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APS is pleased
to announce the national election results. Thanks to the nominating
committee for their hard work and to everyone who participated in
the election. Congratulations to those who were elected! Nominating
Committee/Past President Nominating
Committee/Members-at-Large *Michael Gold was appointed by the APS Board of Directors to fill the vacancy left by Charles Inturrisi (now President-Elect).
Honoring Multidisciplinary Pain Care
With 30 years of leadership in pain management, the American Pain Society initiated a Clinical Centers of Excellence (CCOE) in Pain Management Awards Program to recognize and reward top-quality clinical care in pain management. This was an ambitious effort for APS and involved the time and talents of many individuals. APS wishes to thank the CCOE program development committee—co-chairs Russ Portenoy and Deb Gordon and committee members Christine Miaskowski, Judy Paice, Lori Reisner, Michael Byas-Smith, Robert Jamison, and Steve Weisman—as well the final review committee co-chairs Judy Paice and Dennis Turk and committee members Michael Byas-Smith, Steven Weisman, Lonnie Zeltzer, and Mark Jensen. APS would also like to thank the staff for its administrative oversight and Endo Pharmaceuticals for providing the vision and financial support to create this program. APS is extremely proud to recognize its first group of CCOE award recipients. They are
These programs represent the many clinical programs throughout the United States that overcome difficult challenges to provide exemplary multidisciplinary pain care to their patients. APS also recognizes the following programs as 2007 CCOE honorable mentions:
Eligibility The CCOE award is intended to honor 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 was eligible to apply. Criteria The Clinical Center of Excellence in Pain Management Award honors programs that
APS would also like to acknowledge the following companies for their generous support of this program: Endo Pharmaceuticals, Pfizer, Inc., Abbott Laboratories, Cephalon, Inc., King Pharmaceuticals, and Merck & Co., Inc.
CCOE Gala at the Smithsonian Museum of Natural History
APS believes that a special award deserves a special celebration. To mark this milestone and honor the 2007 award recipients, APS will host a gala at its Annual Scientific Meeting next month. This celebration will take place at the Smithsonian National Museum of Natural History on Thursday, May 3. That evening, recipients and hundreds of guests will enjoy cocktails and dinner and countless wonders at the Smithsonian, such as the Hope Diamond. Guests will have cocktails and hors d'oeuvres in the Gems and Minerals Halls, whose walls are lined with some of the finest jewels in the world. The evening's presentation will include remarks from the APS leadership, an award presentation, and acknowledgement of industry partners who have supported this magnificent program. Please show your support and commitment to multidisciplinary pain care by attending this prestigious event. Tickets can be purchased online for $100 per person here. Transportation to and from the museum will be provided from APS headquarter hotels. The funds collected are for cost recovery; this is not a fundraising event.
The
NIH Pain Consortium Symposium The National
Institutes of Health (NIH) Pain Consortium will host its second
annual symposium, Advances in Pain Research, immediately before
the APS Scientific Meeting. The NIH Pain
Consortium was established to enhance pain research and promote
collaboration among researchers across the many NIH Institutes and
Centers that have programs and activities addressing pain. The NIH
Pain Consortium is made up of representatives from 20 institutes,
centers, and offices across NIH. It is co-chaired by Lawrence Tabak,
DDS PhD, Director, National Institute of Dental and Craniofacial Registration to the Symposium is at no cost, but required (see below). For the agenda, directions, and online registration information see the symposium link at www.edjassociates.com. The symposium will be videocast live, podcast, and archived at videocast.nih.gov. For more information contact Victoria Wang by telephone at 240-221-4037 or by email at pain2007@edjassociates.com. Organizing
Committee John W. Kusiak,
PhD Kathy Mann Koepke,
PhD Ann O'Mara,
RN PhD David Thomas,
PhD Barry Davis,
PhD Ann Berger,
MD
26th
Annual Meeting
Click here to access the abstract database. To register for the meeting, visit ampainsoc.org/meeting.
