APS JUL22 eNews

Australian Pain Society Newsletter

Editor’s Note

Joanne Harmon

Hi everyone, the year is indeed progressing fast.

We have an action-packed newsletter for you all. Plus - great news, the dates for the next APS 2023 conference have been released. Yay Canberra here we come! As a starter, now is the time to start thinking about your topical session submissions. Not only that, but abstract submissions are also opening soon. So get out your thinking caps and start smashing out some abstracts and start sharing your fabulous research findings. I wonder what the topic will be for the next debate? We have a summary of the last topical debate of ‘Will a Cannabis Crisis Replace the Opioid Crisis?’. Great to see the unique insights presented both from political and consumer perspectives in addition to clinicians and researchers. It’s an interesting read and certainly letters to the editor are always welcomed if you would like to contribute to the debate more.

Check out the interview by Dr Lincoln Tracy with A/Prof Suzanne Nielsen on understanding and reducing drug related harms. It’s a great read on the challenges currently faced in Australia and the importance of evidence-based policy reform.

It is great to be able to showcase some new publications by our APS members in this newsletter. The Basic Pain Research Special Interest Group (BPR SIG) Journal Watch is also back. It is such a fabulous opportunity to be able to communicate on recent publications by our members, and our readers are asked to please be mindful to share their articles as they come to hand as well.

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We are also highlighting a member’s spotlight and for this issue we are catching up with Karalyn Huxhagen and how she came to join the APS Board. Such great advice as well, to pick the area of work that makes your heart sing.

It’s great to be able to be involved as an assistant editor on the APS newsletter. What is even better is being able to bring to the readers more sharing of stories. It was with great joy I read about Jacqueline Iredale and Vida Nazemian’s journey to get to the APS conference and the networking undertaken. It is easy to take travel for granted and their stories highlight the importance that travel grants can provide to early career researchers.

Keep sharing your stories,

Until next time, take care

Joanne Harmon

The aim of painSTAR is to bring together a group of exceptional PhD/post-doctoral (or equivalent) pain researchers to participate in an intensive program focussed on linking the bench to bedside.

The painSTAR program includes a range of lectures, workshops and pain labs with experienced faculty and speakers as well as social dinners and networking opportunities. Consumer representatives will also be part of the faculty, providing attendees with exposure to the personal and social consequences of living with persistent pain, and providing inspiration about the importance of translational pain research.

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Investment from successful applicants is only AU$500. Registration will include:

> Access to the full program & leaders in the field of pain research

> Shared accommodation for the duration of the event

> All meals for the duration of the event

> Attendance at all social functions & dinners

> Transfers to/from the Novotel and Adelaide Airport

Applications to attend the inaugural painSTAR, have been extended! The strict deadline is Monday 18 July 2022.

For further information and to submit your application, visit the painSTAR website

The Australian Pain Society is delighted to announce painSTAR 2022 will be held from 13 - 17 November 2022 at the Novotel Barossa Valley Resort, Adelaide Hills.

IMPORTANT DATES FOR YOUR DIARY

Tuesday 28 June 2022

Topical Session Submissions Open

Tuesday 12 July 2022

Rising Star Award Applications Open Free Paper/Poster Abstract Submissions Open

Tuesday 11 October 2022

Rising Star Award Applications Close Topical Session Submissions Close

Tuesday 25 October 2022

Free Paper/Poster Abstract Submissions Close

Tuesday 15 November 2022

Registrations Open!

SAVE THE DATE

APS 2023 will be held from 02 – 05 April 2023 at the National Convention Centre Canberra, ACT

Please visit the conference website here: www.dcconferences.com.au/aps2023

If you have any questions, please contact the APS Conference Secretariat: apsasm@dcconferences.com.au

TOPICAL SESSION SUBMISSIONS NOW OPEN!

Submissions Open: Tuesday 28 June 2022

On behalf of the Scientific Program Committee and the Local Organizing Committee, we are pleased to advise topical session submissions for APS 2023 are now open.

The deadline for Topical Session submissions is: Tuesday 11 October 2022

View the topical session submission guidelines.

The online topical session submission portal will be available via the conference website from Tuesday 28 June 2022

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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ABSTRACT SUBMISSIONS OPENING SOON!

Submissions Open: Tuesday 12 July 2022

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

The deadline for Abstract submissions is: Tuesday 25 October 2022

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.

