A Look Ahead: APS Annual Meeting
May 8–10, 2008
Tampa, FL
Register online today!

Workshops, Friday, May 9
8:30 am–12:15 pm (includes 45-minute break)
APS is pleased to offer the following workshops, which are available to all attendees at no additional cost.

Parental and Sociocultural Factors in Pediatric Pain: Laboratory-Based, Translational, and Clinical Research Perspectives
Susmita Kashikar-Zuck, PhD (Moderator); Christine Chambers, PhD; Tonya Palermo, PhD; Christopher Eccleston, PhD; Qian Lu, MD PhD; Subhadra Evans, PhD
This session will address findings from basic, translational, and clinical research on parent-child interactions that determine children's pain experience and ability to cope with pain. There will be an interactive discussion about implications for the development of effective behavioral therapies using knowledge gained from laboratory-based research and future research directions including the combined use of traditional and nontraditional research methodologies to study social and cultural factors in pediatric pain.

Promoting Safe and Effective Chronic Opioid Therapy: An Integration of Scientific Evidence and Practice Considerations
Robert Kerns, PhD (Moderator); Jodie Trafton, PhD; Bruce Naliboff, PhD; Bridget Ann Martell, MD MA; Paul Kreis, MD; Kenneth Berkowitz, MD FCCP; Scott Fishman, MD
This workshop will review the evidence base for patient-level and public health concerns related to chronic opioid therapy and propose strategies for promoting safe and effective use of opioids. Faculty will also conduct a case-based discussion of important clinical, ethical, and legal issues relevant to the safe and effective use of opioids for the management of chronic, nonmalignant pain.

Voltage-Gated Sodium Channels and Calcium Channels in Pain Transmission and Therapy
Robert Gereau, PhD (Moderator); John Wood, PhD DSc; Sulayman Dib-Hajj, PhD; Michael Jarvis, PhD; Yu-Qing Cao, PhD; Cenk Ayata, MD; Charlie Taylor, PhD; Terrance Snutch, PhD FRSC
This workshop focuses on voltage-gated sodium channels found in nociceptors and their role in pain, as well as voltage-gated calcium channels in pain transmission and therapy. Speakers will discuss both inherited pain disorders mediated by mutations in voltage-gated sodium channels and the analgesic properties of novel compounds that target these ion channels. Speakers will also discuss research progress of calcium channel mutations associated with familial hemiplegic migraine type 1 as well as compounds that target calcium channels for chronic pain treatment.

APS Posters and Paper Presentations
More than 300 posters will be presented at the 2008 Annual Scientific Meeting. There will also be three oral paper sessions. The list of first authors for accepted abstracts will be available on the APS Web site in early January, and confirmation letters will be mailed in late January.

Clinical Centers of Excellence in Pain Management Awards Program Deadline Rapidly Approaching

Applications for the 2008 Centers of Excellence awards are due by Friday, December 14, 11:59 pm PDT.

The Clinical Centers of Excellence (CCOE) in Pain Management award honors programs or services that exemplify the provision of outstanding clinical care. Pain care providers, ranging from large medical centers to community-based clinics, are encouraged to submit their program for consideration. Any U.S.-based, multidisciplinary clinical program that provides direct patient care and is primarily focused on the treatment of pain is eligible to apply. Apply today.

The Journal of Pain Highlights

The following highlights summarize selected articles from the December 2007 issue (volume 8, number12).

Chronic Widespread Pain in Veterans of the First Gulf War: Impact of Deployment Status and Associated Health Effects
Valerie Forman-Hoffman, Paul Peloso, Donald Black, Robert Woolson, Elena Letuchy and Bradley Doebbeling; University of Iowa, Indiana University and Roudebush VA Medical Center, Indianapolis

A large study of military veterans showed that those deployed during the first Gulf War had a significantly higher incidence of chronic widespread pain and poorer overall health status than soldiers not deployed to combat. These findings may have value in providing care for soldiers returning from duty in Iraq and Afghanistan.

