Complementary and Alternative Medicine: Roles in Chronic Pain Management & Research

This preconference symposium will raise awareness of approaches and challenges for Complementary and Alternative Medicine (CAM) researchers and discuss possible clinical applications for health care professionals.  The challenges and opportunities associated with current CAM research as it relates to chronic pain management in the field of medicine will be addressed. A primary goal of the conference is to encourage collaborations among pain clinicians and researchers in CAM practice and research.   Advance registration is required for this event.  Click here to learn more about the CAM symposium.

(119) Nursing Issues
Rapid reports of four research topics will be moderated by Maureen Cooney, DNP PNP BC.  Participants will discuss the nursing implications related to each of the following topics:

Do Self-Reported Analgesic Barriers Translate into Objective Analgesic Adherence for Cancer Pain?
Salimah Meghani, PhD MBE CRNP

This presentation will report on whether self-reported analgesic barriers translate into objective adherence to analgesia for African Americans and whites. Analgesic barriers were elicited using the Barriers Questionnaire.

Postoperative Pain Time from Severe to Mild: Effect of Frequent and Multimodal Interventions
Fern FitzHenry, PhD RN

Management of postoperative pain remains a challenge despite continued attention by accrediting and standards organizations. This presentation will report on a retrospective study that analyzed data from the electronic records of postsurgical acute pain episodes for a 2.5-year period at an academic medical center.

The Pain Care Quality Study: One Hospital’s Experience
Patricia Brandon, RN-BC

Nurses play a critical role in promoting quality pain management by assisting patients in establishing a realistic comfort goal, administering analgesics and adjunctive measures as needed, evaluating effects, and advocating for patients.  This presentation will report on a study that assessed patients’ perception about the quality of pain management.

Atomized Lidocaine Prior to Nasogastric Tube Placement
Michele Farrington, BSN RN CPHON

This presentation will report on a project to develop and implement an evidence-based practice to decrease discomfort and distress associated with placement of nonemergent nasogastric (NG) tubes in adult and pediatric patients. Patients who need an NG tube inserted are now screened by bedside nurses for appropriate use of atomized lidocaine.

The Nursing Issues SIG meeting has been designated for continuing nursing education. Nurses can earn 1.5 contact hours and 1.5 pharmacology hours. Nurses must attend the SIG  meeting and complete the Nursing Issues SIG section of the online evaluation in order to receive credit.

(120) Advancing the Sciences of Quality
The goals of this SIG are to create an interdisciplinary forum to advance the science of quality as it relates to pain management, enhance the identification and understanding of quality measures in pain, and facilitate the creation and dissemination of innovative pain management quality improvement methodologies and resources.  One such method is a global registry. PAIN OUT is a quality improvement and registry project endorsed by IASP and run by a group of 17 academic and clinical sites throughout Europe with several participating sites in the U.S. Brief presentations by Debra Gordon and Julio Gonzalez of the current status of and opportunities for joining PAIN OUT will be followed by discussion.  The benefits of participating in the registry, such
as benchmarking, research opportunities, and access to an electronic knowledge library, will be discussed.

(121) Clinical Trials SIG
The SIG will discuss reducing the risk of failure in analgesic clinical trials with two presentations:

An Evidence-Based Approach to Improving Assay Sensitivity in Clinical Trials
Nathaniel Katz, MD MS

Applying the Principles of Improved Assay Sensitivity in Analgesic Drug Development
Neil Singla, MD

(122) Geriatric Pain
A 30-minute journal club session, Management of Moderate-Severe Persistent Pain in Older Adults: A Conundrum, will highlight this article about issues related to managing persistent pain in older persons and highlight best practice recommendations, key management issues, and implications of ongoing analgesic management concerns. The cochairs will facilitate a discussion with SIG members.  A 60-minute business meeting will follow. It
will include elections of officers and a review of the SIG’s mission statement and awards, among other topics.

(123) Pain and Disparities
This SIG promotes advocacy, education, policies, programs, and research to eliminate the unequal burden of pain among racial minorities and underserved populations and to optimize the quality of life for all persons with pain. The SIG is very interactive and includes discourse with seasoned researchers and experts in pain care disparities as well as presentations of new ideas by young investigators. The SIG offers a platform to generate new ideas and enables individuals to collaborate on projects.

