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2016 Australian Pain Society
36th Annual Scientific Meeting

2016 Australian Pain Society
36th Annual Scientific Meeting

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Topical Sessions

Please click below for session outlines and confirmed speakers - 
Topical Sessions 1 - Monday 14 March 2016, 1.30 pm - 3.00 pm

Topical Sessions 2 - Monday 14 March 2016, 3.30 pm - 5.00 pm

Topical Sessions 3 - Tuesday 15 March 2016, 3.30 pm - 5.00 pm

Topical Sessions 1 - Monday 14 March 2016,
 1.30 pm – 3.00 pm

1Sensorimotor dysfunction in musculoskeletal pain: Novel perspectives from mechanisms to treatments

Chair: Dr Siobhan Schabrun, University of Western Sydney, NSW

Sensorimotor dysfunction is a common feature of musculoskeletal pain, yet the mechanisms are poorly understood and treatments that target this aspect of pain have limited effect sizes. Increasing evidence suggests the sensorimotor system undergoes a range of changes in the presence of pain. These changes manifest as facilitation and impairment of central pain mechanisms together with reorganisation of sensorimotor control at peripheral, spinal and cortical level. Initially, this workshop will provide evidence for specific mechanisms thought to underpin sensorimotor dysfunction in pain and how these can be reliably assessed in experimental and clinical settings. Subsequently, the workshop will discuss similarities and differences in the manifestation of altered sensorimotor control in a range of musculoskeletal pain conditions. In addition, data on how these mechanisms develop during the transition from acute to chronic pain will be provided. Finally, novel treatments that target sensorimotor dysfunction in musculoskeletal pain will be presented including targeted motor training, non-invasive brain stimulation and the combined application of ‘top-down’ (non-invasive brain stimulation) and ‘bottom-up’ (trans-spinal stimulation, peripheral electrical stimulation and exercise) approaches. Factors that impact on an individual’s responsiveness to treatment will be outlined and suggestions for treatment optimisation discussed.

 Presenters:
Professor Thomas Graven-Nielsen, Aalborg University, Denmark
Professor Paul Hodges, University of Queensland, QLD
Dr Siobhan Schabrun, University of Western Sydney, NSW

1B  Cost-effectiveness 101: A how to guide to cost-effectiveness research

Chair: Karl Bagraith, Interdisiplinary Persisent Pain Centre, Gold Coast Health, QLD

With burgeoning costs for the delivery of healthcare there is ever growing pressure on healthcare spending. For those that fund healthcare the presence of various treatments with varying benefits can make resource allocation decisions challenging; particularly in the presence of new and expensive medical products, procedures and medications. In addition, comparing and contrasting investments in treatments across conditions can be difficult. This has led to greater emphasis on the provision of ‘cost-effective’ healthcare.

Cost-effectiveness research compares the costs and health effects of interventions. Cost-effectiveness research facilitates better understanding of the relative value of comparative interventions for clinicians and researchers as well as supporting decision-makers to make informed choices regarding the allocation of scarce resources. Cost-effectiveness research considers the economics of healthcare delivery and provides another suite of methods for demonstrating the utility of pain management treatments and services. As such, understanding and performing cost-effectiveness research can be challenging for pain researchers and clinicians. The aim of this topical session is to provide an introductory overview of cost-effectiveness research for pain researchers and clinicians to support increased confidence in using and undertaking cost-effectiveness research. This session will: 1) provide an overview of what cost-effectiveness research is and what it is not, 2) use examples to demonstrate application of cost-effectiveness research to painful conditions and, 3) discuss opportunities and challenges of undertaking and using cost-effectiveness research to inform practice and decision-making.

Presenters:
Professor Nicholas Graves, Queensland University of Technology, QLD
Associate Professor Steven McPhail, Queensland University of Technology, QLD
Professor Elizabeth Geelhoed, The University of Western Australia, WA

1C Pelvic Pain: Inside and out

Chair: Professor Lorimer Moseley, University of South Australia, SA

Pelvic pain constitutes a wide range of diagnoses, pathophysiology and treatments. This session will focus on three distinct clinical presentations with shared similarities as well as differences. Dr Susan Evans will discuss some of those similarities before focussing inside the pelvis, giving us an overview of current concepts in endometriosis related and visceral pain, and its sequelae. Susan’s particular interest lies in the assessment and management of the ‘big picture’ of symptoms commonly present in these complex patients.

