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2019 Australian Pain Society 39th Annual Scientific Meeting

2019 Australian Pain Society 39th Annual Scientific MeetingIn the IASP Global Year Against Pain in the Most Vulnerable7 - 10 April 2019 | Gold Coast Convention and Exhibition Centre, QLD

Topical Session

Please click below for session outlines and confirmed speakers -

Topical Sessions 1 - Monday 8 April 2019, 10.45 am - 12.15 pm
Topical Sessions 2 - Monday 8 April 2019, 1.45 pm - 3.15 pm 
Topical Sessions 3 - Tuesday 9 April 2019, 3.30 pm - 5.00 pm 
 

Topical Session 1 - Monday 8 April, 10.45 am - 12.15 pm

Topical Concurrent Session 1A: What is not working? A discussion of opioids, surgery and placebo
Chair: TBC

Experimental and clinical pain research often focuses on the exciting results of a new treatment or therapy. However, one of the key ways to ensure that the field continues to advance is to also discuss what is not working and thus, what we need to do about it. This symposium will bring together eminent speakers from around the world to discuss precisely that. Dr Owen Williamson (Canada & Australia) will provide an international perspective on the use of opioids for pain, how this problem rose to epidemic proportions, and what steps are needed to address this problem. Professor Ian Harris (Australia), the author of “Surgery: The Ultimate Placebo?”, will then discuss what’s not working in the field of orthopaedic surgery for pain, exploring the critical need for sham surgical testing to robustly evaluate efficacy.  Last, Professor Tor Wager (USA) will discuss the mechanisms that underlie how we as researchers and as clinicians can ‘get things so wrong’, particularly discussing the role of non-specific treatment effects (placebo) in contributing to pain reduction. 

Speakers:
Associate Professor Owen Williamson, Monash University, VIC
Professor Ian Harris, University of New South Wales & Liverpool Hospital, NSW
Professor Tor Wager, University of Colorado Boulder, USA 

Topical Concurrent Session 1B: Pain management in CALD Communities
Chair: Ms Fiona Hodson, Hunter Integrated Pain Service, NSW

Managing chronic pain in multicultural societies requires attention to the unique ways culture and language shape the pain experience for Culturally and Linguistically Diverse (CALD) communities.  Locally, the problems facing people living with chronic pain from CALD communities were formally recognised by the NSW Agency for Clinical Innovation (ACI) in 2015 (Pain Management Network Multicultural Report, 2015).  This report recommended that existing materials on living with pain and service delivery models address the needs of CALD communities. Ideally, the report recommended translated and culturally adapted self-management approaches be provided in the local community by local health workers, with the involvement of the participants’ local general practitioner, and in their own language as much as possible. The largest language groups were identified as Chinese, Arabic, Vietnamese, and Greek.

This workshop will outline some recent innovative work in NSW and in South-East Asian countries addressing the challenges of delivering pain management within CALD communities. The session will include original research on:

  • challenges and strategies for chronic pain assessments for CALD communities in  implementing a culturally-adapted physiotherapy programs in south-western Sydney
  • an experiential account of practical solutions for implementing a Chinese language pain self-management program in south-eastern Sydney
  • current initiatives in developing and establishing pain services in south-east Asian countries in partnership between IASP and ASEAPS.

Speakers:
Ms Bernadette Brady, Western Sydney University & Liverpool Hospital, NSW
Ms Meng Chen, St George Hospital, NSW
Ms Maria de Sousa, Royal North Shore Hospital, NSW

Topical Concurrent Session 1D: Nutritional considerations for pain management in vulnerable populations
Chair: TBC

In the IASP Global Year Against Pain in the most vulnerable our team will provide an overview on the role of nutrition in pain management in three key vulnerable populations. Nutrition is an important factor in modulating chronic pain and we will compare the role of nutrition in three vulnerable populations followed by a Q&A session.
1. Indigenous: The traditional Aboriginal way of living includes nutrient rich food with an emphasis on grazing, sharing and sustainability. We will compare a traditional Indigenous diet with the current Australian Dietary Guidelines with a focus on pain management. Hear from elders sharing their own knowledge about traditional foods and eating.
2. Culturally and linguistically diverse (CALD) population: Culture and language play a key role in the foods we consume and the way we value eating. What should we consider when translating nutrition advice to those from other cultures experiencing chronic pain? Listen to feedback from Mandarin and Cantonese speaking patients.
3. Older people: Age is significant risk factor for developing chronic pain. We will provide information on how to identify and manage nutrition-related issues such as malnutrition and dehydration which are highly prevalent in older people and significantly affect pain.