(124) Pharmacotherapy
The meeting will include updates from the SIG as well as cochair nominations and two 20-minute educational presentations with time built in for questions and answers.

Update on Migraine Treatment
Richard Wenzel, PharmD

Opioid-Induced Hyperalgesia and Tolerance
James B. Ray, PharmD CPE

(125) Psychosocial Research
A brief business meeting to update members on any major issues and hold an election for a cochair will be followed by the fourth annual SIG Young Investigator Poster Award presentation.  The winner(s) will present research in a platform session. The last portion of the meeting will feature three or four brief presentations addressing pain and the developmental spectrum, with an emphasis on psychosocial implications and intervention. Experts in pediatric and aging pain research including Francis Keefe, PhD, Joseph Riley, PhD, and Kevin Vowles, PhD, will give 5  to 10 minute presentations, which will be followed by a discussion session with this panel.

(126) Pain Rehabilitation
This SIG’s current focus is on creating awareness among patients, providers, legislators, and payers regarding best practices; providing treatment recommendations to utilization review and
employers/payers; describing business practices that both promote and prevent patients from receiving such  evidence-based care; and identifying tools, such as wireless telemedicine, mobile health, and personalized and genomic medicine, as a means to extend pain rehabilitation throughout the United States and worldwide.

The Future of Pain Research: Challenges and Opportunities
Story Landis, PhD

This keynote address will highlight recent scientific findings and significant advances in pain research and explore how they might inform future research needs and goals. The challenges faced by pain researchers and funding agencies in setting priorities in a time of fiscal uncertainty will also be discussed. Identifying and implementing the next most important steps for the future of pain research and the potential role of volunteers, private foundations and industry, private and public funders, patients, and healthcare providers in moving forward will be discussed.

Why Image Pain?
Irene Tracey, DPhil FRCA

Relating specific neurophysiological, chemical, and anatomical measures to perceptual changes in pain experiences induced by peripheral or central sensitization, genetic, cognitive, emotional, contextual, or  pharmacological factors and identifying their site of action within the human central nervous system has been a major goal for scientists, clinicians, and the pharmaceutical industry. Identifying noninvasively where such influences occur along the pain neuraxis for an individual and relating this to his or her specific multifactorial pain experience or pain relief has both neuroscientific relevance and potential  diagnostic value. This lecture will address what pain imaging does and does not tell us and its potential for providing a fuller understanding of pain perception in health and disease.

(300) Rita Allen Foundation Scholarsin Pain: Frontiers in Basic Pain
Edgar Alfonso Romero-Sandoval, MD PhD (Moderator); Yuan-Xiang Tao, PhD; Sarah Ross, PhD; Michael Jankowski, PhD

This symposium will bring together 2011 and 2012 American Pain Society/Rita Allen Foundation Scholars in Pain to report on their ongoing research, which covers areas of interest to both basic researchers and clinicians. Researchers will present and discuss recent advances in pain mechanisms at the molecular and cellular levels.

(301) Primary Afferent Hyperexcitability Drives Chronic Pain
Susan Carlton, PhD (Moderator); Edgar Walters, PhD; Tim Brennan, MD PhD; Patrick Dougherty, PhD

Although hypersensitivity of primary sensory afferent neurons is a well-known correlate of some forms of chronic pain, the degree to which chronic pain and persistent central sensitization depend upon ongoing drive from hyperexcitable primary afferents has been in dispute. Moreover, the role of chronic spontaneous activity in primary nociceptors in driving chronic pain has been underestimated. The speakers will provide several lines of evidence documenting persistent primary afferent input in a variety of chronic pain states.

(302) Co-Occurring Chronic Pain and Substance Use Disorders: Clinical Challenges and Promising Treatment Approaches  (1.5)
Rollin Gallagher, MD MPH (Moderator); Benjamin Morasco, PhD; Robert Jamison, PhD; Declan Barry, PhD

This symposium will review different approaches for managing co-occurring chronic pain and substance
use disorders.

