Pain Bills Moving Ahead in Congress Continuing efforts by APS and other pain care organizations to pass federal pain care legislation are beginning to show results in the 110th Congress as both the House and Senate are deliberating separate pain bills. Proponents are encouraged that the bills could become law by the end of next year. The Energy and Commerce Committee’s Subcommittee on Health has jurisdiction on HR 2994, the Pain Care Policy Act of 2007, which is sponsored by representatives Lois Capps (D-CA) and Mike Rogers (R-MI). The bill already has 13 cosponsors, and many are senior members of the Committee. “There were more than 40 cosponsors for the pain bill Representative Rogers sponsored in the previous Congress, and we expect to greatly exceed that number with strong bipartisan support for HR 2994,” said Robert Saner, Washington Counsel for the Pain Care Coalition (PCC). The current House bill is similar to previous legislation supported by PCC that failed to gain recommendation for passage by the Committee. It was narrowed to focus only on NIH and other programs at the Department of Health and Human Services. Provisions relating to the Veterans Administration and military health programs are now being pursued separately with interested legislators in the House and Senate. Senator Daniel Akaka (D-HI) introduced S2160, the Veterans’ Pain Care Act of 2007, and that bill has passed the Senate Veterans Affairs Committee without amendment. The Senate bill has good prospects, according to Saner. Key provisions of HR 2994 would authorize an Institute of Medicine Conference on Pain Care and permanent status for the Pain Consortium at NIH. The bill also would establish grant programs to train healthcare practitioners in treating and managing pain appropriately and develop a national consumer awareness campaign about pain management, conducted by HHS, with special emphasis on improving access to pain treatments for underserved populations. “The new House bill has been streamlined to emphasize research, training, education, access, outreach and patient care,” said Saner. He added that APS and other interested advocacy groups are pushing for introduction of a Senate version of the bill soon. Saner said APS members and other supporters of HR 2994 should urge their representatives to become cosponsors of the pain bill. Current cosponsors are Tammy Baldwin (WI-2) Rick Boucher (VA-9) Bart Gordon (TN-6) Gene Green (TX-29) Maurice Hinchey (NY-22) Patrick Kennedy (RI-1) Zoe Lofgren (CA-16) Jim Marshall (GA-8) Mike Rogers (MI-8) Janice Schakowsky (IL-9) Bart Stupak (MI-1) Fred Upton (MI-6) Timothy Walberg (MI-7)   The Journal of Pain Highlights The following highlights summarize selected articles from the November 2007 issue (volume 8, number 11). Measuring Perceived Harmfulness of Physical Activities in Patients with Chronic Low Back Pain: The Photograph Series of Daily Activities—Short Electronic Version Maaike Leeuwa, Marielle E.J.B Goossensa, Gerard J.P. van Breukelenb, Katja Boersmac and Johan W.S. Vlaeyen, Maastricht University, The Netherlands In low back pain patients, the fear of pain or further injury from performing common physical activities can be assessed with a series of photographs to allow patients to indicate the extent to which they believe certain activities would be painful for them. Research published in The Journal of Pain concluded this method could help clinicians better manage pain related fears and minimize disability. A team of Dutch researchers evaluated the Photograph Series of Daily Activities (PHODA) to measure the perceived harmfulness of daily activities in patients with chronic low back pain. Pain-related fear can be exhibited in beliefs that certain movements may be harmful to the back by causing further injury. In the PHODA analysis, back-pain patients indicated to what extent they believed certain activities would be harmful. The mean perceived harmfulness scores were highest for activities that involved bending, such as shoveling soil, lifting a crate, or vacuuming. Results showed that patients experiencing more pain are the most apprehensive about activities that may aggravate their pain. The researchers concluded that a shortened, less costly, version of PHODA is a valid tool to help clinicians evaluate patient pain perceptions in rehabilitative and pain-clinic settings. Contribution of Myofascial Trigger Points to Migraine Symptoms Maria Adele Giamberardino, Emmanuele Tafuri, Antolella Savini, Alssandra Fabrizio, Giannapia Affaitati, Rosanna Lerza, Livio Di Ianni, Domenico Lapenna, and Andrea Mezzetti; Headache Center, Department of Medicine and Science of Aging, G. D’Annunzio University, Chieti, Italy