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Acknowledgment:
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August APS E-News
Your Ideas Needed for National Pain Awareness Month September is National Pain Awareness month, and APS is helping members promote Pain Awareness by sharing ideas with this survey. Please participate by telling us how you and your organization help promote pain awareness, research and treatment to the general public, or to other audiences (legislative, eductional institutions, the medical community, etc.). All responses are anonymous; we will just summarize results and report to the APS membership. Please click here to complete this brief 4 question survey. And
to celebrate National Pain Awareness month,
you will recieve a bonus issue of APS
E-News in September, which will highlight
pain awareness activities and themes. Legislative Update: National Pain Care Policy Act Introduced in Senate APS is please to report the introduction of a new Senate companion to the House's National Pain Care Policy Act of 2007 (HR 2994), which calls for improved pain care, research, education, access, and funding. The Senate's National Pain Care Policy Act of 2008, S3387, was introduced by Senators Dodd (D-CT) and Hatch (R-UT). According to APS legislative counsel Bob Saner, the Senate bill is a "true companion" to HR 2994. He notes only slight technical differences in the bills. "The key now is to [first] move it forward in the House and make sure the Senate is receptive," he says. Saner is awaiting more information on S. 3387 before enlisting the help of APS members in recruiting cosponsors. At APS E-News deadline, the House bill had more than 50 cosponsors. Right before the August recess, the House unanimously passed HR 6445, the Veterans Health Care Policy Enhancements Act of 2008. Efforts on the part of APS will now turn toward getting that legislation passed into law in September. This will entail helping to get the Senate bill passed in the House, the House bill passed in the Senate, or a larger comprehensive bill passed in both chambers—the most likely alternative.
The Mayday Fund Announces 2008-2009 Mayday Fellows The Mayday Fund announced the selection of six experts in pain management to be fellows under The Mayday Pain and Society Fellowship. The new fellows hail from across the United States and Canada, specializing in a wide range of healthcare disciplines including anesthesiology, nursing, pharmacy pediatrics, and pain policy. APS extends special congratulations to the six new fellows-Paul Christo, Lisa Robin, Bonnie Stevens, Scott Strassels, Anna Taddio, and William Zempsky-all of whom are APS members. "The caliber of candidates for this fellowship continues to amaze us, and we wish we could have awarded a fellowship to so many more," said Russell Portenoy, MD, Mayday Fellowship Advisory Committee Chair, and chair of the Department of Pain Medicine and Palliative Care at Beth Israel Medical Center. "The twenty-four fellows who have been through the program to date are true leaders in pain management," he said. "They bring new energy and focus to pain issues that need so much attention. We know the six new fellows will expand the effort." 2008-2009
Fellows Established in 2003, the Fellowship provides leaders in the pain management field with tools and skills to advocate on behalf of better treatment for pain. Thirty fellows will have completed the program by 2009. Applications will be accepted for the sixth year of the Mayday Fellowship in early 2009. Six more applicants will be chosen. For more information, visit www.maydayfellows.org.
The
Journal of Pain Highlights Massage
Reduces Pain Perception and Hyperalgesia
in Experimental Muscle Pain: A Randomized,
Controlled Trial For those who experience lingering pain following exercise, a relaxing deep massage can help relieve musculoskeletal pain associated with exercise-induced pain, according to research reported in The Journal of Pain. Researchers at the University of Iowa performed a double-blinded, randomized controlled trial to study the effects of massage on pressure-pain thresholds and perceived pain using delayed muscle soreness following exercise as the pain measurement. Trial participants were divided into three groups: no-treatment (control), superficial touch, and deep tissue massage. Pain was assessed before treatment, after exercise, and before and after treatment. Massage has been used for rehabilitation and relaxation for thousands of years with no adverse effects. Unfortunately, few well-controlled trials of massage exist either in clinical or experimentally induced pain populations. The purpose for the study, therefore, was to determine the effects of massage using an endogenous muscle-pain model on otherwise healthy individuals. The authors found that subjects given deep-tissue massage were able to increase their pain thresholds and decrease stretch pain compared with the no-treatment group. When combining the deep-tissue massage and light-touch groups, they found that stretch-pain reductions remained significantly better than in the control group although the light-touch treatment was not significantly better than no treatment. The authors concluded that their study demonstrates that soft-tissue massage can reduce hyperalgesia and pain using a delayed onset muscle soreness model. The findings support use of massage to reduce stretch-pain perception and hyperalgesia. A
Pilot Study of Potassium Supplementation
in the Treatment of Hypokalemic Patients
with Rheumatoid Arthritis: A Randomized,
Double-Blinded, Placebo-Controlled Trial
In the first study of its kind, published in The Journal of Pain, a team of Iranian researchers showed that oral potassium supplementation can decrease pain intensity in rheumatoid arthritis (RA) patients. Researchers examined patients given orally administered white grape juice with 6,000 mg of potassium per day, compared with those given placebo grape juice. Thirty-six female subjects diagnosed with RA enrolled in the study. In the potassium group, 43% had 33% lower pain intensity and 31% showed moderate pain intensity reduction compared to the control group. The authors concluded that the pilot study associated high potassium intake with an improvement in RA symptoms and lower disease activity and pain intensity. They noted their findings could be relevant for planning dietary regimens for RA patients.
