Call for Award Nominations

The APS Awards Committee invites nominations for awards to be presented at the 28th Annual Scientific Meeting May 7-9, 2009 in San Diego, California.

To make one or more award nominations, visit the APS Web site and complete the electronic nomination form. Please be sure to include all of the requested information. All nominations should be completed online by July 25, 2008. Please contact Jennifer Reinard at the APS office at jreinard@connect2amc.com with any questions. The committee solicits nominations for the following APS awards:

John and Emma Bonica Public Service Award
Recognizes distinguished contributions by an individual or an organization to the field of pain through public education, dissemination of information, public service, or other efforts that further knowledge about pain. The recipient of this award need not be a member of APS, and the award may be given to either an individual or a group. The nominee must have produced a body of outstanding achievements through direct public service, dissemination of information and public education, or activities that have enhanced the field of pain and pain scholarship and have had a direct impact on the public.

Wilbert E. Fordyce Clinical Investigator Award
Recognizes individual excellence and achievements in clinical pain scholarship and is presented to a professional whose career achievements have made outstanding contributions to the field of clinical pain research and/or practice. Nominees must be APS members.

F. W. L. Kerr Basic Science Research Award
Recognizes individual excellence and achievements in pain research and is presented to a pain professional whose total career achievements make outstanding contributions to the field. Nominees must be APS members.

Jeffrey Lawson Award for Advocacy in Children's Pain Relief
This award was established in memory of Jeffrey Lawson, whose mother, Jill, brought to the attention of professional organizations the practice of performing surgery and other procedures on children without the benefit of analgesia. The award recognizes advocacy efforts to improve management of pain in children. The award may be given to a patient, parent, professional, other individual, or a group of individuals or an organization. This award is not restricted to APS members.

John C. Liebeskind Early Career Scholar Award
Recognizes early career achievements of individuals who have made outstanding contributions to pain scholarship or show substantial promise of doing so. For example, nominees must have made a series of distinguished empirical contributions to the field of pain or contributed substantially to the development of new theories or methods. Typically, nominees will be at the assistant professor level or its equivalent. The nominees must be APS members and must have received their terminal degree within the last 7 years. All nominees must have their vita and a supporting letter submitted by the individual(s) making the nomination.

Elizabeth Narcessian Award
Recognizes outstanding educational achievements in the field of pain. The award is given in memory of Elizabeth Narcessian, who lectured tirelessly on the mechanics of the appropriate use of opioids, patient assessment, and the various approaches to the rehabilitation of patients who have been devastated by chronic pain. Nominees must be APS members and must have made an outstanding contribution or innovation in education in the field of pain. All nominees must have their vita and a supporting letter submitted by the individual(s) making the nomination.

Distinguished Service Award
Honors outstanding and dedicated service to the American Pain Society and is presented to an individual or a group that has advanced the mission of the society in a significant and lasting way. Emphasis is given to a body of contributions, which have been made within the context of APS and on behalf of the society.

2009 Awards Committee
Judith Paice, PhD RN, Chair
Ronald Dubner, DDS PhD
Robert Edwards, PhD MPH
Perry Fine, MD
G. Allen Finley, MD FRCPC FAAP
Steve Passik, PhD
Srinivasa Raja, MD
Karin Westlund High, PhD

In Memoriam
Passing of Dr. Hubert Rosomoff

Long-time APS member and past president (1992-1993) Hubert L. Rosomoff, MD DMedSc, died on June 5, 2008, at the age of 81.

Dr. Rosomoff, founder of the The Rosomoff Comprehensive Pain and Rehabilitation Center, devoted his career to freeing patients from pain—first as a neurosurgeon and then through rehabilitative therapies.
In a 2004 interview with the APS Bulletin, he called the noninterventional multidisciplinary approach to pain, of which he was a pioneer, the "hallmark of pain medicine."

Dr. Rosomoff is widely recognized as a world authority on pain and its treatment. Among many accomplishments, he pioneered investigation of hypothermia for intracranial vascular surgery and developed techniques of cryosurgery. He also introduced several innovative surgical procedures for the spine.

In 1971, Dr. Rosomoff became professor and the first chair of the then new department of neurological surgery at the University of Miami School of Medicine.