Palpations within facial trigger points can cause pain and tenderness in migraine patients whose symptoms coincide with trigger-point locations. In this study of 78 migraine patients, researchers sought to assess the benefits of local therapy of active myofascial trigger points for improving migraine symptoms. Migraine patients have been shown to present significantly greater numbers of facial trigger points. In the study, trigger points were treated at the muscle level by injecting an anesthetic. In one group of patients, the number and intensity of migraine attacks decreased by 46% and 17%, respectively. The authors concluded the results suggest that systematic local treatment of facial trigger points in migraine patients eventually could lead to substantial reductions in the use of migraine drugs. Contralateral Attenuation of Pain After Short-Duration Submaximal Isometric Exercise Kelli F. Koltyn and Masataka Umeda, University of Wisconsin-Madison There have been several studies published examining the role of exercise in altering pain sensitivity. In general, researchers have found that exercise can decrease pain known as exercised-induced hypoalgesia (EIH). EIH has been characterized by elevations in pain thresholds and pain tolerances, as well as reductions in pain intensity ratings during and after exercise. In this study, researchers examined whether EIH occurred in women after short duration submaximal isometric exercise, and whether the responses were limited to the exercised hand or had occurred in both hands. Fourteen healthy women aged 18 to 22 were evaluated. Results showed that hypoalgesia occurred after isometric exercise performed for 2 minutes. Pain thresholds were significantly elevated while pain ratings were lower after exercise. EIH occurred in exercised and nonexercised hands. The authors noted that activation of endogenous opioid systems during exercise may be responsible for the hypoalgesic response. Pain Medicine Highlights The following highlights summarize selected articles from the October/November 2007 issue (volume 8, number 7). Transdermal Fentanyl Reduces Pain and Improves Functional Activity in Neuropathic Pain States Shefali Agarwal, Michael Polydefkis, Brian Block, Jennifer Haythornthwaite, Srinivasa N. Raja, The Johns Hopkins University, Baltimore, MD In a 16-week open-label study, researchers from John Hopkins University examined the effects of transdermal fentanyl on pain and function in patients with chronic neuropathic pain states. The study evaluated pre- and post-drug therapy effects. Patients wore actigraphs and recorded their pain scores (0–10 scale) three times daily. Activity levels were continuously measured throughout the day (8 am-8 pm). After a 2-week baseline period, patients entered a 6-week drug titration period in which the transdermal fentanyl dose was titrated twice weekly based on analgesic response. After the titration period, an 8-week maintenance period followed. Results showed a significant reduction in pain and percent pain relief with an accompanying increase (37.4%) in daytime activity. Researchers observed that, “transdermal fentanyl is effective in reducing neuropathic pain, with a trend toward a greater decrease in pain intensity in patients suffering from peripheral neuropathy compared with those suffering from CRPS-1 and postamputation pain.” Evaluation of the Iowa Pain Thermometer and Other Selected Pain Intensity Scales in Younger and Older Adult Cohorts Using Controlled Clinical Pain: A Preliminary Study Keela Herr*, Kevin F. Spratt†‡, Linda Garand§, Li Li¶ *The University of Iowa, Iowa City, IA †Dartmouth Medical School, Hanover, NH ‡Multidisciplinary Clinical Research Center, Hanover, NH §University of Pittsburgh, PA ¶Zhujiang Hospital, Southern Medical University, Guangzhou, Guangdong, China Inadequate assessment of pain and pain relief is a barrier to optimal patient care. Researchers evaluated the sensitivity and utility of the Iowa Pain Thermometer (IPT) and other pain intensity scales in 61 younger (age 21–55 years) and 36 older (age 65–87 years) patients with arthritic pain at two rheumatology clinics. Patients received a standard joint injection that included a steroid plus lidocaine and reported current pain intensity before and after the injection using the following scales: IPT, Numeric Rating Scale (NRS), Verbal Numeric Rating Scale (VNS), Faces Pain Scale (FPS), and Visual Analog Scale (VAS). The results showed that the IPT demonstrated the lowest failure rate of all the scales evaluated. There was no significant difference noted in scale failure by age, gender, or education level, but cognitive impairment was significantly related to failure on the VAS and the NRS. All five pain scales detected changes in pain intensity before and after joint injection. Authors concluded that, “Based on sensitivity to change, lower failure rates, higher preference evaluations, and little appreciable effects associated with cognitive impairment, the IPT was judged to be the best choice for assessing pain intensity for both age cohorts and warrants further study."   