Pain
Medicine Highlights Sleep-Disordered
Breathing and Chronic Opioid Therapy (1)
Lifetree Clinical Research and Pain Clinic,
Salt Lake City, UT. Recent increases in deaths believed to be associated with unintentional overdoses of the drug, methadone, provide the background for an observational study of patients with chronic pain and sleep apnea. An apnea-hypopnea index measured the intensity of sleep apnea and assessed the relationship between chronic pain and sleep apnea medications in 140 patients. Opioids are commonly prescribed for patients with chronic pain, but they are also associated with a risk for sleep apnea. The study examined whether methadone might cause sleep disorder problems overnight that could affect a patient's mortality. Data was analyzed for 140 patients who had opioids for chronic pain around-the-clock. Demographics were collected for age, gender, race, body mass index, disease history, family history, and primary diagnosis, in addition to pain-related information. Data on patients studied while sleeping were collected and rated on three indices. The apnea-hypopnea index measured how many apneas (absence of air flow for at least 10 seconds) the patient had in an hour of sleep. The central sleep apneas index measured how many central sleep apneas occurred per hour of sleep. Additionally, the number of obstructive and mixed apneas per hour were examined with the obstructive/mixed apnea index. All patients in the study took opioid medications; however, not all patients took methadone. Abnormal apnea-hypopnea index scores were submitted for 75% of the patients in the study. The results showed that obstructive and central sleep apnea was significantly more common in the study than in the general population. Although a connection was drawn between those taking methadone and having sleep apneas, no connection was made with other opioids. The authors concluded that sleep apneas were more common with methadone and also benzodiazepines so caretakers must use additional caution when monitoring patients taking opioids.
(1)
Miller School of Medicine at the University
of Miami, Miami, FL Researchers interested in knowing what percentage of chronic malignant pain patients exposed to chronic opioid analgesic therapy will develop an addiction or abuse the medicine examined 67 existing studies in detail. For years, the stance on whether or not opioid therapy caused addiction varied. In a review of nine studies, Portenoy determined that addiction occurred as a result of the drug properties themselves, and the psychological mindset the patient brought into treatment, although these patient variables were generally uncommon. Other reviews, such as one by Aronoff, note that it is not regular opioid use that causes addiction but the inappropriate usage of opioids. This risk is higher in those who already have a high risk for substance abuse problems. A third review by Bartleson suggested that chronic opioid analgesic therapy was associated with a low risk of abuse or addiction. The detailed study of 67 existing reviews was executed by searching MEDLINE, Psychological Abstracts, Science Citation Index, and the National Library of Medicine Physician Data Query, using key terms related to opioid abuse. Each study was rated to describe how relevant it was to the study. The overall incidence of opioid abuse or addiction was 3.27%. Some studies stated that this percentage would be lower if recognized problematic criteria were used earlier. Findings indicated that a tendency toward addiction was genetically based, so knowing the family history would be helpful for physicians. Future studies should document opioid exposure times and document opioid doses at which addiction or abherrant drug-related behaviors are observed. Use of chronic opioid analgesic therapy will likely only lead to abuse or addiction behaviors in a very small percentage of users, and can be lessened further by examining their history.
