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Applications for the 2013 Rita Allen Foundation Award in Pain Will Close January 17
The Rita Allen Foundation (RAF) and APS announce the 2013 Award in Pain. The RAF and APS may award two grants each 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 faculty level. The entire award is to be allocated to projects specifically chosen by the recipient. Overhead is not supported.
To learn more about the RAF Award in Pain, please visit the APS website where additional details and an application link are posted.
Save the Date for the 2013 APS Meeting
Join us in the Crescent City for next year's APS 32nd Annual Scientific Meeting May 8–11, 2013. For more information and updates, visit the APS website.
Young Investigator Travel Award Program
APS is planning to offer Young Investigator travel support for the 2013 APS Annual Scientific Meeting, May 8–11, 2013, in New Orleans, LA. A limited number of funding awards may be available to individuals who will be presenting poster abstracts at the meeting. Applicants may be from any research training background (basic or clinical science, psychology, medicine, or biostatistics) and may be at any level in training, including students, residents, predoctoral trainees, postdoctoral fellows, or those who have completed their postdoctoral training within the last 3 years. All applicants must be APS members and must have an abstract accepted for presentation. Applications from nonmembers will not be considered.
The Young Investigator Travel Award application is available on the APS website. To apply for funding, visit the APS site and complete the online application. Note that an applicant’s abstract must be accepted for presentation before he/she is eligible to submit an application for Young Investigator travel support. The listing of accepted abstracts, by primary author, will be available on the APS site December 21. Please check the abstract acceptance list before applying for a Young Investigator award. Applications must be completed online by January 24, 2013. If you have difficulty completing the application, contact APS at 847.375.4715. Applications will be reviewed by the APS Scientific Program Committee, and stipends will be awarded in late February 2013. Notifications will be sent to applicants in February. Those applicants selected for the 2013 meeting will receive their travel grants at the APS Annual Scientific Meeting.
The APS 2013 Fundamentals Course: An Interdisciplinary Primer—Application Deadline is December 31, 2012
The APS 2013 Fundamentals Course: An Interdisciplinary Primer, designed primarily for third- or fourth-year residents and other select interdisciplinary healthcare providers, will be held just prior to the APS Annual Scientific Meeting. Scholarships to the course include attendance at the 32nd Annual Scientific Meeting. Both events will be held in New Orleans, LA. Dates for the course and meeting are as follows:
Fundamentals Course: Monday, May 6–Wednesday, May 8, 2013
The Fundamentals course, developed by a group of dedicated pain professionals within the American Pain Society, is designed to provide each participant with a unique opportunity for interdisciplinary learning, a mentored first exposure to the Annual Scientific Meeting, and a foundation for lifelong learning focused on pain management. The APS is proud to offer this educational opportunity and grateful to Endo Pharmaceuticals for their continued support provided through an educational grant. The Fundamentals course is designed for candidates who are interested in pursuing an academic career involving pain management and is primarily for those in Anesthesiology, Emergency Medicine, Family Practice, Internal Medicine, Neurology, Physical and Rehabilitation Medicine and other related disciplines. Applications from Physical and Occupational Therapists, Pharmacists, Nurses, Advanced Practice Nurses, Psychologists, and Social Workers are encouraged. Each year the grant provides funding for a specified number of participants to be selected through a competitive scholarship application process. The 2013 course will offer 75 seats to well-qualified applicants.
For more information and to complete an application, visit the Fundamentals page of the APS website.
The deadline for applications is December 31, 2012. For questions about the application process, please contact Susan Gebhart or Erica Boyer at 918.343.6005.
Clinical and Basic Science Data Blitz—Submission Forms Available in February
APS will host the Clinical and Basic Science Data Blitz on Wednesday, May 8 from 6–8 pm in New Orleans, LA, as part of the 32nd Annual Scientific Meeting. The Data Blitz submission form will be available on the APS website in early February 2013; the deadline for submissions will be March 18. Authors are encouraged to submit "hot topics" for presentation during the Blitz; submissions from doctoral students and postdoctoral fellows are encouraged. Selected presenters will have 5 minutes to present data and 5 additional minutes for questions. The Blitz will be moderated by Greg Dussor, PhD; Steve George, PhD PT; and David Seminowicz, PhD. Please visit the APS website in early February for further information and to download the submission forms.
What is your area of specialty?