Speaker:
Ms Katherine Brain, University of Newscatle, NSW 

Topical Concurrent Session 1E: Let's talk about us. Transparency and engagement in pain research
Chair: TBC

Better patient care is linked with conscientious and judicious use of the best available evidence. With increasing availability of clinical research, we should be seeing improvements in the quality of care for patients in pain, but this is not always the case. We have identified an important contributing factor, with two parts. First, clinicians do not necessarily engage with research evidence. Second, the evidence itself may not be trustworthy. This workshop aims to explore both issues to facilitate better care for patients with pain.

We will present data on contributors to effective clinician engagement with research, and new strategies centred on the ‘clinician-as-scientist’ concept. The approach reflects current initiatives from funders and research-practice partnerships that will influence the future research agenda in the pain field. This will be relevant to clinicians and researchers interested in a collaborative approach to knowledge generation and implementation. Whether or not the evidence is trustworthy is a complex issue that includes how reproducible and replicable the research is. Attempts to translate poorly-performed or reported research findings into clinical practice can have serious implications for clinical care. Following our Topical Review in PAIN, we will present advances for clinicians to identify, evaluate and translate trustworthy research.

Speakers:
Professor Lorimer Moseley, University of South Australia, SA
Mr Aidan Cashin, University of New South Wales, NSW
Mr Matthew Bagg, Neuroscience Research Australia, NSW

Topical Concurrent Session 1F: Migraine-News
Chair:  Ernest Jennings

The session will provide updates on migraine with updates on new discoveries in the area of the underlying signalling pathways causing migraine and new developments in the area of migraine treatment followed by an introduction into the understanding of genes related to migraine. 

Speakers:
Dr Ernest Jennings, James Cook University, QLD
Professor Paul Rolan, University of Adelaide, SA
Professor Lyn Griffith, Queensland University of Technology, QLD

Topical Session 2 - Monday 8 April, 1.45 pm - 3.15 pm

Topical Concurrent Session 2A: Managing the opioid dependent patient with chronic pain - Learning by case-based discussions
Chair: TBC

A workshop to explore the management of complex pain management cases using case-based discussions. The focus will be on the management of individuals with opioid dependence and the management of acute and chronic pain conditions in this cohort. In addition there will be a discussion of legislative issues of relevance to managing this group of patients and discussions of innovative approaches to treatment. This will be  a highly interactive forum  with audience participation. Participants are encouraged to bring relevant de-identified cases with them for sharing, preferably in a brief powerpoint format,  so that these can form part of the discussion. 

Speakers:
Professor Stephan Schug, Royal Perth Hospital, WA
Associate Professor Malcolm Hogg, Royal Melbourne Hospital, VIC

Topical Concurrent Session 2B: Care across distance - Delivering self - Management programs into regional and remote communities
Chair: TBC

With approximately a third of the Australian population living in rural or remote areas and higher prevalence of persistent pain in these communities, how are multidisciplinary pain services addressing the issue of accessibility for this vulnerable population? In this session, three Queensland public pain services will present local service delivery initiatives, each tailored to their unique geography. 

Speakers:
Mr Darren Doherty, Gold Coast Interdisciplinary Persistent Pain Centre, QLD
Dr Tania Morris, Sunshine Coast Persistent Pain Management Service, QLD
Ms Alison Beeden, North Queensland Persistent Pain Management Service, QLD

Topical Concurrent Session 2C: Innovative solutions & clinical pathways to improve management of common MSK pain conditions
Chair: TBC

Our first speaker, Prof Sterling (UQ), will discuss the results of a trial where physiotherapists, trained by psychologists, delivered a programme targeting post-injury stress in patients with acute whiplash at risk of poor recovery 1,2. She will then discuss a proposed clinical care pathway for people with road traffic injury spanning hospital ED to primary care. 

Second, Prof Nicholas (USyd) , clinical psychologist and pain researcher will discuss 3 models of care for early interventions and the case for and against each, with examples from the research literature and a current study with high risk injured workers that utilises interdisciplinary pain management integrated with the workplace.

Thirdly, Dr Darren Beales (Curtin) is a practicing specialist musculoskeletal physiotherapist and senior research fellow. Blending his experience and expertise from these two roles, he will discuss the challenges in having clinicians engage in contemporary models of care/care pathways for musculoskeletal pain. This will touch on clinician knowledge, beliefs and behaviours. He will discuss broad strategies to bridge the gaps from research knowledge to clinicians ‘knowing’ and ‘doing’.

