APS Election—Remember to Cast Your Vote

Remember to cast your vote for the APS board and nominating committee by February 28, 2010. You should have received your ballot electronically. For those without e-mail look for your ballot via U.S. mail. If you have any questions about the election, please contact APS as soon as possible at (847) 375-4715.

The Journal of Pain Announces New Editor-in-Chief: Mark Jensen, PhD

Effective January 1, 2010, Mark P. Jensen, PhD, assumed the role of editor-in-chief of The Journal of Pain. Dr. Jensen is a professor and vice chair for research at the
University of Washington School of Medicine, Department of Rehabilitation Medicine.  During his tenure, he has published more than 200 articles in peer-reviewed journals and authored or coauthored 23 book chapters, almost all of which focus on pain assessment, the development of pain theory, or pain treatment. Dr. Jensen has been an editorial board member for The Journal of Pain since 2004 and PAIN since 2005. He has also been associate editor for three indexed journals: the Clinical Journal of Pain, the International Journal of Clinical and Experimental Hypnosis, and the Archives of Physical Medicine and Rehabilitation. 

Dr. Jensen states, “I believe very strongly in the mission of the APS and in the use of The Journal of Pain for facilitating that mission. My overall vision for the journal is to maintain and build upon the important gains that the journal has made in the last 9 years, with the overarching goals of maintaining strength through diversity of disciplines represented by the authors published in the journal; and maintaining the highest standards of scientific excellence. I see the journal as one of the most important benefits of APS membership, both as a trusted source of the state-of-the-science information concerning pain, and as an outlet for APS member scientists who wish to communicate new findings that move the field forward.”

Register Now for the APS 29th Annual Scientific Meeting!

Online registration for the 29th Annual Scientific Meeting is open! Be sure to check out the APS Annual Meeting page on the APS Web site to learn more about all that’s planned for Baltimore. Information about travel and hotels is posted; book your flight and hotel room now!

Volunteer Application for NIH Study Section Service

Among the overarching strategic goals that guide the work of APS is that the National Institutes of Health (NIH) and other funders will recognize pain as a distinct and high priority healthcare problem deserving increased resources for research.

By increasing the number of pain experts participating in NIH integrated review groups (IRG) that review pain grants, it is possible to increase the number and quality of pain grant applications being funded. Working in collaboration with NIH, APS has opened an application Web site where interested members may volunteer for nomination to a study section.

The quality of the NIH peer review process reflects the quality of the reviewers serving on study sections. The NIH is seeking highly qualified and experienced members of the pain research community who are willing to volunteer to serve as NIH reviewers. Both permanent and ad hoc study section members are needed periodically.

Are you

• A recognized authority in your field?
• A principal investigator on a research project comparable to those being reviewed?
• Dedicated to high quality and objective reviews?

APS members are invited to submit their names and qualifications for nomination to NIH study section services. Submission of your information does not guarantee nomination or selection for service.

The general requirements for NIH study section service include

• Current peer-reviewed research funding at a level consistent with the grants that will be reviewed by the study section (typically at the NIH R01 level)*
• Expertise in the study section's scientific area
• Availability to serve 3 times per year for 4 years OR 2 times per year for 6 years (for permanent members, but initial service is often temporary)
• Fulfillment of diversity requirements for geographic distribution, gender, race, and ethnicity.

* Grants such as Veterans Affairs Merit Review, National Science Foundation, private foundation grants, or foreign grants that are peer-reviewed and indicate a substantial research endeavor would be looked on favorably.

Specific study section requirements for service may include

• Familiarity with grant mechanisms reviewed by the study section
• Appropriate breadth of basic, translational, and/or clinical scientific knowledge

The NIH Center for Scientific Review determines reviewer eligibility for nomination and selects individuals for service based on numerous factors including but not limited to eligibility. To better understand the nomination and selection process, service requirements, and factors for study section development and updating, please visit the NIH Web site.

If you would like to be considered for nomination to study section services, please complete an application form.

Volunteer Spotlight: Seddon Savage, MD

Seddon Savage, MD, is a clinician, educator, and policy consultant in the fields of addiction medicine and pain medicine. Dr. Savage currently serves as the director of the Dartmouth Center on Addiction, Recovery and Education (DCARE) in Lebanon, NH. She is also the incoming APS president.

