Follow Us On
Contact Us
info@ampainsoc.org847.375.4715
American Pain Society
4700 W Lake Ave
Glenview, IL 60025
APS is pleased to offer the following session recordings from the Austin meeting. These recordings are not being offered for continuing education credit, and there is no fee to view the sessions. Click on the arrow within the video player box to view that particular session.
Josephine Briggs, MD
A variety of non-traditional health practices including acupuncture, manipulative therapies, relaxation techniques, imagery and meditation are being used by Americans as part of the management of chronic pain. Dr. Briggs will summarize data on the current patterns of use of complementary and alternative health practices for pain management, and outline topics of interest in understanding the mechanisms by which such approaches may modulate pain or improve function.
Frank Porreca, PhD
A majority of patients with neuropathic pain report that it has either a continuous or paroxysmal component that is not related to any applied somatic stimulus. However, most current preclinical models use enhanced responses to evoked stimuli as the primary measure of neuropathic pain. The measurement of non-evoked pain in animals has been difficult, and for this reason, its underlying mechanisms are poorly understood. We have recently shown that nerve injury induced spontaneous pain can be unmasked through negative reinforcement (King et al., 2009). Agents and manipulations that are clinically effective in alleviating neuropathic pain in patients produced conditioned place preference in nerve injured, but not sham-operated, rats when administered at sites that are not a part of the reward pathways. This method can be used to explore the neural mechanisms driving spontaneous neuropathic pain and to identify molecular targets that might be relevant to therapy.
Seddon Savage, MD MS, APS President
Dennis Turk, PhD (Moderator); Thomas Chelimsky, MD
Patrick Green, MBA; Jeff Livovich, MD
Steve Stanos, DO; David Tauben, MD
Kenneth Goldschneider, MD
Accumulating research supports the clinical effectiveness and cost-effectiveness of interdisciplinary pain care, yet many pain programs are on life-support and others have “died”. A number of suspects have contributed to the current situation; including third-party payers who are reluctant to cover the costs for interdisciplinary pain care and facility administrators who are unable or unwilling to absorb lost revenue attributed to these programs. However, pain care facilities that have failed to provide outcomes important to payers, and clinical investigators who have not performed well-controlled studies or effectively communicated their results are equally culpable and share the guilt. In this workshop: (1) the case of the demise of one program "successful" will be analyzed; (2) the evidence demonstrating the clinical and cost-effectiveness of interdisciplinary pain management will be summarized; (3) perspectives from “suspects” involved (ie, Hospital Administration, Third-party payer)will be presented; and (4)strategies used by "surviving" programs will be described. Practical suggestions for promoting successful programs will be presented from each perspective. This workshop will foster dialogue amongst participants to share effective strategies supporting the survival of interdisciplinary pain programs.
Henrik Kehlet, MD PhD
Persistent postsurgical pain adversely affects daily life for 5 - 30 % of patients after a variety of procedures. There is a general agreement that a neuropathic pain state is dominant. The key question is the relative role of patient vs. surgery related factors. Preoperative risk factors including the preoperative function of the nociceptive system, psycho-social factors and preoperative pain at the site of surgery or other parts of the body are well documented. Intraoperatively, nerve injury is the most important factor and where nerve identification or minimal invasion techniques may reduce risk. Although acute postoperative pain correlates to persistent pain this relationship is probably caused by a preoperative disposition to a hyperreactive nociceptive system and the studies on preemptive analgesia or effective postoperative analgesia to reduce persistent pain remain debatable. Pharmacological management follows the principles for neuropathic pain states.
Patricia Grady, PhD RN FAAN
Research in pain and its sequelae have been a long-standing priority for the NIH. Reflective of this commitment was the creation in 1996 of the NIH Pain Consortium. The Consortium was established as a trans-NIH initiative designed to advance pain research, improve pain management, enhance quality-of-life, and promote collaboration among researchers across NIH and beyond. Currently, over 20 NIH Institutes, Centers, and Offices are represented in the Consortium. This plenary session will address the history of the Consortium, its multi-faceted activities and goals within the NIH intramural and extramural communities, and current funding opportunities for pain researchers. Additional topics will include the Affordable Care Act of 2010 as it relates to the Consortium and training opportunities in pain research. Particular attention will focus on the pain research activities of the National Institutes of Health, including the National Institute of Nursing Research.
