APS AUG24 eNews

Volume 44, Issue 6, August 2024

Editor’s Note

Australian Pain Society Newsletter

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Contents

Contents

Editor’s Note

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ASM 2025

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ASM 2024

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2024 Global Year

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Cops for Kids Clinical Research Grant

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BPR Pain Hour

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FPM ANZCA Pain Management Education Standards

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National Pain Week 2024

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PinC SIG Journal Watch

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Survey

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Recent Publications

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Events

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New Members

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FYI

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Calendar of Events

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Vision, Purpose & Priorities

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APS Directors

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Office Bearers

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Australian Pain Society Newsletter

Volume 44, Issue 6, August 2024

Editor’s Note

Editor’s Note Dr Lincoln Tracy

As the calendar moves into August, the pain world’s attention turns to the preeminent international meeting on pain research, treatment, and education – the IASP World Congress on Pain, which will be held in Amsterdam from August 5-9.

The Congress features an incredible program, highlighted by the keynote plenary lectures from the 2021 Nobel Prize Laureates in Physiology or Medicine, David Julius and Ardem Patapoutian.

The World Congress also marks the 50th Anniversary of the IASP, who have created an absolute treasure trove of resources as part of the anniversary celebrations. There are timelines, biographies, and interviews with founding members and other individuals who have made substantial contributions to the association over the past five decades. I encourage all members to explore this collection and to learn more about the association’s history.

I hope any and all APS members who are making the trip to the Netherlands for the World Congress have a safe and enjoyable journey! It painsBEme W that GOLBI will not be able to join you, and will instead be stuck in the cold, grey Melbourne winter.

The latest edition of the APS eNewsletter includes all the usual features: the latest updates on the 2025 ASM, two great reports from our travel grant recipients, journal watch submissions from our Pain in Childhood SIG, and abstracts of new research from our members and their collaborators.

This month we also include a series of articles summarising talks and sessions from our ASM in Darwin earlier this year, which focus on how physiotherapists can upskill to more effectively manage the pain experienced by their patients, and how psychological treatments can be used to improve patient outcomes. We thank the Australian Physiotherapy Association for their coverage of our Darwin meeting, and for sharing their content with us.

Our Basic Pain Research SIG is hosting a forum next month that will explore the biology of placebo and nocebo effects in pain, featuring Professor Elisa Carlino from the University of Turin. I have long been fascinated by the placebo effect, and am sure this will be an interesting and insightful session. All are welcome, so please head along if you are keen to learn more about the complex interplay between psychological expectations and physiological responses.

Until next time, Lincoln

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ASM 2025 2024

Important Dates for Your Diary Monday 9 September 2024 Topical Session Submissions Close Tuesday 1 October 2024 RisingBLOG Star Award WEB Applications Close Tuesday 15 October 2024 Free Paper/Poster Abstract Submissions Close Thursday 31 October 2024 Distinguished Member Nominations Close Tuesday 19 November 2024 Registrations Open!

30 November 2024 All Travel Grant Applications Close

Save The Date APS 2025 will be held from 13 - 16 April 2025 at the Pullman Melbourne Albert Park, VIC Please visit the conference website here: www.dcconferences.com.au/aps2025 If you have any questions, please contact the APS Conference Secretariat: apsasm@dccam.com.au

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Australian Pain Society Newsletter

Volume 44, Issue 6, August 2024

Recent Publications ASM 2025

TOPICAL SESSION SUBMISSIONS NOW OPEN Submissions Deadline: Monday 9 September 2024 BEW

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On behalf of the Scientific Program Committee (SPC) and the Local Organising Committee, we are pleased to advise topical session submissions for APS 2025 are now open.

The deadline for Topical Session submissions is: Monday 9 September 2024 View the topical session submission guidelines.

The online topical session submission portal is now available via the conference website.

We look forward to receiving your submissions.

The SPC have put together a video to help answer the question, “what you need to know to put together a great topical session”. You can watch it via the conference website.

Should you have any further queries regarding your submission or the process, please contact the Conference Secretariat.

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ASM 2025 2024

RISING STAR AWARD

Now accepting applications!

Submission Deadline: Tuesday 1 October 2024 This award showcases rising star painBLOG researchers WEB in Australia and may be awarded annually subject to the application of suitable candidates. The Rising Star Winner will receive a return domestic airfare, accommodation, and complimentary registration to attend the 2025 APS 45th ASM where they will give a plenary presentation to showcase their work and ideas.

Applications are now open, for further information and to apply, please click here.

Selection Criteria

Eligibility Criteria

This award will be based on excellence in pain research achievements. Applicants are asked to self-nominate and provide a one-page (A4, 12pt, Times New Roman) personal statement addressing the following criteria, with evidence:

• Nominees must hold a PhD and be within five (5) years of the date on the official conferral letter from the awarding institution, by the deadline of this award application.

• Track record, relative to opportunity (i.e., achievements rather than aspirations) • Research Impact • Leadership Along with three (3) selected publications that reflect your most important research-related contributions. These may be from any stage of your research career. Each publication should be accompanied by a 200 word summary detailing what your contribution was, why you think the publication is important and what impact it has had.

• Applicants can be working in any field of pain research.

• The selection committee will take into account personal or extenuating circumstances that might provide grounds for consideration if the above eligibility criteria are not met.

• Only individual scientists are eligible (not research teams).

• Applicants must be available to attend APS 2025 in person to deliver the Rising Star presentation.

• Applicant must be a current member of the APS. • Australian citizen/resident, currently working in Australia and have spent at least two postdoctoral years in Australia, or have returned to continue working in Australia.

For further information and to apply, please visit the Rising Star Application Guidelines.

We look forward to receiving your submission!

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Australian Pain Society Newsletter

Volume 44, Issue 6, August 2024

Recent Publications ASM 2025

ABSTRACT SUBMISSIONS NOW OPEN Submissions Open: Tuesday 2 July 2024 BEW GOLB and Poster presentations.

Abstracts will be accepted for Free Communication Opportunities to be involved in the Rapid Communication Sessions are also available.

The deadline for Abstract submissions is: Tuesday 15 October 2024 Please click here to view the Abstract Submission Guidelines.

There are THREE categories for Abstract Submissions.

Please visit these portals below: Experimental Studies & Clinical Trials Abstract Guidelines Clinical Practice & Service Delivery Abstract Guidelines Case Reports Abstract Guidelines We look forward to receiving your submissions. Should you have any queries regarding your submission or the process, please contact the Conference Secretariat.

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ASM 2025 2024

NOMINATION FOR AUSTRALIAN PAIN SOCIETY DISTINGUISHED MEMBER AWARD – 2025 The Board of Directors is seeking nominations from all Australian Pain Society (APS) members for candidates to be considered for the Distinguished Member Award(s) to be presented at the APS 45th Annual Scientific Meeting to be held in Melbourne from 13 - 16 April 2025.

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Eligibility criteria:

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Candidates must be APS members who generally have had a lengthy career in the field of pain and have: • Made major contribution1 towards the Society, and • Significantly contributed to the science of pain management, and/or • Played a significant clinical, educational or research role in the field of pain management in Australia Major contributions include, but are not limited to: 1

• Scientific Program Committee involvement • Pain research

Nomination Guidelines: • A ‘Nomination for Distinguished Member Award’ form must be completed.

• As a guide, it is desirable that nominees have held continuous APS membership for over 10 years.

• Nominations must include an 800-900 word biography of the nominee. The Board will not consider incomplete nomination forms.

• Unsuccessful nominations are not automatically put forward in subsequent years.

• The nominator must be prepared to present a brief summary of the Distinguished Member biography in the ASM program, or arrange a suitable alternate for the presentation segment.

Submission:

• APS projects • Subcommittee involvement • Board liaison • Contributions to ASM presentations

• All nominations to be submitted to the APS Secretariat by 31 October 2024.

Notification: • The APS Board will notify successful nominees by 31 December 2024.

• Distinguished Member recipients are actively encouraged to attend the Annual Scientific Meeting in order to receive their award in person from the APS President.

The nomination form and a listing of past recipients of the Distinguished Member Award, including their biographies, can be found on the APS website.

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Australian Pain Society Newsletter

Volume 44, Issue 6, August 2024

Recent Publications ASM 2025

ASM TRAVEL GRANTS The Australian Pain Society (APS) is pleased to announce the availability of several Travel Grants for members to present their research at our Annual Scientific Meeting (ASM).

