January 2015

David Craig, PharmD
Editor

Departments

Education

Research

Members

Funding Announcements

Summaries

Society

Important Dates

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APS E-News is made possible through an unrestricted educational grant from Purdue Pharma.


Education

Recognizing Pioneers

The APS Annual Scientific Meeting will change the way you think about and treat pain. The educational program covers diverse topics across several disciplines, which allows you to learn more.

Join hundreds of pain researchers and clinicians from across the country May 13–16 in Palm Springs, CA. You will learn about the best clinical and basic science discoveries.

Plan to attend the following award presentations on Saturday, May 16, to learn what's new in the field.

8–8:30 am
(105) Frederick W.L. Kerr Basic Science Research Lecture: Making and Braking Pain
Clifford Woolf, MD PhD

The initiating point of most pain is the activation of the nociceptor. Using a small set of transcription factors, it is now possible to transform mouse or human fibroblasts into nociceptors. Read more.

8:30–9:00 am
(106) Wilbert E. Fordyce Clinical Lecture: Fibromyalgia: A Disease, Common Pathway, or Rubbish?
Daniel Clauw, MD

Rather than being thought of as a discrete disease, fibromyalgia should be considered a final common pathway that occurs in subsets of most, if not all, chronic pain states. Read more.

Continuing education credit/contact hours are available for nurses, pharmacists, physicians, and psychologists at the APS Annual Scientific Meeting.

Clinical and Basic Science Data Blitz

The Clinical and Basic Science Data Blitz will be held Wednesday, May 13, 6:15–8:15 pm, in Palm Springs, CA, as part of the 34th APS Annual Scientific Meeting.

This year's Data Blitz will feature research from the Spring Pain meeting and presentations by annual meeting attendees. The blitz will include selected presentations of new research in a rapid format, with presenters having 5 minutes to present data and 5 minutes to answer questions from the audience. The blitz will be moderated by Todd Vanderah, PhD; Michael Jankowski, PhD; Benedict Kolber, PhD; and the 2014 Data Blitz session winner, Peter Grace, PhD.

APS will issue a call for submissions for the Data Blitz in February 2015. Submissions will be due March 19.

Fundamentals of Pain Management: An Interdisciplinary
Primer

APS is pleased to announce the application process for scholarships for the 2015 Fundamentals of Pain Management: An Interdisciplinary Primer.

The course will take place Monday, May 11–Wednesday, May 13, in Palm Springs, CA.

APS will award 30 scholarships to attend the Fundamentals course. Participants will experience a unique opportunity for interdisciplinary learning, a mentored exposure to the APS Annual Scientific Meeting, and a foundation for lifelong learning focused on pain management.

This course is designed for third- and fourth-year residents and other select interdisciplinary healthcare providers who are training in an academic pain management setting. Applicants in the fields of anesthesiology, emergency medicine, family practice, internal medicine, neurology, and physical and rehabilitation medicine are encouraged to apply.

Each scholarship will cover

  • attendance to the Fundamentals course (Monday, May 11–Wednesday, May 13)
  • attendance to the APS Early Career Forum (Wednesday afternoon, May 13)
  • attendance to the APS Annual Scientific Meeting (Wednesday evening, May 13–Saturday, May 16)
  • 1-year membership to APS
  • meals during the Fundamentals course
  • hotel accomodations
  • travel allowance for roundtrip transportation.

The deadline to apply is Friday, January 30. Learn more.

Women's Pain Update TweetChat: Thursday, January 29

Join APS and the American Society of Anesthesiologists (ASA) on Thursday, January 29 for a TweetChat on the Women's Pain Update. This TweetChat will feature several APS members: Roger Fillingim, PhD, whose research focuses on gender differences in pain; and Georgine Lamvu, MD MPH, whose pain practice focuses on advanced minimally invasive gynecology. Follow @ASALifeline and @AmericanPainSoc on Twitter and use the hashtag #ASAPainUpdate to participate. Questions will be answered by Anita Gupta, MD, via @ASALifeline.

The TweetChat will begin at 1 pm EST.

New FDA Drug Disposal Information

The U.S. Federal Drug Administration (FDA) recently released Drug Info Rounds, a series of training videos for practicing clinical and community pharmacists. Drug Info Rounds was developed by pharmacists in the FDA’s Center for Drug Evaluation and Research, Office of Communications, Division of Drug Information.