Why did you join APS?
When I joined APS in the mid-1980s, pain was a relatively new but burgeoning field. There was growing interest in pain, but colleagues who really appreciated its importance and complexity seemed few and far between. Those days attending APS meetings felt like arriving at a vibrant oasis after working in relative isolation. What kept me coming back, and the thing that I love most about our organization, is that we come together to look at problems and challenges from very diverse perspectives. We are clinicians and scientists from across broad spectrums of care, and all of us look at this puzzle very differently. That’s what makes us a strong organization and it will help us through the challenging times we now face.

What are the greatest challenges facing APS?
Two major societal forces are coming together that we will need to navigate carefully over the coming years: the economy and healthcare reform. The economic times are creating challenges for all organizations, but particularly for nonprofits such as APS.  Individuals have less to spend on memberships, endowments have been shrinking, and corporate sponsors have less discretionary funds which, combined with a number of regulatory changes, makes us less able to rely on industry for support of our programs. 

The other issue that we will need to respond to is reform of our healthcare system. We can’t predict its future with certainty—maybe it won’t happen at all—but if healthcare reform is successful, it’s likely to center on certain core principles, among them: promotion of evidence-based practice and support for coordinated care of chronic illness across disciplines, but especially, between the primary care and specialists. The convergence of these issues provides interesting challenges and opportunities for APS.  

How can APS meet these challenges?
I think APS is actually in a great position to lead the pain community as healthcare reform evolves. Our strong commitment to research and science will allow us to take a leadership role in infusing the clinical practice of pain care with evolving evidence. Our interdisciplinary membership that includes so many clinical professions relevant to the treatment of pain gives us the capacity to work together to develop pioneering models of coordinated care. How can a pain specialist help orchestrate engagement of a psychologist who works in a solo practice with a primary care doctor who works for a hospital-based practice with a physical therapist who is part of a local orthopedic group to facilitate timely patient centered pain care?  

In addressing the current fiscal environment, we will have to get creative with our programs and how we support them. APS has a strong and clearly articulated strategic plan that balances attention to research, education, clinical practice, and policy; it is important that we focus our activities to ensure that we nourish each of these in the current environment. 

A key priority in challenging times must be to actively engage our current members and continue to grow our membership. To that end we need to facilitate ongoing communication among members with APS leadership to identify emerging needs of members and not-yet-member colleagues and determine how APS can help meet those needs. I hope we can energize more members to take on larger roles within APS, especially younger members who are ripe for development as leaders and who, in my experience, often have stunning bursts of creativity and easily identify solutions and opportunities that more senior people may not recognize. In addition, it is important that we cultivate constructive relationships with other professional organizations that address pain; collaboration is more likely than competition to help us thrive in the current environment.   

APS has exceptional educational programs, publications, and guidelines. We have an opportunity to expand awareness of and access to these through creative use of online, electronic, cellular, and other emerging technologies. We may be able to further broaden audiences for our programs and services by actively reaching beyond pain specialists to all clinicians who treat pain; this year’s offering of the Strategies in Pain Management course for primary care providers is a great example.

Finally, underscoring much of our work as a pain community—including both clinical work and research—is our understanding that pain is not just a symptom, but often a chronic illness in its own right. This understanding has not been as widely shared by our colleagues outside the field of pain. If we work successfully for acceptance of the chronic illness paradigm of pain, however, we will likely find greater support for our work, including increased funding of research, greater support for interdisciplinary care and, perhaps most importantly, greater commitment by all clinicians to caring for patients who suffer with pain.  

What does APS mean to you professionally and personally?
For the past 25 years much of my work has tried to bridge two fields: pain medicine and addiction medicine. I most often work with complex patients who are challenged by a convergence of pain and co-occurring conditions. I have practiced in a variety of different care contexts, from briefly serving as a solo pain practitioner in private practice early in my career, to directing an out-patient pain clinic in an academic setting, to serving as a pain consultant in a VA primary care system. Each practice context has had its strengths, but also significant challenges in terms of the potential to offer optimum care; engagement with APS has provided a consistent vision of what interdisciplinary pain practice can and should be and this has served as a sort of benchmark to work towards.  I think the ongoing challenge for all of us is to create systems to implement this vision of ideal care in the diverse, complex, and changing healthcare contexts in which our patients and we find ourselves today.  