Reminder: Call for Leadership Nominations Do you possess leadership qualities such as vision, strategic thinking, and motivation? Are you dedicated to APS and its mission? Do you know someone who is? If you answered yes to any of these questions and have not yet done so, send the APS Nominating Committee your nominations for the upcoming election. Open positions include secretary, three directors-at-large, and seven positions on the nominating committee. Nominees must be APS Regular Members, and most importantly, want to achieve positive outcomes for the society, its members, and those who are served by its efforts. Elections for these positions will take place this winter and the new leaders will take office at the 2008 annual meeting. Position descriptions, a current list of board and nominating committee members, position vacancies, and the disciplinary composition and geographic representation of the board are available at the APS Web site. Please take advantage of this opportunity to be involved in the nomination process. Your participation is important to the future of APS.   Clinical Centers of Excellence in Pain Management Awards Program Deadline Rapidly Approaching Applications due December 14 The Clinical Centers of Excellence (CCOE) in Pain Management award honors programs or services that exemplify the provision of outstanding clinical care. 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. Selection of awardees will be based on judgment of the quality of services provided and not program size. Attempts will be made to balance service excellence with available resources. The CCOE award honors programs that provide care that is patient-centered, state-of-the-art, evidence-based, and safe provide appropriate access to multidisciplinary and multimodal care through the involvement of specialists from a variety of disciplines to ensure expert care act as local champions to improve pain management in systems of care that are related to the program, and/or are regional or national demonstrate innovation and serve as models of excellence in the structure, processes, and outcomes that are critical for excellence in pain management. actively work with other health care organizations, health care providers, and the community to improve the quality of pain management across the continuum of care demonstrate a commitment to advancing and applying current scientific knowledge related to pain and disseminating relevant information to patients, colleagues, and the public. The 2008 recipients will be honored at an awards gala, which will take place on Thursday, May 8, during the APS Annual Scientific Meeting. A Look Ahead: APS Annual Meeting May 8–10, 2008 Tampa, FL APS is pleased to announce the 2008 plenary and keynote speakers. Keynote Allan Basbaum, PhD Plenaries Gary Macfarlane, MBChB PhD Mitchell Max, MD John N. Wood, PhD DSc Data Blitz for Clinical and Basic Science Research Wednesday, May 7, 7 pm Kick off your annual meeting experience during the Data Blitz for Clinical and Basic Research. Speakers will make short slide presentations and participate in a moderated question-and-answer session. Visit the APS Web site, www.ampainsoc.org, in January for more details and instructions on how to submit your work for possible presentation. Make Your Hotel Reservations for the APS Annual Meeting APS has secured a limited number of sleeping rooms at a special rate at the following hotels: Tampa Marriott Waterside Hotel & Marina 700 South Florida Avenue Tampa, FL 33602 $195 single/double Embassy Suites Downtown Tampa Convention Center 513 South Florida Avenue Tampa, FL 33602 $189 single/$199 double Reservations can be made online, by fax, or by mail using the APS housing form, which can be found on the APS Web site at www.ampainsoc.org. These rates are guaranteed until April 4, 2008, based on availability. Reservation requests must be sent directly to the APS Housing Bureau through May 1, 2008. Do not send the housing form to APS headquarters or individual conference hotels; this will delay processing your request.   