IASP to Begin Global Year Against
Musculoskeletal Pain

Each October, the International Association for the Study of Pain (IASP) targets a specific pain condition for its Global Year Against Pain public awareness program. For 2009–2010, IASP identified musculoskeletal pain as its focus. According to IASP, more people around the world experience musculoskeletal pain than any other pain condition. Many locations of pain fall in this category, such as bones, lower back, limbs and neck, and share similar underlying mechanisms and potential treatments.

The new campaign will kick off October 19, and IASP will support it with a variety of materials for pain care professionals and the media. According to cochair Kathleen Sluka, PhD, professor, physical therapy and rehabilitation science, University of Iowa, IASP is preparing more than two dozen facts sheets for the program to cover specific topics related to musculoskeletal pain, such as rheumatoid arthritis, repetitive strain injuries, joint pain, recommended exercise therapies, and evidence-based treatments for acute and chronic musculoskeletal pain. 

“Our Global Year team has developed the objectives and framework for the program, but its ultimate success in building greater professional and public awareness about musculoskeletal pain depends on the efforts of IASP chapters around the world. We encourage all member organizations to make plans for symposia, media events, and other activities to support this Global Year Against Pain initiative,” said Dr. Sluka, an APS member and current IASP liaison to the APS Board of Directors. APS is the official U.S. chapter of IASP.

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Commentary: APS and the FDA
What’s Your View on the Onsolis Risk Evaluation and Mitigation Strategies (REMS)? Click here to enter your response.

In a letter sent in July 2009 to the U.S. Food and Drug Administration, APS petitioned the agency, on behalf of the terminally ill and their families, to modify a restricted distribution program for the newly approved pain medication Onsolis, a short-acting product that delivers fentanyl through the mouth’s mucous membranes. 

“We recognize that some opioid products, because of their potency and potential for abuse and unintentional death, may require additional limitations to assure safe use, but restrictions for Onsolis and perhaps other medications could affect access to the best quality pain relief for patients suffering from cancer-related pain at the end of life and inhibit physicians from delivering the best therapeutic care,” wrote APS. 

On July 16, FDA approved Onsolis but required that it be made available only through a restricted distribution program from specialty pharmacies. APS said the restriction poses serious concerns for terminal patients in hospitals. “Transmucosal fentanyl is used in acute situations and often at the end of life,” noted APS, “and not allowing hospital and institutional pharmacies to stock these medications for immediate use denies access to a medication that might be the best option to ease acute or chronic pain in the final days of life.”

Please share your views with E-News on this controversial pain care issue. Do you agree with the APS position? Click here to enter your response.

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APS Wants to Hear from You

APS envisions a world where pain prevention and relief are available to all people. In your opinion, what is preventing APS from realizing this vision? Click here to enter your response.

APS 29th Annual Scientific Meeting Call for Paper and Poster Abstracts

The Call for Paper and Poster Abstracts for the 2010 annual meeting in Baltimore, MD, is now available on the APS Web site. Abstracts can be submitted until 11:59 pm Pacific time on Tuesday, October 27. Please visit the APS home page to access the submission requirements and forms.

The Journal of Pain Highlights
The following highlights summarize selected articles from September 2009 (volume 10, number 9).

Self-Report of Alcohol Use for Pain in a Multi-Ethnic Community Sample
Joseph L. Riley III and Christopher King; Department of Community Dentistry and Behavioral Science, College of Dentistry, University of Florida

Clinicians treating patients with chronic pain must assess their alcohol use and, if necessary, provide counseling regarding problems associated with mixing alcohol and pain medications, according to a study published in The Journal of Pain.

Researchers from the University of Florida College of Dentistry examined use of alcohol to relieve pain in more than 4,000 adults with tooth pain, jaw or face pain, and arthritis. Previous studies have shown that adverse reactions occur when alcohol is mixed with prescription pain medications, particularly gastrointestinal disorders and liver problems. Also, studies show alcohol is used often to manage stress, and chronic pain is considered a significant stressor. 

