Education

2015 Annual Scientific Meeting Includes the Return of the Spring Pain Meeting

You may have heard that APS is delivering a new experience at the 2015 Annual Scientific Meeting.

APS has reexamined the attendee experience to meet the evolving educational needs of pain science professionals. The 34th Annual Scientific Meeting features exciting new opportunities for attendee engagement and experiences that should not be missed. The Annual Scientific Meeting is the premier pain science event, uniting hundreds of pain researchers and clinicians from across the country.

In upcoming issues of APS E-News, we will feature various enhancements to the annual meeting that you can look forward to.

The Return of Spring Pain
The 2015 Spring Pain meeting will be held May 11–13, prior to the APS Annual Scientific Meeting.

Be the first to hear presentations of original, not-yet-published research being conducted in the basic and clinical pain sciences. Participate in informative talks on hot topics in sensory research. Enjoy fun activities with colleagues each afternoon.

Basic science presentations will then continue at the APS Scientific Meeting. Stay in Palm Springs for the annual meeting, May 13–16.

Spring Pain attendees receive a discount on registration fees for the APS Annual Scientific Meeting.

Additional details regarding Spring Pain sessions can be found at www.springconference.com.

Bring your desire to learn to Palm Springs. Meeting registration will open in early December.

The Methadone Safety Guidelines: A Live Webinar

APS would like to thank the individuals and speakers wwho participated in "The Methadone Safety Guidelines: A Live Webinar" on Tuesday, Novemeber 11.

This webinar addressed important safety gidelines and methadone safety prescribing strategies for primary care clinicians. Attendees gained insight and knowledge on improving care for their patients safely and effectively.

The webinar was based on the Methadone Safety clinical practice guideline recently published in The Journal of Pain and developed by APS and the College on Problems of Drug Dependence, in collaboration with the Heart Rhythm Society.

Presenters included Keela Herr, PhD RN AGSF FAAN, Melissa Wiemer, DO MCR, and Roger Chou, MD, lead author of the Methadone Safety guideline.

If you missed the live webinar, a recording of the webinar and presentation slides are now available.

The webinar recording is not available for CME credit.

Young Investigator Travel Award Application Will Open in January!

APS is offering travel stipends through the Young Investigator Travel Award for the 2015 APS Annual Scientific Meeting. A limited number of funding awards will be available to individuals presenting poster abstracts at the meeting, May 13–16, in Palm Springs, CA. Applicants may come from any research training background (basic or clinical science, psychology, medicine, or biostatistics) and may be at any level in training (students, residents, predoctoral trainees, postdoctoral fellows, and those who have completed their postdoctoral training within the past 3 years). Applicants must be APS members and must have an abstract accepted for presentation. Applications from nonmembers will not be considered.

To apply for the travel grant, visit the APS website after January 6 to complete the online application. Note that an applicant’s abstract must be accepted for presentation before he or she is eligible to submit an application for this grant. Poster abstract acceptance letters will be e-mailed to primary authors in late December, and a listing of accepted abstracts, by primary author, will be available on the website by December 31. Please check the abstract acceptance list before applying for a Young Investigator award.

Applications must be completed online by February 10, 2015.

Applications will be reviewed by the APS Scientific Program Committee, and stipends will be awarded in late February. Notifications will be sent to applicants in March. Those applicants selected to receive a 2015 award will receive their travel grants at the annual meeting.

2015 Annual Scientific Meeting Call for Poster Abstracts: Your Last Chance to Submit

APS invites the submission of abstracts for poster presentations at the 34th Annual Scientific Meeting, May 13–16, 2015, in Palm Springs, CA. The Call for Poster Abstracts is open on the APS website through November 21 and instructions for submissions are now available.

New for 2015! Accepted posters will be on display in the Experience Exchange (exhibit hall) for the entire duration of exhibit and poster viewing times. APS will not “turn” the posters in Palm Springs, and all posters will be on display during specified times. Poster presenters should plan to set up their posters on Wednesday, May 13, 2–4:15 pm. Posters will remain on display until 10:30 am Friday, May 15.

Research

2015 Rita Allen Foundation Award in Pain Applications Accepted Beginning November 3

The Rita Allen Foundation (RAF) and APS announce the 2015 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 the 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 RAF Award in Pain, please visit the APS website, where additional details and an application link are posted.