Young Investigator Application Due February 26

APS will again offer Young Investigator travel support for the 2010 meeting. A limited number of funding awards are available to APS members presenting paper or poster abstracts at the meeting, May 6–8, 2010, in Baltimore, MD. 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.

The Young Investigator Travel Stipend application is now available on the APS Web site. To apply for funding, please complete the application. Applications must be completed online by February 26, 2010. 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 by March 17, 2010. Notifications will be sent to applicants after March 17. All eligible young investigators will receive their travel grants at the Annual Meeting.

The APS Young Investigator Travel Support program is made possible through an allocation of APS operating funds.

Clinical and Basic Science Data Blitz Submissions Open

The submissions process for the Clinical and Basic Science Data Blitz is now open. The Blitz will be held on Thursday, May 6, 2010, from 4:15-5:45 pm in Baltimore, MD, as part of the 29th Annual Scientific Meeting. Authors are encouraged to submit “hot topics” for presentation during the Blitz; submissions from young investigators and junior faculty are encouraged. Selected presenters will have 5 minutes to present data and 5 additional minutes for questions. The blitz will be moderated by George Wilcox, PhD, professor of neuroscience and pharmacology at the University of Minnesota.

To submit your work for consideration, please visit the annual meeting section of the APS Web site. All submissions are due March 12, 2010. Primary/presenting authors will be notified of acceptance by the Data Blitz committee in early April. Blitz presenters will be responsible for all costs associated with travel to the annual meeting, including meeting registration. Authors who will be presenting paper or poster abstracts at the annual meeting should not submit their work again for the Data Blitz.

Corporate Satellite Symposia Focus on Cancer Pain, Opioids, and More

Five corporate satellite symposia and one corporate educational program will be offered in conjunction with the APS 29th Annual Scientific Meeting. These independently sponsored, commercially supported symposia are open to all meeting registrants. The programs have been reviewed by the APS Scientific Program Committee and approved after determining the topics to be presented are relevant to the audience and complementary to the official APS program. There is no fee to attend these symposia, but preregistration is required. Seating will be available at no charge to those responding on a first-come, first-served basis. Program details and speakers are subject to change. Please visit www.symposiareg.org/aps for the most current information.

Corporate Satellite Educational Program
Thursday, May 6, and Friday, May 7
9–11 am
9:30–11 am
2:30–6:15 pm
3–6:15 pm

The Challenge of Managing Pain While Mitigating Risk
Howard Heit, MD; Douglas Gourlay, MD; Paul Arnstein, PhD RN

Running continuously during the days and times listed above, this CME activity can be attended at your convenience, designed to be completed in 20 minutes to 1 hour. You can decide when to attend based on your own schedule and educational needs.

Thursday, May 6
12:30–2 pm
Lunch Symposium

Novel and Future Directions in Cancer Pain Management
Christine Miaskowski, PhD RN FAAN, Moderator; Patrick W. Mantyh, PhD; Cielito C. Reyes-Gibby, DrPH; Oscar de Leon-Casasola, MD

12:30–2 pm
Lunch Symposium

Opioids in Our Communities, Unintended Consequences: A Focus on Adolescents—Insights from Teens Recovering from Prescription Drug Addiction
Carol J. Boyd, PhD MSN FAAN; Scott M. Fishman, MD

Friday, May 7
12:30–2 pm
Lunch Symposium

Practitioner’s Edge^SM Application of Multimodal Therapy to Improve Patient Outcomes: A Clinical Case Challenge
Moderator and Faculty to Be Announced

12:30–2 pm
Lunch Symposium

Low Back Pain: Evaluation, Management, and Prognosis
B. Eliot Cole, MD MPA; Roger Chou, MD; Bill McCarberg, MD

Saturday, May 8
Noon–1:30 pm
Lunch Symposium

Revisiting Pain Management in Cancer Patients: Breakthrough Pain and Its Treatments
Perry G. Fine, MD (Moderator); Larry C. Driver; Steven D. Passik, PhD

Please refer to www.symposiareg.org/aps for new listings.