For the Iowa Gulf War Study, researchers from the University of Iowa, Indiana University, and Roudebush VA Medical Center, Indianapolis, IN, studied 3,695 veterans to compare the prevalence of chronic widespread pain in deployed versus nondeployed military personnel. They hypothesized that individuals who saw action in the Gulf would show a higher rate of chronic widespread pain and, as a result, their overall health would worsen and lead to a higher use of medical services.

Results of the study showed that 16% of the sampled veterans had chronic widespread pain, twice the prevalence in nondeployed subjects. Those with chronic pain also were more likely to be unemployed and rated their health status as fair to poor. They had greater utilization of mental health services and higher incidence of alcohol abuse, depression, anxiety, and chronic fatigue than nondeployed veterans.

The authors believe that their findings can predict health outcomes for veterans returning from Iraq and Afghanistan and provide guidance for possible treatments. Early recognition of the elevated risk for chronic widespread pain and associated downstream health conditions "may help optimize care and limit inappropriate health care utilization," the study concluded.

A Randomized Clinical Trial of Cognitive Behavioral Treatment to Reduce Catastrophizing in Chronic Headache Sufferers
Beverly Thorn, Laura Pence, L. Charles Ward, Gary Kilgo, Kristi Clements, Tony Cross, Amber Davis, and Patricia Tsui; University of Alabama Psychology Department, VA Medical Center, Tuscaloosa and Kilgo Headache Clinic

For many with chronic headaches, anxiety-laden anticipation of an episode could be as debilitating as the pain itself. According to previous research, an important predictor of adjustment to pain is catastrophizing, the exaggerated anxious mental state brought on during the pain experience. Studies have suggested that changes in catastrophizing can help reduce pain intensity. University of Alabama researchers conducted a randomized clinical trial to examine the benefits of cognitive-behavioral therapy in treating chronic headache patients. They predicted that study participants receiving cognitive-behavioral treatments would report better outcomes.

Forty patients were evaluated. Eligibility required at least 3 pain days per month from migraine or tension headaches and no significant cognitive impairments.

Results showed that chronic headache patients who were exposed to intensive cognitive therapy to mediate pain catastrophizing reported significant changes in their headache management self-efficacy compared with wait-list control subjects. There also were significant posttreatment differences in headache frequency, peak intensity, catastrophizing, depression, and anxiety. The authors concluded that cognitive-behavioral therapy is effective for reducing distress associated with chronic headaches and can reduce headache frequency.

Epidural Labor Anesthesia: Continuous Infusion Versus Patient-Controlled Epidural Anesthesia With Background Infusion Versus Without a Background Infusion
Manuel Vallejo, Vimala Ramesh, Amy Phelps, and Neera Sah;University of Pittsburgh, Department of Anesthesiology

Researchers at the University of Pittsburgh compared three commonly used epidural anesthesia procedures: continuous epidural infusion, patient-controlled epidural anesthesia (PCEA) with a background infusion, and demand-dose-only patient-controlled epidural anesthesia. The objective was to assess which procedure is most advantageous for reducing labor pain, using the least medication, lessening motor block, and minimizing staff intervention. One hundred ninety-five obstetric patients were evaluated.

PCEA allows patients to self-manage their labor pain without significant risk for overdosing or underdosing. It can be provided on demand only or with a continuous background infusion. Compared with continuous epidural anesthesia, the patient-controlled method reduces staff time, improves patient satisfaction, and cuts down local doses of anesthetics.

Results showed that PCEA decreased drug utilization in the demand-only procedure, with no differences in patient satisfaction, motor block, and overall outcome. The benefit of reducing drug doses with demand-only PCEA, therefore, does not lead to improved maternal and neonatal outcomes compared with continuous epidural infusions.

Clinical Journal of Pain Highlights

The following highlights summarize selected articles from the November/December 2007 issue (volume 23, number 9).