In 1974, Dr. Rosomoff founded the University of Miami's Comprehensive Pain and Rehabilitation Center (now the Rosomoff Comprehensive Pain and Rehabilitation Center). He served as its medical director, and his wife Renee Rosomoff serves as program director. In 2007, APS honored the Center as one of its first national Clinical Centers of Excellence in Pain Management.

During his career, Dr. Rosomoff was a leader in APS and many other professional organizations including the International Association for the Study of Pain, the Eastern Pain Association, the American Academy of Pain Medicine, and the Southern Pain Society.

APS extends its deepest sympathy to Renee Rosomoff and the Rosomoff family.

APS Launches 2008 Small Grants Research Program

The call for applications for the 2008 Future Leaders in Pain Management Small Grants Research Program launched on June 11. 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.

Applications may be submitted online through the APS Web site and are due by midnight July 31, 2008. Grant awards will be announced by October 1, 2008.

To be eligible for an APS Future Leaders in Pain Management Small Grant, applicants must

• be APS members
• be within 6 years of completing their doctoral degree
• not yet been awarded major NIH or foundation grant funding.

Click here to begin an application. For additional information contact APS at 847/375-4715 or info@ampainsoc.org.

Good Prospects for VA and DOD Pain Bills; NIH Measure Needs Push

It has been a successful year on Capitol Hill so far for the pain care community, but there still is much to be done to increase pain research funding at NIH.

On federal legislative matters, APS works within the Pain Care Coalition (PCC), which comprises APS, the American Academy of Pain Medicine, the American Headache Foundation, and the American Society of Anesthesiologists. The National Pain Care Policy Act, first introduced in 2003, was crafted by PCC and the measure keeps moving forward, although at a frustrating pace, in each session of Congress. The bill would focus support for pain research at NIH, setting the stage for better funding in the future. The bill awaits consideration by the House Energy and Commerce Committee.

At the beginning of the 110th Congress, supporters of the earlier National Pain Care Policy Act of 2005 (HR 1020, championed by Rep. Mike Rogers [R-MI] and now cosponsored by Rep. Lois Capps [D-CA]), worked with Congressional offices to create three new and separate bills with different congressional committee jurisdiction. "The goal was to ensure broad-based support and streamline congressional consideration. Together with our ongoing coalition-patient advocacy groups, physician organizations, and manufacturers working together toward a common goal—this three-part strategy has proved highly successful," said Robert Saner, legislative counsel for PCC.

Important provisions to improve pain care for active duty military personnel were introduced in the House as HR 5465, and subsequently included in the House-passed Department of Defense (DOD) bill for FY 2009. "I am hopeful that this effort will reach the finish line when the Senate acts later this summer," said PCC Chair Richard Rosenquist, MD.

Similar provisions to improve pain care in the VA Health System passed the Senate as part of S. 2162 last month. Companion legislation was introduced in the House as HR 6122, and the House VA Committee held a hearing on the bill this month. Rosenquist said the bill enjoys the support of the committee chair, and he's cautiously optimistic the VA measure will also be enacted this year.

"The VA pain bill has a 10-year requirement in which the VA must report to Congress every year and show the progress it has achieved in enhancing clinical care, research, and training in pain management. This will help keep veteran pain issues top of mind for the House and Senate," Saner explained.

However, Saner notes the status of the National Pain Care Policy Act of 2007 (HR 2994), with its NIH provisions, is less encouraging. "On the bright side, it has been endorsed by over 150 professional, patient, and industry groups, ranging from the American Medical Association to the American Cancer Society. Forty-three members of the House from both parties now support it, including many from the Committee on Energy and Commerce, which has jurisdiction over the bill. This wide support is a testament, in part, to the efforts APS and other societies have made in targeting key House members."

Saner added that if HR 2994 is to advance further this year all interested organizations must bring more pressure. "I'm sure that strong grassroots pressure will generate additional cosponsors for the bill," said Saner.