Call for Applications! IASP Research Symposia

A grant of as much as $40,000 may be awarded to support the costs of a symposium on a specific pain-related topic that is of interest to both basic scientists and clinical researchers. The symposium may be followed by a state-of-the-art volume covering the topic of the meeting. The deadline for applications for 2011 symposia is March 15, 2010.

For complete details about this grant—including guidelines, application forms, and previous recipients—please visit www.iasp-pain.org/Grants.

How to Apply
Please submit your completed fellowship application form by e-mail (as a Word document) to iaspdesk@iasp-pain.org or fax to (206) 283-9403. If you have questions or need assistance, please e-mail iaspdesk@iasp-pain.org or call (206) 283-0311.

The Journal of Pain Highlights

The following highlights summarize selected articles from February 2010 (volume 11, number 2).

The Clinical Importance of Changes in the 0 to 10 Numeric rating Scale for Worst, Least and Average Pain Intensity: Analysis of Data from Clinical Trials of Duloxetine in Pain Disorders
John T. Farrar, Yili L. Pritchett, Michael Robinson, Apurva Prakash and Amy Chappell, University of Pennsylvania School of Medicine

Though pain is a subjective experience, clinicians use a numeric scale to help assess pain severity and improvement following treatments. However, variances in how patients rate their pain prior to treatment in clinical trials can pose challenges for standardizing pain assessments. New research published in The Journal of Pain recommends that calculating the within-person percentage change in pain ratings might be the most accurate indicator of a patient’s perception of improvement in pain status.

Researchers at the University of Pennsylvania School of Medicine reviewed data from 1,700 patients pooled from five randomized placebo controlled studies for treatment of diabetic neuropathy and fibromyalgia with duloxetine. The objective was to determine clinically relevant differences (CIDs) in self-reported pain ratings in numeric (0-10) pain scales. They noted that baseline pain severity scores usually vary widely in a study population, making it difficult to compare the meaning of one patient’s baseline score to another. However, they hypothesized that reductions of pain intensity scores would be clinically relevant.

The duloxetine studies evaluated the drug’s treatment success at doses of 60 mg a day.  For each patient, the baseline and endpoint pain scores were recorded and percent changes calculated. 

From the data analysis, the researchers concluded the association between the percentage change in pain intensity for both worse and average pain in neuropathy and fibromyalgia patients shows that the Numeric Rating Scale-Pain Intensity (NRS-PI) can be interpreted more appropriately when the improvement is analyzed as a percentage change rather than as absolute change. They noted: “Our data suggest that, at least in a clinical trial setting where the change in pain intensity is the primary outcome, the measurement of baseline and final pain intensity on the NRS-PI calculated as a percentage change will appropriately reflect the patient’s assessment of change.”

The authors concluded that measuring within-patient percentages makes the numerical pain scale a reliable and valuable indicator of a patient’s perception of improvement in pain severity.

Perceiving Pain in Others: Automatic and Controlled Mechanisms
Kenneth D. Craig, Judith Versloot, Liesbet Goubery, Tine Vervoort and Geert Crombez; University of British Columbia, Canada and Ghent University, Belgium

Another study published in The Journal of Pain this month examined the significance of pain expressions and the social reactions of observers. Canadian and Belgian researchers analyzed how recognizing the expression of pain in others can alert observers to possible risk of personal danger. 

They determined that individuals who express spontaneous or automatic reactions to pain are most likely to be viewed by others with empathy and concern for their welfare, whereas controlled expressions of pain lacking spontaneity usually cause observers to question the seriousness and validity of the pain response. 

The authors noted that better understanding of the interactions between persons with pain and anyone reacting to them, such as family members or health care providers, could help enhance the delivery of appropriate care.

Clinical Journal of Pain Highlights

The following highlights summarize selected articles from January 2010 (volume 26, issue 1).

