American Pain Society (APS) meeting highlights

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:   

Speakers: Jeffrey Gold, Emily Law, Sean Mackey, David Patterson, David Thomas

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).