Hawaii plus
the great group of people I had the pleasure of hanging out with, the CHLA painteam, made this the best conference I’ve attended so far. As shocking as it may
sound, instead of spending all my time at the beach, I did make it to quite a
few lectures and learned about some cool new research in the field of pain
management.
Here are
some of the presentations that made an impression on me:
Title: Virtual
Reality (VR) and Pain Management
The entire CHLA team was there
along with
a packed house of conference attendees really interested in this great
research
or maybe hoping to participate in the VR research and play the games themselves. If you have not read or
seen this research check it out, it's fascinating. (Patterson showed a
video demonstrating the huge relief in pain for a burn patient
undergoing dressing change and burn patients undergoing PT.)
Speaker: Jon
Levine
Title:
Translating her opioids into his opioids
Discussing
how men and women have a different response to opioids, he focused on opioids
that target kappa receptors. He described his study of patients after they had
surgery to remove their wisdom teeth. His studies demonstrated not only a
difference in response between men and women (i.e. women responded better to a
clinical dose of kappa opioids while men had little or no response to the same
dose) but also showed that changing the dosing of the drugs also created
differences between the response. When the dose was doubled, for example, men
had a better response and women did not; while reducing the dose in half
produced a worsening of pain in men but a much better outcome in women.
Speaker: Lorimer Moseley
Title: The
body in mind: disruption and treatment of cortical body maps in people with
chronic pain
Moseley is a
great speaker and made a difficult and complicated subject very simple and
memorable. I was rather impressed and inspired by his lecture. He opened with a
cool story about a large knife and hitchhiking that you have to hear in his own
words... I found a printed version of this story in his book Painful Yarns (page 47).
His work and
research into Chronic Regional Pain Syndrome (CRPS) centers around
understanding how the brain perceives the body in space. His lab has done
experiments which demonstrate that the brain holds maps of the body as well as
the space around it and that it will ignore the space around a painful area in cases of chronic pain. By training
the brain in specific ways, Moseley and his team show that they can reduce the
patient’s pain. Among some of the cool methods that he described using was the
use of a prosthetic arm which you can see on his website (the site, by the way,
is an incredible resource of information in the subject). He also described an
experiment where his team took pictures of patient’s hands, duplicated the picture
and slightly changed the size of one hand in the photo. They then placed about
6 or 7 of these photos alongside the original one and asked CRPS sufferers as well
as healthy individuals to identify their own normal hand picture. The healthy
individuals quickly identify the normal photo while CRPS sufferers would always
pick the photo where the hand affected by CRPS was slightly altered to look
larger in the photo, as their own “normal” hands. Check out his work for a much
better description of this fascinating stuff. (click on his name above or visit: bodyinmidn.org)
Speaker: David Dodick
Title:
Global year against pain: migraine: pathophysiology and emerging therapies
In his
lecture, Dodick presented new ways to think about migraines, which, according
to him, are among the most prevalent and disabling medical conditions on the planet.
He pointed out that the widely accepted theory that headaches and migraines are
a neuro-vascular problem (suggesting that it begins outside the brain) may not
paint the full picture. He argued, instead, that migraines may actually begin
in the brain itself and have a strong genetic association. During his lecture, Dodick
demonstrated, through very complex slides and models, how changes in the brain which
lead to a sudden wave of hyperactivity (cortical spreading depression),
abnormal activation of trigeminovascular
nociceptive pathways, and abnormal processing of sensory stimuli are the key
factors in migraines. (He also had evidence to demonstrate that the botulism
bacteria reached the secondary motor neurons, trigeminal neurons, and argued that
that may be the reason botox injections work to reduce pain in some migraine
sufferers).