What has been a highlight of your work? Perhaps you and your staff are proud of a certain project or accomplishment.
Is there a particular challenge that you've either overcome or hope to address soon?
How has membership in APS been of value to you and your professional development?
The society also publishes clinical practice guidelines and other resources that are intended for use by physicians, nurses, psychologists, and other healthcare professionals. Since 1999, APS has published a series of evidence-based guidelines, which in some cases provide the only available evidence-based recommendations on their topics. APS publications are developed by interdisciplinary panels of experts who combine scientific evidence and expert judgment to develop recommendations for pain management.
The Journal of Pain Highlights
The following highlights summarize selected articles from December 2012 (Volume 13, Issue 12).
Identification of Patients Subgroups and Risk Factors for Persistent Breast Pain Following Breast Cancer Surgery
Approximately 25% of individuals who have had breast cancer surgery experience significant persistent pain 6 months after surgery, and new research published in The Journal of Pain showed that women with preoperative breast pain have the highest risk for extended post-surgical pain.
Researchers from the University of California San Francisco studied approximately 400 women who had breast cancer surgery and followed them monthly for 6 months to determine the prevalence of persistent pain in the breast and to characterize distinct breast pain phenotypes. They also evaluated the study participants for differences within the pain classes based on demographic, preoperative, intraoperative, and perioperative characteristics. Persistent pain was evaluated using the Breast Symptom Questionnaire, which obtained information about the occurrence of breast pain and patients’ ratings of pain intensity. This was the first study to identify subgroups of patients with distinct, persistent breast pain following breast cancer surgery.
The results of the study showed that 31.7% of the study participants said they had no breast pain, 43.4% had mild pain, 13.3% had moderate pain, and 11.6% reported having severe pain that lasted for 6 months. The findings suggest that about 1 in 4 women will experience significant and persistent pain in the first 6 months following breast cancer surgery.
Four non-modifiable demographic characteristics were associated in the severe pain group: younger age, less education, non-white ethnicity and lower income. Consistent with previous studies, younger age was associated with higher risk of being in all three classes of pain groups used in the study.
The major modifiable variables were preoperative breast pain, changes in breast sensations, severity of postoperative pain, number of lymph nodes removed, and having axillary lymph node dissection (ALND). The authors noted that the data suggest that improvements in postoperative pain management are needed to reduce the occurrence of persistent breast pain.
Traditional Acupuncture Triggers a Local Increase in Adenosine in Human Subjects
Until now, the biological mechanisms of acupuncture for relieving pain have been poorly defined, but a new study published in The Journal of Pain shows that adenosine-mediated anti-nociception contributes to the clinical benefits of acupuncture.
Practiced worldwide, acupuncture is one of the most common non-pharmaceutical pain relieving treatments. Even though it has been used for centuries, the mechanism of acupuncture analgesia is not entirely clear. One commonly held belief is acupuncture is usually applied in close proximity to the pain site and analgesia occurs from the peripheral and local action of acupuncture and is not a systemic treatment. Also, a recent study in mice showed the analgesic effects of acupuncture occurred from local release of adenosine and activation of adenosine receptors.
Researchers from the University of Rochester and Beijing Tiantan Hospital sought to assess the adenosine-mediated relief from acupuncture that was observed in mice in 15 healthy human volunteers aged 24 to 30. The researchers used microdialysis to sample interstitial fluid in the human subjects who received acupuncture treatment. The microdialysis probe was placed along the peroneal nerve and interstitial fluid samples were taken before during after the procedure.
Analysis of the interstitial fluid samples showed that acupuncture induced a significant increase in adenosine concentrations and remained elevated for at least 30 minutes after the acupuncture needle was removed. The researchers concluded that adenosine released during acupuncture binds to A1 receptors on afferent nerves that transmit pain information to the spinal cord and temporarily reduce transmission of painful stimuli.
Depressive and Anxiety Symptoms as Risk Factors for Temporomandibular Joint Pain: A Prospective Cohort Study in the General Population
There is an ongoing debate about the role of psychological disorder symptoms as risk factors for temporomandibular joint (TMJ) pain. Previous studies have associated depression and TMJ pain but large-scale studies have not been performed. German researchers writing in The Journal of Pain evaluated more than 3,000 community subjects and found that those with depression and anxiety had increased risk for temporomandibular pain upon palpation.