Complementary and Alternative Medicine Use for Arthritis Pain in Two Chicago Community Areas
Joe Feinglass, PhD,* Chin Lee, MD MPH,† Michelle Rogers, ND,‡ Leslie Mendoza Temple, MD,§|| Cynthia Nelson, MA,¶ and Rowland W. Chang, MD MPH#**

*Division of General Internal Medicine, Northwestern Feinberg School of Medicine, Chicago, IL
†Division of Rheumatology, Northwestern Feinberg School of Medicine, Chicago, IL
§Department of Family Medicine, Northwestern Feinberg School of Medicine, Chicago, IL
#Department of Preventive Medicine, Arthritis Division, Northwestern Feinberg School of Medicine, Chicago, IL
**Department of Physical Medicine and Rehabilitation, Northwestern Feinberg School of Medicine, Chicago, IL
‡Center for Integrative Medicine, Northwestern Memorial Physician's Group, Chicago, IL
||Program in Integrative Medicine, University of Arizona, Chicago, IL
¶College of Liberal Arts and Sciences, Northern Illinois University, DeKalb, IL

This study compared the use of complementary and alternative medicine (CAM) between two demographically distinct Chicago-area communities distinguished as the north and south Chicago areas. The south area had a majority of African American respondents (79.7%) and the north area had a majority of White non-Hispanic respondents (88.9%). All participants were asked about their general demographics, whether they had joint pain or were diagnosed with arthritis, what their pain and functional limitations were, and their utilization of and satisfaction with nutritional supplements, vitamins, herbal therapies, nutrition counseling, relaxation techniques, meditation, massage, acupuncture, naprapathy, or chiropractic therapies (i.e., the CAM therapy categories).

The study showed that although 53% of all respondents met the Centers for Disease Control criteria for arthritis, 15.4% more south respondents reported having arthritis or chronic joint symptoms and 16% more reported using prescriptions for their conditions. South respondents also reported a higher burden of activity limitation, pain, and disability. Overall, 74.6% of all respondents reported using one or more of the CAM therapies. Nutritional supplements, vitamins, or herbal therapies had the highest usage (more than one-third of the respondents in both areas) and south area respondents were more likely to use relaxation techniques, meditation, biofeedback, and massage (43.8% versus 20.4%). The report concluded that overall use of CAM therapies was driven by the severity of the arthritis rather being driven by any evident sociodemographic or cultural differences. The report further noted that the "results thus contradict the common stereotype of the 'typical CAM user' as white, female, highly educated, and upper middle class."

An Investigation into the Effect of Electrode Placement of Transcutaneous Electrical Nerve Stimulation (TENS) on Experimentally Induced Ischemic Pain in Healthy Human Participants
Lesley Brown, BSc (Hons),* Ghazala Tabasam, BSc (Hons) PhD,*† Jan M. Bjordal, PT PhD,‡§ and Mark I. Johnson, BSc (Hons) PhD*†

*Faculty of Health, Leeds Metropolitan University, United Kingdom
†Leeds Pallium Research Group, United Kingdom
‡Institute of Physiotherapy, Bergen University College, Norway
§Section of Physiotherapy Science, Faculty of Medicine, University of Bergen, Norway

Although transcutaneous electrical nerve stimulation (TENS), a noninvasive technique used to relieve pain, is a widely used technique for pain relief, randomized controlled clinical trials and systematic reviews have not been consistent in their findings. Some suggest that these inconsistent findings are a result of misplaced electrodes, which are typically placed on the site of pain. This study compared TENS administered in the forearm, which was experimentally induced with ischemic pain, with TENS administered in the contralateral lower leg, which is further from the pain site. Ten pain-free and healthy volunteers were given the created ischemic pain by using a modified version of submaximal effort tourniquet technique, and pain intensity was taken at 1-minute intervals for 5 minutes while the volunteer received TENS in the arm or contralateral leg. Hypoalgesia was examined between electrode strokes. The findings concluded that there were no detected differences in ratings to the experimental pain when TENS was administered in the arm (at the site of the pain) than in the leg (at a site distant to the pain). The authors of this study acknowledge "obvious limits" when trying to get results from artificially induced pain and applying them to the clinical setting, and state that "the findings of this study should be seen as a call for further research into the relative importance of electrode placement on TENS outcome."

