Military Pain Bill Introduced in Congress

APS and the Pain Care Coalition (PCC) have achieved another significant milestone with the recent introduction of HR 5465, the Military Pain Care Act of 2008, in the U.S. House of Representatives. David Loebsack, a freshman Democrat representing the second district of Iowa, is the lead sponsor and there are 13 cosponsors. Loebsack is a member of the House Armed Services Committee, which is expected to consider the legislation soon.

HR 5465 is intended to improve pain care for armed services personnel and their families. The bill authorizes the Department of Defense to implement a pain-care initiative, and requires that all military health facilities assess their patients for pain, ensure they receive appropriate pain care, and refer chronic pain patients to specialty pain management services and comprehensive multidisciplinary pain management providers when appropriate.

In a letter to Rep. Loebsack, Richard Rosenquist, MD, PCC chairman, wrote, "The Department of Defense and the uniformed services are doing much to provide good pain care within their various medical care programs and facilities, but much, much more remains to be done. Your bill is a vital first step in making good pain care a national priority within the military healthcare systems. The brave men and women in military service, and their families, deserve no less."

National Pain Care Policy Act Is Also Being Considered
The House also is deliberating HR 2994, the National Pain Care Policy Act of 2007. The bill would increase funding for pain research, education, and training. A key component of the legislation would permanently place the Pain Consortium at NIH.

PCC Counsel Bob Saner described the bill as the third leg of the PCC's legislative agenda in this Congress. "Together with HR 2994 promoting better pain research and education at NIH and HHS, and S 2160, the Veterans Pain Care Act, Congress now has a comprehensive agenda to consider."

HR 2994's 39 cosponsors are listed below. If your representative is not already a cosponsor, APS urges you to request support for the bill in writing.

Current Cosponsors of HR 2994, the National Pain Care Policy Act of 2007
Capps, Lois (CA-23), Sponsor
Allen, Thomas H. (ME-1)
Baldwin, Tammy (WI-2)
Berman, Howard L. (CA-28)
Boucher, Rick (VA-9)
Butterfield, G. K. (NC-1)
Deal, Nathan (GA-9)
DeGette, Diana (CO-1)
Gilchrest, Wayne T. (MD-1)
Gonzalez, Charles A. (TX-20)
Gordon, Bart (TN-6)
Green, Gene (TX-29)
Grijalva, Raul M. (AZ-7)
Hinchey, Maurice D. (NY-22)
Hooley, Darlene (OR-5)
Kennedy, Patrick J. (RI-1)
Kildee, Dale E. (MI-5)
Latham, Tom (IA-4)
Lofgren, Zoe (CA-16)
Markey, Edward J. (MA-7)
Marshall, Jim (GA-8)
Murtha, John P. (PA-12)
Platts, Todd Russell (PA-19)
Rahall, Nick J., II (WV-3)
Rogers, Mike J. (MI-8)
Ross, Mike (AR-4)
Rothman, Steven R. (NJ-9)
Rush, Bobby L. (IL-1)
Schakowsky, Janice D. (IL-9)
Shea-Porter, Carol (NH-1)
Solis, Hilda L. (CA-32)
Stupak, Bart (MI-1)
Tiberi, Patrick J. (OH-12)
Towns, Edolphus (NY-10)
Upton, Fred (MI-6)
Walberg, Timothy (MI-7)
Wexler, Robert (FL-19)
Wynn, Albert Russell (MD-4)

A Look Ahead: APS Annual Meeting
May 8-10, 2008
Tampa, FL

Register online today! Early bird registration ends March 13.
The foundation of the APS Annual Meeting is a symposia program with nearly 30 sessions that feature some of the most important topics and prominent speakers in the field of pain.

Thursday, May 8
For more information about these sessions, visit www.ampainsoc.org/meeting/annual_08/prog_desc_thurs.htm.