Members

Welcome New Members

APS is pleased to welcome and recognize the following new members from September and October 2014:

Funding Announcements

Clinical Evaluation of Adjuncts to Opioid Therapies for the Treatment of Chronic Pain (R01)

This funding opportunity announcement (FOA) aims to fund applications designed to assess the clinical value of adjuncts prescribed to chronic pain patients together with opioid analgesics. Adjuncts of interest are either approved by the U.S. Food and Drug Administration (FDA) or have previously been studied as an investigational new drug. Studies with adjuncts of interest should be focused on enhancing analgesia rather than on reducing an adverse effect. A secondary purpose is to increase awareness among opioid prescribers of the potential value of adjunctive therapies by focused data dissemination.

It is hoped that by increasing availability of data describing the use of opioid adjuncts, their use will increase and levels of opioids needed for analgesia will diminish. Reductions in the dosage of opioids prescribed would improve the quality of life of chronic pain patients by reducing opioid-associated adverse effects and lowering the risk of addiction development.

Studies should examine clinical populations and address whether a proposed adjunct can reduce the dose of opioid required for analgesia compared with opioid monotherapy. Applications will be evaluated on the feasibility, scientific rigor, and likely value of the proposed outcomes of randomized control trials (RCTs) to study opioid-adjunct combinations. In addition, the investigators should describe their plan to disseminate the study results. This plan will be evaluated with a view to how effectively the study results will be communicated to the types of healthcare providers who typically prescribe opioids to the chronic pain population under examination.

The purpose of this FOA is to examine adjunctive therapies to reduce the need for opioids in chronic pain patients. Therefore, in the patient group under investigation the pain syndrome should chronologically precede opioid exposure and the opioids should be prescribed as a treatment for the pain.

In the population proposed to be studied, the subjects should be etiologically homogenous and symptomatically well defined. Examples of such chronic pain populations in which opioids often are prescribed include patients with radicular cervical pain, metastatic bone pain, or peripheral neuropathies.

Studies should use an RCT design to examine opioid and adjunct formulations that are either typically used in the outpatient chronic pain population under study or are feasible for daily use in that population. For example, a formulation that requires once a day oral dosing is likely to be of much higher programmatic interest than a formulation requiring multiple daily dosing or intrathecal administration. Adjuncts to be examined should preferably be FDA approved, examples of which would include pregabalin, duloxetine, or dronabinol. However, agents that currently are being (or previously have been) studied as investigational new drugs (for example, Sativex/Nabiximols) also will be considered.

Submissions were accepted beginning September 5 and letters of intent are due 30 days before applications are due. For more information about this funding opportunity, visit the NIH grants page.

Development of Opioid and Adjuvant Fixed Combination Dosage Forms for the Treatment of Chronic Pain with Reduced Addiction Potential (R41/R42)

This funding opportunity announcement seeks small business organizations to develop opioid and adjuvant drug combinations within a single dosage form for treatment of a pain condition. The drug combination should provide improved analgesia when compared with the same dose (morphine equivalents) of opioid monotherapy. Such dosage forms should minimize opioid exposure while optimizing analgesia to reduce risk of addiction and limit severity of other opiate adverse effects.

When designing this new product, investigators should consider FDA guidance (21 CFR 300.50) and address the following issues. Both of the agents contained in the proposed new product should currently have at least one existing FDA-approved indication, as well as some existing clinical evidence to support the use of the chosen adjuvant-opioid combination and a reasonable expectation that the combination will present minimal drug-drug interaction concerns. The application should emphasize available evidence that the chosen drugs and doses in the combination will allow a substantial patient population to gain sufficient analgesic value from the contained opioid dose while the adjuvant dose remains within a safe and effective "therapeutic window." One example of a potentially viable adjuvant is gabapentin, a drug known to reduce neuropathic pain and to which patients typically exhibit no more than mild adverse effects. Gabapentin typically does not induce substantial drug interactions because it is eliminated as parent drug by renal excretion and does not bind extensively to blood proteins.

The adjuvant should be chosen for a capacity to increase overall analgesia, rather than an ability to reduce opioid adverse effects. For example, inclusion of a poorly absorbed opioid receptor antagonist, with the intent of reducing constipation, would not be considered of high programmatic interest.

The combination dosage form proposed by the application should provide sustained relief when it is the only analgesic used and is administered no more than three times in a 24-hour period. The formulation should be such that a patient with reasonable mobility is able to self-administer the drug (e.g., oral dosage form).