Saner encourages APS members to take action now by writing a letter, making a phone call, or visiting a House member's local district office or office in Washington. (Contact information is available by clicking on "Representatives" at www.house.gov.) Drive home the message that passing HR 2994 and promoting pain research and education is important to their constituents. Offer the PCC's DC staff as a resource if there are questions or concerns about the bill. Legislative staff can contact Bob Saner or Adam Chrisney at 202/466-6550 or rsaner@ppsv.com or adam.chrisney@ppsv.com.

Call for Symposia and Call for Corporate Satellite Symposia

Visit the APS Web site to access the submission forms for the Call for Symposia and the Call for Corporate Satellite Symposia for the 28th Annual Scientific Meeting, May 7-9, 2009, in San Diego. The deadline for proposals for both calls is July 25, 2008.

The Call for Paper and Poster Abstracts will be available on the APS Web site beginning September 1. Please watch future issues of APS E-News for updates.

Highlights from The Journal of Pain

The following highlights summarize selected articles from the June 2008 (volume 9, number 6).

A Randomized, Placebo-Controlled, Crossover Trial of Cannabis Cigarettes in Neuropathic Pain
Barth Wilsey, Thomas Marcotte, Alexander Tsodikov, Jeanna Millman, Heather Bentley, Ben Gouaux, and Scott Fishman, University of California-Davis

The growing body of evidence that marijuana (cannabis) may be effective as a pain reliever has been expanded with publication of a new study in The Journal of Pain reporting that patients with nerve pain showed reduced pain intensity from smoking marijuana.

Researchers at University of California-Davis examined whether marijuana produces analgesia for patients with neuropathic pain. Thirty-eight patients were examined. They were given high-dose (7%), low-dose (3.5%), or placebo cannabis.

The authors reported that identical levels of analgesia were produced at each cumulative dose level by both concentrations of the agent. As with opioids, cannabis does not rely on a relaxing or tranquilizing effect, but reduces the core component of nociception and the emotional aspect of the pain experience to an equal degree. There were undesirable consequences observed from cannabis smoking, such as feeling high or impaired, but they did not inhibit tolerability or cause anyone to withdraw from the study. In general, side effects and mood changes were inconsequential.

The authors noted that because high- and low-dose cannabis produced equal analgesic efficacy, a case could be made for testing lower concentrations to determine if the analgesic profile can be maintained while reducing potential cognitive decline.

In addition, the authors said further research could probe whether adding the lowest effective dose of cannabis to another analgesic drug might lead to more effective neuropathic pain treatment for patients who otherwise are treatment resistant.

Nonmedical Use of Prescription Opioids: Motive and Ubiquity Issues
James P. Zacny and Stephanie A. Lichtor, University of Chicago

Drug-use surveys have shown an increasing prevalence of nonmedical use of opioid pain medications. Researchers reported that critical information would be gained if motives for nonmedical use were studied more extensively.

Nonmedical use of opioids is defined as any nonprescribed use of the medication.

The authors reviewed the three major epidemiological surveys to measure the prevalence of nonmedical use of opioids, but focused on the National Survey on Drug Use and Health (NSDUH) survey because it is the largest annual U.S. drug-use survey.

A key drawback of the NSDUH survey identified by the authors is the instrument does not probe for motives or reasons for nonmedical use of opioids. For example, pain relief is a motive for using an opioid and so is getting high or inducing sleep.

The authors reviewed results from two Web-based surveys, one of which polled 4,580 students attending a large Midwestern university. To probe the prevalence of nonmedical use of opioids the questionnaire asked: "On how many occasions in a) your lifetime or b) in the last 12 months have you used the following types of drugs not prescribed to you?" Respondents were given eight drug choices. They were then asked to provide the reasons for taking nonprescribed pain medications.

The results showed that lifetime and past 12 month incidence was 14.3% and 7.5 %, respectively. Most of the respondents (63%) who said they were nonmedical users reported that pain relief was the motive. Other common reasons cited were "because it gives me a high" and "experimentation." However, just 40% of lifetime nonmedical users reported using opioids only to relieve pain.

Based on the Web survey results, the authors recommended the NSDUH survey add questions about motives and that survey officials should convene a summit with APS and other groups to move forward in this direction.

Pain Medicine Highlights

The following highlights summarize selected articles from the
April 2008 issue (volume 9, number 3).

