Friday, May 15

7:30–8:30 am
General Session

Continuing Education Credit Available for Sessions 103-104: 1 Hour for Physicians, Psychologists, Nurses, and Pharmacists

7:30–8 am

(103) Plenary Lecture
Cannabis and Pain: Old Drug, New Perspectives
Mark Ware, MD MRCP (UK) MSc

The primary reason for patients’ self-reported medical use of cannabis is for pain management. The pain management community is deeply aware of our need for new approaches to manage chronic pain. Can these two positions be reconciled in an evidence based manner? Is there a role of cannabis and/or its derivatives, the cannabinoids, in modern pain management? This presentation will explore the scientific rationale for cannabinoids in pain modulation, the epidemiology of cannabis use in pain, and the evidence base for cannabis in pain management. Attendees will be challenged to confront their own perceptions of cannabis, to consider how the stigma of cannabis influences their therapeutic decisions, and encouraged to participate in finding ways to safely and constructively deal with the exploding reality of medical cannabis. We are facing an issue that can no longer be ignored, a therapy that is increasingly available not through regulatory approval but through court challenges and the ballot box. How we respond is a matter of importance to the health profession, the policy makers, the general public and, most importantly, our patients.

8–8:30 am

(104) Plenary Lecture
Effect of Environment on the Long-Term Consequences of Chronic Pain
Catherine Bushnell, PhD

There is accumulating evidence that chronic pain leads to consequences that go far beyond the pain itself. Chronic pain patients show associated anxiety and depression, as well as deficits in cognitive functioning. Rodent models confirm similar emotional and cognitive changes in controlled longitudinal studies, suggesting that the effects are caused by the chronic pain condition, rather than reflecting unrelated differences between individuals with chronic pain and control subjects. Brain imaging studies in both pain patients and in rodent pain models show alterations in gray matter volume, white matter integrity and even epigenetic changes in the brain. Despite the widespread nature of the alterations related to chronic pain, there is now evidence that these effects can be prevented or reversed by environmental factors. In human pain patients, lifestyle choices, such as yoga or meditation, reduce pain perception and counter age-related decreases in gray matter density and white matter integrity. This contrasts with chronic pain that accelerates gray matter loss and disrupts white matter integrity. Rodent models show that increased stress alters pain behaviors, whereas socially and physically enriched environments reduce such behavior and reduces pain-related brain changes. Together, these data indicate that the far-reaching adverse effects of chronic pain are not inevitable and may be reduced or prevented by environmental factors that could affect pain modulatory systems in the brain.

8:45–10:15 am
Poster Session and Networking in the Experience Exchange

8:45-10:15 am
Session Sound Bytes in the Learning Lounge

Join us for informal, TED-style talks in which you’ll have an opportunity to interact with the speakers and engage in dialogue on clinical and basic science topics.

Ted Price, PhD (Moderator)

8:45-9:05 am: Stefan Friedrichsdorf, MD
9:10-9:30 am: Hants Williams, BSN
9:35-9:55 am: Linda Watkins, PhD
10-10:20 am: Mark Ware, MD MRCP (UK) MSc

10:30 am–Noon
Symposia 

Continuing Education Credit Available for Sessions 400-405: 1.5 Hours for Physicians, Psychologists, Nurses, and Pharmacists

(400) Modeling the Transition from Acute to Chronic Pain
Theodore Price, PhD (Moderator); Jon Levine, MD PhD; Cobi Heijnen, PhD; Annamieke Kavelaars, PhD

This session will focus on preclinical models of the transition to chronic pain, highlighting new advances in molecular mechanisms driving neuronal plasticity underlying this change. Compelling evidence will be presented for changes along the neuraxis, from peripheral nociceptors to spinal circuits to descending modulatory centers. Discussion will focus on moving these advances in molecular knowledge toward future potential therapeutic applications.