The application should propose late-stage drug development–oriented studies that significantly drive the project toward an ultimate aim of a New Drug Application [505(b)(1 or 2)] or Abbreviated New Drug Application [505(j)] for the treatment of a long-term pain condition.

Studies planned for Phase 1 of the project should focus on issues that concern the feasibility of the project. The exact nature of such studies will differ depending on the proposed drug combination project.

Studies that might be appropriate for Phase 1 STTR applications include, but are not limited to

• development of a formulation that safely delivers the desired amount of both agents over an appropriate dosing interval
  
• preclinical studies demonstrating additive or synergistic analgesia with the opioid-adjuvant combination
  
• studies to provide data for an Investigational New Drug (IND) submission, such as short-term stability studies
  
• pre-IND consultations with an FDA project management group and development of the IND documentation.

Examples of projects appropriate for Phase 2 of an STTR award might include

• pharmacokinetic absorption and disposition studies to demonstrate the bioequivalence between approved dosage forms and the proposed product
  
• proof of concept clinical studies. Appropriate outcome measures might aim to detect and distinguish value added by an opioid adjunctive therapy, whether due to improved analgesia or reduced required opioid dosage.

Submissions were accepted beginning March 5 and letters of intent are due 30 days before applications are due. For more information about this funding opportunity, visit the NIH grants page.

Neurobiology of Migraine (R01)

This funding opportunity announcement (FOA) is issued by the National Institute of Neurological Disorders and Stroke (NINDS) in conjunction with the National Institutes of Health (NIH) Pain Consortium. It solicits R01 grant applications from institutions and organizations to perform innovative research that will elucidate the mechanisms underlying migraine; expand our current knowledge of the role of genetic, physiological, biopsychosocial, and environmental influences in migraine susceptibility and progression; and explore new therapeutic targets and therapies for acute migraine management and longer term prevention.

The National Center for Complementary and Alternative Medicine (NCCAM) is interested in research that would elucidate the mechanisms by which a given complementary or integrative health approach beneficially affects migraine, either as an acute intervention or prophylactically. For this FOA, complementary or integrative health approaches could include those within the “mind and body” domain but not in the “natural products” domain and would include, but are not limited to, meditation, mindfulness, yoga, tai chi, qi-gong, acupuncture, massage, and spinal manipulation. The primary outcomes for these studies should be focused directly on the mechanism(s), though it may be appropriate to have secondary outcomes that assess clinical outcomes. There should be sufficient prior data to indicate either efficacy or effectiveness of the proposed complementary or integrative health approach.

The National Institute for Dental and Craniofacial Research (NIDCR) is interested in the neurobiological mechanisms underlying migraine headache as they pertain to overlaps with pathophysiological mechanisms of chronic temporomandibular and other orofacial pain disorders. Research examining common genetic, environmental, neurobiological, and biobehavioral factors underlying the co-occurrence of these disorders is encouraged. NIDCR is interested in funding meritorious research that focuses on studies addressing the comorbidity of temporomandibular and other orofacial disorders and migraine headache.

NIDCR is interested in the development of diagnostic, interventional, and novel therapeutic tools for headache pain associated with a variety of communication disorders such as tinnitus, Meniere’s disease, odynophagia, and burning mouth syndrome. Any individual(s) with the skills, knowledge, and resources necessary to carry out the proposed research as the program director or principal investigator (PD or PI) is invited to work with his or her organization to develop an application for support. Individuals from underrepresented racial and ethnic groups as well as individuals with disabilities always are encouraged to apply for NIH support.

Submissions will be accepted beginning May 5. For more information about this funding opportunity, visit the NIH grants page.

Summaries

The Journal of Pain Highlights

The following highlights summarize selected articles from Journal of Pain (Volume 15, Issue 11, November 2014 Issue).

Validation of a Brief Opioid Compliance Checklist of Patients with Chronic Pain
Robert N. Jamison, Marc O. Martel, Robert R. Edwards, Jing Qian, Kerry Anne Sheehan, and Edgar L. Ross; Pain Management Center, Departments of Anesthesia and Psychiatry, Brigham and Women’s Hospital, Harvard Medical School, Boston, MA; and Division of Biostatistics and Epidemiology, School of Public Health and Health Sciences, University of Massachusetts, Amherst, MA

Assuring appropriate use of drug theory is important for effective pain management, and a new study published in The Journal of Pain reported that use of a short compliance checklist can best predict individuals most likely to misuse prescription pain medications. Researchers at Brigham and Women’s Hospital developed and validated a brief self-administered compliance checklist for chronic opioid therapy in patients with chronic pain. Currently, there are no widely accepted assessments for monitoring ongoing opioid therapy and adherence, and few studies have attempted to link self-report variables with objective evidence of prescription drug misuse.