The Journal of Pain Highlights
Assessor
Status Influences Pain Recall Researchers from the University of Michigan observed pain and mood in 70 patients with low-back pain. At their 2-week follow-up, patients were asked to recall their post-procedural rating at the time they received epidural lumbar injections. Because there are no biomarkers for pain, subjective patient reports are used extensively in pain intensity evaluations. In this study, patients who were called by physicians gave pain ratings that closely matched the post-procedural ratings. However, those phoned by research assistants gave significantly worse pain ratings, showing a clear assessor bias in the pain ratings. From a clinical perspective, the researchers noted that physicians depend on patient pain recall to assess trends and progression of therapy. From the study, it cannot be concluded that physicians or research assistants give inaccurate pain assessments. However, intensity ratings do differ based on the status of the reviewers. It was recommended that serial pain assessments should be done by individuals of similar status over time to minimize reporting biases.
Older, inexpensive antidepressant medications in the tricyclic classification often are prescribed to treat neuropathic pain. In various studies, several of these agents have been proven to block peripheral nerve sodium channels, which may be responsible for their analgesic action. Scientists from Merck Research Laboratories compared the sodium blocking abilities of several tricyclic antidepressants as well as some newer agents, known as selective serotonin reuptake inhibitors (SSRIs). Results showed that all drugs tested have some sodium channel blocking activity with the tricyclics amitriptyline, nortriptyline, imipramine, desipramine, and maprotiline having therapeutic efficacy for treatment of neuropathic pain as well as depression. The SSRIs tested were fluoxetine, paroxetine, mianserine, and zimelidine. They showed channel-blocking ability but were not as efficacious as tricyclics for treating post-herpectic neuralgia and diabetic neuropathy. The researchers concluded, "Since neuropathic pain is a complex phenomenon that may involve a diversity of pain-signaling mechanisms, depending on patient population and underlying cause of the disease, it is likely that antidepressants derive their superior efficacy from the combination of several pharmacologic mechanisms. Our results suggest that one of these mechanisms is the blockade of peripheral nerve sodium channels."
Brain imaging studies have identified a pain system that is activated in response to physically noxious stimuli. This neural network has been called the pain matrix. Researchers from the University of Liverpool investigated whether the pain matrix could be activated by the recall of pain memories in the absence of overt pain stimuli. Fourteen pain-free subjects were asked to recall painful episodes in response to hearing pain-related words. The results showed that recall of pain memories did activate the pain matrix and suggest that pain-free individuals have a pain-processing network that can be activated by the cognitive reappraisal of a painful event triggered by pain-related words.
While it is well established that the cyclooxygenase enzyme plays an important role in the induction of pain and inflammation, researchers from the National Institute of Dental and Craniofacial Research evaluated the expression of COX-1 and COX-2 following extractions of impacted molars. Biopsies were performed on the extraction sites to assess levels of COX-1 and COX-2. The results showed that COX-1 is responsible for the immediate response to inflammatory stimuli and COX-2 becomes the primary contributor to prostaglandin production as inflammation progresses. The outcome of this study showed the peripheral elevation of COX-2 after tissue trauma. This may contribute to increased prostaglandin levels at the site of injury, the onset of pain, and the analgesic activity of nonselective and selective COX-2 inhibiting agents.
APS Members Speak at NIDA Conference on Opioid Abuse Opioids are not dangerous if used properly, stressed Nora Volkow, MD, director of NIH's National Institute on Drug Abuse (NIDA), at a recent NIDA-sponsored conference on pain, opioids, and addiction in Washington, DC. "We need to develop the knowledge that maximizes our ability to use them properly." So began a conference where three APS members spoke—and despite their differing views on the topic, they were impressed by NIDA's measured approach to the opioid abuse problem. APS E-News asked them about their presentations, attendees' reaction to their talks, and their views of the conference that was also sponsored by the American Medical Association and the NIH Pain Consortium. APS members who spoke presented their own opinions and did not represent APS in any official capacity.