Correlates of Postoperative Pain and Intravenous Patient-Controlled Analgesia Use in Younger and Older Surgical Patients
Lucia Gagliese, PhD, ^1,2,3, Lynn R. Gauthier, MA,^1,2 Alison K. Macpherson, PhD, ¹ Melissa Jovellanos, MSc, ^1,2 and Vincent W.S. Chan, MD ³

⁽¹⁾ School of Kinesiology and Health Science, York University, Ontario
⁽²⁾ Behavioural Science and Health Research Division, Toronto General Research Institute and Palliative Care and Psychosocial Oncology, Ontario Cancer Institute, University Health Network, Ontario
⁽³⁾ Department of Anesthesia and Pain Management, University Health Network, Ontario and Faculty of Medicine, University of Toronto, Ontario, Canada.

In spite of increased knowledge in the surgical field, many patients still experience considerable pain following surgery, causing some to wonder if there is a link between postoperative pain and patient-controlled analgesia. The goal of the study was to gain a better understanding of the demographic, surgical, and biomedical links of postoperative pain and IV patient-controlled analgesia (PCA) morphine intake.

A total of 504 patients, ranging in age between 18 and 86 years old, qualified to participate in the study. Patients were interviewed prior to the surgery to establish a baseline pain level. Approximately 24 hours after the surgery, patients were evaluated based on patient pain scales. Researchers found that although the correlates varied by age, the same factor often had a different effect on various age groups. Higher pain scores were more often associated with young patients. Higher pain was usually attributed to females, but it differed between younger women and older women. Younger females had higher pain with previous surgery without PCA, whereas older females experienced higher pain with previous experience of postoperative PCA. Males with either no previous surgical experience (older males) or lower morphine intake (younger males) experienced less pain. The study results showed the older patients were more likely than younger patients to have impaired physical status.

Open-Label, Multicenter Study of Combined Intrathecal Morphine and Ziconotide: Addition of Morphine in Patients Receiving Ziconotide for Severe Chronic Pain
Lynn R. Webster, MD, ¹ Keri L. Fakata, PharmD, ¹ Steven Charapata, MD, ² Robert Fisher, MD, ³ and Michael MineHart, MD ⁴

⁽¹⁾Lifetree Clinical Research and Pain Clinic, Salt Lake City, UT
⁽²⁾Pain Management Associates, Clinical Research Department, Kansas City, MO
⁽³⁾R.C. Goodman Institute for Pain Management, Sparks Regional Medical Center, Fort Smith, AK
⁽⁴⁾Advanced Pain Institute, Duarte, CA

In patients with severe chronic pain, a first-line intrathecal (IT) analgesic such as IT morphine is often prescribed. In other cases a patient might be given ziconotide, the first nonopioid intrathecal to be approved by the FDA. Some patients either do not respond to the morphine or require a combination of drugs. Results from animal studies suggest that use of an N-type calcium blocker (ziconotide) with morphine will have a positive result. This study was designed to determine if the combination of IT morphine and ziconotide in patients experiencing severe chronic pain will be both safe and effective. Attention was also given to the level of pain experienced by the patient and levels of opioids in the system.

The first phase of the study involved weekly clinic visits for 4 weeks, where ziconotide was administered in unchanging doses while morphine was gradually increased. Adverse events were closely tracked and vital signs were taken at each visit to monitor the safety of the trial.

The visual analog scale of pain intensity (VASPI) measured efficacy, as well as patient input on whether or not combination therapy provided additional pain relief compared to ziconotide. Twenty-three patients completed the first four weeks of clinic visits; 24 patients entered the extension phase. The VASPI scores improved by a mean of 26.3% from the beginning of the trial to the end of week 4. Although none of the patients reported complete pain relief, 68% experienced "moderate" or "a lot" of improvement in their pain. The study results present evidence for some level of decreased pain for patients who took the combination drugs; however, more studies are needed to back up the results of this smaller study.

Volunteer Spotlight: Mark Jensen, PhD

Mark Jensen dislikes serving on committees and attending committee meetings. But he makes a strong exception for his work with APS, in which he has toiled on several committees since he joined the organization in 1990.