(303) Improving Pain Education in Medical, Pharmacy, Nursing, and Dental Schools in the United States 
David Thomas, PhD (Moderator); Beth Murinson, MD; Chris Herndon, PharmD; Paul Arnstein, PhD RN

This session will highlight the efforts of the National Institutes of Health Pain Consortium’s Centers of Excellence in Pain Education (Co-EPEs) to enhance pain education in medical, nursing, dental, and pharmacy schools across the United States. The CoEPEs pain education portal will be described in terms of its stage of development, how one operates it, and what it has to offer to educators and healthcare providers in the pain field. Speakers will also review current problems in pain education and ways the CoEPEs and other organizations are trying to address them.

(304) Insight into the Neuropathic Aspect of Cancer Pain (1.5)
Todd Vanderah, PhD (Moderator); Patrick Mantyh, PhD; Brian Schmidt, MD DDS PhD

This symposium will focus on understanding some of the causes of cancer pain and the therapeutics

(305) Herbal Marijuana in Pain Medicine: Science, Practice, Policy, and Ethics
Michael Schatman, PhD CPE (Moderator); Greg Carter, MD MS; Elizabeth Rahn, PhD; Seddon Savage, MD MS

Medical marijuana is increasingly becoming an accepted potential treatment for many pain conditions.  However, confusion regarding its appropriate use as a treatment, prejudices based on the drug’s recreational use history, and policy and ethical issues continue. In addition to educating attendees about the science behind the practice, this symposium will address these concerns, allowing attendees to make better-informed decisions about medical marijuana’s potential use.

(306) Pain Management in Wounded Service Members: A Department of Defense Perspective
Laura McGhee, PhD (Moderator); Dayna Loyd Averitt, PhD MSci; Marcie Fowler, PhD; Steven Hanling, CDR MC USN

The pain conditions and comorbidities experienced by injured service members and the challenge of pain management by the military medical system offer an opportunity to inform pain management and  medical research. This session describes ongoing basic and clinical pain research being conducted within the U.S. Department of Defense. The research programs represented in this session will focus on the unique challenges in pain management faced by the military medical system; novel therapeutic options currently being explored, including complementary and alternative medicine techniques; and the translation of these therapies into clinical tools and practice.

(307) Ethnic and Racial Disparities in Pain: Biobehavioral and Psychosocial Correlates
Robert Edwards, PhD (Moderator); Burel Goodin, PhD; Claudia Campbell, PhD; Toni Glover, MSN FNP-BC

This session will highlight the multifactorial nature of ethnic/racial disparities in pain to help further the understanding of how such disparities arise. Biobehavioral and psychosocial factors have been shown to partially underlie some of the consistently observed ethnic and racial disparities in pain-related outcomes. These putative contributors to pain disparities may hold promise as important and modifiable treatment targets that could help to mitigate ethnic and racial disparities in the experience of pain.

(308) Profiling the Pain Transcriptome with RNA-Seq 
Michael Iadarola, PhD (Moderator); Andreas Beutler, MD; Robert Blakesley, PhD

Investigation of what genes within the dorsal root ganglion (DRG) and the spinal cord are changed by nerve injury or tissue damage and the degree of alteration has provided insight into the profound nature of the relationship between genes and pain. The advent of massively parallel DNA sequencing methods provides a new level of genetic definition at both the genomic and  transcriptome levels. This symposium will address the processes of transcriptome regulation in the DRG, spinal cord, and peripheral tissue; how to use the information from high-throughput  sequencing; and what this information can tell us.

(309) From Receptors to Pain: The Molecular Dynamics of Pain  (1)
Luda Diatchenko, PhD (Moderator); Michael Salter, MD PhD; Kenneth Hargreaves, DDS PhD; Alexander Samoshkin, PhD

This symposium will focus on molecular mechanisms of pain receptors activation and signaling.

(310) Transcutaneous Electrical Nerve Stimulation: Mechanisms and Strategies for Effectiveness 
Kathleen Sluka, PhD PT (Moderator); Barbara Rakel, PhD RN; Jan Magnus Bjordal, PhD

The goal of this symposium is to review and discuss the evidence on transcutaneous electrical nerve stimulation (TENS; i.e., mechanisms and effectiveness), including what we know about the most effective TENS application methods and outcomes measures, to direct future clinical trials and use for a variety of pain conditions.