Theodore Price, PhD and Derek Molliver, PhD (Moderators); Frank Porreca, PhD; Narender Gavva, PhD; Chris Flores, PhD; Karin Petersen, MD
Pain drug discovery has been hard hit by the recent financial downturn. Problems have included decreases in federal funding and closing of pain drug discovery efforts in the pharmaceutical industry. Despite this, treating acute and chronic pain is still a major clinical problem. This session will include panelists who are leaders in academic and industrial pain research. Panelists will give short presentations that will encapsulate their ideas on how to move pain drug discovery forward and will be followed by a moderated discussion during which attendees will be encouraged to share their opinions and ideas on how to improve drug discovery for pain.
Robert Saner, JD
This session will provide an overview of recent legislative and regulatory developments of interest to APS members, and a preview of pending legislation that may be considered in the 112th Congress. Specific topics to be addressed will include: (1) enactment of much of the National Pain Care Policy Act as part of health reform legislation in 2010; (2) the status of implementation of Pain Policy Act provisions by the NIH Pain Consortium and the Institute of Medicine’s Conference on Pain; (3) implementation of the Veterans Pain Care Act by the VA Health System; (4) initial implementation of the Military Pain Care Act by the Defense Department; (5) proposed legislation in both the House and Senate to address the abuse and diversion of prescription painkillers; (6) the funding outlook for pain research at the NIH and professional training at the Health Resources and Services Administration; (7) the status of and funding for prescription monitoring programs at the Federal and state levels; and (8) the role APS members can play in advocating for progressive pain policies through effective interaction with their Senators and Representatives.
Arthur (Bud) DeWitt Craig, Jr., PhD
A spino-thalamo-cortical pathway unique to primates conveys homeostatic afferent activity beyond the spinal and brainstem cardiorespiratory integration regions, which are present in all mammals, directly to the dorsal posterior insular cortex. Functional imaging, lesion and stimulation evidence in humans all support the view that this pathway provides a somatotopically organized, primary cortical representation of the physiologic condition of the body, which can be called “interoceptive cortex.” This interoceptive pathway underlies all affective human feelings from the body, including pain, cool, itch, muscle ache, toothache, and so on.
Imaging evidence in humans suggests that the interoceptive activity in the posterior insula is re-represented first in the mid-insula and then in the anterior insula, where activation is observed in association with all subjective feelings and emotions. A model will be presented in which the progressive posterior-to-mid-to-anterior integration in the insula culminates, in the anterior insula, in a coherent representation of all salient conditions both inside and outside of the body at each moment of time. In this model, the anterior insula engenders fundamental aspects of human awareness. This model is consistent with the James-Lange theory of emotion and Damasio's "somatic marker" hypothesis, and it underscores the potential importance of the von Economo neurons (VENs) that are uniquely concentrated in the anterior insular and anterior cingulate cortices of hominid primates, especially humans.
Michael Rowbotham, MD
Clinical research on pain has undergone sweeping changes in the past two decades. Clinical trials of new therapies are now international affairs, enrolling many times more subjects per study than in the past. An entire industry of private, independent clinical research organizations has grown up. Much of the ethics debate has centered on the use of deception and whether or not placebos are necessary or desirable. This is just the tip of the iceberg and a full consideration of the ethics of clinical research requires a broader view. Can pain be considered an incurable disease? Is it ethical to ask a patient to taper off medications in order to enter a trial when their pain is already poorly controlled? What about patients with few prior attempts at treatment? Should some types of trials be limited to ‘refractory’ patients, and if so, how is that defined? What constitutes an appropriate comparison group for injection, surgical, and implanted device trials? Should a patient be asked to participate in a trial if they might have no chance of receiving the experimental treatment? Who should participate in clinical trials of potentially addicting medicatons? How can patients and clinicians get beyond ‘evidence-based reviews’ to become better informed? If a patient is eligible for multiple studies, what advice should the researcher provide? In this lecture I will attempt to put these and other issues into a broader framework for considering where we are now in clinical research and where the future might take us.