Temporomandibular disorders (TMDs) are a subgroup of craniofacial problems and etiology is believed to be multi-faceted. Tooth grinding, facial clenching and genetic factors may initiate TMD and bio-behavioral studies suggest an association between TMD pain and depression, anxiety and post-traumatic stress disorder. In this study, the research team sought to estimate the relative risk of depressive symptoms and anxiety on TMD pain over 5 years. More than 4,000 subjects participated and underwent medical examinations, oral health assessments, and overall health check interviews. They also completed a psychiatric risk factor questionnaire. TMD pain was assessed from the oral health exams according to guidelines from the Academy of Orofacial Pain. The investigators found that depressive symptoms were more strongly related to joint pain than muscle pain, and that anxiety symptoms were more strongly related to muscle pain. The authors explained that depressive and anxiety symptoms may initiate muscular hyperactivity followed by muscle abnormality and altered muscle mechanics, which can produce inflammation and cause muscle pain. They also suggested that TMD might be related to abnormal pain stimuli processing caused by imbalances in the neurotransmitters serotonin and catecholamines. So, TMD pain might reflect physical manifestation of anxiety or depression.
In concordance with previous published research, the authors concluded there is a strong to moderate relationship between symptoms of depression or anxiety and signs of TMD.
Systemic Administration of an Alpha-7 Nicotinic Acetylcholine Agonist Reverses Neuropathic Pain in Male Sprague Dawley Rats
Although neuropathic pain usually occurs from peripheral nerve injury or inflammation, immune cells in the central nervous system are increasingly being recognized as important contributors to neuropathic pain. Glial cells become activated and release pro-inflammatory cytokines, reactive oxygen species, nitric oxide, and chemokines.
Scientists at the University of Colorado tested whether systemic delivery of an alpha-7 nAChR agonist attenuates neuropathic pain and associated inflammation. Hind-paw response thresholds to mechanical stimuli in male rats were assessed after sciatic chronic constriction injury or sham surgery. Osmotic mini pumps containing an alpha-7 nAChR selective agonist were implanted in the rats 10 to 14 days after surgery. Spinal cords were harvested 2 weeks after placement of the pumps and were processed for microglial activation markers.
Results showed that the selective agonist may be a suitable treatment for neuropathic pain because it effectively attenuated the mechanical allodynia induced by nerve injury. Therefore, the effect of an alpha-7 nAChR agonist on peripheral nerve on immunocompetent cells, within the periphery and CNS, make it a promising therapeutic target for neuropathic pain.
Pain Medicine Highlights
The following highlights summarize selected articles from November 2012 (Volume 13, Issue 11).
Aberrant Drug-Related Behaviors: Unsystematic Documentation Does Not Identify Prescription Drug Use Disorder
Chronic pain is a common presenting problem in the primary care (PC) setting; approximately 22% of PC patients report chronic pain. During the past 2 decades, opioid prescribing for chronic non-cancer pain has dramatically increased, accompanied by rising rates of opioid misuse, unintentional overdose, and legal prosecution of physicians. Benzodiazepine prescribing has similarly become a topic for debate, not only because of risks for medication abuse and diversion, but also because of the association of benzodiazepines to opioid-related deaths. Considering that PC physicians (PCPs) prescribe the vast majority of psychoactive substances nationally, they must take great care in the decision to prescribe these medications and monitor for side effects to avoid such negative outcomes. In addition, PCPs must assess for risk for prescription drug use disorder (PDUD). One method that can be used to monitor patients who are taking opioids and benzodiazepines is to assess for aberrant drug-related behaviors (ADRBs).
To establish an evidence base for the use of aberrant drug-related behaviors as a proxy for PDUD in patients with chronic pain who were prescribed opioids and benzodiazepines, researchers compared chart documentation of ADRBs with a systematically obtained patient diagnosis of prescription drug use disorder.
The data revealed no differences; ADRBs as noted in routine PC practice do not identify patients with prescription drug use disorders. Despite the clinical insight that went into the development of these recommended “clinical pearls,” empirically they did not help to identify patients who should be of great concern to clinicians. However, the negative results of this study do provide insight about physician recording in the electronic medical record (EMR) and suggest that relying on nonsystematic documentation to identify addiction or diversion is not useful.
Based on these findings, physicians and researchers should be cautious before using documented aberrant drug-related behaviors in the EMR as a proxy for PDUD. Prospective studies in which ADRBs are systematically assessed are needed to determine the true significance of these behaviors.
