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APS Annual Scientific Conference Gains National Media Attention This year's APS Annual Meeting in Washington, DC, attracted significant media attention. Seventeen journalists registered for the meeting. Public relations leading up to the conference emphasized the panel session, The Battlefield and Beyond, which covered the timely topic of pain management for wounded veterans returning from Iraq and Afghanistan. Writers for the Associated Press, Newsweek, and JAMA covered the session and conducted follow-up interviews with speakers Chester Buckenmaier, Michael Clark, Rollin Gallagher, and Robyn Walker. On May 7, the Associated Press issued a national wire story, "Doctors Urge Better Pain Care for Troops." AP Science Writer Lauren Neergaard's piece was picked up by more than 80 newspapers, Internet news services, and other media with an estimated combined audience of more than 20 million. Media outlets for the story included MSNBC, CBS News, Fox News, Philadelphia Inquirer, San Francisco Chronicle, Newsday, Los Angeles Times, Washington Post, Denver Post, Miami Herald, Orlando Sentinel, and Seattle Post Intelligencer. The cover story of Newsweek's June 6 edition was "The New War on Pain." Correspondent Mary Carmichael also covered the battlefield pain care session. She and her colleagues followed up after the meeting with extensive phone interviews with APS sources including the four panelists from the battlefield session as well as Judy Paice, Dennis Turk, Chuck Inturrisi, Gil Fanciullo, and Edward Covington. APS was the major influence on the tone and direction of the Newsweek story, "The Changing Science of Pain" The piece communicates several key APS messages:
Visit an interactive piece, Pain and Pathways, which provides a graphic presentation of how pain works. A still version of the piece was published in Newsweek. APS Board members Chuck Inturrisi and Gil Fanciullo were key sources and are credited in the piece. A JAMA article is scheduled for publication later this month and will provide more clinical detail about what was presented during the battlefield session.
New York Times Cover Story, "When Is a Pain Doctor a Drug Pusher?" A June 17 New York Times story by Tina Rosenberg explores many aspects surrounding the prescription of opioids in the treatment of pain. The story, which cites APS members Russell Portenoy and Scott Fishman, details the subjective nature of pain and the conflict doctors have about wanting to relieve suffering yet facing patients who might not be truthful about their pain. Physician deception by patients is an ethical dilemma with profound legal implications, at times leading to physician convictions. The rise of state-issued guidelines, such as the Washington State opioid-dosing guidelines are also discussed. The APS Board is working with the Pharmacotherapy SIG to respond to the Washington guidelines. To read the article, visit the New York Times online here. The Journal of Pain Highlights
Ketamine
as an Adjuvant for Treatment of Cancer Pain in Children and Adolescents Low-dose infusions of ketamine, a drug used as adjuvant therapy for chronic and acute pain in adults, could help provide significant pain relief for children with advanced cancer whose pain is uncontrolled by other pain medications, according to research reported in The Journal of Pain. Refractory pain is a common reason for hospitalization of children with cancer and often warrants prolonged stays. According to published studies, in a significant number of children with terminal cancer pain therapy appears to be inadequate. This is the first study examining the role of ketamine as an adjuvant treatment for children with advanced cancer and pain that doesn't respond to large doses of opioids, or in which there were serious side effects related to opioid use. In some patients, high opioid doses can be associated with hyperalgesia, allodynia, myotonia and seizures. Eleven children with advanced cancer were evaluated at George Washington University Medical Center, of which five were admitted for optimization of pain therapy. After administering ketamine, the researchers found that 8 of 11 patients (73%) had reduced need for opioids to manage their pain and improved ability to interact with relatives and friends. The authors noted that tolerance to opioids and possible opioid-induced hyperalgesia typically result in inadequate pain relief in young cancer patients. Ketamine possibly reversed opioid tolerance. Also, by increasing opioid efficacy and reducing side effects, the children became more interactive. The findings offer the potential that ketamine, by preventing or reducing opioid-induced tolerance or hyperalgesia, might be an effective adjuvant in the treatment of cancer pain in children.