Foley said further that history shows that patients are able to use opioid drugs safely and effectively. There is "no evidence of any major degree of prescription drug abuse" over extended periods of time, such as between the early 1980s and 1996, she said. On the contrary, patients have been able to maintain analgesia often for several years, and those who received effective treatment have "rapidly discontinued their drugs." This raises several questions, Foley said. To what extent does pain change the response to opioid analgesics? How is the patient or system of care different for patients with cancer versus those with chronic nonmalignant pain? And given increased survival rates among cancer patients, how do we distinguish between treatments for cancer patients and those with chronic nonmalignant pain? Both types of patients "may have the same problem like post herpetic neuralgia," she said. "Is the cancer patient more deserving than a noncancer patient? I don't think so." Attendees' interest in and reaction to her talk were strong. For example, a primary care physician from Maine whose patients include teens addicted to Oxycontin said he thought she was trivializing the problem. "I have a great deal of respect for [those] difficulties," Foley said, "but that's a law-enforcement issue, not a doctor issue." As for her view of the conference, Foley said, "my concern about this meeting is that its purpose suggested, at least to me…a relationship between the use of opioids in patients with chronic nonmalignant pain and prescription drug abuse….It continues to be a concern." She added, however, that the NIDA staff and Dr. Volkow were very respectful of the needs of pain patients and wanted to address those needs.
"There's no doubt but that opioid prescribing is strongly connected to opioid abuse," Katz said. "It's impossible any longer, as much as some would like to think otherwise, to conclude that 'it's not our prescriptions after all'—it is our prescriptions after all. Always has been. Always will be. It's been known for thousands of years and will continue to be that way in the future." According to Katz, it is well known that from 20%–40% of patients on long-term opioid therapy have active substance abuse disorders. Second, among people prescribed opioids, about 30% of them develop new problems with misuse or abuse of opioids. Also, a "significant" percentage of people with prescription opioid addictions obtain the medications they abuse either directly or indirectly from prescriptions by U.S. doctors—either from single or multiple physicians or from friends and family under physicians' care. "It's not a question of blame. The doctor is trying to relieve pain and that remains doctors' most ancient obligation," Katz said. "It's not a matter of their doing something wrong; it's more of a matter that they're in a critical position to improve the public health by paying greater attention to how they use their prescription pads." Katz said that conference attendees were relieved to hear someone address this issue clearly and publicly, and breathe "reality in this conversation." He added that this conference was notably different than others because of the respect and appreciation paid to clinical science. Several presentations, such as those on the use of functional neuro-imaging to study pain pathways or on genetic libraries to study risk factors for opioid abuse, demonstrate that scientific methods are being applied to actual clinical material. "This really inaugurates a new type of conversation in the area, which is very exciting to me," he said.
"Patients with mental health and substance abuse disorders have been excluded from the efficacy trials to date," Sullivan said. "In chronic pain, they've been excluded as high-risk patients when in fact if you look at current clinical practice they are precisely the people who are most likely to get medication. There's a serious mismatch between the evidence base and clinical practice in this area." As for his view of the conference, Sullivan said: "I think establishing a dialogue between pain people, with [their] palliative care ethos, and substance abuse people is very important so that we don't get some sort of irrational, natural knee-jerk reaction to the escalating rates of opioid abuse—when in fact the nature of the link between increased rates of prescriptions for chronic pain and increased reports of abuse is not clear at all." Sullivan stressed that the relationship between opioid abuse and increased use of opioids for chronic pain is unclear. "Are we turning patients into addicts by giving them opioid prescriptions? We don't know," he said. "The data could be compatible with that, but surveys of adolescents reveal they are getting pills from friends for injuries (and some to get high)—but a lot of the 'nonmedical' use is basically people getting pills from family and friends to just use for …what they think are pain problems." Sullivan acknowledged that APS members are concerned about increased regulatory oversight or scrutiny. "I think that NIDA, while it has a mandate to pay attention to disturbing trends in opioid abuse, is trying to be measured and informed about what they're doing," he said, "Nora Volkow tried to make that clear." Share your thoughts about opioids with APS E-News. Fill out the survey below.