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Travel Grants are awarded as follows:

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NEW! Professor Michael Cousins AO Travel Grant

• PhD students (up to the value of $500) • A single dedicated Travel Grant for a Pain in Childhood (PinC) SIG member ($500) • A single dedicated Travel Grant for a Basic Pain Research (BPR) SIG member ($500) • If funds permit, further travel grants may be offered to nurses, allied health professionals, and other post-graduate students.

This Travel Grant program is designed to encourage contribution to, and participation in, the ASM, and is made possible through an allocation of a capped pool of APS operating funds.

In honour of Professor Michael Cousins AO, the Australian Pain Society (APS) is pleased to announce a single, dedicated Travel Grant for an Allied Health Practitioner (AHP) member to present their research abstract at our Annual Scientific Meeting (ASM).

The Professor Michael Cousins AO Allied Health Practitioner Travel Grant includes: • Complimentary ASM registration at the relevant early bird rate • $500 towards ASM travel and accommodation expenses

Full eligibility criteria and Terms and Conditions are available on the Travel Grants webpage.

To be considered for any Travel Grant: a. an EOI for a Travel Grant must be indicated when your abstract is submitted; AND b. a Travel Grant Application form must be submitted to aps@apsoc.org.au by 5pm on 30 November 2024 – no exceptions.

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ASM 2024

Annual Scientific Meeting Travel Grant Recipient Report Jackson Karrasch

Jackson is a PhD student in the Laboratory of Neuroimmunology and Behaviour at the University of Sydney. He performs highparameter imaging studies on human tissues to explore how the immune system and nervous system interact in the context of chronic neuropathic pain. He is passionate about science and learning, particularly in relation to harnessing aspects of human physiology to better the lives of patients with chronic diseases.

Author contact details: jkar5025@uni.sydney.edu.au

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Energising the Future of Pain Research: A PhD Student’s Experience at the Australian Pain Society’s 44th Annual Scientific Meeting Earlier this year, I flew to Darwin for the Australian Pain Society’s 44th Annual Scientific Meeting (ASM). I was fortunate enough to attend, for the second year running, this inspiring gathering of pain researchers and clinicians with several colleagues from the Brain and Mind Centre at The University of Sydney. This time I was determined to make the absolute most of the opportunity – I participated in the light-hearted 3-Minute Thesis competition at the Basic Pain Research (BPR) Pre-Conference Workshop and presented my research at a Free Paper Session focussing on neuroinflammatory and neuroimmune pain conditions. Speaking to an audience of clinicians, academics, and fellow early- and mid-career researchers, I outlined some preliminary data from a recent clinical cohort study on Complex Regional Pain Syndrome (CRPS) conducted by our group. Briefly, we utilised Imaging Mass CytometryTM to perform a high-parameter imaging study on CRPSaffected skin biopsies to investigate cutaneous neuroimmune interactions. By visualising nerve fibres and immune cell populations 10

Australian Pain Society Newsletter

simultaneously and combining this with an unbiased computational data analysis pipeline, we found a possible role for Langerhans cell- and CD183+ cell (lymphocyte)-nerve fibre interactions in CRPS pathophysiology.

Although further analyses are required to confirm our findings, we are incredibly excited by these developments, and it was a privilege to be able to share them at the ASM this year.

We are continuing to work closely with our immunologist and bioinformatician colleagues at the Westmead Institute for Medical Research, so keep an eye out for a publication soon! To top it all off, my presentation was very well received, and I was asked thoughtful and interesting questions at its conclusion.

As this was my second Free Paper Session presentation at an ASM, I was far more confident behind the lectern and in my ability to deliver an insightful talk. Likewise, I felt comfortable approaching people during the morning tea, afternoon tea, and lunchtime breaks to ask them questions about their presentations and posters. I spoke with numerous people about all things pain research; everything from niche neuroimmunology to transmission electron microscopy to the latest in pharmaceutical development. I also met Professor Peter Drummond, our collaborator from Murdoch University and a long-term supporter of our research, for the first time.

Professor Drummond provides our laboratory with human skin biopsies from various patient cohorts and, as such, has made an invaluable contribution to our investigations.

On the Tuesday morning following my talk, I introduced myself to Professor Cheryl Stucky from the Medical College of Wisconsin.

Professor Stucky’s work is extremely relevant to the research conducted by our group and aligns closely with my personal interests.

We had a brief, but insightful chat and I was able to provide her with a quick overview of my current research goals for my PhD. She

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ASM 2024

generously offered to put me in contact with one of her colleagues who is performing similar experiments to me in diabetic neuropathic pain.

Professor Stucky’s kindness and approachability has left a lasting impression on me. Another notable interaction was a discussion I had with Professor Rainer Haberberger from The University of Adelaide about his latest research on the ultrastructure of human dorsal root ganglia (DRG). I found the use of electron microscopy to understand the cellular and subcellular composition of the DRG totally fascinating.

Over the duration of the ASM, there were certainly some noteworthy presentations.

Unsurprisingly, I thought both of Professor Stucky’s Plenary talks were outstanding. I found her work on keratinocyte-mediated nociception particularly interesting, and it has inspired me to further consider how this cell population may be contributing to acute and chronic pain signalling in CRPS-affected skin. Sharing what she’d learnt after 24 years in scientific research was also a touching way to conclude her talk. I made sure to quickly snap a picture of her tips for success so that I could remember those important lessons. Another presentation that I thoroughly enjoyed was that of Dr Colleen Johnston-Devin from Central Queensland

University, which outlined her lived experience with CRPS. This was the most moving talk of the entire conference and hearing a firsthand account of how CRPS can completely change someone’s life has further motivated me to continue my research on this terrible condition.

A bonus highlight for me was the BPR Special Interest Group Dinner on the Sunday night. I met Dr Arjun Muralidharan and Professor Maree Smith AC, and we spoke about academic life, shared ideas on how I could make the most of my PhD and discussed the current state of pain research. Next year at the ASM in Melbourne, I’m looking forward to forming more personal relationships with people who conduct similar research to me and to developing productive collaborations with like-minded individuals. I’m also excited to spend time exploring Melbourne with my friends and fellow pain researchers and to participate in any social activities that may be Bon EWtheGOagenda!

LB Declaration: Jackson Karrasch and his supervisor Associate Professor Paul Austin are supported by a philanthropic donation from the Neil and Norma Hill Foundation and a research grant from the Australian and New Zealand College of Anaesthetists (ANZCA).

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ASM 2024

Annual Scientific Meeting Travel Grant Recipient Report Sophie Crouch

Sophie Crouch is a doctoral candidate at the University of South Australia. Her thesis aims to investigate how pain is socialised in early childhood through children’s media (e.g., YouTube videos). Her research is underpinned by the goal of aligning the development of children’s conceptualisations of pain and injury with contemporary pain science understanding.

Author contact details: sophie.crouch@mymail.unisa.edu.au

‘I’m in charge, but not always in control: a qualitative exploration BLOGof WEB women’s beliefs and knowledge about their pelvic pain’ and ‘Representation of pain and injury in children's picture books - a qualitative analysis’ I had the privilege of attending the APS conference in Darwin, where I presented two posters and participated in a rapid communication session. My first poster, ‘I’m in charge, but not always in control: a qualitative exploration of women’s beliefs and knowledge about their pelvic pain’, outlined what women with pelvic pain believe and understand about their pain. This qualitative study highlighted three main themes: 1) women with pelvic pain held some biopsychosocial views of their pain, yet emphasised the biological aspects, 2) women with pelvic pain felt as though it was up to them to be in charge of their pain management, however they felt as though they were not always in control of the pain, and 3) pelvic pain was perceived to be predictable in the short term (e.g., when associated with menstruation), but unpredictable in the long term (e.g., uncertainty if pain will end with menopause). I presented my second poster, ‘Representation of pain and injury in children's picture books - a qualitative analysis’, on behalf of my colleague Dur-E-Nayab Mehar, who completed the study in 2023. This study involved a content analysis of children’s picture books from public libraries to identify and analyse pain and injury content. Some key findings from this 12

Australian Pain Society Newsletter

study included the portrayal of common gender stereotypes (e.g., boys experiencing injuries more frequently, girls crying and being comforted by supporting characters), and minor pain/injury being most commonly represented, which is reflective of children’s real-life pain experiences. I also presented a rapid communication session for this work and was honoured to receive the Best Rapid Communication Award.