Genetic Variations in Susceptibility to Chronic Pain and Pain Processing
Cielito Reyes-Gibby, DrPH (Moderator); Michael Costigan; PhD, Jeffrey Mogil, PhD; Jon-Kar Zubieta, MD PhD

Opiate Dosing Guidelines: Outrage or Imperative
Gregory Terman, MD PhD (Moderator); Gary Franklin, MD MPH; Jane Ballantyne, MD FRCA; Scott Fishman, MD; Mark Sullivan, MD PhD

Acute Pain in the Emergency Department: Clinical Practice, Research, and Development
Peter Lacouture, PhD (Moderator); Knox Todd, MD MPH; David Hewitt, MD; Bob Rappaport, MD

Management of Intractable Pain in Children with Life-Limiting Conditions
Stefan Friedrichsdorf, MD (Moderator); Charles Berde, MD PhD; Christine Gibbon, PhD LP

The Persistence of Pain: Long-Term Potentiation, Central Sensitization, and Pain Memory
Bryan Hains, PhD (Moderator); Júrgen Sandkúhler, MD PhD; Vania Apkarian, PhD

Traumatic Onset of Chronic Pain
Allen Lebovits, PhD (Moderator); Brian Hainline, MD; Steven Cohen, MD; Dennis Turk, PhD

Risk Factors for Onset and Persistence of Pain
Roger Fillingim, PhD (Moderator); Robert H. Dworkin, PhD; Samuel McLean, MD MPH; Gary Macfarlane, MD

Cooling-Activated TRP Channels in Physiological and Pathological Cold Sensation
Robert W. Gereau IV, PhD (Moderator); Ajay Dhaka, PhD; Thomas Voets, PhD; Jianguo Gu, MB PhD

Methadone: Science, Clinical Use, and Public Policy
Scott Strassels, PharmD PhD (Moderator); Gavril Pasternak, MD PhD; Douglas Weschules, PharmD BCPS; Thomas Hazlet, PharmD DrPH

Biofeedback: Past, Present, and Future
Sean Mackey, MD PhD (Moderator); Robert Gatchel, PhD ABPP; Richard Robinson, PhD

Use of E-Health Technologies in the Assessment and Management of Pediatric Pain
Jennifer Stinson, PhD RN CPNP (Moderator); Tonya Palermo, PhD; Mark Connelly, PhD

Evidence-Based Medicine for Evaluation and Management of Low Back Pain: Update on Guidelines from the American Pain Society
Roger Chou, MD (Moderator); Rick Rosenquist, MD; John Loeser, MD

Paper Presentations: Molecular and Systems Biology

Friday, May 9
For more information about these sessions, visit www.ampainsoc.org/meeting/annual_08/prog_desc_fri.htm.

Effects of Aging and Comorbidity on Pain Processing: Clinical and Preclinical Studies
Lucia Gagliese, PhD (Moderator); Robert Yezierski, PhD; Joseph Riley III, PhD; Debra Weiner, MD

Empathy for Pain: Clinical Implications
Raymond Tait, PhD (Moderator); Kenneth Craig, PhD; Mohammedreza Hojat, PhD

Evidence-Based Pain Management Practices for Older Adults in Multiple Practice Settings: The Challenge of Translation
Keela Herr, PhD RN FAAN (Moderator); Perry Fine, MD; Mary Ersek, PhD RN; Marita Titler, PhD RN FAAN

Lumbar Epidurals for Radicular Low Back Pain: Ongoing Controversy and Conflicting Evidence for and Against Their Use for Radiculopathy—Can They Be Used Effectively in the Daily Practice of Pain Management?
Steven Stanos, DO (Moderator); Charles Argoff, MD; Venu Akuthota, MD; Jerome Schofferman, MD

Saturday, May 10
For more information about these sessions, visit
www.ampainsoc.org/meeting/annual_08/prog_desc_sat.htm.