APS
Volunteer Spotlight: Robert Jamison, PhD A psychologist, Jamison began his career in the pain care field in 1983 while at Vanderbilt Medical School. He also joined APS at that time as a way to "get immersed in the field." He knew APS would offer opportunities to meet new colleagues, build relationships with top thought leaders, and find opportunities for research collaborations. "I was inspired by the work of Dennis Turk and Frank Keefe and decided to focus my interests in the area of behavioral medicine and pain," Jamison told APS E-News. "I enjoyed meeting the members at APS conferences and received excellent support for my own studies." Positive feedback encouraged Jamison to get involved as an APS volunteer and he hasn't stopped since. "What I liked about the APS conferences was the unique opportunities they presented for multidisciplinary information exchanges and collaborations. They were not overwhelming and I always came home with new ideas." Jamison has been on numerous APS committees and SIGs and also served on the APS Board of Directors and Executive Committee. He will be the chair of the 2010 APS Annual Meeting Scientific Program Committee. "The meeting format isn't broken, so there's no need to fix it," he said. "Of course, we'll look to make some improvements and continue to offer a strong balance between science and clinical practice." Jamison noted that translational research has become a major priority within APS and believes this focus can foster more extensive multidisciplinary research collaborations in the pain field. Although he is actively involved in research, Jamison sees pain patients every day at the Pain Management Center of Brigham and Women's Hospital in Boston. "We have a lot to learn in this field, especially in knowing more about how pain influences mood and sleep and the long-term implications for chronic pain patients. Jamison has published extensively on how can clinicians can better track and apply patient feedback about their pain experiences. He recently coauthored a study in The Journal of Pain in which the team evaluated a new screening tool to predict which pain patients are most likely to exhibit aberrant medication-related behavior.
Call for Nominations for the APS Board of Directors Nominating and electing the leadership of APS is an important and fundamental responsibility of all society members. But what are the benefits to the volunteer of stepping up for a leadership role, whether as director, nominating committee member, or other officer? Volunteer leaders have an unparalleled opportunity to work at the strategic level to affect the direction of the association. Perhaps strategic planning has not been a significant part of your daily routine. Election to a board of directors' position provides the opportunity and challenge to develop these perhaps unfamiliar skills. A leadership position also affords the opportunity to represent the needs of the membership, and to advance the profession or the industry. Are you looking for a new challenge or opportunity for growth? Perhaps you know a colleague who is motivated, dedicated, and inspired about the future of APS or advancing the knowledge and treatment of pain. Please start thinking now about who you might nominate for the APS Board of Directors or Nominating Committee. The call for nominations will be sent to all APS members in October to nominate potential election candidates. Position descriptions, current list of board and Nominations Committee members, vacancies and the disciplinary composition and geographic representation of the board will be available in the members-only section of the APS website. Nominees must be regular APS members. Please watch for notification of the nominations process and be prepared to take advantage of this opportunity. Your participation is important to APS.
PPSG Release 2008 Policy Evaluation Reports The University of Wisconsin Pain & Policy Studies Group (PPSG) recently announced the release of two new resources, which are part of the PPSG's continuing pain and public policy research program.
The Evaluation Guide is the fifth in a series of evaluations of federal and state pain policies. The Progress Report Card quantifies state pain policies and tracks progress to promote pain management and reduce policy barriers by comparing 2008 state policy grades with those from 2000, 2003, 2006, and 2007. These two reports are important tools that can be used by government and nongovernment organizations, as well as policy-makers, healthcare professionals, and advocates to understand the policies in their state that reinforce the right to pain management, or that can hinder patient access to effective treatment. Visit the PPSG Web site at www.painpolicy.wisc.edu.
Call for Paper and Poster Abstracts 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.
Georgia
Shows Greatest Improvement in Patient
Pain Policies Click here to read more pain-related news in the media.
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PhD,
a longtime APS volunteer and annual meeting
contributor, says, "There still are
some Nobel Prizes to be won." He
is passionate about the potential for
pain research to bring long-awaited breakthroughs
for millions who suffer chronic pain.
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American
Pain Society
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847/375-4715 | Fax: 877/734-8758 | info@ampainsoc.org |