Our final speaker Dr Rebbeck, (USyd) is also practicing specialist musculoskeletal physiotherapist and senior research fellow. She will discuss results from implementation of a risk- based clinical pathway of care to improve outcomes following whiplash injury (Whiplash ImPaCT) 3,4. She will introduce a new national initiative on behalf of the team, where this clinical pathway has been scaled and adapted to improve health service delivery for common musculoskeletal disorders in primary care (PaCE study).

Speakers:
Dr Trudy Rebbeck, University of Sydney, NSW
Professor Michele Sterling, Recover Injury Research Centre, QLD
Professor Michael Nicholas, University of Sydney, NSW
Dr Darren Beales, Curtin University, WA

Topical Concurrent Session 2D: Improving pain experiences amongst indigenous children, youth and their families and neurodevelopmental vulnerability and pain
Chair: TBC

 Pain is influenced by attitudes, beliefs, personality and social factors, and can affect emotional and mental wellbeing. How then might we understand the pain experience of children and young people with an underlying neurodevelopmental vulnerability such as autism or autism spectrum disorder (ASD), which is characterised by impairments in reciprocal social interaction and communication skills? Anecdotally, a significant number of children and young people who present with persistent pain have a pre-existing diagnosis of ASD or are subsequently identified and referred for further developmental assessment. Persistent Pain Services delivering intervention across the age span should consider potential concurrent diagnoses to facilitate greater understanding of the patient’s experience of pain, allow targeted intervention, and appropriate referral for developmental support. Failure to identify these vulnerabilities is likely to result in the persistence of pain, poor outcomes in social and emotional domains, and perceived blocks to treatment.

This paper will describe the existing literature on the link between pain and ASD in terms of epidemiology, pain experience, and intervention. Case examples from an interdisciplinary paediatric pain service will be used to explore these concepts in more detail. Disparities exist between the health and well-being of Indigenous adolescents compared with non-indigenous adolescents. The burden of some painful conditions—notably headache and back pain—has been recognised. These painful conditions are more prevalent amongst mid-late adolescents, and Indigenous adolescents living in urban/non-remote areas. Although no other pain conditions have been specifically reported in population surveys, many of the known inequitably distributed injuries and conditions are typically associated with acute, recurrent or chronic pain. The cumulative impacts of pain, racial discrimination and socioeconomic adversity are evident in our clinic where more than 20% of presenting children and adolescents are Indigenous. Elise Anthony, a proud Aboriginal woman of Ngunnawal descent, will share insights into multi-generation experience of pain in families and how this might affect presentation to pain services. Susie Lord, a non-Indigenous clinician, will share progress with local initiatives aimed at increasing service accessibility and cultural safety. Ultimately, harnessing Indigenous knowledge and community strengths will further improve pain care for Indigenous young people during this transformative life phase.

Speakers:
Dr Sue Wilson, Lady Cilento Children's Hospital, QLD
Dr Susie Lord, John Hunter Children’s Hospital, NSW

Topical Concurrent Session 2E: "Pain forget me not in the frail, forgetful me" - Pain in older people living with cognitive impairment and frailty
Chair: TBC

Pain management in older people with frailty and/or cognitive impairment presents a unique set of challenges. These will become increasingly prevalent with the ageing of the population. Frailty and cognitive impairment are heterogeneous conditions. Frailty is associated with increased vulnerability to stressors such as pain and its treatments. The barriers in people with cognitive impairment extend just beyond memory loss and an inability to communicate or comprehend. They have variable expressions presenting as behavioural changes, impaired cognition to process the stimuli, altered emotional state and coping mechanisms, impact of the associated co-morbidities, and the resulting changes in their function and psycho-social context. The challenges in optimal management extend from difficulties in identification, assessment, treatment and monitoring. The self- reporting screening tools and applications of standard treatments are often ineffective in more advanced stages of cognitive impairment. This often leads to under-treatment or even inappropriate use of therapies.

In this session, Dr. Savvas will present about the subjective 'pain experience' for people with neurocognitive dysfunction. Dr. Anand will speak about the challenges and approaches to the identification and assessment of pain. Prof Katz will conclude the session with an adaptation of multidisciplinary treatment approaches for people with frailty and/or cognitive impairment.

