intervention during the active phase of labor. In countries in which epidural anesthesia is routine, this noninvasive nonpharmacological modality provides a safe alternative for the mother and fetus and also provides mothers with a choice if they prefer to avoid invasive pharmacological methods of pain management during labor. This method may be particularly attractive to mothers who want to be more involved in their care. More research in controlled clinical trials is needed to evaluate the effectiveness of heat therapy alone and when combined with other nonpharmacological methods. Fentanyl Buccal Tablet Compared with Immediate-Release Oxycodone for the Management of Breakthrough Pain in Opioid-Tolerant Patients with Chronic Cancer and Noncancer Pain: A Randomized, Double-Blind, Crossover Study Followed by a 12-Week Open-Label Phase to Evaluate Patient Outcomes This is the second study designed to compare the efficacy and safety of a rapid-onset opioid fentanyl buccal tablet with traditional short-acting opioids (SAOs, immediate-release oxycodone), both titrated to a successful dose, for the treatment of breakthrough pain (BTP) in opioid-tolerant patients with chronic pain. This study included a 12-week open-label extension during which functional improvement and patient satisfaction were assessed. The results from this randomized double-blind, active controlled crossover study of opioid-tolerant patients with chronic pain were consistent with results from a previous, similarly designed, head-to-head study. In the treatment of BTP, onset of analgesia was more rapid after administration of a fentanyl buccal tablet than after administration of immediate-release oxycodone. Statistically significant differences between fentanyl buccal tablet and immediate-release oxycodone were observed in pain intensity as soon as 10 minutes after administration of the study medication, and in pain relief as early as 15 minutes postdose. After 12 weeks of open-label treatment, patients and clinicians reported consistently better functional improvement and satisfaction with fentanyl buccal tablets compared with traditional SAOs. The results of the efficacy assessments are corroborated by findings from a BTP preference questionnaire, in which 47% of patients preferred fentanyl buccal tablet and 35% of patients preferred immediate-release oxycodone. Safety and tolerability profiles were comparable. PAIN HighlightsThe following highlights summarize selected articles from PAIN (Volume 154, Number 10, October 2013 Issue). ![]() Sex Differences in Emotion-Related Cognitive Processes in Irritable Bowel Syndrome and Healthy Control Subjects Irritable bowel syndrome (IBS) occurs with a slightly higher prevalence in women, and sex-related differences in visceral perception, autonomic nervous system, and brain responses to visceral stimuli have been reported. In their response to emotion-related stimuli (including faces, images, words, odors, and music), women generally show greater brain activation related to emotions of sadness, disgust, and unpleasantness, whereas men demonstrate stronger neural responses to emotions such as anger, fear, and guilt. In the current study, investigators used the paradigm of viewing negative affective (fear and anger) and neutral faces to test sex- and IBS-related differences in brain response associated with cognitive processes (processing negative emotions). The following hypotheses were tested: greater brain responses in affective regions and less recruitment of prefrontal inhibitory regions will be observed in IBS subjects compared to healthy controls (HCs), in men compared to women, in men with IBS compared to women with IBS, and in male HCs compared to female HCs. Investigators also hypothesized that greater regional brain activation by the emotional faces paradigm would be accompanied by changes in the effective connectivity of the emotion-related circuit and its cortical modulatory input. Functional magnetic resonance imaging was used to measure neural responses to an emotion recognition paradigm using faces expressing negative emotions (fear and anger). Sex and disease differences in the connectivity of affective and modulatory cortical circuits were studied in 47 IBS subjects and 67 HCs. Although most fell within normal clinical ranges, 18% of all subjects (IBS + HC) had anxiety scores above the clinical cutoff, and less than 1% of all subjects had depression scores above the clinical cutoff. Compared to HCs, IBS subjects as a group showed significantly higher anxiety symptoms, with men with IBS showing slightly higher levels than women with IBS. Functional activity during the viewing of emotional faces did not differ when IBS subjects as a group were compared to HCs. Greater IBS-related engagement of emotional arousal and cognitive modulatory brain circuitry can be demonstrated in men, but different stimuli are required in men and women to elicit these disease- and sex-related differences. These findings emphasize the importance of taking sex-related