DEA Symposium on Drug Diversion

Up to 10% of adolescents who abuse prescription drugs get their drugs from Internet pharmacies, many of which do not require written or oral prescriptions to dispense medicine, said Joseph T. Rannazzisi, deputy assistant administrator, Office of Diversion Control, the Drug Enforcement Administration (DEA), at a November 2 symposium on pharmaceutical diversion. The diversion of opioid drugs continues to grow as the prescription drug distribution system expands on the Internet, Rannazzisi said at "Good Medicine, Bad Behavior: A National Symposium on Pharmaceutical Diversion," which was hosted by the DEA and the DEA Museum Foundation.

Rannazzisi supports legislation to curtail Internet trafficking of prescription drugs. He also calls for an update to the Controlled Substances Act (CSA) because the Internet was not considered when it was enacted. CSA is the legal basis by which the manufacture, importation, possession, and distribution of certain drugs, chemicals, and substances are regulated by the federal government.

Meanwhile, William S. Jacobs, MD, associate professor of addiction medicine at the University of Florida in Gainesville, FL, said that opioid use has been rising since the 1990s, so much so that American per capita opioid use is twice that of Denmark, which has the second highest per capita use of opioids in the world.

Jacobs, who is president of Nexstep Integrated Pain Care in Jacksonville, FL, also said that the number of deaths due to illegal drug diversion has tripled in the past few years. He believes that physicians who prescribe certain opioid drugs should be held accountable when patients abuse or divert drugs.

Currently, physicians receive inadequate training on how to detect prescription drug abuse and diversion, Jacobs said, adding that such training is not part of medical school curricula.

Jacobs also said that major problems exist with interstate prescription diversion, and he called for increased funding for a national monitoring program. When asked whether the development of pain killers should be scaled back, Jacobs said the opposite is true; physicians need more options so the drug industry can move forward with finding powerful but nonaddictive alternatives.

H. Westley Clark, MD JD MPH CAS FASAM, the Center for Substance Abuse Treatment of the Department of Health and Human Services, called for a balanced approach to the problem. He stressed that the medical benefits of these drugs must be weighed against the risk of illegal drug diversion.

NIH Director's Pioneer and New Innovator Award Programs Launch 2008 Application Cycles: Highly Innovative Research Proposals Sought

NIH is calling for applications for the 2008 NIH Director's Pioneer and New Innovator awards. Both programs support exceptionally creative scientists who take highly innovative—and often unconventional—approaches to major challenges in biomedical or behavioral research. Pioneer Awards are open to scientists at any career stage, while New Innovator Awards are reserved for new investigators who have not received an NIH regular research (R01) or similar grant. The programs, part of the NIH Roadmap for Medical Research, complement other NIH efforts to fund innovative research and support scientists in the early stages of their independent research careers.

Pioneer Awards provide $2.5 million in direct costs over 5 years and New Innovator Awards provide $1.5 million in direct costs over the same period. NIH expects to make five to 10 Pioneer Awards and up to 24 New Innovator Awards in September 2008.

Pioneer Award applications will be accepted from December 16, 2007, to January 16, 2008. The New Innovator Award application period is March 3–31, 2008.

The streamlined, electronic application process centers on an essay describing the investigator's idea, its significance, and what makes it particularly innovative. New Innovator Award proposals allow preliminary data but do not require it. Consistent with the novelty of other elements of the programs, applications are evaluated using a special process that is itself an experiment in peer review.

Research on Comorbid Mental and Other Physical Disorders (R01)

The National Institute of Mental Health (NIMH) and the National Institute of Nursing Research (NINR) solicit grant applications that propose studies on the co-occurrence and comorbidity of mental disorders with other physical disorders. An important goal of this Funding Opportunity Announcement (FOA) is to identify potent, modifiable risk and protective factors amenable to intervention, and to translate the results of such studies into initial tests of theory-driven prevention and early intervention strategies. Risk and protective factors include biological, psychosocial, behavioral, and environmental contributors to comorbid disorders. This FOA encourages research on the efficacy, effectiveness, long-term outcome, and safety of preventive, treatment, and rehabilitative interventions across the lifespan; clinical trials and intervention studies targeting functional and symptomatic outcomes adapting pharmacological, psychosocial, behavioral, or environmental approaches individually or in combination; studies to improve the recruitment and retention of individuals with comorbid disorders in real-world practice settings; and research on the impact of separate organizational systems and different financing mechanisms for mental and other physical disorders. Major emphasis is placed on the identification of principles motivating and sustaining behavior changes critical to reducing the risk for co-occurring disorders. For more information, click here.