Effectiveness of Water Physical Therapy on Pain, Pressure Pain Sensitivity, and Myofascial Trigger Points in Breast Cancer Survivors: A Randomized, Controlled Clinical Trial
A symptom that is commonly associated with pain is sensory disturbance, which is experienced by about 50% of breast cancer survivors. Evidence suggests that breast cancer survivors present with changes in nociceptive processing because mastectomy may enhance the experience of pain by sensitizing the central nervous system as the result of nociception that originates from damaged small nerve fibers during surgery.
Because the presence of sensory disturbances after surgery is a predictive factor for persistent pain after breast cancer treatment, physical therapy programs should be targeted to decrease clinical pain and nociceptive gain. The aim of this randomized clinical study was to evaluate the effectiveness of an 8-week low-intensity water therapy program to address cervical-shoulder pain, pressure pain hypersensitivity, and active trigger points in a population of breast cancer survivors.
All water exercise program participants completed more than 85% of the 24 sessions, showing a high adherence rate to the program. After 8 weeks, the program was found to be effective for improving neck and shoulder/axillary pain and reducing the presence of trigger points in breast cancer survivors as compared with usual care. However, no significant changes in widespread pressure pain hyperalgesia were found.
These results reveal that physical therapy interventions may be clinically useful to help avoid persistent pain and sensory disturbances in breast cancer survivors, but futures studies are needed to determine the long-term effects of physical therapy on sensory disturbances in patients with breast cancer.
The following highlights summarize selected articles from December 2012 (Volume 153, Issue 12).
Adherence to CONSORT Harms-Reporting Recommendations in Publications of Recent Analgesic Clinical Trials: An ACTTION Systematic Review
Consolidated Standards of Reporting Trials (CONSORT) statements are used in an attempt to standardize randomized controlled trial (RCT) reporting by providing a checklist of necessary content. To evaluate the impact of the CONSORT harms recommendations, several studies have examined adverse event reporting in RCTs. Despite some evidence that RCT harms reporting has improved since the publication of the CONSORT harms-reporting recommendations, the conclusion of these studies is that greater efforts are needed. The present study investigated changes in harms reporting since the 2004 CONSORT recommendations by assessing 101 double-blind RCTs of pharmacologic analgesic treatments reported in three pain journals (European Journal of Pain, Journal of Pain, and PAIN) during two epochs (2000–2003 and 2008–2011) and to explore associations between various trial characteristics and harms reporting. To qualify for inclusion in this systematic review, studies needed to be primary reports of randomized, double-blind trials of noninvasive pharmacologic treatments in humans with pain as a principal outcome.
This study’s results highlight the need for improved harms reporting in publications of analgesic RCTs. Out of 10 CONSORT harms recommendations, only six, on average, were fulfilled, a low mean given relatively liberal coding criteria. The specific recommendations for harms collection methodology, denominators for harms analyses, risk of harms per arm, and discussion of trial harms were well reported, indicating a generally adequate overview of a treatment’s harms. However, coverage of harms in the title, abstract, or introduction, as well as the harms assessed, data analysis or presentation plans, and withdrawals attributable to harms, were not as well reported in the publications examined.
This study’s authors recommend that pain researchers, peer reviewers, and journal editors use the CONSORT recommendations for harms reporting when designing analgesic RCTs, as well as when preparing and reviewing publications describing these RCTs. These practices will begin to ensure that the results and reports of analgesic trials more accurately and comprehensively reflect treatment tolerability and safety, thereby increasing the validity of evidence-based evaluations and comparisons of analgesic treatments.
Brain Networks Predicting Placebo Analgesia in a Clinical Trial for Chronic Back Pain
Placebo conditioning studies demonstrate that placebo analgesia is a true antinociceptive effect with psychobiological origins. To investigate the mechanisms for marked individual variability in pain relief with a placebo treatment, researchers investigated brain functional connectivity differences between patients with chronic back pain (CBP) who were treated with a 5% lidocaine topical patch are patients who were not treated at baseline, testing the hypothesis that in patients with CBP, placebo responses are contingent on predispositions that may be captured with brain network properties.