(401) Multidimensional Pain Mechanisms in Fibromyalgia: Implications for Understanding Individual Differences
Robert Edwards, PhD (Moderator); Christopher Coe, PhD; Michael Jankowski, PhD

The pathophysiology of fibromyalgia is incompletely understood, and interpatient variability in presentation, illness course, and treatment response is enormous. This symposium will present recent findings on multiple neurobiological mechanisms underlying fibromyalgia-related symptomatology (e.g., alteractions in functional connectivity of the brain assessed with fMRI, immune alterations involving cytokines, autoantibodies, etc.), and will involve discussion of these findings’ implications for understanding and treating patient subgroups.

(402) Pain in Older Adults: Predictors, Functional Consequences, and Considerations for Treatment
Yenisel Cruz-Almeida, PhD MSPH (Moderator); Kelly Naugle, PhD; Barbara Rakel, PhD RN

This symposium will focus on characterizing the central and peripheral mechanisms/predictors increasing the risk for chronic pain in older adults. We will describe how these pain-related risk factors may also exacerbate functional decline in older adults. Efforts will be made to integrate this knowledge into the management of pain in older adults.

(403) Using Mixed-Methods Research to Enhance the Understanding of Pain Management
Joke Bradt, PhD (Moderator); Caryn West, PhD RN; Vicki Plano Clark, PhD; Minjung Shim, MA

Mixed-methods research is ideally positioned to help answer clinical questions embedded within a biopsychosocial conceptualization of pain management. This symposium will highlight the advantages of using mixed-methods research to enhance understanding of multidimensional factors that impact pain management and optimize treatment interventions. Faculty will provide examples of applications of the NIH guidelines for Best Practices for Mixed Methods Research in the Health Sciences in the context of pain research.

(404) Combination Pharmacotherapy for Pain: Preclinical and Clinical Perspectives 
Laura Stone, PhD (Moderator); George Wilcox, PhD; Ian Gilron, MD

Individual pain relievers provide incomplete relief and can produce undesired and dose-limiting side effects. The use of multimodal analgesic techniques can offer distinct advantages over single-drug treatments. However, combinations can also result in serious side effects. With more than half of patients with chronic pain receiving two or more different analgesic drugs, improved understanding of the safety, efficacy, and mechanisms underlying combination therapies is a high priority for both basic scientists and clinicians.

(405) Engineering and Delivery of Druggable Targets for the Treatment of Pain 
Yan Xu, PhD (Moderator); Anne Marie Malfait, MD PhD; Joseph Glorioso, PhD

This session will focus on novel strategies to engineer and deliver druggable targets for the treatment of chronic pain. We will discuss the use of RELIEPH (Receptor Engineering to Lessen Inflammation-Evoked Pain and Hypersensitivity) and DREADD (Designer Receptor Exclusively Activated by Designer Drugs) technologies in combination with gene therapy for installing exclusive druggable targets and for selectively silencing targeted populations of peripheral neurons.

12:15–1:30 pm
Lunch Symposia

1:45–3:15 pm
Symposia

Continuing Education Credit Available for Sessions 500-501: 1.5 Hours for Physicians, Psychologists, Nurses, and Pharmacists

(500) Potential Targets for Future Migraine Therapeutics
Greg Dussor, PhD (Moderator); Yu-Qing Cao, PhD; Michael Gold, PhD

This session will emphasize the contribution of calcium and potassium channels, immune cells, and brain-derived neurotrophic factor (BDNF)–dependent plasticity in the brainstem to the pain of migraine. Data from three preclinical research laboratories will be presented and will include discussion of ion channels that may regulate pain signaling from the meninges, how the immune system can contribute to the initiation of a migraine attack, and how neuronal plasticity at central synapses can increase pain signaling in migraine. Presenters will also discuss the suitability of these topics as potential therapeutic targets for future drugs to treat headache.

(501) Complementary and Alternative Medicine (CAM) for Pain: Translating Between Bedside and Bench
Magali Millecamps, PhD (Moderator); Susan Masino, PhD; Carolyn Fairbanks, PhD

Among patients with chronic painful conditions, the use of complementary and alternative medicine (CAM) has increased from 40% in the 1990s to more than 90% today. In this symposium, participants will first be introduced to the history and actual use of CAM by patients to cope with chronic pain. Level of clinical evidence and neurobiological underlying mechanisms will be addressed for three therapies. Drs. Millecamps, Masino, and Fairbanks will delineate how an active lifestyle, diet, or acupuncture can modulate various chronic pain conditions across species.

1:45–5 pm
Workshops

Continuing Education Credit Available for Sessions W700-W701: 3 Hours for Physicians, Psychologists, Nurses, and Pharmacists

(W700) Clinical Application of American Pain Society’s Guidelines for Managing Postoperative Pain 
Debra Gordon, RN DNP FAAN (Moderator); Renee Manworren, PhD APRN-BC FAAN; Timothy Brennan, MD PhD

Many preoperative, intraoperative, and postoperative interventions and management strategies are available for reducing and managing postoperative pain in adults and children. The American Pain Society, in partnership with the American Society of Anesthesiologists, the U.S. Veterans Health Administration Health System, and the Department of Defense Health System, commissioned a systematic review to inform and update clinical practice guidelines on management of postoperative pain. This workshop will review the guideline recommendations and discuss implementation and evidence of guideline application on patient outcomes.

(W701) Necessity Is the Mother of Invention: Innovative Primary Care Responses to the Chronic Pain Crisis
David Tauben, MD (Moderator); Lucinda Grande, MD; Michael Parchman, MD MPH; Michael Vonkorff, ScD

Primary care clinics are starting to address the growing pressures on providers from patients on chronic opioid therapy. Innovative solutions include creative structuring of interprofessional teams, protocol-driven urine screening by support staff, and systematic tracking of performance metrics and patient-centered outcomes. Some results of these efforts will be presented in this workshop-format session that will promote collaborative practice improvement and will inform the pain specialty community of the priorities of some important customers—their colleagues in primary care.

3:30–5 pm
Symposia

Continuing Education Credit Available for Sessions 600-601: 1.5 Hours for Physicians, Psychologists, Nurses, and Pharmacists

(600) Basic Mechanisms for Spinal Cord Stimulation and the Potential Clinical Implications
Haibin Wang, MD PhD (Moderator); Yun Guan, MD PhD

This session will emphasize the role of opioid receptors, glial cells, superficial dorsal horn and wide dynamic range (WDR) neurons, stimulation frequency, and antiinflammation as underlying mechanisms for spinal cord stimulation (SCS). Data from three preclinical research laboratories will be presented and will include discussion of how those different mechanisms contribute to the clinical efficacy of SCS therapy and provide future implications for this therapy.

(601) Keratinocyte Mechanisms in Tactile Sensation, Neuropathic Pain, and Dermatopathologies
Kathryn Albers, PhD (Moderator); Jose Moron-Concepcion, PhD; Michael Caterina, MD PhD

Increasing evidence indicates that keratinocytes play an active neurosignaling role in transducing and modulating tactile sensation, including pain. Mechanisms of normal keratinocyte signaling will be presented as well as pathologies associated with peripheral neuropathic pain and atopic dermatitis. These mechanisms are potential targets for therapeutic strategies to treat neuropathic pain and dermatopathologies.

5:15–7:15 pm
Special Interest Group (SIG) Meetings

Continuing Education Credit Available for SIG Meetings 137-141: 1.5 Hours for Physicians, Psychologists, Nurses, and Pharmacists

(137) Ethics SIG
Basic and Clinical Pain Research Ethics: National Oversight, Data Integrity, and How and Why Your Role as Ethical Steward Outlasts Your Research Study
Beth Darnall, PhD (Moderator); Ranjini Ambalavanar, PhD; Luke Parkitny, PhD

There is a need for basic and clinical researchers to better appreciate the nuances between questionable research practices versus research misconduct, as well as the impact of research misconduct on individuals, organizations, and the public. This interactive session will involve discussion of how the conduct of the terminal stages of a study may enhance or unhinge the results, regardless of the study quality and findings. Real-life case studies will be discussed, and closed cases and forensic tools from the Office of Research Integrity will be presented.

(138) Measurement of Pain and Its Impact SIG
Pain Measurement Across the Lifespan
Yenisel Cruz-Almeida, PhD MSPH (Moderator); Laura Simons, PhD; Miroslav Backonja, MD; Keela Herr, PhD RN AGSF FAAN

During this meeting, presenters will focus on addressing general concepts about pain measurement and assessment across the lifespan. Special considerations will be presented on pain measurement and assessment in children, older adults, and individuals with limited ability to communicate due to cognitive impairments. Efforts to translate the current science of pain measurement into improved management of pain populations will be considered.

(139) Nursing SIG
The Experiences and Perceptions of Advanced Practice Nurses Caring for Patients with Coexisting Substance Use Disorder and Chronic Pain
Barbara St. Marie, PhD ANP GNP (Moderator)

Healthcare providers across several medical disciplines and settings share lack of knowledge and general frustration with their experiences in treating patients with chronic pain and substance use disorder, but the experiences of advanced practice nurses is unknown. Opioid prescribing for treatment of pain is a root of healthcare provision, but the results can be mixed. The purpose of this session is to examine the narratives of the advanced practice nurse’s experiences and perceptions while caring for patients with coexisting substance use disorder and chronic pain.

(140) Pharmacotherapy SIG
Teaming Up with a Clinical Pharmacist: A Unique Practice Model for Chronic Pain Management
Melissa Durham, PharmD (Moderator); Rakhi Dayal, MD

This session aims to provide exposure to a variety of interdisciplinary approaches to pain management, while highlighting a unique practice model involving a clinical pharmacy service. Session participants will discuss their own experiences with interdisciplinary care and will be provided with tools and recommendations for implementation of a similar service in their own practice setting.

(141) Primary Care SIG
Advancing Primary Pain Care Within the American Pain Society and Nationwide
Jessica Merlin, MD MBA (Moderator); Mark Sullivan, MD PhD; Joanna Starrels, MD MS; William Becker, MD

A substantial amount of chronic pain care in the United States occurs in the offices of primary care providers. Common primary care pain challenges include addressing other pressing medical problems when pain is the patient’s top priority; implementation of opioid risk mitigation strategies within a primary care practice; continuing to care for patients with worrisome behaviors (e.g., substance use, doctor shopping) after difficult conversations have occurred and opioids have been tapered; and interfacing with other providers (e.g., pain specialist physicians, psychologists, emergency departments) who may not share the same approach to pain management.

Traditionally, primary care providers have made up a minority of APS membership, and these primary care–focused topics have been underrepresented at APS meetings. This Primary Care SIG meeting will provide attendees with an opportunity to discuss how the SIG can advance the clinical and scientific agenda on primary care pain issues within APS and nationwide. This session will be a structured brainstorming exercise led by Dr. Jessica Merlin, a clinician-investigator in the area of chronic pain in HIV primary care settings and founder of the Primary Care SIG.

(142) Advancing the Science of Quality
This session is not offered for continuing education credit.

Quality science encompasses methods, tools, measures and standards to understand and improve quality. The format for this meeting will be an open interdisciplinary discussion to enhance collaborations and sharing of successful strategies to enhance transmission of evidence into practice, improve healthcare systems, and to identify and understand quality measures in pain. Preliminary recommendations from an ad hoc APS task force on quality outlining priorities and potential future quality projects will be reviewed including updates on the development of a pediatric patient outcome questionnaire and the Pain-Out registry.

(143) Pain Education

The purpose of this Pain Education SIG meeting will be to: Provide updates on members’ activities and interests; Participate in a presentation on "hot topics," the future of pain education, and the role of APS in leading pain education initiatives; Meet in working groups to discuss specific topics of interest in pain education (e.g. approaches for the study and assessment of pain education, strategies for promoting and establishing interprofessional pain education curricula, dissemination of education resources for the general health care public, etc.).

(144) Pain in Infants, Children, and Adolescents

5:30–7:30 pm
Basic Science Research Dinner

(136) A Debate on the NIH Policy for Gender Equality in Pre-clinical Research
Michael Jankowski, PhD, and Benedict Kolber, PhD (Moderators); Jeffrey Mogil, PhD; Laura Stone, PhD; Rebecca Craft, PhD; Geoffrey Bove, DC PhD

Continuing education credit is not available for this session. Seating is limited. Preregistration is required.

Wednesday, May 13 | Thursday, May 14 | Friday, May 15 | Saturday, May 16