(311) Coverage and Reimbursement Reform Initiatives: Similarities, Differences, and Implications for Patients with Chronic Pain Conditions
Brook Martin, PhD MPH (Moderator); Julie Adler-Milstein, PhD; Benjamin Keeney, PhD; Daniel Carr, MD

The purpose of this session is to introduce attendees to the design, implementation, and early experiences of accountable care organizations, bundled payment programs, health information exchanges, and health insurance exchanges.  The expert panelists will demystify how these programs may influence the management of patients with chronic pain conditions.

(312) Reducing Disability from Low Back Pain: Highlights of Primary, Secondary, and Tertiary Prevention
Steve George, PT PhD (Moderator); Julie Fritz, PT PhD ATC; Kristin Archer, PhD DPT

Disability can be prevented before an episode of back pain occurs (primary prevention), during an acute episode (secondary prevention), or during a chronic episode (tertiary prevention). The
purpose of this session is to highlight models of primary, secondary, and tertiary prevention of low back pain. The three speakers included in this session will review specific findings from each prevention domain and provide a general consideration of how findings from a particular domain inform the larger body of knowledge on prevention of disability from low back pain.

(127) Basic Science
Three early-career scholars will give brief presentations on their recent work. In addition, the SIG’s liaisons to the APS Board of Directors and the Scientific Program Committee will give brief reports on APS activities over the past year, and SIG members will have an opportunity to provide ideas for the SIG’s activities over the coming year, including the 2014 Basic Science Dinner
Symposium. A 2013–2014 cochair will be elected.

(128) Complementary and Alternative Medicine
The Complementary and Alternative Medicine (CAM) SIG will meet officially for the first time to engage the contributions of a broader spectrum of the membership to enhance scientific and
clinical discussion, evaluation, and exploration of CAM therapies. The format for the inaugural meeting will be informal.

(129) Ethics
The Industry Conundrum: Ethical Considerations Regarding Industry Funding of APS

The panel presentation and discussion will address the emergent concerns regarding conflict-of-interest issues in pain education, with an emphasis on developing a means of funding that minimizes actual and apparent conflicts of interest within APS. This program will involve a panel that leads audience discussion with members of the panel, including representatives from industry, APS, and the Pain Ethics Community.

(130) Genetics and Pain
This year’s meeting will begin with an award given to recognize the outstanding work of a junior investigator/trainee selected from poster abstracts pertaining to genetics and pain. Next, Jeffrey S. Mogil, PhD, this year’s Kerr Award recipient, will review novel, unexpected, and/or clinically relevant findings published in the area of genetics and pain over the past year and highlight how such findings could potentially influence the direction of the field. Following the presentations, time will be allotted for overall
discussion regarding the growth and direction of the SIG, including ways to build the membership and expand activities.

(131) Measurement of Pain and Its Impact

The meeting of the SIG will include

• a report on activities over the year and changes in the SIG activities, including reporting on a survey of measurement practices
• a report on the current activities of the ACTTION Public Private partnership
• presentation of new analyses from the ACTTION-Baseline pain measurement variability and implications for the improvement of clinical trial assay sensitivity.

(132) Pain Education
The 2011 Institute of Medicine Relieving Pain in America report has called for revolutionary changes in the way we educate health professionals, the public, and policy makers about pain. This forum will allow leaders in the field to discuss available resources, high-priority needs, and the tactics underway to address needed reform. Paul Arnstein, PhD RN, and Larry Driver, MD, (cochairs) will facilitate discussion on the transformational education programs needed.  David Thomas, PhD, and Donna Messersmith, PhD, will discuss the support of the National Institutes of Health to develop Centers of Excellence in Pain Education (CoEPEs) as part of this effort, and the ways in which the CoEPEs plan to work with others in the pain field to enhance pain education in medical, dental, nursing, and pharmacy schools.