Clinical Guideline on Chronic Opioid Therapy in Chronic Noncancer Pain: Process and Progress Report
Perry Fine, MD (Moderator); Christine Miaskowski, PhD RN FAAN; Roger Chou, MD

How Race and Ethnicity Shape the Experience of Pain Across the Life Span: Findings from Clinical and Experimental Settings
Raymond Tait, PhD (Moderator); Qian Lu, MD PhD; Barbara Hastie, PhD; Tamara Baker, PhD

Applying Molecular Technologies to Individual Differences in Pain and Analgesia: Merits and Limitations of the Methodologies
William Lariviere, PhD (Moderator); David Clark, MD PhD; Hyungsuk Kim, DDS PhD

Cortical Stimulation for Persistent Pain Syndromes: Novel Strategies
Ricardo Cruciani, MD PhD (Moderator); Herta Flor, PhD; Helena Knotkova, PhD

Peripheral Mechanisms Underlying Muscle Pain
Kathleen Sluka, PhD PT (Moderator); Alan Light, PhD; Ranjini Ambalavanar, PhD; Brian Cairns, PhD ACPR RPh

Hidden Settings for Health Disparities in Pain: Uncovering the Truth and Policy Implications
Barbara Hastie, PhD (Moderator); April Hazard Vallerand, PhD RN FAAN; Donna Kalauokalani, MD MPH; Carmen Green, MD

Quantitative Sensory Testing for Pain Research and Clinical Practice
Miroslav Misha Backonja, MD (Moderator); David Walk, MD; Nalini Sehgal, MD; Mark Steven Wallace, MD

Prescribing Opioids: Legal Aspects
Ricardo Cruciani, MD PhD (Moderator); Howard Heit, MD; Jennifer Bolen, JD; Mark Caverly

Incorporating Integrative Medicine in Pain Management
Gary Deng, MD PhD (Moderator); Stephen Sagar, MD; Kathleen Wesa, MD

Preclinical Models of Low Back Pain
Laura Stone, PhD (Moderator); Jun-Ming Zhang, MD; Beth Winkelstein, PhD; Weiyong Gu, PhD

Paper Presentations: Human Disease and Models

Paper Presentations: Treatment Approaches

APS President-Elect Lends Expertise to Sickle-Cell Disease Recommendation Panel

Charles E. Inturrisi, MD, president-elect of APS, was a member of an NIH consensus panel that met in Bethesda, MD, February 24–27 to review the use of hydroxyurea for the treatment of sickle-cell disease (SCD). The panel issued a statement that made a number of recommendations, including the increased use of hydroxyurea to treat the nearly 100,000 Americans affected by SCD (http://consensus.nih.gov/).

Pain is the most common SCD symptom. The panel recommended that future hydroxyurea efficacy and effectiveness studies include patients who are receiving opioids for their chronic pain. The panel also recommended that all SCD treatment evaluations include quality-of-life outcome assessments.

Data Blitz for Clinical and Basic Science Research: Request for Submissions

APS announces a request for submissions for the Data Blitz for Clinical and Basic Science Research, which will be held Wednesday, May 7, from 7-9 pm in Tampa, FL, as part of the 27th Annual Scientific Meeting. Authors are encouraged to submit "hot topics" for presentation during the blitz; submissions from young investigators and junior faculty are particularly encouraged. Selected presenters will have 5 minutes to present data and 5 additional minutes to answer questions. The blitz will be moderated by a member of the APS Scientific Program Committee.

To submit your work for consideration, please download the application, complete all requested information, and send it via e-mail to Jennifer Reinard at jreinard@connect2amc.com.

All applications are due by March 24, 2008. Primary/presenting authors will be notified of the Data Blitz Committee's selections in early April. Blitz presenters will be responsible for all costs associated with travel to the annual meeting, including meeting registration.

Important note: Authors who will be presenting paper or poster abstracts at the annual meeting should not submit their work again for the data blitz.

The Journal of Pain Highlights

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

The Severity of Chronic Pediatric Pain: An Epidemiological Study
Anna Huguet and Jordi Miro
Department of Psychology, Rovira i Virgili University, Catalonia, Spain

Approximately 37% of children evaluated in a Spanish study have chronic pain, and 5% have moderate-to-severe chronic pain problems, according to new research published in The Journal of Pain.