APS Board Meeting and Strategic Planning Session The APS Board continued the important ongoing process of strategic planning in early October at the national office. Strategic planning guides the development of a long-range vision for the society through an ongoing planning process. This process is being developed with the assistance of Glenn Tecker, president and CEO of Tecker Consultants. Tecker engaged the board in discussions about the future of APS including emerging themes, conditions, trends, and assumptions raised by recent electronic surveys. The board’s goal is to revisit and reaffirm the envisioned future of APS and develop goals to support that vision. Watch for more information on this important process and initiatives that will be coming soon.   Southern Pain Society Annual Meeting Highlights More than 100 people attended the Southern Pain Society (SPS) Annual Scientific Meeting, “Evaluating and Treating the Pain Patient with Complex Problems,” in late September at the Gaylord Opryland Resort in Nashville, TN. The meeting was preceded by an evening satellite session on opiate monitoring and detoxification strategies by Nashville addictionologist Michael Baron, MD, and noted forensic toxicologist Robert Foery, PhD. Meeting highlights included presentations by the SPS President Dan Doleys, PhD, on the value of psychologically preparing patients for interventional therapy; a lecture by urologist Dean Knoll, MD, on endocrine effects of opioid administration; and a keynote lecture by Tennessee Democratic Congressman Jim Cooper, JD, on healthcare economics and its effect on medical practice. Moreover, internationally recognized pain experts Marshall Bedder, MD, and, Christopher Roberts, MD, gave a special-event presentation on advanced aspects of neuromodulation. Other highlights included a breakfast meeting featuring an update on migraine therapy by neurologist Stephen Landy, MD; a presentation by Jennifer Bolen, JD, on the legal aspects of the practice of pain medicine; a discussion on the links between pain and depression; and an update on billing and coding for interventional procedures. Other meeting presentations focused on pain rehabilitation, triaging the implanted patient, advances in neuraxial infusion therapy, transcutaneous electrical nerve stimulation therapy, and a guide to the critical reading of pain literature. During a post-meeting satellite session, internationally-recognized experts Drs. Howard Heit, Douglas Gourlay, and Mel Pohl discussed using opioid analgesics for complex patients, including those with addictive disorders. Eastern Pain Association Annual Meeting Highlights The Eastern Pain Association (EPA) Annual Meeting, “Innovations in Pain Medicine the Future is Now,” at the New York Academy of Sciences in Manhattan was attended by an enthusiastic and highly interactive audience of pain researchers, healthcare practitioners, and other professionals. Held September 7–8, 2007, the meeting included cutting edge presentations on new therapies and insights on established therapies. A presentation on osteoarthritis therapies discussed COX-2 inhibitors and the controversy surrounding the use of nonsteroidal antiinflammatory agents. Two complimentary lectures addressed immunologic aspects of pain and its associated symptoms. Drs. Robert Dantzer and Joyce DeLeo discussed the use of pro-inflammatory cytokines and CNS immunologic mechanisms, respectively. Later, a roundtable discussion focused on promising pharmaceutical developments for pain, an update on drugs discussed last year, and a presentation by the FDA’s Dr. Bob Rappaport on the upcoming analgesic drug guidelines. John J. Bonica Award recipient Dr. James Eisenach presented a lecture on “Obstetrics: Pain Fibers (but not pain) Speed Labor and Protect Against Chronic Pain.” Against a background of a glittering Manhattan skyline, APS President Judith Paice capped off the first day with a dinner lecture on pain relief and “the essence of humanity.” Saturday was devoted to a review of fibromyalgia, including diagnostic and therapeutic innovations. Topics included an overview of the clinical presentation and behavioral comorbidities of fibromyalgia; current pharmacologic, behavioral, and alternative therapeutic modalities therapies; and innovative fibromyalgia evaluation and therapy. A workshop on botulinum toxin to treat headaches was particularly well received. Due to the overwhelmingly favorable response to the meeting site, EPA is planning to return to the New York Academy of Sciences for the 2008 EPA Annual Meeting on September 12, 2008. Please join your colleagues for another stimulating and educational meeting in a most inspiring location.   