(133) Pain in Infants, Children, and Adolescents
The APS SIG for Pain in Infants, Children, and Adolescents will hold a Pediatric Pain Research Blitz, which will consist of 10-minute presentations of new research. We will also use the meeting to announce the 2013 recipient of the Pediatric Young Investigator Research Award.

(134) Pain in Sickle Cell Disease
This SIG seeks to foster the development of a multidisciplinary community that brings together a diverse group of pain researchers including basic scientists, clinicians, and other health professionals to increase the knowledge of pain in sickle cell disease (SCD).  Catherine Bushnell, PhD, will discuss the effects of chronic pain on the structure and function of the central nervous system in chronic pain and the implications of these findings for pain in SCD. Her presentation will be followed by  discussions of other ongoing pain research and clinical trials by SIG members.

(135) Palliative Care

Mechanisms Controlling Nociceptor Excitability and How They Can Be Targeted for Pain Relief
Martin Koltzenburg, MD FRCP

Impressive progress has been made regarding the molecular and cellular mechanisms of transduction. Transient receptor potential channels have been identified as one of the major classes of ion channels that endow nociceptors with thermal or chemical sensitivity. Nerve growth factor (NGF) has now been identified as a pivotal factor in sensitizing nociceptors in chronic painful conditions such as osteoarthritis. Much less is known about the mechanisms encoding the magnitude of noxious stimuli.

How can basic science advances be harnessed for clinical practice? Antibodies neutralizing NGF have proven analgesic activity in many clinically important inflammatory pain states and will potentially enhance our treatment repertoire. Selective blockers of Nav1.7 are in development with the aim to selectively suppress action potential propagation in nociceptors without affecting other sensory modality or causing  weakness.

(313) Accelerated Cellular Aging in Musculoskeletal Conditions: Exploring Increased Risk for Morbidity
Daniel Clauw, MD (Moderator); Afton Hassett, PsyD; Kimberly Sibille, PhD; John McBeth, PhD

The focus of this session will be to explore the evidence for an increased risk for morbidity and mortality in chronic pain associated with musculoskeletal conditions and present preliminary evidence
supporting a role for accelerated cellular aging as indexed by shortened telomere length. 

(314) Pain, Stress, and Inflammation: Clinical Implications and Individual Differences 
Robert Edwards, PhD (Moderator); Joseph Riley, PhD; Jon Levine, MD PhD; Gary Slade, DDPH PhD BDSc

Pro-and anti-inflammatory systems appear to contribute to the vast majority of persistent pain  syndromes via multiple mechanisms. However, a variety of individual-difference factors, from the  psychosocial (e.g., stress) to the genetic, can modulate these processes. This symposium will focus on the clinical implications of these interrelationships for shaping outcomes in groups such as patients with musculoskeletal or orofacial pain and older adults.

(315) Opioid Cessation: Why, When, and, Especially, How  (1.5)
Michael Clark, PhD (Moderator); Jennifer Murphy, PhD; W. Michael Hooten, MD; Anthony Mariano, PhD
This presentation will assist providers in efforts to terminate opioid therapy responsibly and appropriately when such termination is clinically indicated.

(316) To Do or Not to Do: Does Positive Psychology Have the Answer for Chronic Pain? 
Nomita Sonty, PhD MPhil (Moderator); Lance McCracken, PhD; Francis Keefe, PhD

Psychological approaches to chronic pain have tended to emphasize pathology such as catastrophizing, depression, fear, and avoidance and have largely ignored personal and community resilience in adaptation. The “positive psychology” approach focuses on strengths and positive attributes that enable optimal functioning. The positive psychology or strength-based approach to chronic pain is attracting increased attention and yielding data. This session will examine this approach in the context of chronic pain, look at current evidence, and consider if there is a basis for  scientific progress in this focus on the positive.

(317) Now More Than Ever, Voltage-Gated Na+ Channels as a Viable Target for the Treatment of Pain (.5)
Michael Gold, PhD (Moderator); Michael Jarvis, PhD; Sulayman Dib-Hajj, PhD

This session will provide an update on recent advances in our understanding of the role of voltage-gated Na+ channels in the pain associated with peripheral tissue injury, injury-induced changes in the efficacy of therapeutic interventions, and the identification of channel subtype selective blockers for the treatment of pain.  Speakers in this symposium will focus on Na+ channel beta subunits as well as the alpha subunits NaV1.7 and NaV1.8.