We then go outside the pelvis for Jane Chalmers to present some interesting new developments in provoked vestibulodynia. Jane’s work has investigated the neuroimmune profile present in women with PVD and includes animal and human studies.

Finally, we go inside out and beyond, as A/Professor Helen Slater talks us throughh period pain in young women. Emerging evidence suggests young women with moderate to severe period pain have heightened tissue sensitivity (pressure and cold) even when a number of key potential confounders are considered. What might underlie this heightened sensitivity and what are the clinical implications?

Presenters:
Dr Susan Evans, Pevic Pain SA, SA
Jane Chalmers, University of South Australia, SA
A/Professor Helen Slater, Curtin University, SA

1D From Cells to circuit to patients: The 'reclining' nucleus in chronic pain

Chair: Associate Professor Kevin Keay, University of Sydney, NSW

The nucleus accumbens “reclines” in the base of the forebrain and is well known for its critical role in motivation and reward. There has been a recent surge of interest in this brain region during chronic pain states. This focus has stemmed largely from significant new data from human brain imaging studies. While these human studies have been pivotal in identifying structural and functional changes in the nucleus accumbens following injury and the development of the chronic pain state; it is animal studies that have helped identify neurochemical and cellular changes that may underpin the human observations. In this session Chris Vaughan and Jono Hakim will look at cellular, neurochemical and neuroanatomical changes in the nucleus accumbens in animal models of chronic pain, then Luke Henderson will review data from human brain imaging studies. The discussion after these presentations will be focussed on trying to integrate the findings from each of these three experimental fields. The session will highlight the important relationship of the basic scientist, clinical scientist and practitioner in understanding the brain changes in chronic pain states and the implications for current and future practice.

Presenters:
Dr Christopher Vaughan, Pain Management Research Institute, RNSH, NSW
Jonathan Hakim, University of Sydney, NSW
Associate Professor Luke Henderson, University of Sydney, NSW

1E Stick it to them! Practical peripheral nerve blocks for chronic pain using ultrasound and fluoroscopy

Chair: Professor Eric Visser, University of Notre Dame, WA

We will present an interesting, evidence-based and practical review of suprascapular nerve, abdominal wall, cluneal nerve and knee blocks for chronic pain management.

The session will include demonstrations of nerve block anatomy using real time ultrasound and other imaging, and discussions about block needles, injectables (local anaesthetics, liposomal bupivacaine, steroids, clonidine, midazolam, phenol), neurotomies and pulsed radiofrequency.

Presenters:
Dr James Jarman, PainScience WA, WA
A/Professor Stephanie Davies, Western Australian Specialist Pain Services, WA
Professor Michael Veltman, PainScience WA, WA

1F Addressing adolescent pain at a population health level

Chair: Dr Christopher Williams, Hunter New England Population Health and Hunter Medical Research Institute, NSW

Adolescent musculoskeletal pain is common and burdensome. International data shows that musculoskeletal pain, occurring at least monthly, is experienced by more than 35% of adolescents (Swain, 2014). Recent data shows similarly high prevalence and burden in Australia (O’Sullivan 2012; Williams 2015, under review). For a significant group this is associated with health care seeking, disability, poorer mental health and ‘lifestyle’ risks for other chronic disease. Despite this, consideration of the prevention, prognosis and management of adolescent musculoskeletal pain is largely underserved.

Addressing the burden of adolescent musculoskeletal pain using a population health framework requires consideration of several issues. The first is elucidating challenges in measurement and improving understanding about the prognosis of conditions. Second, better integration of clinical and population health sectors is required to coordinate prevention and management approaches. Finally, avoiding ‘medicalisation’ of episodes of pain is critical to optimise care. Despite these challenges, there is considerable potential to address adolescent pain within a population health framework that includes consideration of health behavioural issues, such as obesity, resilience and mental health.