The purpose of the study was to document the prevalence of alcohol use for managing pain among community-dwelling adults, learn demographic differences in the use of alcohol for pain, and evaluate if the impact of pain and social and economic factors is associated with using alcohol for pain. Study subjects were interviewed by telephone. 

Results showed that use of alcohol as a pain management strategy was consistent across the three patient groups, ranging from 25 to 28 percent. Men used alcohol more frequently as a pain management strategy than women, and increased alcohol use corresponded to higher income levels, which the authors noted was an unexpected finding. Also, alcohol was associated with the frequency of pain but not with intensity or chronicity. The authors attributed that finding to self medication with alcohol being related to regularity of pain symptoms. They concluded that when these patients self-medicate with alcohol, clinicians may need to reevaluate current treatment protocols.

The findings highlight the need for healthcare professionals to educate and monitor their pain patients for toxicity levels and other adverse health outcomes related to alcohol use.

Structure of Posttraumatic Stress Disorder Symptoms in Pain and Pain-Free Patients Scheduled for Major Surgery
Gabrielle M. Pagé¹, Valery Kleiman¹, Gordon J. G. Asmundson², and Joel Katz^1,3,4
(1) Department of Psychology, Faculty of Health, York University, Toronto, Ontario, Canada
⁽²⁾ Department of Psychology, University of Regina, Regina, Saskatchewan, Canada
⁽³⁾ Department of Anesthesia and Pain Management, Toronto General Hospital, Toronto, Ontario, Canada and Mount Sinai Hospital, Toronto, Ontario, Canada
⁽⁴⁾ Department of Anesthesia, University of Toronto, Toronto, Ontario, Canada

There is high comorbidity between posttraumatic stress disorder (PTSD) and pain in both veterans and civilians. Studies have explained that comorbidity is attributable to a mutual maintenance model in which various aspects of chronic pain and PTSD play a role in both PTSD and pain symptoms. The goal of the research, conducted in Canada, was to investigate how the interrelationships among PTSD symptoms differ between pain and pain-free patients scheduled for major surgery.

For the study, data from 447 patients were collected. Sixty-one percent said they had no pain problems and 39% reported ongoing pain. About 3 in 4 of the subjects were scheduled to undergo major abdominal surgery.

Study results showed that PTSD symptoms—such as re-experiencing, avoidance, emotional numbing, and hyperarousal—differ in pain and pain-free patients prior to major surgery. Rates of PTSD symptoms were 21.7% in pain patients compared with 9.9% in pain-free subjects. The finding is similar to results reported in other studies on the comorbidity of PTSD and pain in civilian populations.

The authors concluded that clinically the results show that pain and PTSD symptoms are closely related, and both conditions should be assessed when a patient presents symptoms of one or the other. Both should be the focus of common treatment goals instead of being considered as separate conditions.

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Pain Medicine Highlights
The following highlights summarize selected articles from September 2009 (volume 10, numbers 6).

Risk for Five Forms of Suicidality in Acute Pain Patients and Chronic Pain Patients vs. Pain-Free Community Controls
David A. Fishbain^1,2,3,4,5 Daniel Bruns^6,7 John Mark Disorbio^6,7 and John E. Lewis^1
(1) Department of Psychiatry, Miller School of Medicine, University of Miami, Miami, FL
⁽²⁾ Department of Neurological Surgery, Miller School of Medicine, University of Miami, Miami, FL
⁽³⁾ Department of Anesthesiology, Miller School of Medicine, University of Miami, Miami, FL
⁽⁴⁾ Department of Psychiatry, Miami Veterans Administration Hospital, Miami, FL
⁽⁵⁾ Rosomoff Comprehensive Pain & Rehabilitation Center, Douglas Gardens, Miami, FL
⁽⁶⁾ Health Psychology Associates, Greeley, CO
⁽⁷⁾ Integrated Therapies, Lakewood, CO

Is there a greater risk for suicide in rehabilitation chronic pain patients (CPPs) and acute pain patients (APPs) than in the general community? In this Pain Medicine study, researchers looked at the prevalence of suicide ideation (SI) and suicide attempts (SA) in a sample of community nonpatients, community patients, rehabilitation patients, rehabilitation patients with acute pain, and rehabilitation patients with chronic pain.