I met lots of like-minded people throughout the conference, especially during the poster sessions and at the Gala Dinner. I found it very rewarding to discuss my research with others and to hear their thoughts on my work. I also found it helpful to discuss my upcoming projects with others in the industry, with everyone being very encouraging. In particular, it was great to chat with paediatric pain clinicians who thought my upcoming work would be very meaningful for the field.

This was not only my first APS conference, but my first academic conference altogether.

I found everyone to be very welcoming and I enjoyed listening to the wide variety of speakers.

Professor Christine Chambers’ presentations were particularly fascinating, especially because her work aligns with the focus of my PhD topic. It was also inspiring to hear of some of the incredible initiatives that other Australian researchers are involved in, which really highlighted how exciting this field of research can be. Another highlight of the conference was the ‘You can’t ask that!’ trainee session. I appreciated the insights provided by the expert panel and took a lot away from the session.

I am very grateful for the financial support I received through the APS Travel Grant. This grant greatly contributed to covering my travel expenses and made it feasible to attend the conference. I am looking forward to attending the next APS conference in Melbourne in 2025 and hope to present some of my research from my PhD! Declaration: Sophie Crouch has nothing to declare.

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ASM 2024

Discipline Sub Group Summary Jacintha Bell, WA Director

The Australian Pain Society (APS) Board hosted several Discipline Sub Group Meetings following the pre-conference workshops at the 2024 Annual Scientific Meeting in Darwin on Sunday, 21 April 2024. These forums represent six disciplines – physiotherapy & exercise physiology, psychology, pharmacy & pharmacology, medical, occupational therapy, and nursing – and are designed to facilitate two-way communication between the APS Board and the Society’s membership.

Position Papers and Advocacy

Of the hundreds registered for the conference, the Discipline Sub Group Meetings saw a diverse group of attendees, ranging from long-time members to first-time participants. The Society appreciates the valuable feedback provided, which may assist in shaping future APS activities.

Inclusion and Representation

Common Themes and non-ASM planning Feedback Multidisciplinary Collaboration and Communication Attendees from various disciplines emphasised the importance of maintaining and enhancing multidisciplinary collaboration. Many participants appreciated the high standard of the conference and multidisciplinary approach of the APS, which bridges gaps between professions involved in pain management.

There was strong support for developing more position papers across all disciplines to standardise best practices in pain management.

The Pharmacy group expressed particular interest in creating a position statement for the role of pharmacy in pain management.

Participants also discussed the importance of the APS advocating for multidisciplinary care as per the Advocacy listing on our website.

Ensuring diverse representation was another

Bkey EW theme.

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better representation of various disciplines within the APS activities and for the APS to strengthen its connections with other professional bodies such as Occupational Therapy Australia and the Faculty of Pain Medicine. Our long established Relationships Committee is responsible for these developing and maintaining such connections.

Networking and Support The value of networking opportunities provided by the APS was widely recognised. Participants appreciated the introduction of the pilot mentorship program and the support offered through these meetings. The state-based social networking activities also help to promote collaborative opportunities.

Education and Professional Development

Conclusion

A recurring theme across the meetings was the need for improved pain management education. Several disciplines highlighted the lack of comprehensive pain management training in undergraduate curricula. There was a call for the APS to advocate for better education standards and to provide more targeted educational resources, particularly for underrepresented groups such as general practitioners.

The 2024 Discipline Subgroup Meetings provided valuable feedback that will be considered by the APS Board when planning future activities. The Society remains committed to fostering a multidisciplinary approach and addressing the educational and professional needs of its members.

We look forward to the continued engagement and contributions from our members and anticipate an exciting and productive Annual Scientific Meeting in Melbourne, 13-16 April 2025.

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This article was first published in the July 2024 issue of InMotion magazine, and is reproduced with permission from the Australian Physiotherapy Association

Recent Publications

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Volume 44, Issue 6, August 2024

This article was first published in the July 2024 issue of InMotion magazine, and is reproduced with permission from the Australian Physiotherapy Association

Editor’s Note

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This article was first published in the July 2024 issue of InMotion magazine, and is reproduced with permission from the Australian Physiotherapy Association

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This article was first published in the July 2024 issue of InMotion magazine, and is reproduced with permission from the Australian Physiotherapy Association

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This article was first published in the July 2024 issue of InMotion magazine, and is reproduced with permission from the Australian Physiotherapy Association

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This article was first published in the July 2024 issue of InMotion magazine, and is reproduced with permission from the Australian Physiotherapy Association

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This article was first published in the July 2024 issue of InMotion magazine, and is reproduced with permission from the Australian Physiotherapy Association

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This article was first published in the July 2024 issue of InMotion magazine, and is reproduced with permission from the Australian Physiotherapy Association

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This article was first published in the July 2024 issue of InMotion magazine, and is reproduced with permission from the Australian Physiotherapy Association

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This article was first published in the July 2024 issue of InMotion magazine, and is reproduced with permission from the Australian Physiotherapy Association

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This article was first published in the July 2024 issue of InMotion magazine, and is reproduced with permission from the Australian Physiotherapy Association

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This article was first published in the July 2024 issue of InMotion magazine, and is reproduced with permission from the Australian Physiotherapy Association

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This article was first published in the July 2024 issue of InMotion magazine, and is reproduced with permission from the Australian Physiotherapy Association

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Australian Pain Society Newsletter

Volume 44, Issue 6, August 2024

2024 Global Year

Global Year Report

Biological Differences in Pain Mechanisms Between Men and Women The IASP 2024 Global Year focuses on Sex and Gender Disparities in Pain. For some, it may seem obvious that there are clear sex and gender disparities in pain and health more broadly, perhaps at times too common to have gone unnoticed. For example, when we think of many chronic pain conditions, we often see cases where pain conditions appear specific to, or disproportionately affecting, a particular sex or gender. The intent of the Global Year is to put the spotlight on this problem and examine what is known about sex and gender differences in pain perception and modulation, and address sex-and gender-related disparities in both the research and treatment of pain.

To increase awareness within the pain community and beyond, the Global Year Task Force has created freely available fact sheets prepared by top experts on various aspects of sex and gender. Below we discuss some of the potential mechanisms underlying the biological differences in pain mechanisms between men and women inspired by these fact sheets.

There are clear biological differences between men and women including differences in their anatomy and the function of many different body systems. However, an understanding of how these differences interact with mechanisms causing or maintaining pain is less well known. Accumulating evidence supports a multitude of sex-specific biological mechanisms that underlie pain at both a physiological and pathological level. These potential mechanisms include sex steroid hormones, genes, proteins, and cell types (1).

Sex Steroid Hormones The primary role of sex steroids, such as oestrogens, progestogens, and androgens (including testosterone), involves reproduction.

However, receptors to these hormones are widely

Karly McAfee (Doctoral Candidate) and Aidan Cashin (Senior Research Fellow) at the Centre for Pain IMPACT Neuroscience Research Australia and the University of New South Wales

distributed throughout the central and peripheral nervous system, supporting the idea they have a role in pain processing as well as reproduction (2).

Hormone levels differ markedly between men and women and across the life course of individuals.

BEHormones W GOLB are thought to influence pain in a

variety of ways including altering sensitivity to pain by influencing pain processing pathways (e.g., descending modulation), altering biological processes associated with pain (e.g., inflammation), driving hormonally dependent pathologies (e.g., endometriosis), and impacting on mood to alter the pain experience. However, the relationship between individual hormones and pain is complex and often inconclusive. At times, it is plausible that the pain-inhibitory effects of one hormone or one system, can be mitigated by the pain amplifying effects of another. A better understanding of the underlying mechanisms will allow us to determine the value in using hormone replacement therapies across pain conditions (3).

Genes, proteins, and cell types

Research has recently moved towards investigating the possibility that different genes, proteins (i.e., neuro- and immune-chemicals and their receptors), and even cell types might play a role in pain processing in males and females. Recent transcriptomics studies in rodents (4) and humans (5) have identified numerous genes whose expression in response to pain is regulated in a sex-dependent manner.

Three particular sexual dimorphisms have been investigated in detail.

1) Immune Cells Immune cells and pathways are well documented to play key roles on pain transmission and

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2024 Global Year

the development of chronic pain. However, increasing evidence indicates that males and females show fundamental differences in both innate and adaptive immune responses and may drive sex differences in the development and persistence of pain hypersensitivity and chronic pain (6). For example, glial cells play crucial roles in pain transmission as well as chronic pain development and persistence (7), with differences noted between sexes (8, 9).

2) Calcitonin Gene-Related Peptide (CGRP) Calcitonin Gene-Related Peptide (CGRP) has long been linked to the pathophysiology of migraine, a disorder disproportionately affecting more females than males. Interestingly the application of CGRP to the surface of the brain induces pain hypersensitivity in female but not male mice (10), and neuropathic pain is associated with higher CGRP and CGRP receptor expression in female rats' brains compared to male rats (11). Perhaps unsurprisingly, newly approved CGRP-targeting drugs for migraine are BLOG WEB only effective in women (12).

3) Prolactin Prolactin, known for promoting lactation, also enhances nociceptor sensitisation and pain in a female-selective manner (13). The balance of prolactin receptor isoforms may be protective against pain under normal conditions, but when its expression becomes imbalanced there is an increasing pain risk in females (13). Similar to CGRP, targeting prolactin and its receptors might offer a new way to treat pain in women.

Conclusion There is growing support for several sexspecific biological mechanisms that underly pain. Although inconclusive at times, clinical data is beginning to demonstrate that selective modulation of these mechanisms is more beneficial for one sex or gender over another.

Further understanding and targeting these mechanisms may support advancements in chronic pain care through the development of sex-specific treatment.

Declaration Both authors have nothing to declare.

References 1. Mogil JS. Qualitative sex differences in pain processing: emerging evidence of a biased literature. Nat Rev Neurosci. 2020;21(7):353-65.

8. Mapplebeck JCS, Beggs S, Salter MW. Sex differences in pain: a tale of two immune cells.

Pain. 2016;157 Suppl 1:S2-s6.

2. Vincent K, Tracey I. Hormones and their Interaction with the Pain Experience. Rev Pain.

2008;2(2):20-4.

9. Sorge RE, Mapplebeck JC, Rosen S, Beggs S, Taves S, Alexander JK, et al. Different immune cells mediate mechanical pain hypersensitivity in male and female mice. Nat Neurosci.

2015;18(8):1081-3.

3. Gulati M, Dursun E, Vincent K, Watt FE. The influence of sex hormones on musculoskeletal pain and osteoarthritis. Lancet Rheumatol.

2023;5(4):e225-e38.

4. Fiore NT, Yin Z, Guneykaya D, Gauthier CD, Hayes JP, D'Hary A, et al. Sex-specific transcriptome of spinal microglia in neuropathic pain due to peripheral nerve injury. Glia. 2022;70(4):675-96.

5. Ray PR, Shiers S, Caruso JP, Tavares-Ferreira D, Sankaranarayanan I, Uhelski ML, et al. RNA profiling of human dorsal root ganglia reveals sex differences in mechanisms promoting neuropathic pain. Brain. 2023;146(2):749-66.

6. Gregus AM, Levine IS, Eddinger KA, Yaksh TL, Buczynski MW. Sex differences in neuroimmune and glial mechanisms of pain.

Pain. 2021;162(8):2186-200.

7. Ji RR, Chamessian A, Zhang YQ. Pain regulation by non-neuronal cells and inflammation. Science. 2016;354(6312):572-7.

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10. Avona A, Burgos-Vega C, Burton MD, Akopian AN, Price TJ, Dussor G. Dural Calcitonin GeneRelated Peptide Produces Female-Specific Responses in Rodent Migraine Models. J Neurosci. 2019;39(22):4323-31.

11. Presto P, Mazzitelli M, Junell R, Griffin Z, Neugebauer V. Sex differences in pain along the neuraxis. Neuropharmacology.

2022;210:109030.

12. Porreca F, Navratilova E, Hirman J, van den Brink AM, Lipton RB, Dodick DW. Evaluation of outcomes of calcitonin gene-related peptide (CGRP)-targeting therapies for acute and preventive migraine treatment based on patient sex. Cephalalgia.

2024;44(3):3331024241238153.

13. Chen Y, Navratilova E, Dodick DW, Porreca F. An Emerging Role for Prolactin in Female-Selective Pain. Trends Neurosci. 2020;43(8):635-48.

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Cops for Kids Clinical Research Grant

Announcing the APS/CFK Clinical Research Grant #8 The Australian Pain Society (APS) is a multidisciplinary association whose purpose is to advance pain management through education, research, and advocacy for transformational improvements in clinical care. Our vision is that all people will have optimal pain management throughout their life.

Cops for Kids (CFK) is a South Australian based charity focused on supporting initiatives that strive to improve the lives of children in that state. Part of the CFK mandate includes the provision of funds for research to assist in the care of sick children and/or enhance the life quality of a child.

APS is pleased to announce our partnership with Cops For Kids is continuing with an eighth Clinical Research Grant Program In brief, the award is to enable clinical research meeting the following criteria: • Approach a meaningful conclusion in one year

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• Conducted in Australia and must be relevant to the South Australian population • The applicant must be an Australian citizen or permanent resident • The applicant and their supervisor (if applicable) must be members of the Australian Pain Society and its Pain in Childhood Special Interest Group • The funded project can be related to any aspect of a childhood pain complaint - including theoretical, mechanistic, diagnostic, treatment, epidemiological, and/or sociological approaches; and • The grant funding of $40,000 (inclusive of GST) will be paid quarterly in arrears upon the submission and acceptance of a combined Progress Report-Acquittal Form Further information about the Clinical Research Grant can be obtained from the APS Secretariat.

Clinical Research Grant Application forms are available online and must be submitted by: 5pm on Wednesday 11 September 2024.

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BPR Pain Hour

BPR Pain Hour: Exploring the Biology of Placebo and Nocebo Effects on Pain Tuesday 17 September 2024, 3-4pm AEST (via Zoom) The purpose of our Basic Pain Research Special Interest Group (BPR SIG) is to share, improve, and promote scientific knowledge and understanding of the mechanisms of nociception and pain across all levels of investigation, from molecular and cellular analyses to preclinical or clinical studies.

This forum will provide an informal platform to promote and share our research and insights from early career researchers (ECRs, including students) and senior colleagues.

BLOGof WEB Session 10: Exploring the Biology Placebo and Nocebo Effects on Pain Summary: This session will explore the effects of placebo and nocebo on pain and the complex interplay between psychological expectations and physiological responses. The talk by Professor Carlino will delve into the biology behind placebo and nocebo effects in pain perception, highlighting how psychological factors can trigger significant physiological responses.

It will cover the neurobiological pathways involved in these effects, explaining how brain chemistry can alter pain experiences. The discussion will also address the implications for clinical practice, offering insights into how understanding these mechanisms can improve patient care and treatment outcomes. This comprehensive overview will be valuable for healthcare professionals, researchers, and students interested in the intricate connection between mind and body in the context of pain management.

Dr Crawford will discuss the cortical and brainstem systems of human placebo analgesia responsivity (endogenous pain control) through the lens of 7-Tesla functional brain imaging.

The neural elements governing human pain control reside in the cortex, subcortex, and

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brainstem. Whilst the cortical pain system has been well-explored and defined, limitations in imaging field strength long held the discrete role of the human subcortex and brainstem a mystery. In a series of experimental investigations, the team produced a schema of brainstem activity that defined placebo analgesia and nocebo hyperalgesia in healthy humans, extending this work to the cortical and subcortical networks that regulate brainstem output to drive placebo responsivity.

The behaviour of placebo analgesia responders will be further discussed, with results from recent work providing evidence for the Bayesian brain hypothesis and the resiliency of conditioning behaviours across time.

The invited speakers: • Professor Elisa Carlino, Department of Neuroscience “Rita Levi Montalcini”, University of Turin, Italy • Dr Lewis Crawford, Neural Imaging Laboratory, Faculty of Medicine and Health, The University of Sydney, Brain and Mind Centre, Australia All are welcome to attend, including postgraduate students.

Please be advised that the speakers and most of the audience will not have clinical or healthcare backgrounds. Therefore, they will not comment or provide advice about whether these findings can be translated into clinical settings, or about managing pain from a healthcare perspective.

We look forward to seeing you there, please register here.

Volume 44, Issue 6, August 2024

FPM ANZCA Pain Management Education Standards

Developing Australian Standards for Health Practitioner Pain Management Education – Stakeholder Consultations In 2019 the “need to improve the pain management-related knowledge and skills of health practitioners” was identified as a key priority within the National Strategic Action Plan for Pain Management. With issues such as increasing waiting times for specialist pain care, lack of adequate access to services in rural regional and remote regions, and long COVID, this priority has become more urgent.

In 2020 the federal government committed to improving pain care in the community by funding the Faculty of Pain Medicine, Australian and New Zealand College of Anaesthetists, to

Author: Ms Genevieve Nolan Genevieve Nolan works in the Faculty of Pain Medicine within the Australian and New Zealand College of Anaesthetists. She is the Project Manager for the Development of Australian Standards for Health Practitioner Pain Management Education. develop a national strategic roadmap for health practitioner pain management education.

In developing the National Pain Management Health Practitioner Education Strategy, the BFaculty EW GOLfound B a lack of consistency in the quality of pain-related education across health disciplines. In response to this, the first goal outlined in the strategic roadmap related to standard setting (see below).

The Faculty is very pleased to now be leading the project to develop Australian Standards for Health Practitioner Pain Management Education. The project, which is funded by the Australian Government, commenced in February and is scheduled for completion in October 2025.

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FPM ANZCA Pain Management Education Standards

A set of well-developed and accepted national standards for health practitioner pain management education will aim to inform policy, education, and practice to improve the care of Australians living with pain. National standards will provide a framework for the development and delivery of pain management education, ensuring consistency across disciplines and education sectors. They will also provide a valuable benchmark to regulators when assessing education programs.

The development of health practitioner pain management education standards requires openness and transparency, inclusivity, and balanced representation. It is therefore vital that a broad range of relevant stakeholders are informed of, or actively engaged in, the Australian standards for health practitioner pain management education project.

In-person workshops will be held in Adelaide (13 August), Perth (20 August), Sydney (27 August), Melbourne (3 September), and Brisbane (10 September). The online workshops (17 and 19 September) will provide access to anyone unable to attend an in-person workshop.

If you would like to attend a workshop, please complete and submit the Expression of Interest form as soon as possible and at least two weeks prior to your preferred workshop date.

Finally, this project is an important step to improving health practitioner education which will positively impact the health, work, and social outcomes of individuals living with persistent pain.

Declaration: Genevieve Nolan has nothing to declare.

To this end, a series of in-person and online BLOG WEB stakeholder consultation workshops are being conducted during August and September 2024.

Check out the new painACT

pain Aged Care Training More background information on our blog

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Volume 44, Issue 6, August 2024

National Pain Week 2024

Media Release

Patient case studies and spokespeople are available upon request.

View the National Pain Survey Report 2024 here.

The full survey is available upon request.

Urgent Call to Federal Government: Invest in High-Value Care for Chronic Pain Issued by: Chronic Pain Australia, Faculty of Pain Medicine of the Australian and New Zealand College of Anaesthetists (ANZCA), Pain Australia, and the Australian Pain Society The Pain Sector has united this National Pain Week to issue a joint statement, urging the federal government to implement high-value care in our communities.

The newly released 2024 National Pain Report has found that pain doesn’t just affect the person living with the condition; it affects our entire economy, health care system and society.

Key insights from the 2024 National Pain Survey include: • Impact on Productivity: Nearly half of those with chronic pain are in their prime earning years, significantly impacting national productivity. Nearly half of survey respondents have had to stop working because of their pain, and almost 30% have had to limit their hours.

• Strain on Relationships: Two-thirds of respondents feel their condition strains family relationships. Over 60% report reduced intimacy or a struggle to have sex as a result of their pain. Four in ten struggle to pick up, carry, or play with their children.

• Stigma and Barriers for Young Australians: Reverse ageism creates stigma and barriers to care for younger Australians, with nine in ten respondents aged 18 to 34 reporting being ignored or dismissed by health professionals. Significantly more in this age group have had thoughts of self-harm, taking their own life, or have attempted suicide.

• Medical Misogyny: Nearly half of women report stigma from health professionals, and almost 40% feel stigmatised by their GPs. • LGBTQIA+ Challenges: Respondents in this

BEWgroup GOLBare more likely to experience higher-

than-average mental health issues, with pain affecting their sleep, ability to work, sexual intimacy, and independence.

• Slow Diagnosis: 45% of respondents say it took longer than three years to get a diagnosis. Women and non-binary respondents face even longer delays, with nearly half of women and almost 60% of nonbinary respondents waiting more than three years.

• Potential for Multidisciplinary Care: Multidisciplinary (MDT) care, which treats chronic pain holistically in one location, in the heart of the community, has the potential to revolutionise treatment and improve the lives of those affected. Sadly, only one in 100 Australians can access MDT care.

We call on the federal government to fund multidisciplinary pain management programs through existing Primary Health Networks.

Expanding access to navigated MDT care would not only enhance individual outcomes and bring care closer to home but also benefit broader society, the health system, and the economy.

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PinC SIG Journal Watch

Impacts of paediatric chronic pain on parents: a qualitative study

Pain in Childhood Special Interest Group

Ngo D, Aouad P, Goodison-Farnswoth M, Gorrie A, Kenmuir T, & Jaaniste T. (2022). Impacts of paediatric chronic pain on parents: A qualitative study. Child: care, health and development, 49, 645-656.

DOI: https://doi.org/10.1111/cch.13079 Reviewer: Dr Eloise Cowie, Senior Clinical Psychologist, QLD Interdisciplinary Paediatric Persistent Pain Service

Review of article Population

BLOG

WEB

Ten parents (eight mothers and two fathers) of children attending the Sydney Children’s Hospital Interdisciplinary Chronic and Complex Pain Clinic completed semi-structured interviews.

Aims

The aim of the study was to investigate the possible psychosocial, functional, and work impacts of caring for a child with chronic pain on parents, including any positive effects of the experience.

Methodology A qualitative design was employed, utilising semi-structured interviews with domains informed by validated quantitative parent impact measures. Inductive thematic analysis (Braun & Clarke, 2006) was applied to identifying and categorising codes, themes, and subthemes.

Parents were included in the study if they were the parent of a child with pain that had lasted for at least three months, they lived with the child for at least part of the week, and their child had completed a full initial clinical assessment.

Potential participants were excluded if they had inadequate English-speaking skills, if their child’s pain was cancer-related, and if another parent from the family was already enrolled in the study.

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Results Summary A sample of ten primarily Caucasian parents, who were largely in married relationships and working full time, were interviewed. Transcripts were analysed to reveal primary themes. Parents shared experiences that connected to “the constant and all-consuming nature of the pain”, “dealing with uncertainty”, “the importance of support and self-care”, and “a revitalised view on relationships and life”. In relation to the theme of “the constant and all-consuming nature of the pain”, subthemes identified included constancy of pain and the experience of needing to provide containment to their child on an ongoing basis. Parents acknowledged that this experience of constancy was experienced within the broader family, noting other impacts such as sacrifices to the lifestyle families had become accustomed to. Another subtheme was the significant emotional and physical toll parents experienced in relation to their child’s pain.

Parents identified various emotions including guilt, frustration, anger, anxiety, and depression, and in reflecting on experiences their child had missed, a prevailing sense of grief. Within the theme of dealing with uncertainty, subthemes of diagnostic uncertainty, the future, and the experience of self-doubt and other challenging emotions arose. Within the third theme regarding the importance of support and selfcare, parents spoke about the way in which supportive relationships enabled them to share and manage the significant load and to be bolstered throughout these experiences. Parents also described various self-care ventures, but that participating in self-care was challenging due to the relentless nature of responding to their child’s needs. The fourth theme, “a revitalised view on relationships and life”, fulfilled the aim of identifying positive effects of parenting a child with pain and was further exemplified by the subtheme of experiencing a “revitalised and optimistic view on life”. Parents shared that their experiences of hardship garnered a sense of perseverance and gratitude.

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PinC SIG Journal Watch

Conclusions Utilising the inductive thematic analysis approach, four overarching themes that exemplify parental impact of paediatric chronic pain were identified. The findings were consistent with other qualitative research, which has demonstrated parents have a similar focus on the challenge of the unpredictable nature of pain, and the challenge of managing parental roles when supporting their child (for example, being “on call”, maintaining vigilance, and sacrificing career development). The authors suggest future potential for longitudinal qualitative research to map the experience of parents supporting a child with chronic pain over time to better understand the unfolding experience of parental burden.

The authors also suggest the importance of parental involvement in paediatric chronic pain interventions to support and improve parent and patient outcomes.

qualitative investigations, demonstrate the importance of keeping the family in mind, and particularly active in the therapy or treatment provided. The challenge of qualitative research is the gap in drawing connections between familycentred interventions and clinical outcomes, and a suggestion from the authors to consider longitudinal qualitative experiences is certainly of merit. As a clinician working within a paediatric complex pain setting, it is accepted, and frankly “canon”, that family-centred work is “gold standard”, but the question raised in the paper (secondary to Rook and Gauntlett-Gilbert, 2016) of “whether parental involvement in paediatric chronic pain programs should be as a cotherapist, co-patient, or independent patient” is pertinent. The authors have helpfully provided avenues for future research in this space.

Declaration Dr Cowie has no financial or other conflicts of

BEinterest W GOLto B declare.

Reviewer’s critique & take home message An Australian-based qualitative exploration of parental experiences in relation to paediatric persistent pain is a welcome and relevant addition to research literature in this space.

The authors acknowledge the similarity and consistency with previous qualitative research, of which there is now a considerable body that demonstrates the importance of parent experiences in relation to a child with complex pain. These snapshots, availed to us through

References Braun V & Clarke V. (2006). Using thematic analysis in psychology. Qualitative Research in Psychology, 3(2), 77-101.

Rook S & Gauntlett-Gilbert J. (2016). Parent involvement in pediatric pain interventions.

Pediatric Pain Letter, 18, 9-13.

Would you like to be featured in an APS member spotlight?

Email the APS Secretariat (aps@apsoc.org.au) if you would like to complete a short interview to introduce yourself and your work to the broader membership.

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PinC SIG Journal Watch

Roadmap to the ‘Chronic Pain GPS for Adolescents’ Interventions: Content and Design Considerations for a Group Peer Support Intervention Linkiewich D, Dib KC, Forgeron PA, Dick BD, & McMurtry CM. (2024). Roadmap to the ‘Chronic Pain GPS for Adolescents’ Intervention: Content and Design Considerations for a Group Peer Support Intervention. The Clinical Journal of Pain, 40(5), 288-298.

DOI: https://doi.org/10.1097/ ajp.0000000000001201 Reviewers: Linsay Rogers, Senior Physiotherapist, Queensland Interdisciplinary Paediatric Persistent Pain Service Rebecca Fechner, Senior Physiotherapist and BLOG WEB PhD candidate, Queensland Interdisciplinary Paediatric Persistent Pain Service

Review of article Study group Fourteen adolescents (mean age 15.2 years, nine females) with chronic pain were interviewed.

Aims of study This study sought to answer the question: What preferences do adolescents with chronic pain have for the content and design of a group peer support intervention for adolescent chronic pain?

Brief methodology This study was a patient-oriented needs assessment. The researchers used a convergent parallel design featuring individual interviews and surveys with adolescent participants.

Responses were analysed using inductive qualitative content analysis. Other survey data (e.g., age, pain characteristics, etc.) were analysed using descriptive statistics. A patient partner with lived experience of paediatric persistent pain was involved in many stages of the study including co-developing the research objectives, recruitment, content analysis, editing the manuscript, and knowledge translation efforts.

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Pain in Childhood Special Interest Group

Brief summary of the results Data were organised into themes to illustrate preferred features of (1) content and (2) design for adolescent group peer support.

1. Content: Adolescents preferred both talking and doing activities was preferable to just sitting in a circle, acknowledging the challenges of building friendships without doing some form of activity. Feelings of normalcy were described as important for adolescents to experience in group peer support. They identified that they didn’t feel like these opportunities existed in other types of peer groups offered.

2. Design: Adolescents generally indicated a preference for in-person group peer support.

They varied in their preferences regarding the frequency and length of peer support meetings but agreed having meetings at a consistent time would be beneficial. For example, after-school meetings would help with scheduling and transport. Participants generally favored group size to be 10-15 adolescents, with some structure at the start of sessions, followed by a flexible approach.

They indicated a strong desire to ‘hang out’ with others like them in a casual and enjoyable environment (a community setting was most favorable) that would facilitate relationship building. Desirable facilitator attributes include lived experience, younger age, and capacity to guide and organise the sessions.

Conclusions Adolescents with chronic pain have stated the need for support from peers, and a peer support group may be a way to address their unmet social needs. This consumer-engagement research highlights their specific preferences for how this group might run.

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support is one intervention that can address the social aspect of the biopsychosocial approach to pain management that is often lacking as a specific intervention. Even if there are groups as part of pain management, if they are not designed with peer support in mind, they do not facilitate relationship building necessary for this need to be met. Considering this, we wonder if there are opportunities in our current service models that might help to address adolescents’ unmet social needs as we hold these important findings in mind.

Reviewer's critique & take home message While this study is limited to data collected from a select group of adolescents, the findings are useful to consider when developing or evaluating service provision for adolescents with chronic pain in Australia. In particular, the findings highlight the importance of adolescents wanting to spend time with other adolescents with chronic pain, and a desire for this time spent to be not solely focused on pain, but an opportunity to form relationships with others that may have shared experiences, common interests, and hobbies. These findings are consistent with our anecdotal observations from adolescents in our care. Group peer

Declaration Nothing to declare.

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Approval by University of Melbourne Office of Research Ethics and Integrity (reference number 2024-28631-53278-4)

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Recent Publications

The smallest worthwhile effect on pain intensity of exercise therapy for people with chronic low back pain: a discrete choice experiment study Thank you to APS members Harrison Hansford, Aidan Cashin, Sam Williams, Saurab Sharma, Jack Devonshire, and Michael Ferraro, as well as their colleagues Matthew Jones, Raymond Ostelo, Alessandro Chiarotto, John Rose, Michael Wewege, and James McAuley for sharing the following recent publication.

Article first published online: 17 April, 2024 Journal Reference: Harrison J Hansford, Matthew D Jones, Aidan G Cashin, Raymond WJG Ostelo, Alessandro Chiarotto, Sam A Williams, Saurab Sharma, John M. Rose, Jack J Devonshire, Michael C Ferraro, Michael A Wewege, & James H McAuley. Journal of Orthopaedic & Sports BLOG WEB Physical Therapy, 54(7): 477-485.

DOI: doi.org/10.2519/jospt.2024.12279

Abstract To identify the smallest worthwhile effect of exercise therapy for people with non-specific chronic low back pain (CLBP).

Setting: Online survey with recruitment through paid advertising on social media and via email obtained from a registry of previous participants.

Subjects: English-speaking adults in Australia with non-specific CLBP. Methods We used a discrete choice experiment to estimate the smallest worthwhile effect of exercise compared to no exercise for pain intensity. Discrete choice experiment is a survey design where participants are asked to choose between different scenarios to identify the importance of different factors of these scenarios. We analysed the discrete choice experiment using a mixed logit model, and mitigated hypothetical bias through certainty calibration, with sensitivity analyses performed with different certainty calibration thresholds.

Australian Pain Society Newsletter

Two-hundred and thirteen participants completed the survey. The mean age standard deviation (±SD) was 50.7±16.5, median interquartile range (IQR) pain duration 10 years (5-20), and mean pain intensity (±SD) was 5.8±2.3 on a 0-10 numerical rating scale. For people with chronic low back pain the smallest worthwhile effect of exercise was a betweengroup reduction in pain of 20%, compared to no exercise. In the sensitivity analyses, the smallest worthwhile effect varied with different levels of certainty calibration; from 0% without certainty calibration to 60% with more extreme certainty calibration.

Conclusions The smallest worthwhile effect for exercise in addition to no treatment was 20% improvement in pain intensity.

Implications/Discussion

Objectives

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Results

This patient-informed threshold of clinical importance could guide the interpretation of findings from randomised trials and metaanalyses of exercise therapy compared to no exercise. Findings indicate that effects of exercise compared to no exercise for chronic low back pain would be considered worthwhile for people with chronic low back pain.

Declaration There was no financial support for this study and all authors declare no conflicts of interest.

Volume 44, Issue 6, August 2024

Recent Publications

Analgesia for non-specific low back pain

Thank you to APS members Caitlin Jones and Christine Lin and their colleagues Martin Underwood, Roger Chou, Mark Schoene, Saniya Sabzwari and Jarrod Cavanagh for sharing the following recent publication.

Article first published online: 27 June 2024 Journal Reference: Jones CMP, Underwood M, Chou R, Schoene M, Sabzwari S, Cavanagh J, Lin CC. Analgesia for non-specific low back pain.

BMJ. 2024 Jun 27;385:e080064. PMID: 38936847 DOI: https://doi.org/10.1136/bmj-2024-080064

Clinical Update Introduction Low back pain is the world’s leading cause of disability. At any time, half a billion (9%) adults are affected. Many are prescribed, or use, analgesics for pain relief. In this article, we review what is known about common analgesics for treating non-specific low back pain (defined as pain without an identifiable structural or disease cause).

Methods This is a review of Cochrane reviews, high quality systematic reviews that followed PRISMA (Preferred Reporting Items for Systematic reviews and Meta-Analyses) guidelines, and high quality single randomised controlled trials (if no reviews were available) investigating the

efficacy of analgesia for low back pain. We did not use observational or non-randomised studies as evidence for efficacy but occasionally referred to them when reporting risk of harm (as these study designs are often more suitable for detecting rare events). When reported certainty of evidence, we report what the systematic review authors report (we did not undertake an independent assessment).

Results Analgesics have limited effects on low back pain and some, such as opioids and benzodiazepines, have substantial risks. Oral and, less certainly, topical non-steroidal anti-inflammatory drugs BE(NSAIDs) W GOLBhave small benefits that may not be outweighed by risks (particularly gastrointestinal) for short term use for low back pain.

Conclusions If an analgesic is to be recommended for management of low back pain, oral NSAIDs (or topical NSAIDs if there are contraindications to oral formulations) probably have the most favourable benefit-harm balance (see infographic on DOI link above). There is high to moderate certainty evidence that paracetamol, opioids, antidepressants, and anticonvulsants are not effective. These medicines have associated harms, many of which are serious.

Declaration Nothing to declare.

Have you had an article accepted for publication recently?

The Australian Pain Society (APS) is keen to share publications from our members with their colleagues via our eNewsletter. If you’ve had an article accepted or published recently, please contact our Assistant Editor Joanne Harmon via the APS Secretariat (aps@apsoc.org.au) with the title, authors, and reference (i.e., journal, volume, and DOI) of your article and request the submission template. We would love it if you also supply a short commentary (300 words max) to give our readers the gist of the article.

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Recent Publications

Paracetamol combination therapy for back pain and osteoarthritis: a systematic review and meta-analyses Thank you to APS members Stephanie Mathieson and Christine Lin and colleagues Zhiying Cao , Kaiyue Han, Hanting Lu, Sandalika Illangamudalige, Christina Abdel Shaheed, Lingxiao Chen, Andrew J McLachlan, Asad E Patanwala, Christopher G Maher, Lyn March and Manuela L Ferreira for sharing the following recent publication.

conducted. Risk of bias was assessed using the original Cochrane tool, and quality of evidence using Grading of Recommendations Assessment, Development and Evaluation (GRADE).

Results

Although paracetamol (acetaminophen) combined with other analgesics can reduce pain intensity in some pain conditions, its effectiveness in managing low back pain and osteoarthritis is unclear. This systematic review investigated whether paracetamol combination therapy is more effective and safer than monotherapy or placebo in low back pain and osteoarthritis (OA).

Twenty-two studies were included. Pain was reduced with oral paracetamol plus non-steroidal anti-inflammatory drug (NSAID) at immediateterm in low back pain (paracetamol plus ibuprofen versus ibuprofen [MD -6.2, 95%CI -10.4 to -2.0, moderate evidence]) and in osteoarthritis (paracetamol plus aceclofenac versus aceclofenac [MD -4.7, 95%CI -8.3 to -1.2, moderate certainty evidence] and paracetamol plus etodolac versus etodolac [MD -15.1, 95%CI -18.5 to -11.8; moderate certainty evidence)]. Paracetamol plus oral tramadol reduced pain compared to placebo at intermediate-term for low back pain (MD -11.7, 95%CI -19.2 to -4.3; very low certainty evidence) and osteoarthritis (MD -6.8, 95%CI -12.7 to -0.9; moderate certainty evidence). Disability scores improved in half the comparisons. Quality of life was infrequently measured. All paracetamol plus NSAID combinations did not increase the risk of adverse events compared to NSAID monotherapy.

Design

Conclusions

Systematic review and meta-analysis.

Low to moderate quality evidence supports the oral use of some paracetamol plus NSAID combinations for short-term pain relief with no increased risk of harm for low back pain and osteoarthritis compared to its non-paracetamol monotherapy comparator.

Article first published online: 28 June 2024 Journal Reference: Drugs. 2024 Jun 28. Epub ahead of print. PMID: 38937394.

DOI: 10.1007/s40265-024-02065-w

BLOG

Abstract

WEB

Background and aims

Subjects Participants with low back pain and osteoarthritis.

Methods Online database searches were conducted for randomised trials that evaluated paracetamol combined with another analgesic compared to a placebo or the non-paracetamol ingredient in the combination (monotherapy) in low back pain and OA. The primary outcome was a change in pain. Secondary outcomes were (serious) adverse events, changes in disability and quality of life. Follow-up was immediate (≤ 2 weeks), short (> 2 weeks but ≤ 3 months), intermediate (> 3 months but < 12 months) or long-term (≥ 12 months). Random-effects meta-analysis was

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Declaration No funding was received to conduct this review.

AJM has provided education services sponsored

by Bayer and Haleon. The Sydney Pharmacy School receives research funding from GSK for a scholarship supervised by AJM. MLF and AJM serve on an Advisory Board for Viatris related to celecoxib use in primary care. All other authors declare they have no conflicts of interest that might be relevant to the contents of this manuscript.

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Events

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Events

BLOG

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Volume 44, Issue 6, August 2024

Events / New Members

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New Member New Member as at 22 July 2024 Dr Cristy Brooks Education

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FYI

NEW! > Chronic Pain Australia’s 2024 National Pain report (released 22JUL24): https:// chronicpainaustralia.org.au/wp-content/ uploads/NPW_2024/CPA_2024_NATIONAL_ PAIN_REPORT.pdf

Other items of interest for our members: > Latest opioid data from the Australian Bureau of Statistics: Opioid induced deaths in Australia. https://www.abs.gov.au/articles/opioid-induceddeaths-australia > Australia’s annual overdose report 2023 from the Pennington institute: https://www. penington.org.au/australias-annual-overdosereport/ > The Third Australian Atlas of Healthcare Variation: BLOG WEB This series explores how healthcare use in Australia varies depending on where people live.

It investigates reasons for variation that may be unwarranted, and provides specific achievable actions to reduce unwarranted variation. https://www.safetyandquality.gov.au/atlas > Painaustralia eNewsletter latest issue, available online at http://www.painaustralia.org.au/media/ enews > ePPOC: electronic Persistent Pain Outcomes Collaboration: The electronic Persistent Pain Outcomes Collaboration (ePPOC) is an Australasian initiative that aims to improve the quality of care and outcomes for people who experience chronic pain. For more information about ePPOC, refer to the website: http://ahsri. uow.edu.au/eppoc/index.html > PainHEALTH website: painHEALTH‘s aim is to help health consumers with musculoskeletal pain access reliable, evidence-based information and tips to assist in the co-management of musculoskeletal pain. painHEALTH is an initiative of the Department of Health, Western Australia. http://painhealth.csse.uwa.edu.au/ > Stanford University: CHOIR Collaborative Health Outcomes Information Registry https://choir. stanford.edu/

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> Opioid Podcasts for GPs: These podcasts are produced by David Outridge GP, and FAChAM Trainee as a project under the auspices of Dr Steven Kelly Staff Specialist in Addiction Medicine, Kullaroo Clinic Gosford. A 20 week series from the Hunter Postgraduate Medical Institute (University of Newcastle) : http://www. gptraining.com.au/recent-podcasts > Airing Pain: Pain resources via an online radio show produced by Pain Concern, a UK registered Charity: https://painconcern.org.uk/ airing-pain/ > Indigenous Resources: New webpage on the APS website aggregating Indigenous resources: https://www.apsoc.org.au/Indigenous-Resources

TGA > Codeine information hub: https://www.tga.gov. au/codeine-information-hub-how-and-whereget-advice

NSW Agency for Clinical Innovation resources: > Brainman and Pain Tool Kit translations, SEP15: http://www.aci.health.nsw.gov.au/chronic-pain/ translated-resources > Pain Management Resources: https://aci. health.nsw.gov.au/networks/pain-management/ resources > Quicksteps to Manage Chronic Pain in Primary Care: http://www.aci.health.nsw.gov.au/chronicpain/health-professionals/quick-steps-tomanage-chronic-pain-in-primary-care > Built into Quicksteps: “How to de-prescribe and wean opioids in general practice”: http:// www.aci.health.nsw.gov.au/chronic-pain/healthprofessionals/quick-steps-to-manage-chronicpain-in-primary-care/how_to_de-prescribe_and_ wean_opioids_in_general_practice > A list of helpful apps for consumers and clinicians now available at: http://www. aci.health.nsw.gov.au/chronic-pain/healthprofessionals/management-of-chronic-pain > Chronic Pain in the ED: https://www.aci.health. nsw.gov.au/networks/eci/clinical/clinicalresources/clinical-tools/pain-management/ chronic-pain-in-the-ed

Volume 44, Issue 6, August 2024

Calendar of Events

Calendar of Events 5-9 August 2024

31 October-2 November 2024

International Association for the Study of Pain (IASP)

Australian Physiotherapy Association

IASP 2024 World Congress on Pain

Crown Perth, Perth, WA

Amsterdam RAI, Amsterdam, Netherlands https://www.iasp-pain.org/iasp-2024-worldcongress-on-pain/

19-22 August 2024 Neurosurgical Society of Australasia (NSA) NSA 79th Annual Scientific Meeting

FOCUS24: The business of physiotherapy https://physiotherapy.eventsair.com/focus24

21-23 November 2024 Royal Australian College of General Practitioners (RACGP) GP24

Darwin Convention Centre, Darwin, NT

Perth Convention & Exhibition Centre, Perth, WA

https://2024.nsa.org.au/

https://www.racgp.org.au/gp24/home

16-18 September 2024

27-29 November 2024

National Rural Health Alliance

BAustralian EW GOLB & New Zealand Spinal Cord Society (ANZSCoS)

17th National Rural Health Conference Perth Convention & Exhibition Centre, Perth, WA

ANZSCoS 2024

https://www.ruralhealth.org.au/17nrhc/

https://www.dcconferences.com.au/ anzscos2024/

Esplanade Hotel, Fremantle, WA

18-20 October 2024 Faculty of Pain Medicine (FPM)

20-22 March 2025

2024 FPM Spring Meeting

New Zealand Pain Society (NZPS)

Pullman Auckland Hotel & Apartments, Auckland, NZ

NZPS25 - Weaving our Kete

https://www.anzca.edu.au/events-courses/ events/anzca-and-fpm-annual-events/fpmannual-events/2024-fpm-spring-meeting

https://www.nzps25.nz/

Te Papa Tonogarewa, Wellington, NZ

13-16 April 2025 Australian Pain Society (APS)

21-23 October 2024 Australia & New Zealand Musculoskeletal Clinical Trials Network ANZMUSC 2024 Scientific Meeting South Australian Health and Medical Research Institute (SAHMRI), Adelaide, SA

2025 Australian Pain Society 45th Annual Scientific Meeting Pullman Melbourne Albert Park, VIC https://www.dcconferences.com.au/aps2025/

https://anzmusc.org/event/anzmusc-2024scientific-meeting/

Australian Pain Society Newsletter

Volume 44, Issue 6, August 2024

45

Recent Publications Vision, Purpose & Priorities

Vision, Purpose & Priorities

Vision: All people will have optimal pain management throughout life.

Purpose: The Australian Pain Society is a multidisciplinary association whose purpose is to advance pain management through education, research, and advocacy for transformational improvements in clinical care.

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Priorities:

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In order to achieve our purpose, the Australian Pain Society will provide: > Membership > Research > Education > Services and resources > Good governance and operations > Advocacy

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Australian Pain Society Newsletter

Volume 44, Issue 6, August 2024

Directors

Directors

President:

NT Director:

Mrs Joyce McSwan

Adjunct A/Prof Cindy Wall

Gold Coast Primary Health Network Persistent Pain Program, QLD and PainWISE Tel: 0412 327 795 Fax: 07 3539 9801

Clinical Psychology Assessment & Consultancy Fannie Bay NT 0820 Tel: 0488 993 210 Fax: N/A

President-Elect:

QLD Director:

Ms Bernadette Smith

Dr Duncan Sanders

Psychology Plus South Burnie TAS Tel: 03 6431 9959 Fax: 03 6431 9950

Pain Management Unit, Sydney Medical School, University of Sydney / Managing Pain Clinic and E3 Physio Gold Coast QLD Tel: 07 5620 1234 Fax: 07 3009 0420

BEW

Secretary: Mrs Dinah Spratt

Physiotas Physiotherapy Shearwater TAS 7307 Tel: 03 6428 7500 Fax: 03 6424 7811

Treasurer: Dr Laura Prendergast Pain Service, Northern Health Broadmeadows VIC 3047 Tel: 03 8345 5166 Fax: N/A Work days Mon & Thu

ACT Director: Dr Andrew Watson Calvary Hospital Canberra ACT 2617 Tel: 02 6201 6352 Fax: N/A

GOLB

SA Director: Ms Heather Gray Royal Adelaide Hospital Adelaide SA 5000 Email: heather.gray@sa.gov.au

TAS Director: Mr Sinan Tejani Launceston General Hospital Launceston TAS 7250 Tel: 0469 967 841 Fax: N/A

VIC Director: Dr Esther Dube Austin Health Heidelberg VIC 3084 Tel: 03 9989 1676 Fax: N/A

NSW Director: Mr Connor Gleadhill

WA Director:

Department of Health and Aged Care Primary Care Division Newcastle NSW 2038 Tel: 0405 203 661 Fax: N/A

Ms Jacintha Bell Lifeworks Occupational Therapy Mount Lawley WA 6050 Tel: 0451 178 880 Fax: 08 6323 3329

Australian Pain Society Newsletter

Volume 44, Issue 6, August 2024

47

Office Bearers

Office Bearers

Immediate Past President:

Newsletter Assistant Editor:

Ms Trudy Maunsell

Dr Joanne Harmon

Retired QLD

School of Clinical and Health Sciences University of South Australia Adelaide SA 5000 Tel: 08 8302 1442

SPC Chair: Professor Kevin Keay Department of Anatomy University of Sydney Sydney NSW 2006 Tel: 02 9351 4132 Fax: 02 9351 2817

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IASP Liaison: Professor Fiona Blyth AM Sydney School of Public Health Faculty of Medicine and Health University of Sydney Camperdown NSW 2006 Email: Fiona.blyth@sydney.edu.au

Scholarship/Grant Selection Subcommittee Co-Chairs: Em Prof Maree Smith AC Centre for Integrated Preclinical Drug Development University of Queensland St Lucia QLD 4072 Prof Luke Henderson Anatomy & Histology, School of Medical Sciences Brain & Mind Centre University of Sydney Camperdown NSW 2006

Communications Coordinator: Mrs Joyce McSwan Gold Coast Primary Health Network Persistent Pain Program, QLD and PainWISE Tel: 0412 327 795 Fax: 07 3539 9801

Newsletter Editor: Dr Lincoln Tracy School of Public Health and Preventive Medicine Monash University Melbourne VIC 3004 Tel: 03 9903 0288

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Australian Pain Society Newsletter

Volume 44, Issue 6, August 2024

Secretariat: DC Conference & Association Management Pty Ltd PO Box 637 North Sydney, NSW 2059 Tel: 02 9016 4343 Email: aps@apsoc.org.au Website: apsoc.org.au