Presenters:
Dr Steven Kamper, The George Institute for Global Health, NSW
Dr Susie Lord, Children Complex Pain Service, John Hunter Children's Hospital, NSW
Professor Peter O’Sullivan, Curtin University

Topical Sessions 2 - Monday 14 March 2016,
 3.30 pm – 5.00 pm

2A  Mindfulness, yoga and beyond: how to integrate mindfulness into a multidimentional pain management approach

Chair: Dr Malcolm Hogg, Royal Melbourne Hospital, VIC

“A disciplined mind leads to happiness, and an undisciplined mind leads to suffering.”
        ― Dalai Lama XIV, The Art of Happiness

Mindfulness has become a popular topic amongst clinicians, but where did it come from? What’s the evidence? How could you practice it? And who is it appropriate for?

This session will present cross-disciplinary applications of using mindfulness for managing persistent pain. The scene will be set by drawing upon the profound experience of the Tibetan meditation tradition and offer insights into its transformative potential in the context of both suffering, and one’s own development of wisdom and self-awareness.

An update of the current science evidencing the geno-pyshco-neuro-immunological changes of mindfulness practice will follow, and complement clinical outcomes-based research to both highlight its range of clinical appropriateness and hypothesized mechanisms of action.

The practical application of mindfulness for pain will then be explored from each of the perspectives of clinical psychology, physiotherapy and yoga and will include methods of how we bridge the gap between the evidence and clinical practice.

The session will close with a practical, chair-based experience of yoga for pain. The mindful attention on the present experience employed in yoga praxis has raised interest in its mediating abilities in cognition and behaviours. This component aims to demonstrate how yoga can be used for the purpose of improving physical, emotional, and spiritual well-being.

Presenters:
Georgie Davidson, Mindful Movement Physiotheraoy, VIC
Nicole Moore, Royal Melbourne Hospital, VIC
Robert Schutze, Wisdome Health Psychology, WA
Rachael West, Findingyoga, WA
Venerable Thubten Dondrub, Australian-born Monk, SA

2B Complex pain issues in young children and adolescents

Chair: A/Professor George Chalkiadis, Royal Children's Hospital, VIC

In this session, attendees will hear results from a unique longitudinal population-based study that examines early-life child and family predictors of recurrent pain childhood. They will also learn about treatment options to manage dystonia in young people. There will also be a presentation of a case-series of complex pain presentation in young children less than 10 years of age.

Presenters:
Dr Emily Incledon, Royal Children’s Hospital, VIC
Dr Ross Drake, Starship Hospital, NZ
Natasha Haynes, The Children’s Hospital at Westmead, NSW

2C Head and orofacial pain – An update on mechanisms and research priorities

Chair: A/Professor Philip Bolton, University of Newcastle, NSW

The mechanisms underlying many types of head and orofacial pain are not well understood. Recent advances in animal studies and human imaging technologies may provide opportunities to better understand the mechanisms and role of the central nervous system in head and orofacial pain disorders. This is essential if new clinical interventions are to be developed.

In this topical session Dr Brett Graham (University of Newcastle, Australia) will consider the possible role of optogenetics as a tool to better understand the role of neural connectivity in pain processing and how this might be applied to the trigemino-cervical system. A/Prof Luke Henderson (University of Sydney, Australia) will then present recent findings derived from magnetic resonance imaging of humans that provides insights concerning mechanisms underlying temporomandibular and orofacial pain. Professor Barry Sessle (University of Toronto, Canada) will highlight key research findings that have improved our understanding and clinical approaches to orofacial pain as well as identify research priorities necessary for further enhancing our understanding and thus clinical management of orofacial pain disorders.

Presenters:
Dr Brett Graham, University of Newcastle, NSW
A/Professor Luke Henderson, University of Sydney, NSW
Professor Barry Sessle, University of Toronto, Canada

2D Understanding the social context of chronic pain and its management: How far have we come and where do we go from here?