Repetitive transcranial magnetic stimulation (rTMS) has been shown to be useful in treating some neurologic-based disorders, such as depression and seizures. More recently, there has been increasing attention devoted to evaluating the efficacy of rTMS for treating patients with chronic neuropathic pain. In rTMS treatment,
electric current passes through a coil applied to the head through
which the electric pulse passes to the cortex of the brain. It is
believed that rTMS influences cortical and subcortical neurons to
reduce pain transmission. The authors conducted a literature review
of 16 studies assessing the influence of TMS in pain management.
They reported the following:
The authors concluded that studies involving functional imaging will be necessary to clarify the neurophysiologic mechanisms that underlie rTMS analgesia.
The Call for Symposia and Corporate Satellite Symposia for the APS 27th Annual Scientific Meeting, May 7–10, 2008, is now available on the APS Web site. The deadline for the receipt of all proposals is Friday, July 27, 2007. Session moderators and faculty will be notified of their proposals' status in October 2007.
APS Future Leaders in Pain Management Small Grants Research Program Applications due July 27. Applications for the 2007 Future Leaders in Pain Management Small Grants Research Program are due July 27. This year APS will again award five grants in the amount of $20,000 each to those research proposals demonstrating the greatest merit and potential for success. This grant program has been established to fund research projects of doctorally prepared investigators who have not yet attained NIH RO1 level funding. The program's intent is to encourage research in pain that will add to the body of knowledge and to allow investigators to develop pilot data that will aid them in securing additional major grant funding. Research
Topics
Eligibility Deadlines APS gratefully acknowledges Cephalon and Endo Pharmaceuticals for their support of this program. For additional information, visit ampainsoc.org/news/052407_smallgrants.htm or contact APS at 847/375-4715 or info@ampainsoc.org.
The APS Awards Committee invites nominations for awards to be presented at the 27th Annual Scientific Meeting May 7–10, 2008 in Tampa, FL. To make one or more award nominations, complete the online electronic nomination form. Be sure to include all of the requested information. Nominations should be completed online by July 13, 2007. Please contact Jennifer Reinard at the APS office at jreinard@connect2amc.com with any questions. The committee solicits nominations for the following APS awards. (Click below to link to 2007 recipients as well as lists of past awardees.)
Volunteer
Spotlight: Knox Todd, MD
"During my emergency medicine residency, I became interested in pain and cross cultural issues that can impact the delivery of optimal care," said Todd. "I was contacted by the Mayday Fund about this work and they have been an important supporter of our work in emergency medicine." After joining APS, I became involved in the disparities group with Rich Payne. But it was Chris who made the APS sale, and I'm glad she did." After that, Todd's career interests continued to focus on pain and he became an active APS volunteer, serving on the Scientific Program and Nominating Committees. "I became friends with many APS leaders and was impressed with the depth and breadth of the organization. I deeply value the opportunity to interact with clinicians and researchers from other disciplines who are interested in pain." It didn't take long for Todd to make a lasting impression on his APS colleagues. He helped organize the Disparties SIG with Payne, Carmen Green, and Ray Tait. His perspective as an emergency-medicine specialist was valuable in identifying cultural biases and discrimination involving minority pain patients. "The emergency department (ED) handles tough pain problems everyday and disparity is a key issue," said Todd. "For example, sickle cell patients often are treated in the ED for the severe pain flare-ups associated with this condition and mutual medical mistrust between patients and emergency physicians is all too common." Recently Todd has expanded his research interests to palliative care and is trying to bring more of his emergency medicine colleagues into APS. "Pain management is a critical part of emergency medicine and emergency physicians must work well with pain specialists. APS is a highly valuable resource for emergency health practitioners of all disciplines." Todd noted that emergency medicine became a recognized specialty about 10 years before pain management. He has experienced the excitement, collegial enthusiasm, and professional satisfaction that comes with helping to build a new specialty three times in his life with emergency medicine, pain management, and now palliative care. Assessing the program from the 2007 APS meeting, Todd pointed to the session on pain care for wounded war veterans as an example of how the APS Scientific Program Committee brought a strong multidisciplinary perspective to a timely medical issue. "There always has been a strong connection between military medicine and emergency medicine," said Todd. "The session featuring Drs. Buckenmaier, Gallagher, Clark, and Walker not only garnered national media attention, it also provided APS attendees with a multidisciplinary perspective on this topic, drawing from anesthesiology, emergency medicine, psychology, and physical therapy." Todd is busy helping plan the scientific program for the 2008 APS meeting in Tampa. "It's too early to share anything about content yet, but you can be sure we're looking to make the program even better than 2007."