A sample of 561 schoolchildren in Catalonia ages 8-16 was evaluated by researchers at Rovira i Virgili University to assess the students' prevalence and severity of chronic pain. Researchers collected information from the children about the presence of pain at the time of the interview and in the preceding 3 months, and also asked questions to learn more about the characteristics of the children's pain experiences and their overall quality of life.

Among pediatric subjects in this new study, lower limb pain, headache, and abdominal pain were the most frequently cited pain problems, and both boys and girls appear to be at greater risk as they get older. Lower-limb pain was more common in boys, and girls were more likely to have more severe chronic-pain syndromes (most notably, headaches).

"This study not only showed that chronic pain is a common problem in the general population of children, it also demonstrated again that chronic pain negatively impacts the everyday functioning of children," says psychologist and lead study author Anna Huguet, PhD. The data also showed children with a chronic pain syndrome have a worse quality of life compared to children without pain, and they also report higher functional impairment.

Patient Self-Criticism Is a Stronger Predictor of Physician's Evaluation of Prognosis than Pain Diagnosis or Severity in Chronic Pain Patients
Zvia Rudich, Sheera F. Lerman, Boris Gurevich, Natan Weksler, and Golan Shahar, University of the Negev, Israel

A new study published in The Journal of Pain demonstrates that patients who are overly self-critical can bias their doctors' clinical judgment of their expected prognosis.

Because pain is a subjective and complex phenomenon, interactions with patients can significantly influence a physician's anticipated prognosis in most pain management settings. Previous studies have shown that a patient's personality and attitude significantly influence physician expectations for successful outcomes.

In this study, an Israeli research team examined self-criticism and sought to assess its significance as an independent influence on physicians' clinical judgments. They defined self-criticism as the "tendency to set unrealistically high self-standards and to adopt a punitive stance toward one's self."

With conditions ranging the full spectrum of pain syndromes, 64 patients were evaluated for the study on their first visit to a tertiary pain clinic. They were interviewed about their pain issues before seeing a physician. Immediately after their visits, the physicians were asked to evaluate each patient's prognosis without seeing the results of his or her interview.

The study concluded that gender, age, self-reported pain, and pain diagnosis had no independent effect on physicians' prognosis for treatments. However, patient self-criticism proved to predict physician pessimism regarding prognosis. The study's authors surmised that overly self-critical patients convey dissatisfaction with their treatment and, in turn, can demoralize their physicians into making negative judgments about potential treatment outcomes.

Sex Differences in Muscle Pain: Self-Care Behaviors and Effects on Daily Activities
Erin A. Danneker, Victoria Knoll, and Michael E. Robinson, Department of Physical Therapy, University of Missouri

Although it has been widely reported that women experience more pain than men from intramuscular injections, the ways in which gender affects movement-induced muscle pain are not as well documented. The authors conducted two studies on students at the University of Missouri to determine 1) sex differences in recalled muscle pain and attitudes about self-care and the effects of muscle pain on daily activities, and 2) sex differences in reporting delayed-onset muscle pain after exercise.

In the first study, there were no sex differences in the ratings of recalled muscle pain and no differences in the frequency of self-care or on recalled activity limitation. The second study also showed no differences in muscle pain. The only variance was that women reported significantly higher activity interference from delayed-onset muscle pain on the third day after exercise.

The authors noted that additional research is needed to interpret potential gender-related differences in self-care behaviors in response to muscle pain and activity interference levels.

The following highlights summarized selected articles from the March/April 2008 issue of Clinical Journal of Pain (volume 24, number 3).

How Common Is Back Pain in Women With Gastrointestinal Problems?
Michelle D. Smith*, Anne Russell, M MedStat**, and Paul W. Hodges*

* Division of Physiotherapy, School of Health and Rehabilitation Sciences, The University of Queensland, St. Lucia
** School of Population Health, The University of Queensland, Herston, Queensland, Australia

Evidence of a possible association between gastrointestinal (GI) problems and back pain has been demonstrated in both experimental pain and epidemiological studies. Findings from these studies, however, generally have been based on small samples and the studies failed to account for potential confounding factors. This study examined the relationship between back pain and GI symptoms in a large-scale population study with consideration of possible confounding factors. A total of 38,050 Australian women from three age cohorts were included in the analysis.