differences into account when evaluating disease differences and when assessing the importance of symptom-related stressors in the clinic. Efficacy, Safety, and Tolerability of Fulranumab, an Anti-Nerve Growth Factor Antibody, in the Treatment of Patients with Moderate to Severe Osteoarthritis Pain Nerve growth factor (NGF) increases in chronic pain conditions. This study examined the analgesic efficacy and safety of fulranumab, a fully human monoclonal anti-NGF antibody, in adults with chronic knee or hip osteoarthritis pain not adequately controlled with standard pain therapies. Patients (n = 466, intent-to-treat) were randomized to receive, in addition to their current pain therapy, subcutaneous injections in one of six parallel treatment groups: placebo (n = 78); fulranumab 1 mg (n = 77) or 3 mg (n = 79) every 4 weeks (Q4wk); or fulranumab 3 mg (n = 76), 6 mg (n = 78), or 10 mg (n = 78) every 8 weeks (Q8wk). Fulranumab treatment resulted in statistically significant efficacy in pain measures and physical function versus placebo and was generally well tolerated. NGF contributes to persistent pain in a variety of animal models of inflammatory and neuropathic pain, and an extensive body of evidence points to the pivotal contribution of NGF to pain mechanisms in the adult mammalian nervous system. Fulranumab is a human recombinant immunoglobulin G2 monoclonal antibody that specifically neutralizes the biological actions of human NGF. All subjects were able to complete the 12-week double-blind efficacy phase and the first 16 weeks of double-blind treatment. The primary efficacy endpoint was achieved with a significant reduction in osteoarthritis pain intensity versus placebo from baseline to week 12 in the 3 mg Q4wk, 6 mg Q8wk, and 10 mg Q8wk treatment groups. Based on the statistical analysis, there was no difference in efficacy between the knee and hip. Dosing frequency appeared to be an important mediator of drug response, with improved efficacy observed at more frequent dosing intervals. ResearchThe Rita Allen Foundation (RAF) and the American Pain Society announce the 2014 Rita Allen Foundation Award in Pain. Request for applications will open November 1, 2013.The Rita Allen Foundation and APS announce the 2014 Award in Pain. The RAF and APS may award two grants in the amount of $50,000 annually, for a period of up to 3 years to those research proposals demonstrating the greatest merit and potential for success. Candidates must have completed their training and provided persuasive evidence of distinguished achievement or extraordinary promise in basic science research in pain. Candidates should be in the early stages of their career with an appointment at faculty level. The entire award is to be allocated to projects specifically chosen by the recipient. Overhead is not supported. To learn more about the Rita Allen Foundation Award in Pain, please visit the APS website where additional details and an application link will be posted on November 1, 2013. Call for Applications for the 2014 Clinical Centers of Excellence Program Now OpenThe call for applications for the 2014 APS Clinical Centers of Excellence (CCOE) in Pain Management Awards is now open September 2–November 29. 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. SocietySIG Update![]() Tamara A. Baker, PhD, is an associate professor in the School of Aging Studies at the University of South Florida in Tampa, FL. Her research focuses on health disparities, patient-centered outcomes, and community-based interventions. She has published extensively in the area of pain management among older minority populations, with an emphasis on understanding the psychosocial facilitators and barriers to pain management among older African Americans. Dr. Baker serves as a Member-at-Large of the APS Pain and Disparities Special Interest Group. Tell us about your new book, Handbook of Minority Aging. Highlight some of the areas in your book that have specific implications for researchers and clinicians who are interested in better understanding the pain experience of minority populations. What are some of the lessons learned from both your disparities research examining pain and health issues among older adults, and your work with diverse populations? You are a founding member of the APS Pain and Disparities SIG. What is your vision for the Pain and Disparities SIG going forward? Scientific Program Committee UpdateAPS’ Annual Scientific Meeting: How Do We Get to Tampa? The SPC is responsible for organizing the Annual Scientific Meeting and is comprised of approximately 16 APS members representing basic scientists, nurses, physicians, pharmacists, psychologists, young investigators, and other pain professionals, as well as a representative from the NIH Pain Consortium. The APS President, education domain chair, and lead nurse planner serve as ex-officio members. The committee is responsible for identifying content for and then planning, developing, and evaluating the Annual Scientific Meeting. The SPC Chair is appointed by the APS President; each chair serves 1 year as chair-elect and then the following year as chair. Committee members are selected by the program chair and each member serves a 2-year term. The SPC’s work is supported by the Education Advisory Committee (EAC), whose function it is to initiate a needs assessment and then share learning needs found to exist within clinical, research, and administrative practice gaps in pain care. These needs form the basis of the call for symposia every year. Once the needs have been indentified, APS puts forth a call for symposia. This is an opportunity for pain professionals to submit proposals for 90-minute symposia sessions or 3-hour workshops. The proposals are collected via an online submission system. For the 2014 meeting in Tampa, APS members and others in the pain community submitted a record 81 proposals for the SPC’s consideration. Each of these proposals was reviewed by all members of the SPC, and scores were assigned based upon a set of rating criteria. During the proposal review process, committee members have the opportunity to review proposed faculty members’ conflict of interest disclosures, learn about the rationale for each proposed topic, and enter comments or suggestions for each proposal while conducting their official review. After completing their review, the SPC meets in person in Chicago for a full-day meeting to discuss all of the submissions and to talk further about the goals and needs for the upcoming annual meeting. This is accomplished by discussing current issues in pain care and research, hearing from the APS president and education domain representative on initiatives set forth by the Board of Directors, and by evaluating the content and topics within each of the proposed symposia and workshop sessions. One of the unique aspects of APS is the fact that we are an interdisciplinary community; as such, the SPC’s goal is to create an annual meeting for physicians, nurses, basic scientists, pharmacists, psychologists, physical therapists, and other professionals who make up the interdisciplinary pain community. To accomplish this, the SPC looks for proposals with faculty representation from more than one discipline, with representation from a variety of facilities and institutions, and with content that addresses the full spectrum of care. Proposals are shepherded by committee members, and in many cases, faculty members and content are changed in order to meet the needs of a variety of disciplines. The annual meeting’s program comprises about 30 sessions, which means that for 2014, more than half of the submitted proposals must be declined. Many of these are high-quality proposals on topics that are timely and fit within the SPC’s and EAC’s needs assessment areas, but there just isn’t enough time or space on the schedule to include all of the meritorious proposals. The committee members work for about 4 weeks to complete assignments related to proposal changes, updates, and to develop sessions on topics that were not represented among the submitted proposals. Once these changes are complete, the program chair assigns each session into a time slot on the program and staff begins to communicate with moderators and faculty members regarding their participation. Faculty are asked to review information related to effective teaching and learning methodologies, to familiarize themselves with copyright guidelines, to develop presentations with active learning components, and to prepare handout materials, self-assessment questions, and in some cases, pre- and post-tests for attendees. The SPC’s work continues during the months leading up to the Annual Scientific Meeting. They are busy reviewing more than 400 abstracts submitted for poster presentation, selecting Young Investigator Travel Award recipients from a competitive application process, organizing mentored poster rounds, communicating with the Keynote and Plenary speakers, and answering questions from members. Approximately half of the committee also begins thinking about the next year’s meeting—planning for the 2015 meeting in Palm Springs, CA, will begin in January. The Annual Scientific Meeting is an opportunity for those in pain research and treatment to gather together to discuss the science behind the treatment of pain, hear from renowned speakers, meet with young investigators and learn about new trends, and network with colleagues. The SPC is looking forward to the 2014 meeting and encourages your continued participation through the submission of your proposals and abstracts and your attendance at the meeting. We look forward to seeing you in Tampa, FL. Important DatesRita Allen Foundation Award in PainOpens Friday, November 1 Call for 2014 Poster AbstractsDeadline: Friday, November 15 Clinical Centers of Excellence Award ProgramDeadline: Friday, November 29 Rita Allen Foundation Award in PainDeadline: Friday, January 17 Call for SubmissionsDo 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. |
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