Patients answered five questions asking if they had a history of wanting to die or of wanting to die because of their pain; and if they had recent frequent suicide ideation, a suicide plan, or a history of suicide attempts. The questions were part of the Battery for Health Improvement Research Version (BHI-R). The study compared patients with APPs and CPPs with a pain-free community control group to learn how the five risks for suicide compared to those without pain, and to compare the numbers with previously published data.

Ultimately, the survey demonstrated a higher risk for suicide in rehabilitation CPPs than in those in the control group. Some of the factors that increased the risks for suicide include the presence of worker’s compensation, litigation status, and personal injury status. Those who were at greater risk for committing suicide had answered similarly for three suicidality questions related to having a history wanting to die, experiencing recent suicide ideation on a frequent basis, and having a suicide plan.

The results strayed on a few items, such as which components most reflected a higher risk for suicidality. APPs had a higher risk for all five items on the suicidality list; in contrast, CPPs demonstrated a higher risk than the control group amongst three of the five items.

The authors found that rehabilitation CPPs and APPs were at a much greater risk for suicide than those in the community pain-free group; however, for those who reported the warning factors, it was unknown if those variables were actually predictive of suicidality. Further research would help indicate how predictive these variables are of suicidal issues and might explain why there were variances in the triggers between CPPs and APPs, as well as in those groups versus other comparable studies.

Quality of Reporting of Regional Anesthesia Outcomes in the Literature
Alexander Stojadinovic^1,2 Sean M. Shockey¹ Scott M. Croll¹ and Chester C. Buckenmaier III^1
(1) Army Regional Anesthesia & Pain Management Initiative, Anesthesia & Operative Service, Walter Reed Army Medical Center, Washington, DC
⁽²⁾ Department of Surgery, Walter Reed Army Medical Center, Washington, DC

Regional anesthesia outcomes are currently reported in a variety of formats, often proving complex to report because of a lack of guidelines in place for reporting such events. The authors of this Pain Medicine study conducted this study of trials published in peer-reviewed journals to examine the quality of reporting and recommend a more structured format for reporting regional anesthesia outcomes.

The lack of a formal system for reporting regional anesthesia outcomes makes measuring morbidity difficult. The authors examined the standards for reporting adverse events from regional anesthesia procedures and evaluated the quality of outcome reporting. Articles retrieved that matched inclusion criteria were judged based on the reported method of study accrual, duration of data collection, definition of complication, morbidity and mortality rates, grade of complication, grade of complication severity, exclusion criteria, and study follow up. In addition, critical reviews from the authors were studied for appraisal of strengths, weaknesses, statistical merits, and overall quality of reporting.

Ninety-one articles were examined, most of which were prospective, involved less than 200 study subjects, and were published in the last 5 years. Less than 50% of the studies reported at least one recognized complication during the follow up of anesthesia administration. In addition, reporting compliance was much lower than for reporting morbidity and mortality rates (29%) and complications leading to death within the study population.

Surprisingly, only 45% of the manuscripts reviewed provided some outpatient follow up to identify potential late complications of the regional block. Previous studies have also reported that a standardized report is missing. The authors propose a six-grade regional anesthetic morbidity and mortality system to identify variations in the methods of regional anesthesia reporting outcomes. In addition, they recommend the use of a modified format based on the “explanation and elaboration” chart used in the revised CONSORT statement.