A secondary aim of the study was to demonstrate whether the clinical trial setting (including physicians, brain scans, and therapy) and neutral instructions (“the treatment may or may not improve your pain”) would be sufficient to evoke a placebo effect based on predisposing factors. Researchers focused on baseline brain activity to identify networks that predict placebo response, with one approach targeting spontaneous back pain-related networks and another approach comparing brain oxygenation level-dependent (BOLD) oscillation properties in the whole brain using a model-free approach.
The primary observation of this study is that baseline brain functional connections predict future placebo response in CBP. These connectivity differences were observed before treatment—that is, at a time when back pain properties were matched—and when brain activity reflecting spontaneous fluctuations of back pain were similar between the groups. BOLD oscillations were predictors of placebo responses, and the localized oscillatory activity was closely related to functional connectivity, suggesting that the two phenomena are different manifestations of a unitary mechanism.
These findings demonstrate that multiple brain measures predispose and effectively forecast placebo response in CBP. The evidence suggests that placebo response can be accurately predicted and is mediated by competing networks: one set of functional connections increases and another set decreases the probability of response. If these results can be replicated and expanded to other chronic pain conditions, they could reveal brain mechanisms of placebo specific to chronic pain conditions and pave the way for more efficient clinical trial designs and an understanding of the biological underpinnings of clinical trial outcomes.
New Funding Announcement Titled “Urologic Chronic Pelvic Pain Syndrome (UCPPS) Research (R01)”
The National Institute of Diabetes & Digestive & Kidney Diseases (NIDDK) is pleased to announce the release of a new funding announcement titled “Urologic Chronic Pelvic Pain Syndrome (UCPPS) Research (R01).” Applications are due February 27, 2013. Please be advised that, although not required, a letter of intent is strongly encouraged to be received by KUH by January 27, 2013. The purpose of this Funding Opportunity Announcement is to seek innovative research proposals that improve our understanding of etiology, pathology, natural history, and risk factors for urologic chronic pelvic pain syndromes (UCPPS), traditionally referred to as Interstitial Cystitis/Painful Bladder Syndrome (IC/PBS) and Chronic Prostatitis/Chronic Pelvic Pain Syndrome (CP/CPPS). The RFA is available at http://grants.nih.gov/grants/guide/rfa-files/RFA-DK-12-025.html.
Act Now to Protect Research Funding
President Obama and the U.S. congressional leadership are negotiating plans now to reduce the nation’s deficit and avoid the “fiscal cliff”—the expiration of several laws that would mean higher taxes for Americans at all income levels—and federal funding for science research is on the table.
If a new plan for deficit reduction is not enacted by January 3, automatic sequestration will go into effect and most non-defense discretionary spending will be cut by 8.2%, meaning funding cuts of $2.6 billion from the National Institutes of Health (NIH) and $600 million from the National Science Foundation (NSF). Funding for defense programs, including those that support science research, will be cut by 9.4%.
Federal science funding agencies have already felt the impact of the 2011 Budget Control Act, which legislated caps on federal spending for the next decade, and NIH’s purchasing power is currently lower than it was before the institute’s budget was doubled beginning in the late 1990s.
Scientists across disciplines are contacting their elected officials in Washington, DC, to urge them to develop a balanced approach to deficit reduction that protects needed investments in science. Join your colleagues now.
News from Regional Societies
If you have any regional news you would like to see included in APS E-News, please send it to email@example.com.
In the Media
Qualitest Issues Voluntary, Nationwide Recall of 101 Lots of Hydrocodone Bitartrate and Acetaminophen Tablets, Usp 10 mg/500 mg Due to the Potential for Oversized Tablets (Food and Drug Administration)
CDC Infection Prevention Checklist for Outpatient Settings: Minimum Expectations for Safe Care (Centers for Disease Control and Prevention)
Drug Offers New Pain Management Therapy for Diabetics (Hochkiss Brain Institute)
Physical Therapy Interventions for Knee Pain Secondary to Osteoarthritis: A Systematic Review (Annals of Internal Medicine)
RF Neurotomy Seen Effective for Whiplash Pain (Anesthesiology News)
Complementary And Alternative Medicine Studied In Swedish Surgical Care (Medical News Today)
A Doctor's Empathy Can Increase A Patient's Pain Tolerance (Medical News Today)
Cause Of Anesthesia-Associated Seizures Identified (Medical News Today)
Music Therapy Improves Recovery For Surgery Patients (Medical News Today)
Promising New Approach in Therapy of Pain (Science Daily)
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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