Chair: Dr Claire Ashton-James, Sydney Medical School, Pain Management Research Institute, NSW

While there has been some progress in our understanding of the social contributors to chronic pain, it is still a relatively neglected area of research. Recent advances in research on the social modulation of chronic pain suggests that there is great potential to improve the pain-related outcomes of people living with chronic pain by addressing their social circumstances, including their work status, social and personal relationships, financial stability, and access to social resources.  This topical session aims to highlight advances in our understanding of social contributors to chronic pain and to offer a critical perspective on how these findings may be utilized to improve patient outcomes.

Presenters:
Professor Michael Nicholas, Sydney Medical School, Pain Management Research Institute, NSW
Dr Claire Ashton-James, Sydney Medical School, Pain Management Research Institute, NSW
Dr Toby Newton-John, University of Technology Sydney, NSW

2E Reassurance: A powerful tool to manage low back pain

Chair: Dr James McAuley, Neuroscience Research Australia, NSW 

Reassuring patients, alleviating their fears and worries about their illness, is a core aim of pain management. It is advocated as first line care by international clinical guidelines for the management of non-specific low back.

This workshop will provide a clinical and research update on optimal methods to reassure patients with low back pain.

Although evidence from systematic review has shown that structured patient education can reassure patients, effects are modest and some methods aimed to reassure may be harmful.

A major conceptual advance in the field was provided by Pincus et al. (2013) who proposed a 2-component model of reassurance: emotional and cognitive reassurance.  This model, based on theories of persuasion, holds significant promise to guide research to develop and test interventions to maximise the helpful effects and minimize potential harms associated with reassurance. Newly available evidence to optimise the effectiveness of interventions to reassure patients with low back pain will be discussed.

Presenters:
Professor Ben Wand, University of Notre Dame, WA
Dr Chris Williams, Hunter Medical Research Institute, NSW
Dr Adrian Traeger, Neuroscience Research Australia, NSW

2F Pain Management Programs: evidence and how to measure efficacy  

Chair: Dr Richard Sullivan, Precision Spine, VIC

Chronic pain is associated with a distinct pathology from acute pain, and therefore requires treatment strategies that acknowledge psychosocial factors that contribute to its presentation. One such multidimensional approach is Pain Management Programs (PMPs) which typically implement psychological and physiotherapy components to treatment. PMPs compliment traditional medical interventions, with a goal to improve patient’s physical and emotional coping. In this topical session, we present both published and prospective research examining change to patient outcomes following participation in a PMP. The first topic will review the efficacy of PMPs, with an emphasis upon meta-analyses, systematic reviews, randomized control trials and estimates of clinical significance. The second topic will present outcomes from one of Australia's largest consortium's of PMP data; Network pain. Outcomes discussed include pain, depression, anxiety, stress and activity levels. Taking these findings into account, the third topic will present a workable private model of pain management programs. Collectively, this topical session will argue that PMPs are an effective treatment for chronic pain, with some caveats. Some of the issues for further discussion include the importance of early referral, support-mechanisms following program discharge, improving long-term outcomes, and predictive factors for program receptivity.

Presenters:
Dr Thomas Perkins, Precision Ascend, VIC
A/Professor Stephanie Davies, Western Australian Specialist Pain Services, WA

Topical Sessions 3 – Tuesday 15 March 2016
, 3.30 pm – 5.00 pm

 3A How complex and regional is CRPS

Chair: Professor Lorimer Moseley, University of South Australia, SA

This topical session will expand on Professor Birklein’s plenary on CRPS, by discussing where we might be heading as a pain science community in our understanding of the disorder. Professor Peter Drummond will provide an overview of his recent work looking at sensory processing and the role of the sympathetic nervous system in CRPS.  He will discuss recent evidence of peripheral up-regulation of α1-adrenoceptors in CRPS, and speculate about central interactions between the nociceptive and “arousal” systems in CRPS.