Predictors of Disability and Pain Six Months After the End of Treatment for Fibromyalgia
Patricia L. Dobkin^1,2, Aihua Liu^2,4, Michal Abrahamowicz^2,4, Raluca Ionescu-Ittu^2,4, Sasha Bernatsky^1,2, Arielle Goldberger⁵, Murray Brown³

⁽¹⁾ Department of Medicine, McGill University, Royal Victoria Hospital, Montreal, Quebec, Canada
⁽²⁾ Department of Medicine, McGill University Health Centre, Royal Victoria Hospital, Montreal, Quebec, Canada
⁽³⁾ Department of Rheumatology, Jewish General Hospital, Montreal, Quebec, Canada
⁽⁴⁾ Department of Epidemiology, Biostatistics, and Occupational Health, McGill University, Montreal, Quebec, Canada
⁽⁵⁾ Department of Psychology, McGill University, Montreal, Quebec, Canada

Following a 3-month treatment program, which factors will predict improvement in disability? What level of adherence to treatment will influence pain outcome? Researchers studied 46 patients with fibromyalgia who had participated in a 3-month outpatient program that integrated physiotherapy, occupational therapy, nursing, and cognitive-behavior therapy to better understand which factors will affect pain and disability outcomes.

Outcomes were determined by physician assessment and self-reported pain using a number of pain scales. Patient adherence to the treatment recommendations was determined by each patient’s response to questions about the difficulty they experienced when following treatment recommendations. Responses were recorded for 3- and 6-month periods.

Receiving higher scores for adhering to the treatment plan and showing an increase in self-efficacy for pain during treatment were indicators of improved disability. The predictor for improved pain was an increase in self-efficacy for pain during treatment. As to whether adherence to treatment would influence the pain outcome, the results showed that those who adhered to the treatment program best were more likely to experience improved levels of pain. Both variables that affected outcome—self-efficacy and adherence—were modifiable variables, the researchers noted, and both improved over the period of the study. However, they acknowledge studies of adherence may be limited by a selection bias; participants with more pain often drop out, and those who complete the study are only the ones willing to be monitored.

Trends in Use of Opioids for Chronic Noncancer Pain Among Individuals With Mental Health and Substance Use Disorders: The TROUP Study
Mark J. Edlund¹, Bradley C. Martin², Andrea Devries³, Ming-Yu Fan⁴,Jennifer Brennan Braden⁴, Mark D. Sullivan⁴

⁽¹⁾ Department of Psychiatry, Division of Health Services Research, College of Medicine, University of Arkansas for Medical Sciences, Little Rock, AZ
⁽²⁾ Department of Psychiatry, Division of Pharmaceutical Evaluation and Policy, College of Medicine, University of Arkansas for Medical Sciences, Little Rock, AZ
⁽³⁾ HealthCore, Inc., Wilmington, DE
⁽⁴⁾ Department of Psychiatry and Behavioral Sciences, University of Washington, Seattle, WA

In this recent Clinical Journal of Pain study on the use of opioids, an Arkansas-based research team examined prescription opioids usage for chronic pain in people with mental health and substance abuse disorders.

Trends were analyzed between the years of 2000 and 2005 in patients with or without mental health (MH) or substance use disorders (SUD) who did not have existing cancer conditions. Data were collected from two very different populations: national, commercially insured patients and Arkansas Medicaid patients. The goal was to determine the following outcomes: rates of prescription opioid use in the past year, rates of chronic opioid use, mean days of opioid supply, mean daily opioid dose in morphine equivalents, and percentage of total opioid dose that was Schedule II opioids.

The researchers found that chronic opioid use was more common among those MH or SUD noncancer pain patients (with or without insurance) than for those who had did not have a history of MH or SUD. In addition, the rates of opioid increases varied widely between those who were commercially insured and Arkansas Medicaid patients. For those who had commercial insurance, rates increased by 34.9% for those with MH or SUD and 27.8% for those who did not have these disorders. In contrast, opioid use in Arkansas Medicaid patients increased by 55.4% for those with an MH or SUD and by 39.8% for those without those disorders.

The authors conclude that the rate of opioid usage is significantly higher for MH or SUD patients, and clinicians should be cognizant of this finding when determining whether to prescribe opioids for these patients. They believe that future studies will need to further examine the complex relationship between chronic pain and mental health illness in order to improve pain treatment.

PAIN Highlights

The following highlights summarize selected articles from January 2010 (volume 148, issue 1).