American Society of Consultant Pharmacists Foundation Pain Management Traineeship The American Society of Consultant Pharmacists (ASCP) Foundation invites applications for the Pain Management Traineeship, a postgraduate traineeship in pain management focusing on the geriatric population. The traineeship offers unique opportunities for pharmacists to learn new skills, sharpen existing skills, and render new services. The Pain Management Traineeship is conducted at Hospice of the Western Reserve in Cleveland, OH, and Heartland of Mentor, in Mentor, OH. The 5-day, full-time traineeship provides individualized, intensive, didactic, and experiential training for pharmacists. It provides pharmacists the opportunity to observe and participate in the development of treatment plans for persons suffering from acute and chronic pain conditions. Trainees gain considerable knowledge of the etiologies and pathophysiology of pain and the appropriate diagnosis and assessment of acute and chronic pain. In addition, trainees gain understanding of appropriate treatment for pain symptomology, including both pharmacologic and nonpharmacologic interventions; management of medication side effects and complications; barriers to appropriate care and treatment; the significant role of patients and caregivers as members of the treatment team; and legal and regulatory issues. The traineeship also offers the opportunity for pharmacists to work with an interdisciplinary team consisting of pharmacists, physicians, nurses, nurse aides, social workers, family members, other caregivers, and patients to positively impact the treatment outcome. For more information, click here.
Incentive Grants for Serving Patients with Pain Management The American Pharmacists Association Foundation will award grants in the amount of $1,000 for projects to be initiated to support a pain management practice model in ambulatory care practice settings that improves patient care and treatment. The project may include patient education, screening, wellness and/or support services in an effort to address the spectrum of patient and provider needs in pain management. These incentive grants provide seed money to help pharmacists initiate a 12-month innovative practice project or to support an already existing project within one's practice that focuses on serving patients with pain management. For more information, click here.
FDA Proposes New Procedures for Membership on Advisory Committees The U.S. Food and Drug Administration (FDA) recently announced new draft guidelines that would implement a more stringent approach for considering potential conflicts of interest for its advisory committee members and for recommending eligibility for meeting participation. The FDA is accepting public comments on the proposal. The FDA currently screens all prospective advisory committee participants before each meeting to determine whether the potential for a financial conflict of interest exists. Under law, the FDA may grant a waiver when certain criteria are met, such as when the need for an individual's expertise outweighs the potential for a conflict of interest. The draft guidance document would replace the guidelines issued in 2000 on FDA Waiver Criteria. The 2000 guidelines attempted to address the complex set of variables that can be applied in reaching a decision about an individual advisory committee participant. However, because of its complexity, the FDA officials found it difficult to achieve consistent results that the public could readily understand. This new guidance would reduce the likelihood that the process for recommending waivers would vary from meeting to meeting. In addition to a more streamlined approach for considering who may participate in meetings, the FDA would tighten its policy for considering eligibility for participation. If an individual has disqualifying financial interests whose combined value exceeds $50,000, after applying certain exemptions, the person would generally not be considered for participation in the meeting, regardless of the need for his or her expertise. If the financial interests are $50,000 or less, after applying certain exemptions, the individual might be recommended to participate as a non-voting member. Only individuals with no potential conflicts would be eligible to fully participate in meetings as voting members. Financial interest means the potential for gain or loss to a person (or their family and outside affiliations) as a result of the government's action on a particular topic. Financial interests screened include, but are not limited to, stock ownership, related research and consulting arrangements.
Pain and Policies Study Group Invites Feedback The Pain and Policies Study Group (PPSG) recently commented on the DEA's proposed regulation to allow a "prescription series," and posed several important questions about how the regulation will be interpreted by law enforcement and practitioners. The commentary is accessible on the PPSG Web site at www.painpolicy.wisc.edu/DEA/Rx_series.pdf. Comments are welcome.