The goal of Drug Info Rounds is to provide important and timely drug information to pharmacists so they can help patients make better medication decisions. FDA Drug Info Rounds pharmacists will discuss medication disposal options and special disposal instructions for expired, unwanted, or unused medicines.


Research

2015 Rita Allen Foundation Award in Pain: Deadline Extended to February 2

The Rita Allen Foundation (RAF) and APS have extended the 2015 Award in Pain deadline to Monday, February 2. 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.

Learn more about the RAF Award in Pain

Young Investigator Travel Award Program

APS plans to offer travel stipends for the 2015 APS Annual Scientific Meeting through the Young Investigator Travel Award Program.

A limited number of funding awards will be available to individuals presenting poster abstracts at the meeting held May 13–16 in Palm Springs, CA.

Applicants of the Young Investigator Travel Program

  • may be from any research training background
  • may be at any level in training, including having completed their postdoctoral training within the past 3 years
  • must be current APS members
  • must have an accepted abstract.

Please check the abstract acceptance list before applying for a Young Investigator Travel Award.

Applications must be completed online by Tuesday, February 10. Apply now.


Members

Welcome New Members

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

  • Kirsten Anderson
  • Malcolm Barrett
  • Michele Curatolo
  • Jose Escarda
  • Bradley Galer
  • Omar Halawa
  • Nosheen Hasan
  • Eli Iacob
  • Prashanth Komirishetty
  • Donna Maier
  • Mary Anne Milone
  • Michael Mousseau
  • Jun-Mo Park
  • Mary Redding
  • Christy Timm-Hughes
  • Michelle L. Witkop

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 National Institutes of Health (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 16, Issue 1, January 2015).

Effectiveness of Jyoti Meditation Patients with Chronic Neck Pain and Psychological Distress–A Randomized Controlled Clinical Trial

Michael Jeitler, Stefan Brunnhuber, Larissa Meier, Rainer Lüdtke, Arndt Büssing, Christian Kessler, and Andreas Michalsen; Institute of Social Medicine, Epidemiology and Health Economics, Charité-Universitätsmedizin, Berlin, Germany; Department of Internal and Complementary Medicine, Immanuel Hospital Berlin, Berlin, Germany; Department for Psychiatry and Psychotherapy, University Hospital Salzburg, Salzburg, Austria; Karl and Veronica Carstens Foundation, Essen, Germany; University Witten-Herdecke, Chair of Integrative Medicine, Witten, Germany; Institute of Social Medicine, Epidemiology and Health Economics, Charité-Universitätsmedizin, Berlin, Germany; Department of Internal and Complementary Medicine, Immanuel Hospital Berlin, Berlin, Germany

Meditation might be an effective treatment for reducing chronic neck pain, according to research reported in The Journal of Pain.

Chronic neck pain can lead to serious comorbidities like depression. Patients with chronic neck pain frequently experience distress. Meditation increasingly has been used as a supportive treatment for individuals with chronic pain.

Previous research has shown that chronic pain is associated with distress and that meditation has stress-relieving benefits. German researchers compared the effects of meditation on pain, perceived stress, and psychological well-being. They hypothesized that an 8-week meditation program would decrease pain more effectively than a standardized exercise program and that pain relief would coincide with stress reduction.

For the study, 89 patients with chronic neck pain who showed increased perceived stress were randomized into meditation and exercise program groups. Outcomes were assessed at baseline and after 8 weeks.

Results showed that meditation training significantly reduced pain when compared with the exercise group and pain-related “bothersomeness” decreased more in the meditation group as well. No significant differences between meditation and exercise were found for pain during movement, pain disability, psychological scores, and quality of life, which is consistent with the known benefits of exercise on pain-related outcomes. The authors concluded that meditation has unique benefits for producing pain relief and for pain coping.

The Associations Between Preexisting Mental Disorders and Subsequent Onset of Chronic Headaches: A Worldwide Epidemiologic Perspective