Professor Lorimer Moseley will focus on current concepts in the clinical factors associated with the onset of CRPS and the transition of acute CRPS to chronic CRPS. He will present some recent experimental evidence of disrupted cortical processing in CRPS, some speculative theories on how such disruptions might emerge and what we might do about them.

Professor Birklein will describe recent work investigating the role of aberrant posttraumatic inflammation in the development of CRPS. He will discuss both human studies and a programme of research developing an animal model of CRPS and present the clinical implications of that work including its limitations and future directions.

Presenters:
Professor Peter Drummond, Murdock University, WA
Professor Lorimer Moseley, University of South Australia, SA
Professor Frank Birklein, University of Medical Centre Mainz, Germany

3B Practical solutions for complex musculoskeletal problems in the workers; compensation setting

Chair: Dr Darren Beales, Curtin University, WA

It is widely acknowledged that a compensation claim adds an additional layer of complexity to the multidimensional nature of musculoskeletal pain disorders.

Health care practitioners and other stakeholders engaged in this field may look to guidance from the ‘Clinical Framework For the Delivery of Health Services’, which has been endorsed by many national organisations. However, our recent research shows that knowledge of the framework across most stakeholders appears to be limited and application of the guiding principles in complex musculoskeletal problems can be challenging. This session will explore a number of topical challenges faced in the management of injured workers, from a systems level down to the individual level. This will include; (i) perspectives on the diagnosis, (ii) unravelling the multidimensional complexity from the injured workers perspective, (iii) challenges in the workplace, and (iv) the conundrum for insurers in balancing claim oversight with guiding management. Each of these themes will include; (i) key strategies that should be implemented NOW to address these challenges, and (ii) proposal of potential strategies for INNOVATION in the management of injured workers. This will span from system based strategies to individual based strategies. Group participation will revolve around ‘blue sky’ discussion of innovation concepts.

Presenters:
Dr Tim Mitchell, Curtin University, WA
Dr Venerina Johnston, University of Queensland
James Hay, Major National Workers Compensation Insurer, WA

3C Understanding the black box that is pain: From neural mechanisms to life experiences

Chair: Dr Flavia Di Pietro, University of Sydney, NSW

Pain is complex. In an effort to understand pain we research countless mechanisms, theories and systems separately, and in depth. While it is obviously important to approach pain from many different angles, sometimes this makes it difficult to step back and appreciate the bigger picture. This topical workshop will present a broad picture of pain. First, Dr Flavia Di Pietro (University of Sydney, Neuroscience Research Australia) will speak about neural mechanisms, specifically the evidence for altered inhibition in the brains of chronic pain sufferers. From neural mechanisms the workshop will then transition into function. Dr Siobhan Schabrun (University of Western Sydney, University of Queensland) will discuss movement outcomes – why and how people move differently in pain and how this might contribute to the perpetual cycle of pain and pain outcome. The final talk will be presented by Dr Tasha Stanton (University of South Australia, Neuroscience Research Australia); this talk will focus on life experiences. Dr Stanton will present exciting new evidence discussing the role of social interaction in pain perception and other protective responses, such as immune function. She will discuss the impact on these responses when social interaction goes wrong, such as when people are bullied.

Presenters:
Dr Flavia Di Pietro, University of Sydney NSW
Dr Siobhan Schabrun, University of Western Sydney, NSW
Dr Tasha Stanton, University of South Australia, SA

3D  Non-psychologist delivered psychosocial intervention for musculoskeletal pain

Chair: Robert Schutze, Curtin University, WA 

Psychological and psychosocial factors are commonly reported by patients with musculoskeletal pain conditions, for example low back and neck pain. These factors have been shown to be associated with poor recovery from injury; associated with higher levels of pain, disability and reduced physical function as well as with a poorer response to rehabilitation. It is not always feasible or practical for people with musculoskeletal pain to be assessed and managed by a psychologist. For example, early aggressive psychological interventions in an acute post injury stage may be detrimental to recovery. For this reason recent research has focused on investigating the benefits and effectiveness of non-psychologists (eg physiotherapists) delivering psychological interventions for common musculoskeletal conditions. This session will comprise of 3 presentations each addressing a different musculoskeletal condition and approach to delivering psychological based interventions.