After adjusting for confounding factors, the number of GI symptoms was significantly associated with back pain among all age cohorts. Constipation was the most commonly reported GI symptom, with a prevalence of 13.6%, 26.8%, and 25.3% among the younger-, middle-, and older-aged women respectively. The odds ratios for experiencing back pain "rarely," "sometimes," and "often" increased with the number of GI symptoms. Factors that may account for this relationship include referred pain through viscerosomatic convergence, altered pain perception, increased spinal loading when straining during defecation, or reduced support to the abdominal contents and spine secondary to changes in function of the abdominal muscles.

Acupuncture for Treatment of Persistent Arm Pain Due to Repetitive Use: A Randomized Controlled Clinical Trial
Rose H. Goldman, MD MPH,* ^†‡, William B. Stason, MD,^§, Sung Kyun Park, ScD,^~~,
Rokho Kim, MD DPH PhD,^@, Rosa N. Schnyer, LicAc, ^#, Roger B. Davis, ScD, ^{‡ #}**,
Anna T. R. Legedza, ScD, ^# **, and Ted J. Kaptchuk,^#**

*Department of Medicine, Cambridge Health Alliance,
Cambridge
†Department of Medicine, Harvard Medical School;
‡Department of Environmental Health, Harvard School of Public
Health
# Osher Institute, Harvard Medical School
**Beth Israel Deaconess Medical Center, Boston, MA
@World Health Organization
~~Department of Environmental Health, Michigan School of Public Health, Ann Arbor, MI
§Department of Health Policy and Management, Harvard School of
Public Health, Boston, MA.

Pain that results from repetitive strain injuries (RSI) is a growing cause of disability for employees in the United States. Some people with RSI arm pain have turned to acupuncture treatment for relief, but there is limited evidence on the effectiveness of this treatment. This study was designed to compare true and sham acupuncture in their abilities to relieve arm pain and improve arm function in people with arm pain that results from repetitive use.

Participants with persistent arm pain (N = 123) were randomly assigned to true or sham acupuncture groups. They received eight treatments over a 4-week period. The primary outcome was pain intensity, and secondary outcomes were arm symptoms, arm function, and grip strength. Arm pain scores improved in both groups during the treatment period, but improvements were significantly greater in the sham group than in the true acupuncture group. This difference disappeared within 1 month of the last treatment. Mild side effects from true acupuncture (predominantly mild pain during treatments) may have overshadowed any positive treatment effects. Overall, this study did not find evidence to support the effectiveness of acupuncture to treat persistent arm pain due to repetitive use.

Celebrate Excellence and Achievements
APS Awards Gala
Thursday, May 8, 2008

In 2008, APS is hosting a gala to honor the recipients of the Clinical Centers of Excellence (CCOE) in Pain Management Awards as well as the APS Annual Achievement Awards.

The evening will honor healthcare teams that have made an impact on multidisciplinary patient care and will recognize the accomplishments of leaders who have made extraordinary contributions to the field of pain.

We invite you to celebrate with us and support these efforts to cultivate the leaders of tomorrow.

Reception and dinner begins at 7:30 pm. Register online for this special event.

Mayday Pain & Society Fellowship: Call for 2008 Applications
Apply online at www.maydayfellows.org

The Mayday Fund, a New York City foundation dedicated to alleviating the incidence, degree, and consequence of human physical pain, has announced it is accepting applications for the 2008 Mayday Pain & Society Fellowship: A Media & Policy Fellows Initiative. This is the fifth year of the program, which is designed to equip physicians, nurses, pharmacists, social workers, scientists, and legal scholars with the skills to become effective advocates and spokespeople about pain issues in the United States and Canada. The six experts chosen will be poised to move the pain field forward with their willingness to educate and work with the media, policymakers, advocates, and health and business leaders. The fellowship program runs through 2009.