Midwest Pain Society The Midwest Pain Society held its 31st Annual Scientific Sessions on October 26-27, 2007, at the Northwestern University Medical School in Chicago. The initial session dealt with pain in trauma victims. Randy Roth, PhD, presented data indicating that post-traumatic stress symptoms represent a significant complicating factor in the treatment of chronic pain, while Steven Krause, PhD, addressed the role of cognitive appraisal as a mediating variable in the relationship between childhood maltreatment and the eventual development of chronic pain. Elizabeth Renaud, RN, addressed controversies arising from the use of pain as a fifth vital sign in tertiary trauma care, and Sam McLean, MD, provided a comprehensive overview of risk factors leading to the development of pain following motor vehicle accidents. APS President Judith Paice, PhD RN FAAN, gave the keynote address on "Pain Management-The Essence of Compassion." Citing Stanley Milgram's famous study on obedience to authority, she discussed interpersonal dynamics in medical settings that may lead to undertreatment of pain and proposed solutions to counteract them. Afternoon sessions were devoted to translational research and headache. In the former, Fletcher White, PhD, discussed recent research on the pathophysiology of CRPS, while Vikram Patel, MD, discussed the applications of this work in the clinical setting. John Flaherty, MD, and Honorio Benzon, MD, addressed similar parallel issues regarding Herpes Zoster. In the headache session, interdisciplinary perspectives were offered regarding both basic science and clinical issues. Nabih Ramadan, MD, offered a thorough overview of migraine mechanisms, while Jennifer Kriegler, MD, addressed the clinical challenges of chronic migraine. In a similar vein, Deborah Zajac, RN, addressed the use of infusion treatments for refractory headaches, while Julie Roth, MPT, provided a fine overview of musculoskeletal issues germane to headache treatment. The Saturday morning sessions addressed pain in Iraq and Afghanistan War veterans. Matthew Bair, MD, addressed the increasing complexity of battlefield injuries, while Shelley Silvers, PhD, discussed the unique psychological challenges of returning soldiers with chronic pain. The meeting concluded with several presentations on recent advances in interventional pain management. Steven Silverman, MD, addressed interventional strategies for treatment of head and neck pain; Nalini Seghal, MD, discussed management of pain following failed back surgery. Attendance increased by 30% over previous years, reflecting considerable interest in the topics. The Midwest Pain Society plans to hold its next meeting in Chicago in September 2008.   Visiting Professorships in Pain Medicine The American Academy of Pain Medicine (AAPM) and Pfizer Inc are sponsoring visiting professorships in pain medicine. This program facilitates in-depth, educationally focused visits by prominent medical experts to U.S. medical schools and teaching hospitals. These unrestricted educational grants are nationally competitive, and grant recipients are chosen by an independent academic advisory board of recognized leaders in pain medicine. For more information visit www.promisingminds.com/AwardDetails.aspx?ProgramID=309 Fellowship Opportunities in Pain Research and Pain Management The APS Web site features a list of fellowships in pain research and management. The program listings were submitted by APS members and include such details as eligibility criteria, length of program, size of program, description and funding. If you would like to submit your fellowship program for inclusion in this online resource, visit http://www.ampainsoc.org/ce/fellowships.htm   Need a Tax Break? Donate and Be a Part of the APS Dream. How will your donation make a difference? Your donation will be used to help to raise awareness in the healthcare community and among the public about the importance of adequate pain management and it will bolster support for better laws and increased research funding in the field of pain management. We invite you to join us and help us fulfill our dream to “move the hearts of all men.” For a $25 donation, you will receive a handsome lapel pin with our sincere appreciation. If you would like to make a contribution to the APS Dream No Small Dreams Campaign, call the American Pain Society at 847/375-4715 to make a credit card contribution. Or send your check payable to the APS Dream No Small Dreams Campaign to: APS Dream No Small Dreams Campaign PO Box 3781 Oak Brook, IL 60522 Looking for a Unique Gift? Beautifully crafted campaign-theme scarves, ties, T-shirts, posters, and note cards make wonderful gifts for family, friends, and colleagues. Each item features the unique Dream No Small Dreams artwork. A portion of the purchase price includes a donation to the Dreams Campaign. Learn more here or by calling your Member Services representative at 847/375-4715.