Psychological Flexibility in Adults with Chronic Pain: A Study of Acceptance, Mindfulness, and Values-Based Action in Primary Care

Lance M. McCracken, Sophie C. Velleman
Centre of Pain Services, Royal National Hospital for Rheumatic Diseases, and Centre of Pain Research, University of Bath, Bath, UK

Researchers from the Royal National Hospital in Bath, UK, recently published the results of their study about the role of psychological flexibility in chronic pain patients who do not receive specialty care. Although psychological flexibilty has been studied previously in patients who receive treatment at specialty pain centers, this study was the first of its kind to look at patients with chronic pain in primary care.

The researchers enrolled 239 adult patients with low to moderately complex chronic pain in the study. Participants provided a pain rating on a 0 to 10 scale and an estimate of how frequently they had visited their healthcare provider because of pain in the past 6 months. Measures of pain acceptance, mindfulness, psychological acceptance, values-based action, health status, and practitioner visits were taken.

The results of the study showed significant relationships between the areas of psychological flexibility and measures of emotional, physical, social, and healthcare visits. The regression analyses determined that pain intensity accounted for an average variance of 9.2%, whereas psychological flexibility accounted for 24.1% variance.

The authors believe the data suggest that psychological flexibility may reduce the impact of chronic pain in patients with low to moderately complex problems outside of specialty care. Because the study was the first to examine patients in a primary care setting, additional studies will be needed to confirm the results. However, if the results are reliable, they suggest that further treatment developments are needed in primary care centers to better serve the many chronic pain patients who never seek medical care in a specialty center.

Spinal Cord Stimulation for Failed Back Surgery Syndrome: Outcomes in a Workers’ Compensation Setting
Judith A. Turner¹, William Hollingworth², Bryan A. Comstock³, Richard A. Deyo^4
(1) Department of Psychiatry & Behavioral Sciences and Department of Rehabilitation Medicine, University of Washington, Seattle, WA
⁽²⁾ Department of Social Medicine, University of Bristol, Bristol, UK
⁽³⁾ Department of Biostatistics, University of Washington, Seattle, WA
⁽⁴⁾ Department of Family Medicine and Department of Internal Medicine, Oregon Health and Science University, Portland, OR

Workers' compensation patients with failed back surgery syndrome (FBSS) who receive spinal cord stimulation (SCS) do not experience greater pain relief after 6 months than those who receive alternative treatments, in a study reported in PAIN.

Researchers conducted a prospective, population-based controlled cohort study to evaluate the outcomes of workers’ compensation recipients with FBSS who received at least a trial of SCS (n = 51) compared to patients who were evaluated in a multidisciplinary pain clinic and did not receive SCS (n = 39) and a usual care group who were not evaluated and did not receive SCS (n = 68)). Patients completed measures of pain, function, medication use, and work status at baseline and after 6, 12, and 24 months.

The primary outcome was defined as therapeutically successful if there was a greater than 50% reduction in leg pain, a 2-point or greater improvement on the Roland-Morris Disability Questionnaire, and lowered daily opioid use. At baseline, the three study groups were similar in pain index, function, and opioid use. At 6 months, the SCS group experienced higher rates of improvement in leg pain and function; however, this was accompanied by a greater daily use of opioids than in the other two groups. The advantage the SCS group experienced in the first 6 months disappeared by later follow-ups.

The authors conclude that a number of factors could explain why the results of this study show SCS to less effective than in randomly controlled trials. For example, differences in study population, study design, and delivery of care or issues related to the workers' compensation population may have had an impact on the results. The lack of long-term effectiveness of SCS in this study doesn't imply ineffectiveness in other settings. More study of workers’ compensation patients is needed.

Pain in the News

NSAIDS May Be More Effective Than Paracetamol for Period Pain

Mirror Therapy Prevents Phantom Limb Pains in Patients Undergoing Amputation

Migraines Force Sufferers to Do Their Homework

Pediatric Psychologist Teaches His Young Patients Skills to Cope with Pain, Overcome Fear

U.S. Troops ‘Vulnerable to Back Pain’

Higher Opioid Dose Linked to Overdose Risk in Chronic Pain Patients

Group Urges Recall of Drug for Fibromyalgia

N.J. Medical Marijuana Law Ignores Chronic Pain Sufferers