Ronny Bruffaerts, Koen Demyttenaere, Ronald C. Kessler, Hisateru Tachimori, Brendan Bunting, Chiyi Hu, Silvia Florescu, Josep Maria Haro, Carmen C.W. Lim, Viviane Kovess-Masfety, Daphna Levinson, Maria Elena Medina Mora, Marina Piazza, Patryk Piotrowski, Jose Posada-Villa, Mohammad Salih Khalaf, Margreet ten Have, Miguel Xavier, Kate M. Scott; Universitair Psychiatrisch Centrum-Katholieke Universiteit Leuven (UPC-KUL), Leuven, Belgium; Department of Health Care Policy, Harvard Medical School, Boston, Massachusetts; National Institute of Mental Health, National Center of Neurology and Psychiatry, Tokyo, Japan; Psychology Research Institute, University of Ulster, Londonderry, Northern Ireland; Shenzhen Institute of Mental Health and Shenzhen Kangning Hospital, Guangdong Province, PR China; National School of Public Health, Management and Professional Development, Romania; Saint John of God Health Park, Barcelona, Spain; Department of Psychological Medicine, Otago University, Dunedin, New Zealand; Université Paris Descartes & EHESP School for Public Health Department of Epidemiology, Paris, France; Mental Health Services, Ministry of Health, Jerusalem, Israel; National Institute of Psychiatry Ramón de la Fuente, Mexico City, Mexico; Mental Health, Alcohol and Drugs Research Unit, School of Public Health, Universidad Peruana Cayetano, Heredia, Peru; Wroclaw Medical University, Wroclaw, Poland; Colegio Mayor de Cundinamarca University, Bogota, DC, Colombia; Ibn Sena Teaching Hospital, Mosul, Iraq; Netherlands Institute of Mental Health and Addiction, Utrecht, The Netherlands; Chronic Diseases Research Center (CEDOC) and Department of Mental Health, Faculdade de Ciências Médicas, Universidade Nova de Lisboa, Lisbon, Portugal

A new study published in The Journal of Pain reports an association between a broad range of preexisting mental disorders and subsequent onset of severe or frequent headaches.

Several studies have shown that headaches are linked with emotional problems and occur twice as often in persons with depressive/anxiety disorders. However, it is not yet clear if the relationship between emotional problems and headaches is confined to depression and anxiety or includes a broader spectrum of mental illnesses.

A multinational team of researchers evaluated global data from 19 World Health Organization World Mental Health surveys in different nations involving more than 50,000 subjects to investigate the association between preexisting mood, anxiety, impulse control, and substance use disorders with subsequent onset of frequent or severe headaches.

Results showed that after adjusting for influences of sex, age, and mental disorder comorbidity, a broad range of mental disorders increased the likelihood of developing severe and frequent headaches by 40%. This supports the hypothesis that people with mental disorders may be more vulnerable to headaches after a mental disorder occurs.

The authors also found that respondents with early-onset preexisting mental disorders (prior to the age of 21) had a 21% higher risk for developing headaches than persons with later onset mental disorders.

PAIN Highlights

The following highlights summarize selected articles from PAIN (Volume 156, No. 1, January 2015 Issue).

Opposite Effects of the Same Drug: Reversal of Topical Analgesia by Nocebo Information

Per Matti Aslaksen, Maria Lorentze Zwarg, Hans-Ingvald Hage Eilertsen, Marta Maria Gorecka, and Espen Bjørkedal; Department of Psychology, Faculty of Health Sciences, University of Tromsø—The Arctic University of Norway, Tromsø, Norway

Most studies on placebo and nocebo responses have involved administration of inert compounds, and few placebo and nocebo experiments have been performed with pharmacologically active drugs. To date, no study has directly tested whether the level of negative emotions after nocebo suggestions actually predicts the nocebo hyperalgesic effect.

To investigate whether nocebo hyperalgesic information could reverse topical analgesia to heat pain, investigators performed an experiment in which healthy volunteers received either EMLA® Cream (a eutectic mixture of lidocaine/prilocaine) administered with standard positive clinical information, EMLA Cream provided with nocebo information, or EMLA Cream administered with reduced information. Two other groups received a placebo cream with the same information (standard positive, nocebo hyperalgesic) as the groups receiving EMLA Cream. A natural history group receiving no treatment but the same pain stimulation was included. Investigators hypothesized that the group receiving EMLA Cream with standard information would display superior analgesic responses compared with the other groups, and that the groups receiving negative drug-related information would report significantly higher pain than the groups receiving reduced or standard/positive information regardless of whether EMLA Cream was administered.

This study showed that pain intensity ratings were significantly increased in the groups receiving negative information together with cream application, regardless of whether the placebo or the topical analgesic was applied. The manipulations had a significant effect on systolic blood pressure (SBP), and the groups that received nocebo information displayed an increase in SBP compared with the groups that received suggestions of analgesia. EMLA Cream produced a significant analgesic effect, even when the time from application to pain measurement was relatively short. However, the analgesic effect of EMLA Cream was prone to modulation in the direction of the information that accompanied administration of the cream.