Speakers:
Dr Raj Anand, HammondCare, NSW
Associate Professor Benny Katz, St Vincent’s Hospital Melbourne , VIC
Dr Steven Savvas, National Ageing Research Institute, ACT

Topical Concurrent Session 2F: Photobiomodulation - a novel non-drug treatment for pain using light as either laser or LEDs, to modulate pain. What is the evidence and what are the mechanisms?
Chair: TBC

Photobiomodulation (PBM) is a novel non-drug treatment for pain. It has been used clinically since laser was "invented" in 1960 though predicted by Einstein in 1916.

Clinical evidence has been steadily growing as has an understanding of the mechanisms for analgesic effects. Light modulates pain via several mechanisms. It specifically inhibits Aδ and C fibres reducing action potential amplitudes and slowing conduction velocity; improves muscle endurance and facilitates exercise; induces anti-inflammatory effects equivalent in vivo and in vitro to those of NSAIDs; stimulates the lymphatic system, cells involved in tissue repair and microcirculation, all contributing to the long term reduction in pain. The multidimensional effects of PBM are unique. The RACGP has called for funding and research into non-pharmacological treatments for pain, given the current opioid epidemic and limited efficacy and side effects of available drugs. PBM is currently used in practice and should provide an adjunctive treatment to reduce the burden of pain.

Speakers:
Dr Roberta Chow, University of Sydney, NSW
Professor Liisa Laakso, University of Queensland, QLD
Dr Ann Liebert, University of Sydney, NSW
Professor Patricia Armati, University of Sydney, NSW

Topical Session 3 - Tuesday 9 April, 3.30 pm - 5.00 pm

Topical Concurrent Session 3A: Using deception to alter perception: What bodily illusions, placebo and virtual reality can tell us about understanding and treating pain
Chair: TBC

The experience of ourselves and of the world is fundamentally a perceptual manifestation. Sensory input is shaped by knowledge and experience, prior to conscious awareness. Current knowledge suggests that whether or not something hurts depends not only on nociception, but numerous multimodal and diverse factors. As such, manipulating perception of a situation, the body, or the environment, provides a novel way to understand and treat pain.

This workshop will present evidence from a variety of ‘deception’ paradigms to explore pain modulation. Dr Tasha Stanton (UniSA) will present findings from mediated reality showing that perceived features of the body can modulate pain. Dr Felicity Braithwaite (Flinders) will present data on the use of placebo paradigms to understand how information can blind individuals to what is a normally painful treatment. Dr Ebonie Rio (Latrobe) will present findings from virtual reality-based rehabilitation in people with painful knee osteoarthritis.

Speakers:
Dr Tasha Stanton, University of South Australia, SA
Dr Felicity Braithwaite, University of South Australia, SA
Dr Ebonie Rio, Griffith University, VIC

Topical Concurrent Session 3B: Less than satisfactory communications about pain? Bridging the language and culture gap
Chair: TBC

The space between healthcare professionals and patients in pain care can vary enormously, even between participants who share a common language and culture. Healthcare encounters increasingly involve crossing language and culture boundaries. Not infrequently the interaction does not achieve the shared understanding necessary for effective therapeutic relationships, especially with vulnerable and distressed patients. Because pain is an inherently subjective experience, patients with pain have to rely on expressive language in order to convey their experience and solicit assistance from healthcare providers. It is therefore vital to understand how patients use pain language in order to optimise healthcare. Data from a recent study will be presented highlighting the relationships between pain language and standardised measures of mood and pain-related disability. Furthermore, health professionals often forget they use a specialised language that is foreign to those in their care. In order to achieve optimal results for patients in pain and their support networks, this ‘MedSpeak’ needs to be translated into simple English. Participants will be given guidance and an opportunity to practise their translation skills.

The session will address the contribution of enhanced expertise in language and cultural competence and understanding to better communication about pain and the need for sophisticated training.

Speakers:
Ms Christine Onishko, Women's And Children's Hospital, SA
Professor Roland Sussex, University of Queensland, QLD
Ms Imogene Munday, University of Technology, NSW

Topical Concurrent Session 3C: Social aspects of pain: New frontiers in pain research and management
Chair: TBC

Despite being a core component of the biopsychosocial model of pain, social aspects of pain have historically been treated as peripheral to the “more fundamental” biological and psychological aspects of pain. A recent surge of research into “social” aspects of pain challenges the notion that the social context of pain is anything but fundamental to its experience and to neglect this important component of pain is to handicap its management. Growing recognition of the importance of social aspects of pain within the International Association for the Study of Pain (IASP) has culminated in the recent formation of a dedicated IASP Special Interest Group for the Social Aspects of Pain (SocSIG). In this Topical Workshop, current SocSIG members – Professor Tor Wager (University of Colorado, Boulder), Professor Beth Darnall (Stanford University), Professor Milton Cohen (University of NSW), and Dr. Claire Ashton-James (The University of Sydney) discuss new research that highlights the scope and diversity of research being conducted within this rapidly emerging field.