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NIH Seeks High-Risk, High-Impact Proposals through NIH Director’s Pioneer, New Innovator, and Transformative R01 Initiatives

The National Institutes of Health (NIH) welcomes proposals for 2010 NIH Director’s Pioneer Awards and New Innovator Awards. Both programs are part of the NIH Roadmap for Medical Research and support exceptionally creative scientists who take highly innovative, potentially high-impact approaches to major challenges in biomedical or behavioral research.

Pioneer Awards provide as much as $2.5 million in direct costs throughout 5 years and are open to scientists at any career stage. New Innovator Awards provide up to $1.5 million in direct costs over the same period and are for early stage investigators (ESI) who have not received an NIH regular research (R01) or similar NIH grant.

NIH expects to make at least seven Pioneer Awards and at least 33 New Innovator Awards in September 2010.

To continue its strong record of diversity in these programs, NIH especially encourages women and members of groups that are underrepresented in NIH research to apply. The deadline for submitting Pioneer Award applications is October 20, 2009. See the instructions in the RFA and visit http://nihroadmap.nih.gov/pioneer for more information. Send questions to pioneer@nih.gov.

The deadline for submitting New Innovator Award applications is October 27, 2009. See the instructions in the RFA and visit http://nihroadmap.nih.gov/newinnovator for more information. Send questions to newinnovator@nih.gov.

Transformative R01 Program
The Transformative R01 (T-R01) supports exceptionally innovative, high risk, original, and unconventional research projects that have the potential to create or overturn fundamental paradigms. Please check http://nihroadmap.nih.gov/T-R01 for more information about the program and upcoming funding opportunities.

The NIH Roadmap for Medical Research, launched in 2004, is a series of initiatives designed to address fundamental knowledge gaps, develop transformative tools and technologies, and foster innovative approaches to complex problems. Funded through the NIH Common Fund, these programs cut across the missions of individual NIH Institutes and Centers (ICs) and are intended to accelerate the translation of research to improvements in public health. Additional information about the NIH Roadmap and Common Fund can be found at www.nihroadmap.nih.gov.

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E. Richard Blonsky, MD: 1935–2009

E. Richard Blonsky, MD, of Glencoe, IL, was a respected physician who practiced neurology and pain medicine for more than 40 years at Northwestern Memorial Hospital and the Pain and Rehabilitation Clinic of Chicago (RIC). He passed away in August 2009. Dr. Blonsky was a past president of the Midwest Pain Society (MPS). His passion for the small but growing society helped advance it for more than two decades. Many times he was not listed as a member of a particular committee (e.g., Scientific Program, Local Arrangements), yet he did as much or more work as many committee members to ensure a top-rated meeting. People take volunteer positions for many reasons; Dr. Blonsky’s reasons were solely to advance the mission of the MPS. In May 2009, the MPS provided research grants to trainees, residents, and fellows in Dr. Blonsky’s name.

Dr. Blonsky was also a past president of the American Academy of Pain Medicine. He served on committees of several pain and neurological organizations. Professionally, he was director of pain studies at the RIC for 7 years and he was the director of the Pain & Rehabilitation Clinic of Chicago (PRCC) since 1993. He also was a clinical professor of neurology at the Feinberg School of Medicine at Northwestern University. 

Dr. Blonksy is survived by his wife Sue; his children Dr. Peter Blonsky, Susan Kaplan, Dr. Adam Blonsky, Stephen, and David; and his grandchildren Kaitlin, Alex, Stacey, Daniel, Benjamin, Jordan, and Olivia. Dick will be dearly missed by his treasured friends and extended family. In lieu of flowers, contributions may be made to the Michael Rolfe Pancreatic Cancer Foundation, 500 N. Michigan Ave., Ste 200, Chicago, IL 60611.

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Pain in the Media

Many Children Receive Little Pain Relief after Surgery

Yoga Can Ease Lower Back Pain

Endothelin Receptor May Play Role in Sickle Cell Pain

Abu Dhabi Gives U.S. Hospital $150 Million

Group Training “May Reduce Pain”

Taking the Fun Out of Popping Pain Pills