Education

2015 Annual Scientific Meeting―Reinvented!

Did you hear? APS is reinventing the 2015 Annual Scientific Meeting! For 33 years, APS has delivered high-level education for those in the pain management profession.

APS has reexamined the attendee experience to meet the evolving educational needs of pain science professionals. The 34th Annual Scientific Meeting will feature new opportunities for learning and engagement.

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

The Learning Lounge
As you may have read in the September issue, the Annual Scientific Meeting’s Experience Exchange will include an innovative, interactive theater, the Learning Lounge. The Learning Lounge will host Session Sound Bytes, a relaxed and informative setting in which to interact with key speakers to extend the conversation on hot topics being presented during annual meeting sessions.

Plan to participate in this unique forum on the morning of Friday, May 15, in the Experience Exchange.

Mark your calendars for May 13–16, 2015, and bring your desire to learn to Palm Springs. Registration will open in December.

2015 Annual Scientific Meeting Call for Poster Abstracts

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 the 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

Clinical Centers of Excellence: Apply Today

Don’t forget to submit an application for the 2015 APS Clinical Centers of Excellence (CCOE) in Pain Management Awards program. APS awards the CCOE designation annually to interdisciplinary healthcare teams who 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 eligible to apply. The selection of awardees is based on judgment of the quality of services provided and not the size or type of the program.

The CCOE program recipients from 2007 to 2011 who have not yet received the award a second time are eligible to apply as well. Past recipients must provide evidence of sustained excellence and fulfillment of CCOE assessment criteria.

APS has recognized 40 CCOEs since its inception in 2007. This distinction is one of APS’s highest honors in the area of clinical treatment. The deadline for applications is Friday, November 21. To apply, visit the CCOE application page.

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 will be posted Monday, November 3.

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 The Journal of Pain (Volume 15, Number 10, October 2014 Issue).

Prevalence of Persistent Pain in the U.S. Adult Population: New Data from the 2010 National Health Interview Survey
Jae Kennedy, John M. Roll, Taylor Schraudner, Sean Murphy, and Sterling McPherson; Department of Health Policy and Administration and College of Nursing, Washington State University, Spokane, WA

In 2011, the Institute of Medicine (IOM) reported that 100 million Americans have chronic pain, but a new study reports that 39 million or 19% have persistent pain, and the incidence varies according to age and gender.

Researchers at the Washington State University College of Nursing conducted the study. They defined persistent pain as frequent or constant pain lasting longer than 3 months. The intent of the study was to

• identify groups at higher risk for persistent pain
• identify body sites, chronic conditions and disabilities associated with persistent pain
• assess the relationship between persistent pain and anxiety, depression and fatigue
• describe the individual experience of persistent pain.

The study was performed using data from the 2010 Quality of Life Supplement of the National Health Interview Survey (NHIS) to calculate the prevalence of persistent pain.

Results of the analysis showed that approximately 19% of U.S. adults reported persistent pain in 2010, and older adults were more likely to experience persistent pain than younger adults. Women also had a slightly higher risk than men.

The authors noted that persistent pain correlated with other indices of health-related quality of life, such as anxiety, depression, and fatigue. Individuals with those conditions were far more likely to report persistent pain.

The authors explained that the disparity between the estimated pain incidence in their study and what the IOM reported is attributable almost entirely to differences in operational definitions of persistent pain. In the 2010 NHIS, an estimated 60% of adults reported lower back pain in the past three months, and all of them would have been described in the IOM report as having chronic pain. However, only 42% of the study respondents with back pain described their pain as frequent or daily and lasting more than three months.

From a public health perspective the difference is significant. Those with persistent pain have high rates of work disability, fatigue, anxiety, and depression. They also are at higher risk for long-term exposure to and dependency on pain medications.

The authors concluded that measuring pain persistence has policy implications because persistent pain is an indicator of an unmet medical need for pain management in the general population, as well as a risk factor for anxiety and depression.

Survival Patterns in Squamous Cell Carcinoma of the Head and Neck: Pain as an Independent Prognostic Factor for Survival
Cielito C. Reyes-Gibby, Karen O. Anderson, Kelly W. Merriman, Knox H. Todd, Sanjay S. Shete, and Ehab Y. Hanna; M.D. Anderson Cancer Center, Houston, TX

Pre-treatment pain intensity is an independent survival predictor for patients with head and neck cancer, according to this article.

Researchers at M.D. Anderson Cancer Center assessed the extent to which pain severity influences survival in 2,340 newly diagnosed patients with head and neck cancer. At first presentation, patients rated their pain using a scale in which 0 meant no pain and 10 meant “pain as bad as you can imagine.” Survival time was calculated from diagnosis to death or last follow-up.

Head and neck cancer is the sixth most common malignancy worldwide, and squamous cell cancer is the most prevalent head and neck cancer, which includes cancers of the oral cavity, tongue, pharynx and larynx. In the United States, approximately 54,000 people are diagnosed every year, and 5-year survival rates for oral, pharyngeal and laryngeal cancers are 56% and 62%, respectively.

Pain often is the first sign of head and neck cancer, as a result of destructive lesions and direct tissue and bone involvement. Acute pain from therapy is very common from surgery, chemotherapy, and radiation.