NINDS Administrative Supplements for Collaborative Activities to Promote Translational Research (CAPTR)

The National Institute of Neurological Disorders and Stroke (NINDS) announces the availability of one-year administrative supplements for NINDS-funded grantees to stimulate new interdisciplinary collaborations in translational research. The proposed studies must be within the scope of the peer-reviewed activities specified within the NINDS parent award and collaborators may not have a significant history of joint interactions.

For more information, click here.

2007: What a Year for APS!

For APS, 2007 was a dynamic and exciting year highlighted by record attendance at the Annual Scientific Meeting in Washington, DC, prominent national media coverage, publication of a breakthrough clinical practice guideline, implementation of the first-ever clinical excellence awards for multidisciplinary pain care, and progress on Capitol Hill legislation to increase funding for pain research and treatment.

"There's no other way to say it, APS had an outstanding year and is looking ahead to even better achievements in 2008," said APS President Judith Paice, PhD RN. "It's been an exhausting but extremely gratifying year for the board and our volunteers and staff working on behalf of APS members and the pain-care community."

Annual Scientific Meeting
The APS Annual Scientific Meeting was held in May at the Washington, DC, Convention Center. Before the meeting, APS Board members made coordinated visits to Capitol Hill to meet with home-state representatives, senators, and key staff to seek support for the National Pain Care Policy Act of 2007 and advocate for increased funding for pain research. The visits yielded beneficial exchanges of information that hopefully will translate into favorable policy.

Perhaps the most newsworthy scientific sessions was "The Battlefield and Beyond," which covered pain management advances for wounded veterans returning from Iraq and Afghanistan. This topic generated national media coverage, as writers for the Associated Press, Newsweek, and JAMA covered the session and did follow-up interviews with Lt. Col. Chester "Trip" Buckenmaier and panelists Michael Clark, PhD, Rollin Gallagher, MD, and Robyn Walker, PhD.

On May 7, the Associated Press published a national wire story "Doctors Urge Better Pain Care for Troops," which appeared in more than 80 daily newspapers and inspired Newsweek's June 6 article "The New War on Pain." Newsweek consulted APS members and speakers for the story, including Judy Paice, Dennis Turk, Chuck Inturrisi, Gil Fanciullo, and Edward Covington.

APS Achievement Awards
APS recognized excellence in the field of pain management by presenting six separate awards for career achievement, pain scholarship, education and public service, advocacy on behalf of children, outstanding service to APS, and early career achievements. Robert J. Gatchel, PhD, was awarded the Wilbert E. Fordyce Clinical Investigator Award; George Wilcox, PhD, received the Frederick W.L. Kerr Basic Science Research Award; Leora Kuttner, PhD, was awarded the Jeffrey Lawson Award; Marion Good, PhD RN, was awarded the Elizabeth Narcessian Award; the Distinguished Service Award was awarded to Allen Lebovits, PhD, and Kathleen Sluka, PhD; the John and Emma Bonica Public Service Award went to Christina Spellman, PhD, (Mayday Fund); the John C. Liebeskind Early Career Scholar Award was awarded to Bryan Hains, PhD; and Scott Finn and Tara Tuckwiller (Charleston Gazette) won the Kathleen M. Foley Journalist Award.