For the study, a 12-item opioid Compliance Checklist was repeatedly administered to 157 patients taking opioids for chronic pain, and the study participants were followed for 6 months. Results showed that five items best predicted subsequent aberrant drug behaviors.

• Lost or misplaced medications
• Ran out of pain medication early
• Missed scheduled doctor appointments
• Used any illegal or unauthorized substances
• Been completely honest about personal drug use

Data collected on the sample of patients with chronic pain suggest these five items may be useful for identifying potential for drug misuse and determining appropriateness of continued treatment.

Guideline-Concordant Management of Opioid Therapy Among Human Immunodeficiency Virus (HIV)-Infected and Uninfected Veterans
Julie R. Gaither, Joseph L. Goulet, William C. Becker, Stephen Crystal, E. Jennifer Edelman, Kirsha Gordon, Robert D. Kerns, David Rimland, Melissa Skanderson, Daniel F. Weisberg, Amy C. Justice, and David A. Fiellin; Yale School of Public Health, Yale University, New Haven, CT; Yale Center for Interdisciplinary Research on AIDS, Yale School of Public Health, Yale University, New Haven, CT; Departments of Psychiatry and Internal Medicine, Yale School of Medicine, Yale University, New Haven,CT; VA Connecticut Healthcare System, West Haven, CT; Institute for Health, Health Care Policy, and Aging Research, Rutgers University, New Brunswick, NJ; Division of Infectious Diseases, Emory University School of Medicine, Atlanta, GA; Atlanta VA Medical Center, Decatur, GA; VA Pittsburgh Healthcare System, Pittsburgh, PA

A study reported in The Journal of Pain showed that publication of clinical practice guidelines by several organizations for prescribing opioid pain medications for chronic noncancer pain have not resulted in substantive changes in opioid therapy management. In a multicenter study, researchers at Yale University and the Veterans Health Administration (VHA) examined the extent to which compliance with opioid guidelines varied based on medical specialty, provider expertise, or patient population. They hypothesized that HIV infection and its association with severe pain and medical and psychiatric comorbidities is likely to present obstacles to guideline-concordant care for patients receiving long-term opioid pain management.

Using electronic medical record data, the researchers retrospectively examined the extent of guideline-concordant care among HIV-infected and uninfected patients receiving long-term opioid therapy. Results showed that from 2000 to 2010, guideline-concordant care was 37% for HIV-infected patients and 33% in uninfected patients. The study concluded that promulgation of opioid therapy clinical guidelines has not resulted in substantive changes over time in opioid therapy management. Therefore, strategies are needed to increase guideline-concordant care for all patients.

PAIN Highlights

The following highlights summarize selected articles from PAIN (Volume 155, Issue 11, November 2014 Issue).

The Effect of Oxcarbazepine in Peripheral Neuropathic Pain Depends on Pain Phenotype: A Randomised, Double-Blind, Placebo-Controlled Phenotype-Stratified Study
Dyveke T. Demant, Karen Lund, Jan Vollert, Christoph Maier, Märtha Segerdahl, Nanna B. Finnerup, Troels S. Jensen, and Søren H. Sindrup; Department of Neurology, Odense University Hospital, Odense, Denmark; Danish Pain Research Centre, Aarhus University Hospital, Aarhus, Denmark; Department of Pain Medicine, Bergmannsheil Hospital, Ruhr-University Bochum, Bochum, Germany; Lundbeck A/S, Copenhagen, Denmark; Department of Physiology and Pharmacology, Karolinska Institute, Stockholm, Sweden

Patients presenting for chronic pain treatment often believe that pain reduction must be achieved before returning to normal functioning. However, treatment programs for chronic pain typically take a rehabilitative approach, emphasizing decreasing pain-related disability first, with the expectation that pain reduction will follow. The primary aim of this study was to investigate longitudinal trajectories of change in pain-related functional disability and average pain intensity for youths with chronic pain who completed a typical course of cognitive behavioral therapy (CBT) with standard medical care for chronic pain.

Investigators hypothesized that both functional disability and average pain intensity would improve over time and that pain-related functional disability would improve at a faster rate than average pain intensity over the course of treatment. Children completed the Functional Disability Inventory and a numeric rating scale of average pain intensity at every CBT session. To examine the longitudinal trajectories of disability and pain, researchers conducted hierarchical linear modeling. Researchers obtained standardized estimates of the slopes of change to test differences in rates of change between pain and disability.

Patients were asked to rate their average weekly pain for about 5 weeks. Functional disability improved significantly and more quickly over time than pain intensity, which did not change significantly during the course of treatment. These results have clinical utility to providers, whose patients often ask them to speculate about their recovery course and timeline. Providers may begin to have more confidence when telling their patients that improved functioning seems to be a promising outcome in and of itself during treatment. However, further research is needed to better understand differential trajectories of improvement and their predictors to help clinicians form specific prognoses and provide targeted education and expectations for patients and families.

Patterns of Opioid Use for Chronic Noncancer Pain in the Veterans Health Administration From 2009 to 2011
Mark J. Edlund, Mark A. Austen, Mark D. Sullivan, Bradley C. Martin, James S. Williams, John C. Fortney, and Teresa J. Hudson; Behavioral Health Epidemiology Program, RTI International, Research Triangle Park, NC; Behavioral Health Services, St. Luke’s Health System, Twin Falls, ID; HSR&D; Center for Mental Healthcare and Outcomes Research, Central Arkansas Veterans Healthcare System, North Little Rock, AR; Department of Psychiatry and Behavioral Sciences, University of Washington School of Medicine, Seattle, WA; Division of Pharmaceutical Evaluation and Policy, University of Arkansas for Medical Sciences, Little Rock, AR; Department of Psychiatry, Division of Health Services Research, College of Medicine, University of Arkansas for Medical Sciences, Little Rock, AR; and South Central Mental Illness, Research Education and Clinical Center, Central Arkansas Veterans Healthcare System, North Little Rock, AR

In this study, researchers sought to better characterize the dosing and duration of opioid therapy for chronic noncancer pain (CNCP) in the Veterans Health Administration (VHA), where more than 50% of its patients report chronic pain. The study addressed the lack of literature about opioid prescribing patterns in the VHA at a national level despite the high prevalence of CNCP and frequent use of opioids among VHA patients with CNCP, noting that most studies utilize either regional data or national subsamples. By analyzing VHA administrative and pharmacy data during the period of fiscal years 2009 to 2011, researchers calculated the distribution of individual mean daily opioid dose, individual total days covered with opioids in a year, and individual total opioid dose in a year.

Inclusion criteria for the study sample included CNCP diagnosis, as defined by two clinical encounters for the same CNCP condition (neck pain, back pain, arthritis, headache/migraine, or neuropathic pain) at least 30 days apart, but no more than 365 days apart; and age 18 years or older. Data included all opioid prescriptions (including date, dose, and type of opioid), other than injectable opioids and opioid suppositories (due to lack of conversion factors).

Analysis of the data revealed that the number of VHA patients with CNCP increased slightly from 2009 to 2011, reflecting increases in the number of veterans receiving care in VHA. In each year, about 50% of VHA patients with one of the CNCP diagnoses received at least one opioid prescription. The median doses (50th percentile) in years 2009, 2010, and 2011 were 21.4, 21.4, and 21.2 mg morphine equivalents respectively. Researchers’ analyses suggested that VHA patients with the identified CNCP diagnoses are frequently prescribed opioids, with about one-half receiving some opioids during a 12-month period. Among those VHA patients with CNCP who received opioids, chronic opioid therapy was common, but opioid doses in VHA were generally modest. More than 60% had an average daily dose of less than 30 mg morphine equivalents. Only 4.5% received an average daily dose of more than 120 mg morphine equivalents, which is sometimes used as a marker of high-dose opioid therapy. The results of this study suggest that this type of high-dose opioid prescribing occurs much less frequently among VHA patients compared to the HealthCore and Arkansas Medicaid populations. Researchers conclude that the results suggest appropriate vigilance at the VHA, which may be facilitated by a transparent and universal electronic medical record.

Clinical Journal of Pain Highlights

The following highlights summarize selected articles from the Clinical Journal of Pain (Volume 30, Number 11, November 2014 Issue).

Pain-QuILT: Assessing Clinical Feasibility of a Web-based Tool for the Visual Self-Report of Pain in an Interdisciplinary Pediatric Chronic Pain Clinic
Chitra Lalloo, Jennifer N. Stinson, Stephen C. Brown, Fiona Campbell, Lisa Isaac, and James L. Henry; Medical Sciences PhD Graduate Program; Department of Psychiatry and Behavioural Neurosciences, McMaster University, Hamilton; Departments of Anaesthesia and Pain Medicine; Child Health Evaluative Sciences, The Hospital for Sick Children; Lawrence S. Bloomberg Faculty of Nursing; and Department of Anaesthesia, University of Toronto, Toronto, ON, Canada

Researchers in this study aimed to evaluate clinical feasibility of the Pain-QuILT (PQ; previously known as the Iconic Pain Assessment Tool) from the perspective of adolescents with chronic pain and members of their interdisciplinary health team. The PQ is Web based and combines the benefits of electronic administration, real-time data collection, and illustration of pain through a mixture of icons and word descriptors on a detailed virtual body-map. The tool was original developed for use by adults with central poststroke pain and then adapted for adults with chronic pain and adults and adolescents with arthritis. However, the PQ has never been used in a clinical setting alongside the current protocol for assessing sensory pain in a clinical feasibility trial.

The PQ was directly compared with standard interview questions that were transformed to a paper-based tool. Specifically, ease of use, time required to train and complete, user preferences, perceived clinical usefulness, and perceived barriers to implementation were assessed. The team used a semi-structure verbal interview format during a follow-up clinic appointment where patients met with an entire health team and participated in a comprehensive assessment. Before this meeting, the adolescent self-reported their pain using both the PQ and the clinic comparator tool in a quiet study room within the clinic. The order of these 2 assessments was randomized for each participant. Each session was audio-recorded, transcribed, converted to text files with identifiers removed, and imported into a qualitative software program. Quantitative data from the General Information Questionnaire, Health Record Questionnaire, PQ, and clinic comparator tool were coded, scored, and entered into a Statistical Package for the Social Sciences (SPSS) database.

A total of 17 adolescents completed the study (8 in the first cycle and 9 in the second cycle). A Related-Samples Wilcoxon Signed Rank Test indicated that adolescents reported significantly more unique locations of pain when using the PQ (median of 5 different locations) versus the comparator tool (median of 3 different locations), z = 16.5, p = 0.013. No significant difference was detected in the number of pain quality descriptors chosen by adolescents to communicate their pain. All adolescent participants described the experience of using the PQ to self-report their pain as “easy” or “very easy,” and no significant difference in time required to complete the record was observed. Given a choice of methods for communicating their pain in the clinic, 15 (88%) adolescents preferred the PQ, 1 (6%) individual preferred the comparator tool, and 1 (6%) person felt that the 2 methods were equivalent. Results indicate that the PQ is: (1) easy to use and understand; (2) quick to complete; (3) preferred by a majority of adolescents; (4) perceived as clinically useful for visually capturing pain and promoting patient-provider communication; and (5) limited by minor barriers to clinical implementation.

Detecting Pain in Traumatic Brain-injured Patients with Different Levels of Consciousness During Common Procedures in the ICU: Typical or Atypical Behaviors?
Caroline Arbour, Manon Choinie`re, Jane Topolovec-Vranic, Carmen G. Loiselle, Kathleen Puntillo, and Ce´line Ge´linas; Ingram School of Nursing, McGill University; Centre for Nursing Research and Lady Davis Institute, Jewish General Hospital, Montreal, Quebec, Canada; Quebec Nursing Intervention Research Network (RRISIQ), Montreal, Quebec, Canada; The Alan Edwards Center for Research on Pain, McGill University; Centre de recherche de Centre hospitalier de l’Universite´ de Montre´al (CRCHUM), Universite´ de Montre´ al, Montreal, Quebec; Trauma and Neurosurgery Program, Keenan Research Center of the Li Ka Shing Knowledge Institute, St. Michael’s Hospital, Toronto, ON, Canada; and Department of Physiological Nursing, School of Nursing, University of California San Francisco, San Francisco, CA

A recent study published in the Clinical Journal of Pain aimed to validate the use of pain behaviors (PBs)—such as grimacing, muscle rigidity, protective movements, and noncompliance with the ventilator—for assessment of critically ill traumatic brain injury (TBI) adults with different levels of consciousness (LOC). TBI patients are unable to self-report pain, contributing to undermanaged pain in these trauma patients. Unfortunately, little evidence regarding TBI patients’ specific behavioral responses during nociceptive exposure is currently available.

Forty-five TBI participants were observed during two routine procedures in the intensive care unit (ICU) performed by ICU nurses: noninvasive blood pressure with cuff inflation; NIBP (known as a non-nociceptive procedure); and turning (known as a nociceptive procedure). For each, participants were observed for 1 minute before (baseline), during, and 15 minutes postprocedure for a total of 6 assessments. In conscious participants able to self-report, the presence of pain (yes or no) and pain intensity (on the 0 to 10 Faces Pain Thermometer) were collected after each assessment period. A video camera was installed at the foot of the bed and another was held by the research assistant positioned at the head of the bed (to capture facial expressions).

Significant differences were observed in the number of PBs documented in participants before, during, and 15 minutes postturning procedure. In contrast, no difference in the number of PBs were observed in participants before, during, and 15 minutes post-NIBP. Post-hoc analyses using Wilcoxon paired-rank tests showed that a significant increase in the number of PBs during turning when compared with baseline (i.e., before; t = –5.336; p ≤ 0.001), and 15 minutes postprocedure (t = –5.402; p ≤ 0.001). Researchers believe that, at the clinical level, the observation that TBI patients with altered LOC present mostly atypical or uncommon PBs in response to nociceptive stimuli brings into question the appropriateness of existing behavioral pain scales for assessing the analgesic needs in the clientele of TBI patients.

Society

2015 APS Award Recipients Announced

APS is pleased to announce the 2015 APS Annual Achievement Award recipients.

	John and Emma Bonica Public Service Award Bob A. Rappaport, MD
	Wilbert E. Fordyce Clinical Investigator Award Daniel J. Clauw, MD
	Frederick W. L. Kerr Basic Science Research Award Clifford J. Woolf, MD PhD
	Jeffrey Lawson Award for Advocacy in Children’s Pain Relief Céleste Johnston, DEd RN FCAHS
	John C. Liebeskind Early Career Scholar Award Adam T. Hirsh, PhD
	Elizabeth Narcessian Award for Outstanding Educational Achievements in the Field of Pain Scott M. Fishman, MD
	Distinguished Service Award Seddon R. Savage, MD MS
	Kathleen Foley Journalist Award Melanie Thernstrom

2014 Future Leaders Recipients Announced

APS is pleased to announce the 2014 Future Leaders in Pain Grant recipients.

	Peter Grace, PhD University of Colorado at Boulder Boulder, CO "Exacerbation of neuropathic pain by opioids: a role for TLR4 and inflammasomes."
	Sarah Linnstaedt, PhD University of North Carolina at Chapel Hill Chapel Hill, NC "MicroRNA mechanisms medicating chronic pain development after motor vehicle trauma."

APS Member Recieves ASPMN Award

APS Member Mary Lyons, RN-BC was awarded the Nurse Exemplar Award for Excellence in the Practice of Pain Management by the American Society for Pain Management Nursing (ASPMN) at the organization’s 2014 Annual Conference. The award is given to members of ASPMN who demonstrate leadership and an extensive history in practice, research, and education dedicated to the care of older adult patients.

With 20 years of work in pain management nursing, Ms. Lyons has participated on national and local levels to improve pain treatment and pain management education. Experienced in training and educating nursing staff in pain management, Ms. Lyons has also encouraged and coached her colleagues and staff to become ANCC Pain Management certified.

Ms. Lyons has worked for many years to develop pain management programs, such as the Pain Management Clinic at Central DuPage Hospital, where she mentored and educated nursing and physician staff, developed an online education program, and served as program coordinator and pain resource nurse trainer. She also played a major role in starting the Chicago Metropolitan Chapter of ASPMN in 1999, in which she has served as secretary/treasurer, chapter president, and board member. As a member of the panel for Pain Management Challenges in Acute Care, Ms. Lyons helped to create and use policies and procedures to improve patient care.

Recently, Ms. Lyons was primary author on a recent publication, Acute Pain Management Algorithms for the Adult Orthopedic Patient. Ms. Lyons is very active with the National Association of Orthopedic Nurses and currently serves as president-elect for the Midwest Pain Society and as cochair of the APS Scientific Program Committee.

Important Dates

Rita Allen Foundation Award in Pain

Deadline: Friday, January 16, 2015

2015 Annual Scientific Meeting Register

Registration Opens Early December

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.