(318) Skin Does Matter: New Insights into How Skin Analysis May Aid in Identifying Pain Mechanisms and Predictors of Treatment Outcome
Charles Argoff, MD (Moderator); Frank Rice, PhD; Phillip Albrecht, PhD; Michael Polydefkis, MD MHS

Recent translational research has led to exciting new data concerning peripheral pain mechanisms within the skin. These data have led to new insight into potential pain mechanisms for various painful conditions, including painful diabetic neuropathy, complex regional pain syndrome, and fibromyalgia, as well as to new pain assessment tools. Such research has also focused on the potential for such  findings to help predict treatment outcomes and develop new treatments for various painful conditions. These translational efforts may enhance a basic scientist’s ability to better understand the mechanisms
of a variety of pain conditions and a clinician’s ability to evaluate and treat patients with pain of diverse types.

(319) Using Objective Physical Activity Data to Improve Understanding and Treatment of Chronic Pain in Children and Adults 
Dennis Turk, PhD (Moderator); Elizabeth Dansie, PhD; Anna Wilson, PhD; Susan Murphy, ScD OTR

This symposium will describe some of the potential uses of actigraphy to provide objective assessment of activity in real time. The potential of objective activity data collected in real time to contribute knowledge on the impact of pain, to guide treatment planning, and to serve as outcomes in clinical trials and clinical practice will be discussed in this symposium.

(320) Opioid-Induced Hyperalgesia: Clinical Evidence and Basic Underlying Mechanisms  (1.5)
Andrea Nackley, PhD (Moderator); David Clark, MD PhD

Opioid-induced hyperalgesia (OIH) constrains the use of opioids in a subpopulation of individuals, so it is important to gain a better understanding of this phenomenon. This symposium will include discussions of clinical evidence in the patient populations affected by OIH as well as basic underlying molecular mechanisms.

(W101) Sleep Disturbance in Chronic Pain: Potential Mechanisms, Recent Cognitive-Behavioral Trials, and Cognitive-Behavioral Management Strategies (2.0)
Luis Buenaver, PhD (Moderator); Francis Keefe, PhD; Monika Haack, PhD; Christina McCrae, PhD CBSM, Michael Smith, PhD; Jordan Karp, MD

This workshop will highlight the importance of considering and addressing sleep disturbance in the management of chronic pain and provide attendees with practical tools that can be readily implemented into clinical care. Potential mechanisms that link disturbed sleep with chronic pain will be discussed evidence for treating sleep disturbance in pain patients will be reviewed. Cognitive-behavioral therapy for insomnia will be discussed as it relates to chronic pain. The session will conclude with a clinical case panel discussion.

(W102) Hypnosis for Pain Management
Mark Jensen, PhD (Moderator); David Patterson, PhD; Joseph Zastrow, MD FAAFP

This workshop will provide pain clinicians from all disciplines with an introduction to hypnosis and hypnotic language skills that they will find immediately useful for helping their patients better manage pain. The workshop will primarily cover hands-on practice of hypnotic skills including basic hypnotic inductions, use of hypnosis and hypnotic language for enhancing positive responses to medical and psychosocial pain treatments, and training patients in the use of self-hypnosis for pain management.

(W103) Essentials of Headache Management
Jennifer Ault, PT DO PhD; Thomas Ward, MD; Tabitha Washington, MD MS; Gregory Dussor, PhD; Edgar Ross, MD

This workshop will explore clinically relevant and emerging therapies for the treatment of headache and focus on the pathophysiology and treatment of migraine, the most common headache type. Five 35-minute sessions will encompass a breadth of topics, including the pathophysiology and treatment of migraine and discussion of novel headache syndromes, emerging pharmacological targets, and innovative procedural/surgical therapies for the treatment of headache. This engaging and interactive workshop will leave the clinician with practical clinical tools as well as a better understanding of basic headache mechanisms and proposed new therapies.