Once selected, the six fellows will attend a 4-day training program in Washington, DC (October 20-23, 2008), develop individual advocacy plans to connect with local and national media, write editorials, develop relationships with university public affairs and government relations leadership, and talk with state legislators and members of Congress. Each fellow will have 5 months of coaching with a communications officer to track their plans' progress.

Mayday Fellows have succeeded in televised panel discussions and live radio and television interviews, served as advisors to producers working on longer segments on pain, been accepted to policy posts on Capitol Hill, and published editorials and letters to the editor. They use the tools they receive in training to advance advocacy goals.

The fellowship program is steered by an advisory committee made up of some of the nation's leading experts in the pain field. Russell K. Portenoy, MD (Chair); James Campbell, MD; Scott Fishman, MD; Kathleen M. Foley, MD; Sandra H. Johnson, JD; Patrick John McGrath, PhD; Joan Teno, MD MS; and Lonnie Zeltzer, MD, serve on the Advisory Committee for the Mayday Pain & Society Fellowship.

Candidates for the fellowship must be accomplished experts in pain management, be 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 demonstrate an interest in going beyond their professional pursuits to inspire change and make a difference in the pain field.

Those interested may apply online at www.maydayfellows.org. The application deadline is June 15, 2008.

Senate Passes Mental Health Parity Act
There's good legislative news for psychologists and others practicing in multidisciplinary centers. Following the Senate's historic passage of the Mental Health Parity Act S 558 by unanimous consent in September, the House took up its bill HR 1424 on March 5.

The Paul Wellstone Mental Health and Addiction Equity Act of 2007 expands the Mental Health Parity Act of 1996 by prohibiting group health plans from imposing treatment or financial limitations on mental health benefits that are different from those applied to medical/surgical services. The legislation applies only to group health plans already providing mental health benefits and exempts plans sponsored by small businesses with fewer than 50 employees. For extensive information, see the Mental Health Liaison Group's Parity Page.

American Society of Consultant Pharmacists Announces a Pain Management Traineeship for Pharmacists

This traineeship provides didactic and experiential training in the most current information concerning the etiologies and pathophysiology of pain and the appropriate diagnosis and assessment of acute and chronic pain. The traineeship is open to pharmacists from all practice settings. Applicants must be willing to interact directly with patients suffering from acute and chronic pain. For more information visit http://ascpfoundation.org/traineeships/train_painmanagement.htm

Register Now for 2008 NIH Regional Seminars on Program Funding and Grants Administration
San Antonio, TX: March 25-26, 2008
Chicago: June 19-20, 2008

Registration is now open for the 2008 NIH regional seminars. The seminars provide a unique opportunity to interact with key NIH experts in extramural program funding and grants administration and discuss topics ranging from identifying opportunities and preparing applications to post-award administration. Presentations are targeted towards research administrators, new and experienced investigators, post-docs, and trainees. Here's your opportunity to meet experts from the NIH Small Business Innovation Research/Small Business Technology Transfer (SBIR/STTR) Program, Division of Grants Policy, Office of Laboratory Animal Welfare, and Office of Human Subject Protections. Participants also have the chance to meet program officers from several NIH institutes/centers, grants management officers, and many other experts who can answer specific questions. For more information, visit http://grants.nih.gov/grants/guide/notice-files/NOT-OD-07-076.html.

APS Social Networking Survey Results
During a recent review of members' responses to the social networking survey, the APS Board decided to pursue the creation of a new online members-only networking forum. The survey revealed that 28% of member respondents have an interest in online networking, and more than half indicated that they would use this tool to interact with their peers. The board's first step toward making this tool possible will be to review proposals from vendors that provide this type of online service.

Over 200 members responded to the survey and many provided comments: "I think this would be an excellent way of interacting and communicating with colleagues." "It sounds like a promising tool for this type of information sharing." "[The tool] would allow the review information at a time [that is] convenient to you and [allow you to] comment when you feel the need."

It's not too late to share your feedback with APS. If you didn't have a chance to participate in this survey, send your comments and suggestions about online networking to Marilyn Rutkowski at mrutkowski@connect2amc.com.