Online Access to Annual Meeting Sessions APS is pleased to present selected audio and slide presentations of the following sessions from the 2007 annual meeting. (Please note that you will be prompted to install software from WebEx Communications to view/listen to the presentations.)
Environmental scans reveal that medical challenges have shifted from acute to chronic diseases and conditions. Many of these diseases and conditions result from the complex interplay between and among one's genes, environmental factors, infectious agents as well as behavioral and social issues. Increasingly, investigators are turning towards multi-and interdisciplinary research approaches to help solve heretofore-intractable complex diseases and conditions. NIH has sought to meet these new challenges through a variety of activities and programs that span the NIH Institutes and Centers. Among these is the NIH Roadmap for Medical Research, the Neuroscience Blueprint and the NIH Pain Consortium. The NIH Roadmap for Medical Research has identified major opportunities and gaps in biomedical research that no single institute at NIH could tackle alone but that the agency as a whole must address, to make the biggest impact on the progress of medical research. The NIH Blueprint for Neuroscience Research aims to develop new tools, resources, and training opportunities to accelerate the pace of discovery in neuroscience research. 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 Pain Consortium also seeks to increase visibility for pain research, both within the NIH intramural and extramural communities, as well as outside the NIH, including various advocacy and patient groups. Research gaps that are best approached by trans-NIH participation are also being identified. Current trans-NIH activities related to the support of pain research and training were reviewed, including examples of exciting research presently being supported as well as future funding opportunities across the agency.
Pain clinicians need new drug therapies with decreased side effects in their armamentarium that affect different targets than what is currently available. To address these needs, there has been an exponential growth of research activity in the field of glial-immune interactions in the etiology of pain over the last decade. An explanation of how glial cells and immune mediators can cause the downstream mechanisms of enhanced neuronal firing or decreased thresholds to firing is beginning to emerge with very recent data. The synaptic involvement of glia in the pathogenesis of central sensitization draws upon concepts previously proposed by glial biologists for homeostasis, as well as in disease states, such as neurodegenerative disorders. Glia, which make up over 70% of the CNS cell population, are known to play a key role in both neuromodulation and recovery from injury and stressors. There is an intense debate over whether glia repair and maintain the CNS environment or whether they only play a deleterious role to enhance neuronal damage. An understanding of the dynamic interplay between neurons, astrocytes and microglia and how these cells modulate synaptic function is required to fully understand nociceptive processing. It is known that CNS glia control the composition of the extracellular milieu in terms of ions, amino acids and other neuroactive substances. Therefore, the ability to modulate their action may have major implications for effective and safe drug development. This presentation will provide an overview of glial biology, a timeline of glial developments in the pain field, major findings of glial-neuronal interactions in pain states and how these data will impact novel drug discovery.
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The
following highlights summarize selected articles from the June 2007
issue (volume 8, number 6).
Knox
Todd's decision to join APS in the early 1990s occurred after
a conversation with Christine Miaskowski. He was attending a pain
conference in Vienna when he encountered Christine and immediately
was recruited into the organization to help bring an emergency medicine
perspective to APS. Prior to joining, Todd had active research interests
in pain-management disparities.
American
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