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Comorbid HIV, Chronic Pain, and Substance Use Among Older Adults (R21)
To improve understanding of the intersection of HIV/AIDS and drug abuse, this funding opportunity announcement (FOA) is part of a multipronged 2014 expansion of HIV- and AIDS-related research within the context of drug and alcohol abuse among understudied populations and in understudied settings that show promise for the development of effective prevention and treatment efforts. In addition to this funding opportunity, others included in the 2014 expansion address HIV/AIDS and substance use among the homeless and unstably housed (RFA-DA-14-009); substance use, HIV, and African-American women and young men who have sex with men (MSM) (RFA-DA-14-010); the integration of substance abuse and HIV prevention and treatment within HIV/AIDS service delivery settings (RFA-DA-14-011), and seek, test, treat, and retain data harmonization coordinating center (RFA-DA-14-007).
For this funding announcement, the National Institute on Drug Abuse (NIDA) invites innovative, exploratory research applications proposing to study the intersection of HIV, chronic pain, and substance use among older adults. Applications could include research to examine risk and protective factors contributing to comorbid HIV, chronic pain, and substance use among older adults; to characterize the adverse medical, mental health, and social consequences associated with comorbid HIV, substance abuse, and chronic pain among older adults; or to develop effective prevention and service delivery approaches and behavioral and pharmacological treatments to address these comorbid conditions in older adults. Research also is encouraged on the role of HIV/AIDS-associated conditions, HIV treatment, or other biobehavioral/social factors in the context of aging, chronic pain, and substance use. A range of research approaches is of interest, including epidemiologic, prevention science, health services, and intervention studies. For more information, visit http://grants.nih.gov/grants/guide/rfa-files/RFA-DA-14-012.html.
NIDCR Institutional Career Development Award for Enhancing Research Capacity in Temporomandibular Joint Disorders and Orofacial Pain (K12)
The purpose of this funding opportunity announcement (FOA) is to expand and strengthen the community of investigators engaged in research on temporomandibular joint disorders (TMJDs) and orofacial pain. An increase in the number of well-trained researchers is necessary to reach a critical mass of scientists with contemporary multidisciplinary expertise who will be able to leverage recent advances in genetics, bio-engineering, and bio-behavioral research in order to enhance patient treatment and to advance scientific momentum in the field. The objectives of this FOA are to 1) increase the number of basic and clinical investigators who are trained in the sciences relevant to TMJD or orofacial pain research, 2) facilitate and improve the mentoring of this new group of scientists, 3) bring new scientific expertise to TMJD and orofacial pain research. The expected outcomes of this Initiative will be 1) an increase in the number of TMJD/orofacial pain research leaders who will apply for and obtain independent funding support, and 2) an increased number of multidisciplinary research teams led by junior investigators or investigators new to the TMJD and orofacial pain fields. These new teams will form a robust research community applying novel approaches to TMJD and orofacial pain research that will enhance our understanding of the disorders and lead to effective treatments for patients. These new teams will thrive in academic research centers that foster an environment for developing new collaborative, multidisciplinary and interdisciplinary scientists with skills and expertise that can be applied to the most intractable topics in TMJDs and orofacial pain research. For more information, visit http://grants.nih.gov/grants/guide/pa-files/PAR-11-289.html.
Call for Poster Abstracts
The American Pain Society invites the submission of abstracts for poster presentation at the 33rd Annual Scientific Meeting, April 30–May 3, 2014 in Tampa, FL. The Call for Poster Abstracts will be available on the APS website August 15–November 15, 2013. Please visit the APS website for a full set of instructions and to access the submission system.
APS Receives Record Number of Symposia Proposals for the Tampa Meeting
The 2014 Scientific Program Committee (SPC) would like to thank all those who submitted proposals for symposia and workshops for the 33rd Annual Scientific Meeting in Tampa, April 30–May 3, 2014. APS received 81 proposals for the Tampa meeting—a record number. The SPC met in Chicago at the end of August to discuss all of the submissions, and all moderators/faculty who submitted will be notified of their proposal’s status in early October. The 2014 meeting promises to be one of the best. Mark your calendar now and plan to join us in Tampa!
Member Spotlight: Benedict J. Kolber, PhD
Benedict J. Kolber, PhD
How has membership in APS been of value to you and your professional development?
What is your area of specialty?
What has been a highlight of your work? Are you and your staff especially proud of a particular project or accomplishment?
What initially sparked your interest in working in your field?
Who is your favorite role model and why?
Member Benefit: Grants and Fellowship Opportunities
APS provides its members with several funding opportunities as well as information on fellowships in pain. The following are just some examples of how APS provides financial and career support to pain professionals:
Now Open! APS Sharon S. Keller Chronic Pain Research Grant
Deadline: Call for LOIs opened Tuesday, September 3, and closes Monday, September 30, at midnight. Only approved LOIs will be invited to submit a full application. Please see the LOI instructions and program guidelines in the Research section for more details.
APS Future Leaders in Pain Research Grants Program
Rita Allen Foundation Award in Pain
Fellowship opportunities can be found on the APS Education page.
This information is provided as a resource and does not imply APS endorsement of any of the training programs listed.
The Journal of Pain Highlights
The following highlights summarize selected articles from The Journal of Pain (Volume 14, Number 8, September Issue).
Study Assesses Variations in Pain Treatment in Older Adults During Prehospitalization Emergency Care
A North Carolina study reports that age, gender, and pain severity are the main determinants of which emergency care patients are given pain medications in ambulances. The study showed that older men and women are less likely to receive an analgesic from paramedics than younger patients.
Severe pain is common in patients transported by ambulances, and adults over the age of 65 represent almost 40% of prehospitalization transports. Researchers from the University of North Carolina, University of Virginia, and the University of Florida accessed data on ambulance transports in North Carolina during 2011. During the year, there were 984,807 transports of persons 18 years and older, and 407,763 of the cases were eligible for analysis.
The purpose of the study was to compare analgesia administration for older vs. younger adults during ambulance transport. The authors hypothesized that since the standardized EMT protocol did not differentiate patients by age, pain management at the prehospitalization stage would be similar for older and younger adults.
The results of the analysis contradicted the hypothesis and showed that older adults transported by ambulance in North Carolina were less likely to receive any analgesics than younger patients. However, older women with severe pain were more likely to receive an analgesic than younger women with severe pain, and the differences were most significant in those over the age of 85. Also, only the very oldest men with high pain scores were more likely than patients aged 18¬–64 to receive analgesics or opioids. The authors noted that the interaction between age, gender, and pain severity on the management of acute pain by paramedics had not been previously reported.
The authors indicated that several factors could contribute to the lower rates of pain treatment in older adults, such as
Neuroticism and Depression Influence Patient’s Pain Recall Ability
Pain assessment often depends on the ability of patients to accurately recall daily levels and patterns of persistent pain. Studies have shown that psychiatric health can influence the ability to report pain levels over time. This particular study reported that neurotic patients had better recall of pain unpleasantness and depressed patients had poorer recall.
The study involved 70 patients with chronic low-back pain who completed measurements of neuroticism and depressive symptoms as well as diaries that asked for their ratings of pain intensity and limitations on daily activities. The intent of the research was to evaluate the effects of neuroticism and depression on patients’ pain reports.
The researchers found that patients scoring higher on neuroticism could accurately recall the variability of their pain intensity and unpleasantness over time. The authors concluded that patients showing neuroticism may not be accurate in their recall of pain unpleasantness if measured with a single evaluation but are better at recalling pain over time. This suggests that neuroticism may be related to noticing relative changes in pain rather than absolute pain levels.
The authors noted that the study results for patients with depressive symptoms were unexpected. They found that the severity of depressive symptoms does have an effect on accuracy in recalling pain but not on the recall of pain variability. Subjects who showed higher levels of depression were more accurate in their recall of pain.
The Clinical Journal of Pain Highlights
The following highlights summarize selected articles from The Clinical Journal of Pain (Volume 29, Number 9, September 2013 Issue).
Combining Cognitive-Behavioral Therapy and Milnacipran for Fibromyalgia: A Feasibility Randomized-Controlled Trial
Fibromyalgia (FM) is a common chronic pain condition. Despite the availability of three approved drugs for treatment of FM, the multifaceted nature of FM and the modest benefit demonstrated in monotherapy trials supports the need to begin testing of combination treatments. The main goal of this study was to test the feasibility of a randomized controlled trial to investigate the effectiveness of the combination of phone-based cognitive behavioral therapy (CBT) and milnacipran compared with CBT and milnacipran alone. In the current trial, the use of CBT and milnacipran as adjunct to a patient’s medication regimen at study entry had the advantage of reflecting “real world” clinical practice. Investigators hypothesized that patients receiving the combination therapy would demonstrate larger pretreatment-to-week-21 benefits in the coprimary outcome measures than patients who received either milnacipran or CBT monotherapy.
At least six of the eight phone-based therapy sessions were successfully completed by 89% of the patients, and adherence to the treatment protocols was higher than 95%. Compared with milnacipran, combination therapy demonstrated a moderate effect on improving physical function on the SF-36 Physical Function Scale and reducing weekly average pain intensity. Compared with milnacipran, CBT had a moderate-to-large effect in improving SF-36 physical function. Combination therapy was marginally more efficacious than either milnacipran or CBT in reducing pain and improving physical function. Milnacipran, as an adjunctive treatment, was well tolerated despite the presence of concurrent centrally acting therapies. An adequate recruitment rate (four patients per month) was achieved through physician referrals, and a high retention rate (84%) was observed almost 6 months postrandomization.
The findings from this pilot study support the need to test the efficacy of combination treatment versus medication monotherapy. The additive benefits of CBT, if replicated in a larger study, could prompt clinicians to consider CBT as an add-on therapy before prescribing another medication. These findings also suggest that the additive benefits of milnacipran over and above CBT may be minimal.
Effects of Pain and Prescription Opioid Use on Outcomes in a Collaborative Care Intervention for Anxiety
Pain problems that prompt disability or the seeking of medical care are common among people with depressive and anxiety disorders. Several controlled observational analyses have shown that pain symptoms predict poorer outcome for patients receiving treatment for depression, but the ability to determine differential effects on treatment outcome (a prescriptive or moderator rather than a predictive effect) is limited without a placebo or usual care comparator.
Investigators sought to determine the effects of pain and opioid pain medication use on clinical and functional outcomes in 1,004 primary care patients with an anxiety disorder who were randomized to receive the Coordinated Anxiety Learning and Management (CALM) collaborative care intervention (cognitive behavioral therapy [CBT] and/or medication) versus usual care. Patients with generalized anxiety disorder, social anxiety disorder, or posttraumatic stress disorder were randomized to CALM or usual care. Outcomes at 6, 12, and 18 months were compared in patients with and without moderate pain interference (for the entire anxiety disorder group and also those with comorbid major depression) and in patients taking and not taking opioid medication (the entire group, those with comorbid major depression, and just those with moderate pain interference).
Patients with pain interference and those taking opioid pain medication who were more anxious and disabled at baseline improved over time at similar rates, but at 18 months had lower response and remission rates. There was no moderating effect on the intervention. In patients with comorbid major depression, those using opioid medications showed a trend for less disability improvement over time. Among patients with pain, those using opioids showed less sustained anxiety response at 18 months.
These findings show that patients with pain interference at baseline and those taking prescription opioid medication at baseline are more severely ill, reporting higher anxiety, depression, and disability scores. Although the groups did not respond differently to treatment on continuous measures of anxiety, patients with pain interference and those taking prescription opioid medication were less likely to respond (i.e., show a 50% decrease in their Brief Symptom Inventory anxiety score) or remit. In summary, anxious patients with pain benefit as much as those without pain from CBT and medication treatment.
The following highlights summarize selected articles from PAIN (Volume 154, Number 9, September 2013 Issue).
Cardiovascular Risk Factors Associated with the Metabolic Syndrome Are More Prevalent in People Reporting Chronic Pain: Results from a Cross-Sectional General Population Study
People with chronic pain have a reduced life expectancy compared to the general population, in part as a result of death attributable to cardiovascular disease (CVD). The explanation for the correlation between chronic pain and increased cardiovascular death likely is multifactorial. The aim of this study was to explore whether traditional cardiovascular risk factors, and, in particular, lipid profiles, are independently associated with chronic pain, and to examine any correlations with chronic pain distribution or intensity.
This large general population cross-sectional study revealed interesting associations between cardiovascular risk factors and chronic pain states. The prevalence of CVD risk factors, elevated coronary heart disease risk, and metabolic syndrome was increased in participants reporting chronic pain. The associations between CVD risk factors and chronic pain remained after adjustment for age, gender, activity level, and family grouping. Among participants reporting chronic pain, CVD risk factors correlated with increased pain intensity, but not widespread distribution of pain. The observation that CVD risk factors are associated with increased chronic pain intensity warrants further investigation.
Obesity, increased waist-hip ratio, and high blood glucose, although demonstrating a degree of collinearity in their associations with chronic pain, all remained in the multivariate chronic pain model. These factors cluster and contribute to metabolic syndrome, but it seems that obesity and adverse body proportions are additively associated with chronic pain. The 10-year CHD risk score and metabolic syndrome correlate well with increased pain intensity, but not with widespread pain.
A Phase III Placebo- and Oxycodone-Controlled Study of Tanezumab in Adults with Osteoarthritis Pain of the Hip or Knee
Nerve growth factor (NGF) is a neurotrophin that plays an important role in neuronal survival in the developing nervous system and pain signaling in the adult nervous system. Injury and inflammation induce NGF expression, and chronic pain conditions are associated with increased levels of NGF. Elevated NGF levels also occur in the joints of patients with osteoarthritis (OA), suggesting that NGF contributes to OA pain.
The objective of the current study was to evaluate the efficacy, tolerability, and safety of intravenous tanezumab (5 mg and 10 mg) for the treatment of hip or knee OA pain compared with placebo and controlled-release (CR) oxycodone. Treatment with tanezumab 5 mg or 10 mg resulted in improvements in Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) pain scores that were statistically significant versus placebo by week 4 and remained significant throughout the remainder of the study. Significant improvements in secondary endpoints including physical function, Patient’s Global Assessment, and stiffness also occurred. The results of the current study confirm previous reports that oxycodone CR provides only modest relief in patients with OA pain.
The safety of tanezumab and oxycodone CR was consistent with previous reports, and no new safety signals were identified. The results indicate that tanezumab may provide a promising alternative to opioids for the treatment of OA hip or knee pain.
APS Announces 2014 Sharon S. Keller Chronic Pain Research Grants Program: Call for Letters of Intent Now Open
The call for Letters of Intent (LOIs) for the 2014 Sharon S. Keller Chronic Pain Research Grants Program is now open. This year APS will again award up to four grants in the amount of $35,000 each to pain research proposals demonstrating the greatest merit and potential for success. Interested applicants should submit a required one-page LOI briefly describing the objective, aims, methods, and relevance of their proposed research. LOIs will undergo review to determine their responsiveness to this request. Only approved LOIs will be invited to submit a full application.
The Sharon S. Keller Chronic Pain Research Grants program was established in 2013 to fund research projects that have a high likelihood of leading to new treatments or increased access to and expansion of treatment options for people with chronic pain.
LOI submission opened September 3, 2013, and closes at midnight, September 30, 2013. For more information regarding deadlines, eligibility, topics, and more, please visit Sharon S. Keller Chronic Pain Research Grants Program on the APS website.
Call for Applications for the 2014 Clinical Centers of Excellence Program Now Open
The call for applications for the 2014 APS Clinical Centers of Excellence (CCOE) in Pain Management Awards will open on Monday, September 2. The CCOE Program annually awards the APS Center of Excellence designation to interdisciplinary healthcare teams that provide the most distinguished, comprehensive pain care. Pain management programs from across the United States, small and large, rural and urban, community and university-based, are all eligible to apply. Selection of awardees is based on judgment of the quality of services provided, not the size or type of the program.
CCOE program recipients from 2007–2010 who have not already received the award for a second time are eligible to apply. Past recipients must provide evidence of sustained excellence and fulfillment of CCOE assessment criteria.
APS has recognized 35 Centers of Excellence since its inception in 2007. This distinction is one of APS’s highest honors in the area of clinical treatment. To learn more about the program, past recipients, and how to apply, visit the APS CCOE webpage.
Another Successful Exclusive APS Feature at PAINWeek
September 4–7 marked another successful collaboration between APS and PAINWeek, the largest pain meeting targeting the primary care audience in the United States. This year APS’s active participation included a 4-hour track, a 3-hour opioids REMS course, and presence in the popular exhibit hall. This is the second year for this exclusive APS feature at PAINWeek.
The APS Science of Pain track saw more than 500 attendees and included the following presentations and faculty:
240 pain care clinicians from PAINWeek and the Las Vegas area attended the APS/ Collaborative on REMS Education (CO*RE) opioid REMS course created to address the 2012 U.S. Food and Drug Administration (FDA) mandate for all prescribers of extended-release/long-acting opioids. Attendees were engaged by a multidisciplinary faculty that included Charles Argoff, MD, joined by Katherine Galluzzi of both the American Osteopathic Association and APS, Sandra Keavey of the American Academy of Physician Assistants, and Barbara St. Marie of the Nurse Practitioner Healthcare Foundation. This was the first year for this special course at PAINWeek.
Plenty of support and interest was generated by APS’s booth during 3 days of exhibiting. During this time PAINWeek attendees learned about The Journal of Pain; APS’s 2014 Annual Scientific Meeting in Tampa, FL; the variety of special interest groups available through membership; the clinical practice guideline initiative; and the interests of the society’s diverse membership.
APS CEO Catherine Underwood Selected for 2013–2014 Mayday Pain & Society Fellowship
On September 3 the Mayday Fund announced the selection of six experts in pain management to be fellows of The Mayday Pain & Society Fellowship. APS CEO Catherine Underwood, MBA CAE, was among those selected, who come from across the United States and Canada, specializing in a wide range of healthcare disciplines, including neuroscience, primary care, physical and rehabilitation medicine, patient advocacy, and pain policy. The fellowship program is in its ninth year and will continue for one more session in 2014.
The fellowship provides pain care leaders with skills to advocate for effective pain management. Fellows learn how to better communicate with the media, policymakers and others to raise visibility for their issues.
“The applicant pool was one of the largest and most impressive to date,” said Russell K. Portenoy, MD, Chairman of The Mayday Fellowship Advisory Committee, which selects the fellows each year. “The response showed us that researchers, clinicians, and advocates are becoming increasingly aware of the need for effective communication about the urgent problem of undertreated pain. We are confident that this year’s fellows will bring fresh energy and focus to our program and will acquire the skills they need to more effectively promote the legitimate needs of patients with pain. More than ever, the patient’s voice must be part of the public and professional discourse about pain-related policy and practice,” added Portenoy, who is also chairman of the Department of Pain Medicine and Palliative Care at Beth Israel Medical Center.
“The Mayday Fund Trustees congratulate and welcome this new class of fellows,” said Christina M. Spellman, Executive Director of The Mayday Fund. “We are eager to support such qualified leaders to speak publicly about cutting-edge pain research, education programs, and policy issues impacting pain care.”
As part of their training, the new fellows will attend an intensive 4-day workshop in Washington, DC, in October and will work closely with media and policy coaches from Burness Communications, a public relations firm that works with nonprofit organizations, primarily in health and science. Fellows will learn how to connect with local and national media, write opinion editorials, and educate members of Congress and other policymakers about pain care research and treatment. By improving their communications skills, they will be poised to move the field forward by educating and working with the media, policymakers, advocates, health and business leaders, and their own peers.
Visit the Mayday Fund page for more information on the other recipients and the fellowship program.
Call for Nominations
The secretary and three directors-at-large will be elected to take office at the 2014 annual meeting. In addition, the 2014 seven-member Nominating Committee will be elected, which includes three past presidents and four members at large.
Visit the 2014 nominations page for position descriptions, eligibility, and the nomination form.
Nominations are due by Monday, October 14, 2013.
Thank you for participating in the selection of new leaders for the society.
Regional Society Update
Midwest Pain Society Annual Meeting to Include Opioid REMS Education Session
MPS’s 37th Annual Scientific Meeting, October 25-26, 2013, at Northwestern Memorial Hospital in Chicago, will include a session on ER/LA Opioid REMS: Achieving Safe Use While Improving Patient Care, presented by Steven Stanos, DO, and Chris Herndon, PharmD FASHP.
Overall Objective: Demonstrate safe prescribing practices of extended release (ER) and long-acting (LA) opioid analgesics and be able to balance the benefits to treat pain against the risks of serious adverse outcomes including addiction, unintentional overdose, misuse, abuse, and death.
Acknowledgement: Presented by the American Pain Society, a member of the Collaborative on REMS Education (CO*RE), 10 interdisciplinary organizations working together to improve pain management and prevent adverse outcomes. This educational activity is supported by an independent educational grant from the ER/LA Opioid Analgesics REMS Program Companies (RPC). Please see www.er-la-opioidREMS.com for a listing of the member companies.
This activity is intended to be fully compliant with the ER/LA Opioid Analgesics REMS education requirements issued by the U.S. Food & Drug Administration (FDA).
For more information on MPS’s Annual Scientific Meeting, view the brochure here.
Sharon S. Keller Chronic Pain and Research Program
LOI Deadline: Monday, September 30
Call for Nominations
Deadline: Monday, October 14
Call for 2014 Poster Abstracts
Deadline: Friday, November 15
Clinical Centers of Excellence Award Program
Deadline: Friday, November 29
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 firstname.lastname@example.org for consideration.
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