First, Professor Tor Wager (University of Colorado, Boulder, USA) will begin by explaining the impact of social cues on pain experience and physiology from a neuroscientific perspective. Second, Dr. Claire Ashton-James (The University of Sydney) will demonstrate the subtle ways in which social interactions shape people’s experience and expression of pain. Third, Professor Beth Darnall (Stanford University) will examine the mechanisms underlying the intergenerational transmission of depressive symptoms and chronic pain. To conclude, Professor Milton Cohen, a long-term proponent of a “sociopsychobiomedical” approach to pain management will provide his perspective on clinicians’ reluctance to embrace social aspects of pain and the benefits of braving these “new” frontiers.  

Speakers:
Dr Claire Ashton-James, University of Sydney, NSW
Professor Tor Wager, University of Colorado Boulder, USA
Professor Beth Darnall, Stanford Univeristy School of Medicine, USA
Professor Milton Cohen, University of New South Wales, NSW

Topical Concurrent Session 3D: Developing and implementing a national pain strategy: Lessons learned and ideas welcomed
Chair: TBC

In 2010, the Australian National Pain Strategy was successfully launched and has provided a framework for the recognition and treatment of pain in jurisdictions around Australia. It is yet to be formally endorsed by all Australian Governments. In 2012, a Canadian National Pain Strategy was launched but failed to gain the support of the federal government.

The implementation of aspects of the Australian strategy has lead to some measurable improvements in the management of pain and provides a backdrop against which to frame the recently announced National Strategic Action Plan for Pain Management. This Plan outline practical activities that, if funded and supported, could further improve the lives of Australians living with pain. In Canada, we have learned much by comparing the initial approaches of both countries and are now well advanced in the development of a new national pain strategy.

The aim of this session is to present a pragmatic guide to the development, implementation, assessment and renewal of a national pain strategy. The steps required to raise a strategy to a federal government decision agenda will be discussed, as will negotiating the acceptance of responsibilities when the federal and state/provincial governments share responsibility for implementation.

Speakers:
Dr Owen Williamson, Monash University, VIC 

Topical Concurrent Session 3E: Pockets of vulnerability and disadvantage: Targeting services to meet needs
Chair: TBC

Adapting services to meet individual needs may be more appropriate amongst populations who are socially disadvantaged or marginalised because they sit outside the conventional stream of the pain clinic.
Topic 1 – Refugee Population – Dr Saras Henderson
                Case scenario
                Discussion of the results of a chart audit performed to illustrate the complexity of the refugee populations referred to the pain clinic.
Topic 2 – The Low Social Economic Population – Mr Michael Deen
                Case scenario
                Discussion of recent study in which investigated how neighbourhood socio-economic status impacts patient’s attendance at a tertiary pain clinic.
Topic 3 – Prison Population – Dr Anthony Schoenwald NP
                Case Scenario
                Discussion of the challenges with managing individuals with persistent pain in the prison system and the use of a tele-mentoring model of care to solve some of the problems.

Speakers:
Dr Aston Wan, Metro South Health Persistent Pain Management Service, QLD

Topical Concurrent Session 3F: Poisoning pain - How toxins tell us about pain
Chair: Proessor Rainer Harberger

Toxins have a bad reputation as they can cause pain or numbness but nevertheless they are valuable tools in research. Toxins allow us to specifically block signals and help us to understand the underlying pathways that lead to eg chronic pain. This session will provide exciting insights into poisons from one of the world experts in toxins, A/Prof Jamie Seymour, followed by two talks from top Australian scientists that will describe how toxins can be used to tackle pain. A/Prof Stuart Brierley will describe how toxins help to understand the painful communication between gut and bladder and A/Prof Irina Vetter will highlight how venom peptides help us to modulate key channel proteins that are relevant for chronic pain.

Topic 1 -  Abdominopelvic pain: Why your gut is ‘talking’ to your bladder?
Topic 2 -  Peripheral pain mechanisms and novel analgesics: lessons from venom-derived peptides
Topic 3 -  TBC

Speakers:
A/Prof Stuart Brierley, Research Scientist, SA Health & Medical Research Institute
A/Prof Irina Vetter, Group Leader, Chemistry and Structural Biology Division and Deputy Director, Centre for Pain Research