The results of this study suggest that the intended pharmacological pain-relieving effect of a topical analgesic can be reversed to hyperalgesia by nocebo information. These findings underscore the importance of accounting for possible nocebo and nocebo-related effects in clinical studies and clinical practice even when a proven drug with known pharmacological effects is used.

Presurgical Assessment of Temporal Summation of Pain Predicts the Development of Chronic Postoperative Pain 12 Months After Total Knee Replacement

Kristian Kjær Petersen, Lars Arendt-Nielsen, Ole Simonsen, Oliver Wilder-Smith, Mogens Berg Laursen; Center for Sensory-Motor Interaction, Department of Health Science and Technology, Faculty of Medicine, Aalborg University, Aalborg, Denmark; Orthopaedic Surgery Research Unit, Aalborg University Hospital, Aalborg Denmark; Department of Anaesthesiology, Pain and Palliative Medicine, Radboud University Medical Centre, Nijmegen, the Netherlands

Nearly 500,000 total knee replacements (TKRs) were performed in the United States in 2011; this number is estimated to increase to 3.5 million in 2030. Approximately 20% of these patients will have chronic postoperative pain after TKR surgery. Pressure pain thresholds (PPTs), temporal summation (TS) of pain, and conditioned pain modulation (CPM) are three types of quantitative sensory testing (QST) measurements that have been widely used to diagnose altered pain processing in patients with hip and knee osteoarthritis (KOA).The aims of this study were to compare preoperative pain intensity and QST parameters in patients with KOA who develop different degrees of chronic pain after TKR surgery and to identify preoperative parameters that possibly predict the development of chronic postoperative pain after TKR.

Knee pain intensity (as assessed on the 0 to 10 visual analog scale [VAS]), PPTs, TS, and CPM were collected before, 2 month after, and 12 months after TKR. Patients were divided into low-pain (VAS lower than 3) and high-pain (VAS 3 or higher) groups based on their VAS score 12 months after TKR.

This study showed that by using preoperative assessment of TS, it is possible to identify a group of patients with KOA at high risk for developing long-term postoperative pain 12 months after TKR. No prognostic information could be gained from the preoperative PPT or CPM values. Among patients who underwent KOA surgery, 22% had moderate to severe chronic postoperative pain, which is comparable with previous literature citing an approximate 20% risk for developing severe chronic postoperative pain after TKR surgery. Preoperative pain intensity and TS correlated with 12-month postoperative pain intensity and showed a trend toward independence. TS of pain may be a mechanistic preoperative predictor of the development of chronic postoperative pain in patients with knee OA after TKR surgery.

Clinical Journal of Pain Highlights

The following highlights summarize selected articles from the Clinical Journal of Pain (Volume 31, Number 11, January 2015 Issue).

Long-Term Evaluation of Opioid Treatment in Fibromyalgia

Xiaomei Peng, Rebecca L. Robinson, Philip Mease, Kurt Kroenke, David A. Williams, Yi Chen, Douglas Faries, Madelaine Wohlreich, Bill McCarberg, and Danette Hann; Eli Lilly and Company; VA HSR&D Center of Excellence for Implementing Evidence-Based Practice, Indiana University; Regenstrief Institute Inc.; PharmaNet/i3, Indianapolis, IN; Seattle Rheumatology Associates; Division of Rheumatology Research, Swedish Medical Center; Department of Internal Medicine, University of Washington School of Medicine, Seattle; Chronic Pain and Fatigue Research Center, University of Michigan, Ann Arbor; Kaiser Permanente, Escondido, CA; and INC Research, Raleigh, NC

A 12-month prospective observational study conducted previously by these investigators, REFLECTIONS (Real World Examination of Fibromyalgia: Longitudinal Evaluation of Costs and Treatments), found that two of the most commonly reported medications used for fibromyalgia (FM) were opioids (24.2%) and tramadol (15.3%). The purpose of this longitudinal observational analysis was to evaluate the effects of long-term opioid treatment relative to tramadol or nonopioids on outcomes of relevance to FM and on the length of time patients remained on these treatments in the REFLECTIONS study.