To encourage member feedback and open a forum for idea sharing, APS is initiating a regular survey feature in APS E-News. We'll report on the results in future issues. This month's question is
APS has selected
the Grand Hyatt Washington and Renaissance Washington, DC Hotel
as headquarter hotels for the 26th Annual Scientific Meeting. When
making a reservation please be sure to indicate that you are attending
the APS conference. Because we are past the group rate cutoff date,
reservations will be taken on a space- and rate-available basis. Renaissance
Washington, DC Hotel
A
New Look at Heat Treatment for Pain Disorders, Part 1
Mayday Pain & Society Fellowship: Call for Applications for 2007 Apply online at painandhealth.org/maydayfellows/fellows.html. The Mayday Fund, a New York City foundation dedicated to alleviating the incidence, degree, and consequence of human physical pain, announced today that it will begin accepting applications for the 2007 Mayday Pain & Society Fellowship: A Media & Policy Fellows Initiative. This is the fourth year of the program designed to equip physicians, nurses, pharmacists, social workers, scientists, and legal scholars with the necessary skills to become effective advocates and spokespeople about pain issues in the United States and Canada. Developing their communications skills, the six experts chosen will be poised to move the field forward with their willingness to educate and work with the media, policymakers, advocates, and health and business leaders. Six fellows are chosen each year, and the fellowship program runs through 2009. Once selected, the six fellows will attend a 4-day training in Washington, DC (October 2–25, 2007), developing individual advocacy plans to include connecting with local and national media, writing opinion editorials, developing relationships with university public affairs and government relations leadership, and talking with state legislators and members of Congress. Each fellow will have 5 months of coaching with a communications officer to track progress on their plans. Mayday Fellows have succeeded in televised panel discussions, live radio, and television interviews; served as advisors to producers working on longer segments on pain; been accepted to a policy post on Capitol Hill; and published editorials and letters to the editor, to name a few. They use the tools they received in training to advance advocacy goals. Candidates for the fellowship must be accomplished experts in pain management, established at an institution with peer-reviewed research, and able and willing to devote a significant amount of time to using the skills learned in the fellowship. They must show an interest in going beyond their professional pursuits to inspire change and make an impact on the pain field. Those interested can apply online at painandhealth.org/maydayfellows/fellows.html.
PAIN Exhibit Launches Spanish Language Version The PAIN Exhibit recently launched a Spanish language version of PainExhibit.com. Feel free to take a tour by going to www.PainExhibit.com and clicking on "Espanol." |
The
abstracts to be presented as papers and posters during the annual
meeting are now available in an online searchable database. The
more than 340 abstracts represent the best innovations and research
in the study and treatment of pain. Plan your poster viewing experience
before the annual meeting by viewing the abstract titles, author
listings, and text online prior to your arrival in Washington, DC.
Abstracts can be searched according to poster number, author, title,
or keyword.
The
following highlights summarize selected articles from the April
2007 issue (volume 8, number 4).
Kathleen
M. Foley, MD, Memorial Sloan-Kettering Cancer Center: Although
asked to speak on the history of opioid use by patients with chronic
pain, Foley said that "the thrust of my talk was that I don't
see that opioid receptors know the difference between patients with
cancer and those who don't have cancer."
Nathaniel
P. Katz, MD MS, Tufts University, School of Medicine, Boston; Analgesic
Research: Katz's presentation focused on the nature of
prescription opioid abuse and the connection between opioid prescribing
and prescription opioid abuse. 
Mark
Sullivan, MD PhD, University of Washington: As part of
Sullivan's presentation on the epidemiology of chronic pain and
its treatment with opioids, he discussed preliminary study data
on trends in the use of opioids and highlighted the role that mental
health disorders play on both the use and potential abuse of opioids.
Past
issues of the APS Bulletin are archived online for your
convenience and reference. This month, we're highlighting an article
that you may have missed when it was first published: