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2017 Australian Pain Society 37th Annual Scientific Meeting

2017 Australian Pain Society 37th Annual Scientific MeetingExpanding Horizons9 - 12 April 2017 | Adelaide Convention Centre, South Australia

Topical Sessions

Please click below for session outlines and confirmed speakers - 

Topical Sessions 1 - Monday 10 April 2017, 1.30 pm - 3.00 pm

Topical Sessions 2 - Monday 10 April 2017, 3.30 pm - 5.00 pm

Topical Sessions 3 - Tuesday 11 April 2017, 3.30 pm - 5.00 pm

Topical Sessions 1
Monday 10 April 2017,
 1.30 pm – 3.00 pm

1A Pain in aged care settings
Chair: A/Professor Benny Katz, St Vincent’s Hospital, VIC

The number of people living in residential aged care facilities within Australia is projected to increase by more than 250% by the middle of this century.  Epidemiologic studies indicate that more than half of this rapidly growing population will suffer from persistent or bothersome pain.  Under-treated or unrelieved pain can have major impacts on function, mood, sleep, health, cognitive function and overall quality of life.  The current topical session will examine some of the unique features of pain in an aged care setting.  A/professor Katz will examine the prevalence of pain, the impacts of pain and tailored considerations around the assessment and management of pain in this special population.  Dr Andrews will discuss some of the findings from the Hammond Care “Intervene” study examining pain in residents with dementia.  Dr Veal will discuss the apparent under-treatment of pain in residential aged care facilities and the results from her recent study on analgesic use in residential aged care facilities.  Interactive audience participation and discussion will be encouraged. 

Presenters:
A/Professor Benny Katz, St Vincent’s Hospital, VIC
Dr Sharon Andrews, Hammondcare, NSW
Dr Felicity Veal, University of Tasmania, TAS

1B: Complex Regional Pain Syndrome: Practical perspectives on assessment and management
Chair: Dr Malcolm Hogg, Royal Melbourne Hospital, VIC

European and American guidelines regarding the assessment and management of CRPS have been published and form the basis of current management.  We will discuss aspects of the condition’s pathophysiology and the development of a CRPS pathway incorporating initial allied health assessment with pain medicine support.  The utility of a sensory-motor retraining program as an early part of this multidisciplinary clinical pathway will be presented, with results from the initial cohort of clients.  A suggested data-set and its comparison to recently presented core outcome measures for CRPS clinical trials (COMPACT) will be discussed.

Controversial aspects of the medical management, including data from recent trials involving biological’s, neuromodulation and bisphosphonates will be presented.

Presenters:
Dr Malcolm Hogg, Royal Melbourne Hospital, VIC
Ms Hayley O’Sullivan, Royal Melbourne Hospital, VIC
Professor Lorimer Moseley, University of South Australia, SA
Dr Marc Russo, Hunter Pain Clinic, NSW

1C: “ePPOC across epochs” Pain outcomes across the ages, and where to from here?
Chair: Dr Jordan Wood, Sydney Children’s Hospital, NSW

This session will provide attendees with a 2017 update on pain epidemiology and clinical outcomes.  This session will also address chronic pain as a public health problem.  The expert speakers will argue we need to utilise data to maximise the effect of clinical intervention in people with pain – young and old.

Initial functional outcomes for paediatric and young adult pain patients following intervention are far superior to older people, but are these outcomes sustained?  Do people just relapse back into chronic pain and dysfunction soon after they leave the pain clinic?  Where should the pain dollar be best invested?

Professor Fiona Blyth will present pain epidemiological data and consider what we know, what is missing, and what we are likely to know soon. 

Dr Hilarie Tardif will present the most recent pain intake and outcome data for different age groups from the electronic Persistent Pain Outcomes Collaboration (ePPOC) project.  She will discuss future strategies for ePPOC, including tracking patients within and across clinical services.

Finally, Dr Susie Lord will examine how these data might inform clinical triage and pain services planning.  She will discuss priorities for future investment across the sector in order to reduce the growing public health problem of chronic pain.

A stimulating discussion is anticipated.

Presenters:
Professor Fiona Blyth, University of Sydney, NSW
Dr HIlarie Tardiff, University of Wollongong, NSW
Dr Susie Lord, John Hunter Children’s Hospital, NSW

1D: Neuromodulation – The Science, The Evidence and the Application in Multidisciplinary Pain Management
Chair: Dr Matthew Green, Pain Medicine of South Australia, SA

Neuromodulation has been helping people suffering from chronic neuropathic pain for close to 50 years. As science and medicine work hand in hand to understand the mechanisms of pain, new advancements are driving improved clinical outcomes for a broadening array of people suffering from persistent pain conditions.

Over 90 minutes, the three presenters will show how basic science in combination with the latest RCT based clinical research is changing how Neuromodulation is integrated into multidisciplinary programs for persistent pain.

Looking at the latest developments in the cellular and molecular origins of hyper-nociception we aim to broaden the  understanding of the mechanisms of persistent pain and the potential “targets” of newer interventional therapies. As this knowledge deepens it becomes increasingly important to define when and for whom Neuromodulation should be considered. The session will therefore explore how these interventional treatments (such as Radiofrequency ablation, Spinal Cord Stimulation and Dorsal Root Ganglion stimulation) are provided in the complex world of clinical practice. Following the presentation session, an expert panel including a Psychologist, Physiotherapist and Pain Practice Nurse will allow for the audience to interact with the multidisciplinary group.

Presenters:
Dr Matthew Green, Pain Medicine of South Australia, SA
Professor Mark Hutchison, ARC Centre of Excellence for Nanoscale BioPhotonics, SA

1E: Evolution of pain perception
Chair: A/Professor Greg Neely, University of Sydney, NSW

Recent discoveries in the pain field and elsewhere have demonstrated the exquisite conservation of gene function over hundreds of millions of years of evolution, and across virtually all taxonomies in life. In this session we will focus on pain perception from an evolutionary perspective. Greg Neely will discuss the conserved genomic architecture of pain perception across phyla, and recent advances investigating neuropathic pain and central sensitization in invertebrates. Michael Costigan will discuss rodent selective breeding methods that allow us to screen mechanisms in chronic pain. In addition, the use of specifically engineered genetic organisms and how to collate experimental genetic evidence will be discussed. Glenn King will discuss exciting new developments using spider venom compounds that have evolved to target neuronal ion channels in both insect prey and vertebrate predators to better understand human pain perception in healthy and disease states, with a focus on Nav1.1 channels and mechanical pain. Following the presentations there will be a discussion between researchers and practitioners focused on how best to target pain genetics research to make an impact in the clinic.

Presenters:
A/Professor Greg Neely, University of Sydney, NSW
A/Professor Michael Costigan, Harvard University, USA
Professor Glenn King, Institute of Molecular Bioscience UQ, QLD

1F: Prognostic screening tools for musculoskeletal pain conditions: development, application and clinical value
Chair: Emma Karran, University of South Australia, SA

Stratified approaches to health care delivery – which aim to match patients to the most appropriate care pathways - are gaining popularity for their potential to optimise treatment benefits and maximise care efficiency.  A common approach bases stratified care decisions on patients’ prognostic profiles, which requires early, accurate screening using a valid and reliable instrument.  This symposium will report on the recent external validation of a clinical prediction rule for whiplash, prediction of back pain outcomes using the Chronic Pain Risk Score, and a head-to-head comparison of 3 popular screening instruments in a secondary care setting.  In light of their research findings and the challenges encountered when conducting research in this field, the presenting team will debate and discuss questions of particular relevance to both researchers and clinicians.  These will include:

  • How do we decide on the clinical value of screening instruments? 
  • What’s in a name?  Predictive Tools, Prognostic Models, Clinical Prediction Rules, Prognostic Screening Instruments - are they all the same?
  • Striking the balance:  screening instruments/prediction tools vs clinical reasoning and individualised care.

Presenters:
Emma Karran, University of South Australia, SA
Dr Carrie Ritchie, Recover Injury Research Centre, Griffith University, QLD
Professor Judith Turner, University of Washington, USA

Topical Sessions 2
Monday 10 April 2017,
 3.30 pm – 5.00 pm

2A: Pain and opioid management in primary care
Chair: Dr Simon Holliday, Albert St Medical Centre Taree, NSW

While everybody agrees there should be better communication between the tertiary pain sector and Primary Care, do the two sectors understand the context in which this occurs? Three general practitioners reflect on some limitations and potentials for pain management within the context of Primary Care. Challenges include the commercial provenance of continuing education, pain/addiction dualism and throughput-based remuneration. Strengths of Primary Care include longitudinal relationships, the care of entire families and the opportunistic pain management in the context of general practice.

Presenters:
Dr Simon Holliday, Albert St Medical Centre Taree, NSW
Dr Milana Votrubec, Delmar Wellness Centre Dee Why, NSW
Dr Hester Wilson, Langton Centre Sydney, NSW

2B: Randomised clinical trial data outcomes in neuromodulation
Chair: Dr Richard Sullivan, Precision Brain, Spine and Pain Centre, VIC

Recent pivotal studies (rated Level 1 CTF) in the US investigating efficacy of newer neuromodulation techniques have demonstrated substantial improvements in pain (50% or greater reduction in 70-80% of subjects sustained to 2 years post implant) and improvements in function and quality of life. Complications are uncommon and the risk profile is very favourable. Yet these therapies are often considered salvage techniques and remain poorly accepted and funded in the public domain in Australia. This session will discuss the evidence base and address the issues that impede access to this form of therapy

Presenters:
Dr Marc Russo, Hunter Pain Clinic, NSW
Dr Nick Christelis, Victorian Pain Specialists, VIC
Dr Richard Sullivan, Precision Brain, Spine and Pain Centre, VIC

2C: Fundamentals of neuroimaging for the investigation of pain
Chair: A/Professor Michael Farrell, Monash University, VIC

Neuroimaging techniques are frequently used to measure changes in brain structure and function associated with pain processing in humans.  In particular, functional brain imaging studies frequently appear in the scientific literature, and have contributed substantially to our understanding of pain processing. However, neuroimaging can deliver information in addition to the familiar maps of “activation”.  The nature of these alternative neuroimaging measures, and the questions to which they are applied will be discussed in this topical workshop.  The three presenters will each focus on two aspects of the principal neuroimaging modality used to investigate pain – Magnetic Resonance Imaging (MRI).

A/Prof Luke Henderson will discuss two techniques that are used to associate structural changes in the brain with the experience of pain. He will briefly describe voxel based morphometry (VBM) techniques, and also discuss tractography based on diffusion tensor imaging (DTI). Examples from the pain literature will be used to illustrate the types of hypotheses and questions that are typically addressed by the methods, and how the outcomes are influencing our understanding of pain.

Dr Flavia Di Pietro’s presentation will focus on magnetic resonance spectroscopy (MRS) and multi-voxel pattern analysis (MVPA). She will discuss how MRS can be used to measure levels of metabolites and neurotransmitters in the brain, and how these levels are related to the experience of pain. MVPA as a relatively new form of functional MRI analysis will be highlighted by Flavia, and she will explain how the technique has been used to accurately identify pain experiences and is therefore often presented in the context of “mind reading”.

A/Prof Michael Farrell will discuss the applications of functional connectivity and perfusion-fMRI to the investigation of pain processing.  He will explain how functional connectivity can be used to investigate the patterns of signal changes shared by distributed brain regions, and how this network activity is related to pain processing. The challenges of measuring brain responses associated with clinical pain will be discussed, and perfusion-fMRI will be advocated as a suitable method for this type of research.

Presenters:
A/Professor Luke Henderson, University of Sydney, NSW
Dr Flavia Di Pietro, University of Sydney, NSW
A/Professor Michael Farrell, Monash University, VIC

2D Explain pain better: Recent updates in the science of conceptual change
Chair: Professor Lorimer Moseley, University of South Australia, SA

This topical symposium will focus on innovation and current practice by presenting how developments from outside the pain field have recently been integrated into clinical pain practice. There will be three presentations, each focussing on a different area of innovation. First, Emma Karran will present an approach to primary care first-contact interactions that utilises radiological reports to reassure patients and facilitate an activity-based approach to recovery. Second, A/Prof David Butler will discuss how educational interventions can be tailored to patients according to a framework that considers the patient, the clinician, the target concept and the context in which the encounter occurs, and how metaphors can be both friend and enemy in the conceptual change journey. Finally, Prof Lorimer Moseley will reflect on a week of public engagement activities in rural Australia, undertaken as part of the 2017 Pain Revolution, with a particular focus on the apparent needs and challenges facing mass conceptual change in the bush.

Participants can expect to gain an understanding of how proven conceptual change strategies are being adapted for use in the pain context. Participants can expect to become familiar with a method and framework for assessing and tailoring educational components of their intervention to individual patients and their conceptual change needs. Participants can expect to gain new insight into the opportunities and challenges that they might face becoming part of the educating team, from a clinical, policy or institutional perspective.

Presenters:
Emma Karran, University of South Australia, SA
A/Professor David Butler, NOI Group, SA
Professor Lorimer Moseley, University of South Australia, SA

2E: Managing pain in the patient with an addiction disorder
Chair: Professor Pam Macintyre, Royal Adelaide Hospital, SA

When acute, cancer or chronic non-cancer pain occurs in a patient who has an addiction to opioids or other substances, its management can present a complex clinical challenge to the health care provider(s) and also act as a source of frustration and sometimes anger for the patient. When it comes to effective management of pain, it is an addiction to opioids that impacts most on effective pain treatment. In part this will be because the patients taking long-term opioids will be tolerant to the effects of the drug and have become physically dependent on it. However, the pattern of behaviours and psychological traits that are associated with addiction, especially in patients with a dual diagnosis (psychiatric comorbidity and addiction) as well as some of the legislative requirements surrounding the prescribing of opioids in most jurisdictions, can also impact significantly on treatment strategies. This workshop will look at management of pain in the inpatient setting, often relatively straight forward, and then management in the community, which can be more problematic. In both settings, an understanding of possible treatment options is required, an assessment of the effectiveness and outcomes of pain treatments is important, and there needs to be an understanding of how potential risk can be evaluated and managed. 

Presenters:
Dr Victoria Cock, Drug and Alcohol Services of South Australia, SA
Professor Pam Macintyre, Royal Adelaide Hospital, SA
Dr Meredith Craigie, Royal Adelaide Hospital, SA
Dr Will Liaw, University of Adelaide, SA

2F: Sleep and pain – A complex interaction
Chair: Professor Paul Hodges, University of Queensland, QLD

Pain and sleep interact in complex ways. We all know that pain interferes with sleep, but it is also becoming clear that sleep influences pain, through a variety of mechanisms. Understanding of this relationship is fundamental to treatment of pain. This session aims to highlight the work of three early career researchers who are enhancing our new understanding of the role of sleep in pain. Longitudinal studies of low back pain have identified interactions between sleep quality, nociceptive sensitivity and systemic cytokine responses. Poor sleep quality is associated with increased next day pain, disability and distress. Randomised controlled trials are investigating whether a simple sleep intervention can not only improve sleep quality of patients with acute low back pain but also reduce pain and disability. Laboratory experiments are revealing how the brain response to noxious stimuli, and the likelihood of arousal, varies according to stage of sleep and brain wave or rhythm.

Presenters:
David Klyne, University of Queensland, QLD
Dr Danny Camfferman, Sansom Institute, SA
Edel O’ Hagan, Neura

Topical Sessions 3
Tuesday 11 April 2017,
 3.30 pm – 5.00 pm

3A: Pain and PTSD, shared suffering?
Chair: Professor Alexander McFarlane, University of Adelaide, SA

This topical session will highlight how PTSD has multiple somatic and cognitive manifestations that are not given sufficient attention in the diagnosis of the disorder.  The shared neurobiology with pain and the immune dysregulation of the disorder need systematic assessment in accident victims and other populations who have experienced major psychological trauma.

Presenters:
Professor Alexander McFarlane, University of Adelaide, SA
Kristin Graham, University of Adelaide, SA
Dr Carolyn Berryman, University of Adelaide, SA

3B: Pelvic Pain in Men
Chair: Dr Susan Evans, Pelvic Pain SA, SA

This topical session will be an interactive, case-based opportunity to explore the diagnosis and management of Male Chronic Pelvic Pain (CPP).

Male CPP is often under-diagnosed and poorly managed. Men are often diagnosed with Chronic Prostatitis, but antibiotics fail to resolve their pain and they receive no further diagnosis or management. They usually have multiple sites of pain, are often desperate and have high levels of distress and suffering. It has been suggested that 90% of men diagnosed with Chronic Prostatitis are suffering with CPP syndrome (Shoskes 2009). Using an algorithmic approach to phenotyping, 83% of these men respond to appropriate biopsychosocial management (Shoskes & Nickel 2013). We will discuss and debate the available algorithms to diagnose and manage CPP in men and the roles of different team members.

Presenters:
Dr Patricia Neumann, Pelvic Pain SA, SA
Dr Tonia Mezzini, Pelvic Pain SA, SA
Dr Meredith Craigie, Royal Adelaide Hospital, SA

3C: Perceived injustice after injury: Are compensation systems to blame, and what should we do about it?
Chair: Dr Melita Giummarra, Monash University, VIC

The health impacts of injury are frequently found to be worse when the injury was compensable, suggesting that the mechanism and severity of compensable injury and/or engagement with the compensation system have a negative impact on health outcomes. While symptom exaggeration and malingering may play a role in some cases, it seems that the “compensation effect” arises from factors such as attribution of fault, perceived injustice and the psychological impacts of engagement with the compensation system.

This workshop will discuss evidence relating to:

  • Sources of perceived injustice (e.g., actions of individuals seen to be responsible for the injury, interactions with insurers, and negative experiences with health professionals and family members).
  • The relationship between perceived fault and the development of chronic pain and mental health conditions after injury.
  • Possible pathways by which perceived injustice impacts on recovery processes including the experience of intense and prolonged anger, adversarial relations with insurers, noncompliance with treatment, and conflictual interactions among family members.
  • The role of system-specific factors in the experience of stress, pain and perceived fairness (e.g., fault vs no fault systems, the impact of specific procedures involved in seeking/receiving compensable healthcare, benefits and lump sum payments).
  • Potential avenues for action, from changes in compensation scheme administration procedures to early, targeted interventions for injured persons.

Presenters:
Professor Michael Sullivan, University of Queensland, QLD
Dr Melita Giummarra, Monash University, VIC
Dr Darnel Murgatroyd, University of Sydney, NSW
Professor Jenny Strong, Minimise Pain, QLD

3D: Where and how much does it hurt? Making sense of spatial summation of pain
Chair: Dr Mark Catley, University of South Australia, SA

Chronic pain is frequently characterised by unexplained increases in pain. Experimental pain models, such as spatial summation paradigms, are used to better understand these symptoms. Substantial evidence from experimental pain research exists that spatial summation occurs; that is, pain is increased when two spatially-distinct noxious stimuli, (versus one), are provided. Intriguingly, the magnitude of these effects is highly dependent on the spatial distance between the stimulated body sites. Spatial summation is implicated in a range of clinical presentations, for example, fibromyalgia.

This symposium will provide a comprehensive summary of the importance of spatial summation in pain. Dr Mark Catley will provide the current evidence for spatial summation and whether it occurs in both somatotopic (body-specific) and spatial frames of references: is this phenomenon restricted to anatomically-adjacent body regions or can it occur across anatomically-distinct regions that occupy the same space? Second, Prof Lorimer Moseley will discuss the biological mechanisms that likely underpin spatial summation, at a tissue-, spinal cord-, and brain-level, using clinician-friendly paradigms and labels.  Last, Dr Tasha Stanton will present research evaluating the importance of cognitive factors in this phenomenon: does manipulating the perceived distance between two pain sites, using visual illusions, modulate the degree of spatial summation?

Presenters:
Dr Mark Catley, University of South Australia, SA
Professor Lorimer Moseley, University of South Australia, SA
Dr Tasha Stanton, University of South Australia, SA

3E: How to integrate current pain knowledge into clinical management of chronic pain
Chair: A/Professor Julia Hush, Macquarie University

Recent reports, both internationally and in Australia, have identified that one major impediment to adequate pain relief is patients' limited access to clinicians who are knowledgeable about pain, owing in part to the prevalence of outmoded or unscientific knowledge and attitudes about pain [1,2]. In response, a key recommendation of these reports is to educate health professionals to better understand pain and its causes. This topical symposium is designed to address this imperative, so that health professionals of any discipline can update their understanding of pain and learn how to integrate this into clinical management of patients with chronic pain.

The symposium team includes clinicians and researchers with an extensive background in pain education and clinical pain management, and will combine multidisciplinary pain expertise from medicine, psychology and physiotherapy perspectives.

Presentations will focus on the translation of current evidence into clinical practice. Case-based learning will be integrated to enable delegates to advance their knowledge and practical skills in the management of chronic pain.

Presenters:
A/Professor Julia Hush, Macquarie University, NSW
Professor Michael Nicholas, PMRI Royal North Shore Hospital, NSW
Dr Chris Hayes, Hunter Integrated Pain Service, NSW

3F: Mechanisms, assessment and management of chronic pancreatic pain
Chair: Professor John Windsor, University of Auckland, NZ

This topical session will describe the rationale for and development of an instrument to assess chronic pancreatic pain. It is hoped the instrument will enable improved assessment of pain and provide an indication of the underlying mechanisms driving the pain in order to guide the selection of interventions. The session will include a general overview of the mechanisms of visceral pain, and a focus on some of the specific mechanisms of pancreatic pain as well as the currently available interventions. A brief review of the questionnaires reported in the literature to evaluate chronic pancreatic pain and their limitations will be used to argue for the development of a new instrument. Finally, the composition and development of a comprehensive pain assessment tool, the COMPAT, will be described along with some evidence regarding its utility with chronic pancreatic pain patients as well as other chronic pain patients.

Presenters:
Professor John Windsor, University of Auckland, NZ
Keith Teo, University of Auckland, NZ
Malcolm Johnson, University of Auckland, NZ
A/Professor Stuart Brierley, Flinders University, SA