Clinical Centers of Excellence Awards
The first-ever gala event at an APS meeting was held on May 3 at the Smithsonian Museum of Natural History and honored recipients for the inaugural year of the APS Clinical Centers of Excellence in Pain Management awards. Six multidisciplinary pain programs received awards: NYU Medical Center/Hospital for Joint Diseases, Bellevue Hospital Center, Comprehensive Pain Management Center, New York, NY; The Rosomoff Comprehensive Pain Center, Miami, FL; Brigham and Women's Hospital, Pain Management Center, Department of Anesthesiology, Perioperative and Pain Medicine, Boston, MA; UCSF Pain Management Center and UCSF PainCARE, Center for Advanced Research and Education, San Francisco, CA; Cincinnati Children's Hospital Medical Center, Division of Pain Management, Cincinnati, OH; and James A. Haley Veterans Affairs Hospital, Chronic Pain Rehabilitation Program, Tampa, FL.

These awards honored pain care teams for overcoming difficult challenges every day to deliver optimal and exemplary care for those with chronic pain disorders, postsurgical pain, trauma-induced pain, and pain from cancer and other life-threatening conditions.

Low Back Pain Clinical Practice Guideline
On October 2, APS announced the publication of a new evidence-based, clinical practice guideline for the diagnosis and treatment of low back pain. The primary care version of the guideline was developed in collaboration with the American College of Physicians (ACP) and appeared in the Annals of Internal Medicine. It recommends less reliance on expensive diagnostic imaging and reports strong evidence supporting the benefits of several therapies, with and without medication.

The guideline is based on a multidisciplinary panel's review and analysis of volumes of evidence related to diagnosis and treatment of low back pain in the primary care setting, according to Roger Chou, MD, director of the APS Clinical Practice Guideline Program.

Because low back pain is the fifth most common reason for doctor's office visits and accounts for an estimated $26 billion in direct healthcare costs in the United States, there was considerable national media coverage for the APS guideline. Articles were published in US News and World Report, Washington Post, Reuters, American Medical News, Web MD, and other media.

Progress on Capitol Hill
Both the House and Senate deliberated separate pain bills in 2007, which may become law by the end of next year.

In a July news release, APS urged Congress to enact the National Pain Care Policy Act of 2007, (HR 2994) to increase federal resources for pain care education and training and to strengthen public awareness about pain management and its potential to provide significant relief to the estimated 50 million Americans enduring persistent pain.

The measure was introduced in the House by Rep. Lois Capps (D-CA) and Rep. Mike Rogers (R-MI). Key provisions would authorize an Institute of Medicine Conference on Pain Care and permanent status for the Pain Consortium at NIH. Grant programs to train healthcare practitioners in treating and managing pain appropriately would be established along with a national consumer awareness campaign about pain with emphasis on improving access to pain treatments for underserved populations.

Though similar to previous pain legislation supported by APS, HR 2994 focuses more narrowly on NIH and other programs at the Department of Health and Human Services. Provisions relating to the Veterans Administration and military health programs are covered in separate legislation—the Veterans' Pain Care Act of 2007 (S2160)—which is under active consideration by the Senate Veterans Affairs Committee. Sen. Daniel Akaka (D-HI) is the lead sponsor.

According to Robert Saner, Washington Counsel for the Pain Care Coalition (PCC), the prospects for passing both bills are promising for 2008. "We've made great progress in advancing both bills through the legislative process, but there's still work to be done. Therefore, APS members and other supporters of HR 2994 should continue to urge their representatives to become cosponsors of the pain bills," Saner said.

Looking Ahead to 2008
APS is preparing for another busy year on several fronts, including the second annual Clinical Centers of Excellence in Pain Management Awards program and the 2008 Annual Scientific Meeting to be held May 8–10 in Tampa, FL.

Have a happy holiday season and a healthy and successful 2008.

New York Times Columns Focus on Pain Care

Jane Brody, personal health columnist for the New York Times, devoted three columns in November to pain and pain management. This continues her strong and insightful coverage of pain issues in recent years. She is a past winner of the APS Kathleen M. Foley Journalist Award.

Read more at the New York Times online:

www.nytimes.com/2007/11/20/health/20brod.html?ref=science

www.nytimes.com/2007/11/13/health/13brod.html?ref=science

www.nytimes.com/2007/11/06/health/06brod.html?ref=science

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