(321) Objective Measures of Pain: Scientific, Legal, and Ethical Considerations 
Sean Mackey, MD PhD (Moderator); Mark Sullivan, MD PhD; Henry Greely, JD

Researchers have sought for decades an objective, physiologically based measure of pain. Recent advances in neuroimaging, combined with machine-learning techniques, present a means of quantifying the experience of pain and classifying chronic pain states. This symposium will address the  contemporary scientific, legal, and ethical issues surrounding neuroimaging-based pain detection.

(322) The Structure of Neuropathic Pain: Extracellular and Cellular Structural Plasticity Contributing to Chronic Pain
Patrick Dougherty, PhD (Moderator); Jon Levine, MD PhD; Ru-Rong Ji, PhD

New research is demonstrating that changes occur in the extracellular matrix and structural architecture surrounding both primary afferent and spinal cord neurons and glial cells that aid in  “locking in” chronicity in neuropathic pain. This session will review three types of these longterm  maladaptive changes and consider novel approaches that might be adapted as new treatment avenues for chronic pain.

(136) Basic Science Dinner: The Future of Drug Discovery for Pain 
Gregory Dussor, PhD, and David Seminowicz, PhD (Moderators); Chas Bountra, PhD; and James Campbell, MD

In recent years, several major pharmaceutical companies have scaled back or completely eliminated their pain research divisions, which raises questions about the future of drug discovery for pain.  The  speakers, with their extensive experience in pain research in both academic and industrial settings, will provide insight on potential reasons for past failures to translate preclinical findings to patients and novel approaches for future pain studies.  The lectures will be followed by a panel discussion.  Seating is limited. Pre-registration is required.

(105) Frederick W. L. Kerr Basic Science Research Lecture Mice Are People, Too: Social Modulation of and by Pain in Laboratory Rodents
Jeffrey S. Mogil, PhD

Many people believe that pain-relevant phenomena such as empathy and prosocial behaviors are the sole province of humans. However, the evolutionary antecedents of such phenomena are starting to be demonstrated in nonhuman animals, even in rodents. The speaker will discuss recent experiments showing the effect of social communication on pain behavior and the effect of pain on social interactions.  Many of the research findings can be translated to human beings in a surprisingly direct manner.

(107) Global Year Against Pain Lecture
Chronic Visceral Pain—The Long Path to Better Treatments
Emeran Mayer, MD

Chronic visceral pain in the form of common gastrointestinal, urological, and pelvic pain syndromes is an important clinical problem affecting up to 15% of the population. This session will include discussion of the biological understanding of these syndromes, failures in translational progress, and interest in the last decade in exploring alterations in structural and functional brain networks in these disorders. Future research direction will also be discussed.

(323) Pain Management in the Face of Disaster: Experiences of Clinicians, Patients, and Systems After Hurricane Katrina  (1.0)
Harry Gould, MD PhD (Moderator); Lorraine Reeves; Renee Manworren, PhD APRN PCNS-BC; Dennis Paul, PhD

Hurricane Katrina hit New Orleans on August 29, 2005, leaving a path of destruction that crippled the city, left hundreds of thousands homeless, and severely compromised the delivery of healthcare to much of the southeastern United States.  In this presentation, speakers will review some of the key problems related to providing continuity of pain care that arose in the wake of the storm.  They will also discuss lessons learned from the perspective of the displaced, treating clinicians, patients, and those healthcare providers who accepted and added responsibility of those in need. 

(324) The Association of Suicidality and Chronic Pain in the Veteran Population
David Fishbain, MD (Moderator); Mark Ilgen, PhD; Jan Kemp, PhD RN

The following topics will be discussed in this presentation: suicidality data on armed forces members and veterans, data on suicidality and predictors of suicidality in patients with chronic pain, recent evidence in veterans on the association of suicide completion and chronic pain, and descriptions and results of national veteran suicide prevention programs.