Jensen currently serves on the APS Board of Directors and now Executive Committee with his recent election as secretary. He was first elected to the board in 2005 and also served as member and chair of the Scientific Program Committee.

"I look forward to all the APS committee meetings because the business at hand involves advancing the goals of the organization and fostering scientific exchange and education," Jensen said. "APS committee work is very productive because everyone is committed to the multidisciplinary approach to pain. Therefore, we don't see, for example, psychologists just pushing a psychology agenda. The kind of person attracted to APS wants to advance the science of pain management and is willing to work toward achieving the collective goals of the organization."

Jensen noted that APS committees stay on track with help from the preparation and overall facilitation by the association staff.

APS, in Jensen's view, succeeds because its multidisciplinary mission is aligned with understanding that multifaceted elements comprise the pain experience. "The multidisciplinary approach is the air we breathe at APS and that translates into advocacy for pain management that treats the whole person, not just the pain." Jensen further explained that the second major component of success for APS is the advancement of pain science.

For his "day job," Jensen is professor and vice chair in the Department of Rehabilitative Medicine at the University of Washington School of Medicine in Seattle. His primary research interest is understanding how psychological interventions, such as cognitive behavioral therapy and self-hypnosis training, alter the experience of pain and pain relief. He has become more interested recently in identifying the psychological and physiological processes that explain the efficacy of pain treatments. Jensen said he became interested in studying self-hypnosis as a pain therapy after reading a book published in the early 1990s in which the author described how self-hypnosis changed his life in handling pain from a spinal cord injury.

Jensen recalls that eight of the first ten patients he treated with self-hypnosis training said it was beneficial, and two called the experience "life-changing." These initial statistics seem to hold in more than 100 patients who have completed self-hypnosis training in Jensen's research program. Overall, between 20%-30% of the patients who use self-hypnosis report "substantial" and ongoing pain relief with the use of self-hypnosis; 50% say they can achieve short-term pain relief and other benefits, such as improved sleep; and 10%-20% say they get no relief from it.

Other projects on Jensen's research agenda are studies exploring how aging influences pain and the effects of pain in persons with disabilities. "What we want to learn is how the pain experience changes with advancing age for those with disabilities like spinal cord injuries, multiple sclerosis, and muscular dystrophies," he said.

27th Annual Scientific Meeting Session Recordings

APS is excited to offer online access to the audio recordings and slide presentations of speakers' lectures from the 27th Annual Scientific Meeting, May 8-10, 2008 in Tampa, FL. These recordings and slide presentations will remain accessible for several months. The recordings and slide presentations are available to APS members and nonmembers at no cost.

Click here to access the session recordings from the annual meeting.

Essentials in Pain Management: Principles and Practice Session Recordings

APS is also pleased to offer the audio and slide presentations of speakers' lectures from the Essentials in Pain Management: Principles and Practice course held in Tampa on May 6-7, 2008. The intensive
course was offered to third and fourth year residents and fellows in anesthesiology, neurology, family practice, emergency medicine, and physical and rehabilitation medicine. These recordings and slide presentations will remain accessible for several months and are available to APS members and nonmembers at no cost.

Click here to access the session recordings from Essentials in Pain Management.

APS is not offering continuing education credits for participation in these online sessions.

Pain and Policy Studies Group Announces New Online Course

The course, Increasing Patient Access to Pain Medicines around the World: Improving National Policies that Govern Drug Distribution, provides a synthesis of the critical background material and current methods that have been developed to improve national policies governing medical availability of essential pain medicines for cancer and HIV/AIDS patients. It is free and is self-paced so that it can be taken at any time that is convenient for the learner.

The development of this course was supported by the National Hospice and Palliative Care Organization and the Foundation for Hospices in Sub-Saharan Africa.

For more information, and to access the course, visit http://www.painpolicy.wisc.edu/on-line_course/welcome.htm

10th Annual NIH SBIR/STTR Conference
July 22-23, 2008
Atlanta, GA

Learn about the ins and outs of the NIH and Small Business Research Funding Opportunities (SBIR)/ Small Business Technology Transfer (STTR) program, funding opportunities, and partnership opportunities. The agenda for this 2-day meeting will include leveraging state resources and manufacturing strategies.

Click here to view the agenda or register.