Results of the study showed that severe pain was reported by 19% of the sample, and was most prevalent in patients with oral cancer (20%). Pain intensity varied based on tumor stage, fatigue severity, smoking status, and comorbid lung disease.

Eight hundred twenty-eight patients died. Among those with oral cancer, the overall 5-year survival was 31% for patients who reported severe pain and 52% for those without severe pain. The survival differentiation was similar in patients with pharyngeal cancer.

The authors concluded that pretreatment pain severity in head and neck cancer patients is an independent predictor of overall 5-year survival. They noted that patients who present with severe pain at diagnosis should be closely monitored and promptly treated for pain symptoms.

PAIN Highlights

The following highlights summarize selected articles from PAIN (Volume 155, Number 10, October 2014 Issue).

Differential Changes in Functional Disability and Pain Intensity over the Course of Psychological Treatment for Children with Chronic Pain
Anne M. Lynch-Jordan, Soumitri Sil, James Peugh, Natoshia Cunningham, Susmita Kashikar-Zuck, and Kenneth R. Goldschneider; Division of Behavioral Medicine and Clinical Psychology, Cincinnati Children’s Hospital Medical Center; Department of Pediatrics, College of Medicine, University of Cincinnati, Cincinnati, OH; Pain Management Center, Cincinnati Children’s Hospital Medical Center, and Department of Anesthesiology, College of Medicine, University of Cincinnati; Department of Pediatrics, Emory University School of Medicine, Aflac Cancer and Blood Disorders Center, Children’s Healthcare of Atlanta, Atlanta, GA.

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.

Neuropathic Pain Phenotyping as a Predictor of Treatment Response in Painful Diabetic Neuropathy: Data from the Randomized, Double-Blind, COMBO-DN Study
Didier Bouhassira, Stefan Wilhelm, Alexander Schacht, Serge Perrot, Eva Kosek, Giorgio Cruccu, Rainer Freynhagen, Solomon Tesfaye, Alberto Lledó, Ernest Choy, Paolo Marchettini, Juan Antonio Micó, Michael Spaeth, Vladimir Skljarevski, and Thomas Tölle; INSERM U987 Centre d’Evaluation et de Traitement de la Douleur, Hôpital Ambroise Paré, Boulogne Billancourt, France; Regional Medical Affairs, Lilly Deutschland GmbH, Bad Homburg, Germany; Global Statistical Sciences, Lilly Deutschland GmbH, Bad Homburg; INSERM U-987 Centre de la Douleur, Hôpital Hotel Dieu, Université Paris Descartes, Paris, France; Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden; Sapienza University, Department of Neurology & Psychiatry, Rome, Italy; Zentrum für Anästhesiologie, Intensivmedizin, Schmerztherapie & Palliativmedizin, Benedictus Krankenhaus, Tutzing, und Klinik für Anästhesiologie, Technische Universität München, Munich, Germany; Pain Pathophysiology and Therapy, University of Southern Switzerland, Manno, Switzerland; Diabetes Research Unit, Royal Hallamshire Hospital, Sheffield, UK; Departamento de Neurología, Clínica Creu Blanca, Barcelona, Spain; Section of Rheumatology, Institute of Infection & Immunity, Cardiff University, Cardiff, UK; Pain Medicine Center, Department of Neurology, Hospital San Raffaele, Milan, Italy; Department of Neuroscience, CIBER of Mental Health, CIBERSAM, University of Cádiz, Cádiz, Spain; Spital Linth, Rheumatologie, Uznach, Switzerland; Lilly Research Laboratories, Indianapolis, IN; Neurologische Klinik und Poliklinik, Technische Universität, München, Germany

Sensory profiles are heterogeneous in neuropathic pain disorders, and subgroups of patients respond differently to treatment. The Combination vs Monotherapy of Pregabalin and Duloxetine in Diabetic Neuropathy study (COMBO-DN study), a large, multinational combination treatment trial investigating duloxetine in combination with pregabalin for painful diabetic neuropathy, prospectively assessed patients by the Neuropathic Pain Symptom Inventory (NPSI) at baseline, after initial 8-week therapy with either duloxetine or pregabalin, and after subsequent 8-week combination/high-dose therapy. Researchers performed exploratory posthoc cluster analyses to identify and characterize potential subgroups through their scores on the NPSI items.

Among patients not responding to initial 60 mg/day duloxetine, adding 300 mg/day pregabalin for combination treatment was effective for the dimensions of pressing pain and evoked pain, whereas maximizing the duloxetine dose to 120 mg/day appeared more beneficial for paresthesia/dysesthesia. In contrast, adding 60 mg/day duloxetine to 300 mg/day pregabalin for patients who did not respond to initial pregabalin therapy led to numerically higher decreases in all NPSI dimensions/items compared to maximizing the pregabalin dose to 600 mg/day. Cluster analysis revealed three patient clusters (defined by baseline scores for the 10 NPSI sensory items) with different pain profiles.

Among patients with severe pain, the treatment effect showed a trend in favor of high-dose monotherapy, while combination therapy appeared to be more beneficial for patients with moderate and mild pain. These exploratory analyses further endorse the idea that sensory phenotyping might lead to a more stratified treatment and to personalized pain therapy.

The exploratory analyses of data collected in the COMBO-DN study suggest that duloxetine and pregabalin have different effects on distinct neuropathic pain components in diabetic peripheral neuropathy. These results also add to the knowledge base regarding sensory profiles in neuropathic pain conditions and further support the predictive value of a thorough baseline assessment, as shown in exploratory posthoc analyses of placebo-controlled trials and cross-sectional cohort surveys.

Pain Medicine Highlights

The following highlights summarize selected articles from Pain Medicine (Volume 15, Number 9, September 2014 Issue).

The Design and Methods of Genetic Studies on Acute and Chronic Postoperative Pain in Patients After Total Knee Replacement
Anna Lokshin, Katie Vulakovich, Douglas Landsittel, Feng Dai, Lawrence Crossett, and Jacques E. Chelly; Departments of Anesthesiology, Psychiatry, Medicine and Surgery, Division of Acute Interventional Perioperative Pain and Regional Anesthesia, Center for Research on Health Care Data Center, University of Pittsburgh, Pittsburgh, PA; Yale Center for Analytical Sciences, New Haven, CT.

Doctors performed more than 650,000 total knee replacements (TKRs) in the United States in 2008, and it is projected that by 2030 this number will increase to nearly 3.5 million procedures per year as the population ages. But only 70% of patients are satisfied with their improvement in function and decrease in pain following TKR. Persistent, function-limiting pain occurs for as many as 30% of patients at 1- to 7-year follow-up. As a result, it is critical to identify patients at risk for poor TKR outcomes based on individual parameters, develop pain-preventive procedures, and implement these procedures in target patients who have no option other than replacement of their deteriorated joint. A comprehensive approach that includes measures of clinical variables, cytokine and chemokine profiles, and genetic makeup is needed to understand the array of factors that puts patients at risk for severe postoperative and chronic pain after TKR. This article presents the methodology of a study designed to identify genetic, proteomic, clinical, demographic, psychosocial, and psychophysical risk factors for severe acute and chronic pain that impair quality of life after TKR.

The primary hypothesis of this study is that genes and psychosocial factors may influence post-TKR outcomes. To address this hypothesis, investigators will apply a range of techniques that allow collection of biological samples, clinical data, pain data, and self-report psychosocial data. Their secondary hypothesis is that genes may contribute to pain-related psychosocial characteristics and psychophysical traits, and that these traits can be used as intermediate phenotypes in pain genetic studies. To address this hypothesis, investigators will collect psychosocial measurements (from validated surveys) and pain sensitivity assessments (via quantitative sensory testing).

Genetic data from this study may provide evidence on the contribution of genetic factors to pain phenotypes related to TKR and could lead to a larger multicenter study.

Vitamin D and Central Hypersensitivity in Patients with Chronic Pain
Roland von Känel, Veronika Müller-Hartmannsgruber, Georgios Kokinogenis, and Niklaus Egloff; Department of General Internal Medicine, Division of Psychosomatic Medicine, Inselspital, Bern University Hospital; Department of Clinical Research, University of Bern, Bern, Switzerland

Low serum levels of 25-hydroxyvitamin D3 (25-OH D) have been implicated in various chronic pain conditions including nonspecific musculoskeletal pain, chronic widespread pain, fibromyalgia, low-back pain, headache, and lumbar spinal stenosis. The average prevalence of 25-OH D deficiency or insufficiency among patients with chronic pain is at least 50%.

The primary aim of this study was to further examine the relationship between 25-OH D serum levels and several measures of central hypersensitivity in a sample of patients with chronic pain disorders with or without an initial biomedical cause at the beginning of the disease. As part of a larger project, investigators also assessed the preliminary diagnostic criteria for fibromyalgia and measurement of symptom severity. These criteria refer to the widespread pain index and the scale for symptom severity score (SSS) covering the previous week.

Almost 75% of patients were deficient in vitamin D and another 20% had vitamin D insufficiency. Clinicians should be aware that lower-than-normal vitamin D levels are the rule, not the exception, among patients with chronic pain. A decrease of about 100 nmol/L in 25-OH D corresponded to a two-unit increase on the numeric rating scale (ranging from 0 to 10) for pressure pain intensity. This effect size has been shown to be of clear clinical relevance for self-reports of spontaneous chronic musculoskeletal pain.

Investigators found that low 25-OH D levels were significantly associated with higher scores on the severity scale for somatic symptoms even when taking psychiatric comorbidity into account. The relation between low 25-OH D and increased SSS suggests that the role of low vitamin D for central hypersensitivity has implications for the severity of different somatic symptoms above and beyond pain-related symptoms. Future randomized controlled trials should test for effects of vitamin D supplementation on mechanically evoked pain intensity.

Important Dates

Rita Allen Foundation Award in Pain
Request for Applications Open
Monday, November 3

2015 APS Clinical Centers of Excellence
Application Deadline
Friday, November 21

2015 APS Annual Scientific Meeting
Call for Poser Abstracts Deadline
Friday, November 21

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.