(325) Pain, Itch, and Touch Sensations: Neurons, Circuits, and Genes
Michael Iadarola, PhD (Moderator); Diana Bautista, PhD; Mark Hoon, PhD; Sarah Ross, PhD

Basic pain research faces several challenges.  One of the most long-standing issues is the  establishment of neuronal identity within the pain pathways. Identity can be defined on several levels: physiological, structural, and/or molecular, and each of these contributes in a dynamic fashion to the establishment of the neuronal circuitry that forms the basis of nociceptive or nonnoxious somatosensory sensations and consequent behaviors. This symposium explores sensations of pain, itch, and touch in terms of the underlying molecular basis for these sensory processes in the dorsal root ganglion using transgenic and gene-targeted mice. In addition, the role of spinal interneurons in sharpening sensory acuity is explored, again, using molecular genetic approaches.

(326) Prediction and Prevention of Low Back Pain Throughout the Lifespan
Inna Belfer, MD PhD (Moderator); Dennis Ang, MD MS; Dino Samartzis, DSc; Susmita Kashikar-Zuck, PhD

The precise causes of low back pain (LBP) and its recurrence are poorly understood. Physical findings and structural spine abnormalities do not always reflect patient-reported symptoms. Psychosocial risk factors have consistently emerged as predictors of the course of LBP in both children and adults. Unfortunately, studies of treatment interventions targeting these risk factors have yielded mixed results, suggesting that there may be other important factors that have not been examined.  A genetic approach applied to LBP research may help identify important biological factors that may contribute to the risk for or protection against chronicity and recurrence. It is highly likely that the interactions among genes, psychosocial factors, and psychophysical factors will shape LBP (or outcome) experience.

(327) Targeting Spinal GABAergic Mechanisms to Develop Novel Analgesics (1.5)
Theodore Price, PhD (Moderator); Mark Pitcher, PhD; Louis-Etienne Lorenzo, PhD

It is now clear that peripheral injury alters GABAergic signaling in the dorsal horn, but we are still understanding how to manipulate this system to achieve clinically meaningful analgesia in chronic pain states. This session will present recent evidence pertaining to molecular mechanisms underlying changes in GABA after peripheral injury and will highlight pharmacological approaches that can either augment GABAergic inhibition after injury or achieve effective inhibition despite changes in the endogenous GABAergic system.

(328) Treatment of Chronic Sickle Pain: Lessons from Fibromyalgia and Other Musculoskeletal Disorders  (1.5)
Carlton Dampier, MD (Moderator); Wally Smith, MD; Daniel Clauw, MD; Eufemia Jacob, PhD RN

This symposium will focus on the research and practice gaps in the treatment of chronic pain in adolescents and adults with sickle cell disease (SCD), which currently largely relies on the use of chronic opioids. Novel mobile technology methods for the assessment of frequent pain and other symptoms in children with SCD that are possible precursors to chronic pain in adolescents
and adults will be described. The current limited evidence base for analgesic therapy in adults with SCD, including the prevalence and incidence of chronic opioid use in children and adults, will be described and contrasted with the evidence base for the use of anticonvulsants and antidepressants in fibromyalgia, and related to their potential use in chronic SCD pain.  The design for future studies, and their potential to lead to “personalized analgesia” will also be discussed.

(329) The APS, College on Problems of Drug Dependence, and Heart Rhythm Society Clinical Practice Guidelines on Safer Prescribing of Methadone for Treatment of Opioid Dependence and Chronic Pain 
Ricardo Cruciani, MD PhD (Moderator); Roger Chou, MD; David Fiellin, MD

The safety regarding the use of methadone, both in opioid dependency and pain management, has become controversial due to the perception of higher morbidity and mortality associated with its increased use. As a result, several publications, including three guidelines, have been developed to help prescribers minimize risk. The three guidelines that are now available focus on prevention of cardiac arrhythmias due to the association between methadone and prolonged QTc interval seen on electrocardiogram. This session will outline clinical guidelines on safe methadone prescribing for the management of opioid dependency and chronic pain developed by the APS, College on Problems of Drug Dependence, and Heart Rhythm Society.

This REMS course will provide prescribers with the education needed to effectively assess the pain patient, develop a treatment plan, assess for risk of opioid abuse, and plan for ongoing assessment of the patient.  The REMS session is offered as a separate, no-cost session within the 32nd Annual Scientific Meeting.  Advance registration is required.  Click here for additional information regarding this session.