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APS Bulletin • Volume 15, Number 3, Summer 2005

Translational Research in Pain

Christine Sang, MD MPH, Department Editor

Reflections on the 24th Annual Scientific Meeting of the American Pain Society

Roger Fillingim, PhD

I had the distinct honor of serving as chair of the scientific program committee for APS’s 24th Annual Scientific Meeting, held in Boston from March 30–April 2, 2005. It was a pleasure to collaborate with a group of dedicated, creative, and hard-working colleagues to develop the program content. Now I would like to take the opportunity to provide some reflections on what I believe was a successful meeting. While the meeting had no official theme, the program committee goal was to infuse translational research in pain throughout the content. I like the following explanation for translational research.

The mission of translational research is to translate the basic science discoveries into clinical applications and to use the clinical observations to generate research foci for basic sciences (NIH).

That is, translational research goes from bench to bedside and back to bench.

There are several reasons the scientific program committee members felt it was vital to highlight translational research in pain during this year’s meeting. First, translational research is the top priority of funding agencies, such as the NIH industry. Second, many members argue that successful clinical translation in pain research lags far behind the exponential increases in our understanding of noci-ceptive processing and that we need to enhance our translational efforts. Third, the American Pain Society, based on its mission and the diversity of its membership, is in an ideal position to spearhead translational efforts on pain research. APS has a unique and long-standing history of promoting interactions among clinicians and basic scientists, which is a necessary ingredient for successful translation. Because the ultimate goal of our efforts, in both research and clinical service, is to relieve human suffering associated with pain, translation is our calling.

I apologize for the fact that I will be commenting on sessions I actually attended, so I will inevitably neglect some extremely interesting and valuable presentations. Multiple sessions featured the translational theme. For example, the preconference event, “Methodological Challenges in Genetic Studies of Pain: Animals, Humans, and Complex Traits,” gave a translational perspective on the genetics of pain. This workshop included data from novel genetic findings in mice and their translation to humans. The presentation identified the challenges and opportunities inherent in this type of research. During the keynote address, Dr. Nora Volkow, MD, Director of the National Institute on Drug Abuse, presented data from basic preclinical studies, human laboratory studies, and epidemiologic research while discussing the issue of prescription opioid abuse.

The content of several of the plenary sessions had a translational focus. Jerry Gebhart, PhD, presented basic information regarding the mechanisms underlying visceral hypersensitivity, which helps inform our understanding of psychophysical and clinical findings in various patient populations (e.g., irritable bowel syndrome). Mary Jeanne Kreek, MD, provided a highly informative presentation, including both nonhuman and human data, on environmental stress, genetics, and the basic neurobiology of opioid dependence. Herta Flor, MD, provided intriguing information describing the role of learning and plasticity in the development and maintenance of chronic pain. She presented data regarding the contributions of both classical and operant conditioning to pain processing. Dr. Flor’s presentation underscored the fact that translational research does not have to occur across species. Basic study in humans can be applied to translational research. For example, applying the principles of operant and classical conditioning to explain the mechanisms behind clinical pain and to guide treatment represents an important form of translational research.

Another plenary speaker, Bob Yezierski, PhD, illustrated the importance of bedside to bench translation. He presented epidemiologic and clinical data on the prevalence and effect of spinal cord injury pain, which has been the impetus behind years of basic research into the mechanisms responsible for spinal cord injury pain. Without an appreciation of the clinical need, the basic research would have had minimal support.

Many symposia also adopted a translational perspective. During “A Critical Review on Translational Pain Research,” the three speakers—Jianren Mao, MD PhD, Gary Bennett, PhD, and Tony Yaksh, PhD—discussed successes and failures in translational research in pain. After this session, I felt that although challenges to translation in pain research are formidable, we have done a respectable job addressing them and that the future looks bright. Another symposium, chaired by Ray Dionne, DDS PhD, addressed the challenges to developing novel analgesics, including not only conceptual and scientific issues but also regulatory and economic barriers. I mention this symposium because the goal many people believe defines success in translational research in pain is the development of a new drug. Thus, understanding the obstacles to achieving this endpoint is paramount. Additional sessions with a translational perspective covered topics such as stress and pain, chronic musculoskeletal pain, pharmaco genetics, cholecystokinin antagonists, interstitial cystitis, N-methyl-D-asparate (NMDA) antagonists and opioid addiction and abuse.

I would also like to mention several other aspects of the meeting. The “5th Annual Pediatric Pain Meeting” had an excellent program and garnered a great deal of attention from the national press. The paper presentation sessions covered a variety of topics (e.g., pediatric pain, psychosocial issues, basic nonhuman research, clinical pain management, and basic human research). There were excellent presentations from the two award winners, Bob Dworkin, PhD—Wilbert E. Fordyce Clinical Investigator Award and Linda Watkins, PhD—Frederick W. L. Kerr Basic Science Research Award, and David Joranson’s “3rd Annual Decade of Pain Control and Research Special Lecture” was equally impressive.

A research area of significant growth is ethnic and cultural influences on pain. The meeting included several sessions, a preconference workshop, and a symposium on the cross-cultural narrative. Of particular note was the powerfully poignant presentation by Carmen Green, MD, of the plenary session, “Unequal Burdens, Unheard Voices: Disparities in Health Due to Pain.”

Of course, we had terrific research presented in the poster sessions, which provided an opportunity to interact with colleagues amidst excellent science.

One other aspect of the meeting that deserves special mention is the inaugural APS art exhibit. For those who missed it, view highlights online. The well-attended exhibit displayed artwork created by APS members (or members of their families). Included were photographs, poetry, paintings, cartoons, quilts, and a native mask. I must say, I was overwhelmed by the talent of some of our members. The art exhibit was a resounding success, and I hope it will be a permanent fixture at future meetings. Special recognition for the art exhibit goes to Carmen Green, MD, who presented the idea to the program committee and provided leadership for developing the exhibit, and to the rest of the APS staff for pulling it off.

In my admittedly biased opinion, the 24th Annual Scientific Meeting was a tremendous success. Boston was a great backdrop for 31/2 days of great science and collegiality. I am grateful to have had the opportunity to chair the program committee, and I thank the committee members who worked tirelessly to create the program. I am particularly pleased that we were able to recognize past successes and point out future challenges in translational research in pain. I look forward to evaluating our progress at next year’s meeting in San Antonio.

Roger B. Fillingim, PhD, is Associate Professor at the University of Florida, College of Dentistry, Gainesville, FL.

Please direct your comments or suggestions about these articles or this department to Christine Sang, MD MPH, Department Editor, at csang@partners.org

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