A total of 1,700 patients were enrolled in this study. Changes in outcomes were assessed using the Brief Pain Inventory for Severity and Pain-Related Interference (BPI-S and BPI-I), Fibromyalgia Impact Questionnaire (FIQ), Patient Health Questionnaire for Depression, Insomnia Severity Index (ISI), Sheehan Disability Scale, 7-item Generalized Anxiety Disorder Scale, and economic factors. Time-to-opioid or tramadol discontinuation was analyzed using Kaplan-Meier survival analyses. Participants were mostly female (94.6%) and white (82.9%). Mean (SD) age was 50.5 (11.9) years, duration of FM diagnosis was 5.6 (6.3) years, BPI-S score was 5.5 (1.8), and BPI-I score was 6.1 (2.2); these scores indicated moderate levels of pain severity and pain-related interference with daily functioning.

Patients in the tramadol cohort showed greater improvement on the FIQ and ISI during the 12-month study period and at 3 months postbaseline. Compared with patients in the opioid cohort, patients in the nonopioid cohort reported greater reduction in the BPI-I overall and at 1 and 6 months postbaseline.

These findings suggest that health outcomes and resource use among patients taking opioids at baseline were not significantly different from those of patients taking tramadol (no opioids) or those not using any opioid medications. Significantly less improvement was observed on measures of pain-related interference with daily activities, functioning, depression, and insomnia for patients taking opioids. With regard to resource use, results suggest that taking opioids does not decrease the need for various resources including outpatient or emergency room visits; opioid-treated patients had more outpatient visits than tramadol-treated or nonopioid-treated patients. The tramadol and nonopioid cohorts achieved similar treatment outcomes; there were no significant between-group differences on most health outcome measures. Use of opioids should be carefully considered by practitioners treating patients with FM, because their use may have low utility relative to potential side effects.

Chronic Postoperative Pain After Primary and Revision Total Knee Therapy

Kristian K. Petersen, Ole Simonsen, Mogens B. Laursen, Thomas A. Nielsen, Sten Rasmussen, and Lars Arendt-Nielsen; Department of Health Science and Technology, Faculty of Medicine, Center for Sensory-Motor Interaction; Orthopaedic Surgery Research Unit, Aalborg University Hospital, Aalborg, Denmark

In 2007, nearly 500,000 total knee arthroplasty (TKA) implant surgeries were performed in the United States. However, approximately 13% of patients who undergo TKA will report severe chronic postoperative pain. Among patients with fibromyalgia (for whom pain sensitization is prominent), chronic postoperative pain after TKA affects as many as 44%. Patients with a large number of comorbidities experience less pain relief after revision TKA surgery, indicating that additional pain comorbidities may worsen outcomes.

The aim of this cross-sectional cohort study was to investigate the incidence of chronic postoperative pain after primary and revision TKA and the implications on function and quality of life (QOL). A pain description of current pain (nonexistent, mild, moderate, severe, or unbearable), the pain intensity visual analog scale, the Knee Society Score, and the Osteoarthritis Research Society International questionnaire were used.

The main clinical outcomes (QOL, mobility, and pain) revealed that revision TKA surgery does not provide the same benefits as primary TKA because more patients experience chronic postoperative pain with reduced QOL as a result. Primary TKA surgery led to improved walking distance, whereas revision TKA surgery revealed no such general improvements. Among patients, 19% after primary TKA surgery and 47% after revision TKA surgery experienced severe to unbearable chronic postoperative pain. After revision TKA surgery, patients reported higher pain intensities during rest, while walking, and, on average, over the previous 24 hours compared with patients after primary TKA surgery. This study also identified correlations between pain and function for patients who underwent both primary and revision surgeries.

In general, patients who undergo revision surgery do not benefit significantly from the repeated surgery, and careful selection of patients for revision surgery is recommended. If the indication for revision is based only on pain reports, alternative treatment modalities should be considered.


Society

Your Vote Counts

Voting in the 2015 APS election will open Monday, January 26, for APS regular members. This year, APS members will vote to elect the president-elect, treasurer, three directors-at-large, and all seven members of the Nominating Committee. Voting is an important and fundamental way to make your voice heard in the society. All members will receive an e-mail with an individual username and password on Monday, January 26. Don’t forget that your vote counts!


Important Dates

Fundamentals of Pain Management: An Interdisciplinary Primer

Application Deadline

Friday, January 30

Rita Allen Foundation Award in Pain

Application Deadline

Monday, February 2

Young Investigator Travel Award

Application Deadline

Tuesday, February 10

Annual Scientific Meeting

Early-Bird Registration Deadline

Monday, April 13


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.



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