Professor Michele Sterling will present data demonstrating the feasibility and pilot effectiveness of physiotherapists delivered a stress inoculation integrated with physiotherapy exercise for the management of individuals with acute whiplash injury and at medium/high risk of poor recovery.

Professor Peter O’Sullivan will present data supporting a classification-based cognitive functional therapy model for the assessment and targeted management of disabling low back pain. It integrates cognitive strategies and functional rehabilitation to change provocative movement and cognitive behaviours that provoke and maintain pain.

Associate Professor Kevin Vowles will present data of an interdisciplinary package of acceptance and commitment therapy (ACT), outcome data of the intervention, and how the physiotherapists integrated their core role of physical rehabilitation within the ACT framework

Presenters:
Professor Michele Sterling, CONROD, Griffith University, QLD
Professor Peter O’ Sullivan, Curtin University, WA
A/Professor Kevin Vowles, University of New Mexico, USA

3E Opioid medication reduction strategies for chronic non-cancer pain

Chair: A/Professor Carolyn Arnold, Caulfield Hospital, VIC

Opioids medications are increasingly used for chronic non-cancer pain. Long-term efficacy of those medications for chronic non-cancer pain is not only not established, but also associated with a range of serious adverse effects and social impact, including immune suppression, poor quality of life, worsened pain, depression, a higher rate of un-employment, and fatal and non-fatal overdose. Opioid medication reduction is an important step for pain management for some people.

A recent Cochrane review found only two randomised controlled trialled in this area: one study employed electroacupuncture and the other a special form of cognitive behavioural therapy. Beyond that, very little information is available on the experience of this group of population and how to reduce their opioids usage. Recent Australian studies helped close the knowledge gaps through interviewing patients, conducting a clinical trial and reviewing clinical data. In this workshop, we will share our findings and insights about four types of journey that led to different outcomes for patients with chronic pain, and five opioid medication taking patterns. Clinicians will share their experience and outline strategies in assisting patients reducing opioid medications.

Presenters:
Dr Zhen Zheng, RMIT University, VIC
Professor Michael Nicholas, University of Sydney, NSW
A/Professor Carolyn Arnold, Caulfield Hospital, VIC               

3F Mitigating the tyranny of distance – The use of digital technologies to lever the delivery of effective adult and paediatric pain management services in Australia

Chair: Professor Eric Visser, University of Notre Dame, WA

Digital technologies can help mitigate socio-geographic factors that are barriers to effective delivery of pain management in Australia. Using 3 working examples, the use of digital technologies to lever evidence into practice and up skill consumers in best practice co-care of their pain are discussed:

  1. The Pain Course: is an internet-delivered pain management program. Results of three randomised controlled trials of the Pain Course conducted (N>700 Australians) will be described, with a focus on a very recent study examining demographic and clinical predictors of response to internet-delivered pain management programs
  2. PACE: is an interdisciplinary pain program developed by the recently established Western Australian paediatric chronic pain service. The role of Telehealth and the parallel development of digital resources to augment “Face to Face” therapy will be described in the context of paediatric pain and the needs of families in an area 1/3 of the size of the Australia.
  3. painHEALTH: is an innovative website for consumers with musculoskeletal pain implemented across care settings and aligned with contemporary health policy to deliver best practice pain care. Uptake data provides evidence for successful implementation of this sustainable/accessible resource: since launch: 4,027,992 hits, >258,182 visitors, averaging 294 visitors p/day in 142 countries.

Presenters:
Dr Blake Dear, Macquarie University, NSW
Anna Hilyard, Princess Margaret Hospital, WA
Dr Helen Slater, Curtin University, WA

For further information please contact the APS Secretariat: DC Conferences Pty Ltd
Suite 103, Level 1, 3-5 West Street, North Sydney NSW 2060, Australia | PO Box 637, North Sydney 2059
P 612 9954 4400 | F 612 9954 0666 | E aps2016@dcconferences.com.au