RISING STAR AWARD APPLICATIONS OPENING

SOON!

Submissions Open: Tuesday 12 July 2022

This award showcases rising star pain researchers 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 43rd Annual Scientific Meeting, where they will give a plenary presentation to showcase their work and ideas.

The deadline for Abstract submissions is: Tuesday 11 October 2022

Please click here to view the Rising Star Award Submission Guidelines

To submit an application, please complete the form here

We look forward to receiving your submissions. Should you have any queries regarding your submission or the process, please contact the Conference Secretariat

problems with long-term opioid use in chronic

addiction researcher?

When I was a trainee pharmacist, I was working in a community pharmacy with a large methadone program. I developed a real interest in treating opioid dependence during this time, because I found working with the people in the program was very rewarding from a clinical perspective.

A big part of the rewarding feeling is the amazing improvements you see in people’s lives once they come into these treatment programs. In my pharmacy work I often saw people at a later stage in their lives and things were deteriorating for them. The number of medications they’re on would increase, and sometimes the picture wouldn’t be optimistic. But with this client group, people got better— their lives really came together.

After I was fully qualified, I moved to the UK and was headhunted for a job in a specialist drug treatment clinic—basically because I was the only pharmacist willing to do methadone treatment. The clinic ran trials around injectable methadone and heroin, as well as other novel treatments. That’s where I

now know the long-term benefits of opioids don’t always outweigh the risks, and that many patients don’t do well in the long-term. We are now responding to this first problem by initiating opioids in fewer patients.

At the same time, we have this cohort of patients who were started on opioids a while ago—when prescribing longer-term and higher dose opioids was more common—so the second issue is how we respond clinically to the needs of this cohort. It’s one thing to put strategies in place to prevent people starting opioids so they won’t become opioid dependent. How we meet the needs of those people who are already on a high dose of opioids and may need treatment for opioid use disorder, is challenging. It’s been nearly a decade of playing catch-up in educating clinicians and patients so that they know that providing opioids might not be best in the long term. It takes time to adapt, and we don’t want the pendulum to swing too far in the opposite direction. There are a small number of patients for whom opioids may be appropriate and will provide good clinical outcomes—we need to get better at

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medicines, or people being pushed towards illicit opioids or other things that might be not safe or effective, we want to know this sooner rather than later. We need to have measures in place to identify if and when these unintended harms occur. We are currently doing a lot of work using overdose data from ambulance services, primary care, and hospital data to identify where these unintended harms are emerging. Using these kinds of data sources allows us to monitor such harms in a time-sensitive manner, which is important.

What’s something in your area of research that we don’t currently know, but that you hope we have an answer for in five or 10 years?

I think getting a good handle on how to best use prescription monitoring programs to have positive outcomes for patients is an area we are trying to understand. There has been a huge change in the information clinicians have available to them and this is something

treatment pathway. I think it’s critical that the kinds of conversations we have as clinicians and healthcare providers are along the lines of “how can we make things safer for you”, rather than “I can’t prescribe for you any more”.

Another area is how we can effectively deliver prevention strategies like take-home naloxone and opioid-safety education for people who are prescribed opioids and are at immediate risk of an overdose. We have developed brief tools prescribers can use in a structured way to screen and identify patients who might be at risk so we can immediately get things in place. This is key, so the risks are at least addressed in the short-term while longer term strategies are put in place for pain management. A key part of having naloxone work effectively is educating patients and their families about the signs and symptoms of opioid toxicity that they need to keep an eye out for, and how to use the naloxone if the absolute worst happens. We see coroner’s reports of patients who never wake up, who have stopped breathing overnight due to opioid toxicity. Many of these deaths could

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finding was an unintended consequence of the reformulation and has since spurred on a program of work in Australia to look at unintended consequences in general. This work highlighted the importance of looking at other prescription opioid policies and strategies to make sure we don’t see similar unintended consequences.

We’re just starting to get the data on prescribing from prescription drug monitoring programs and are starting to see the impact those kinds of interventions are having. We are focusing on identifying the populations who are most affected and whether there are the populations that the interventions were targeted at. We want to know if the high-risk people who are prescribed opioids where changes are seen, or are we simply reducing opioid supply to the lower risk people or those prescribed opioids for cancer pain? I’m really looking forward to seeing those results.

The other main policy change that we’ve been looking at has been codeine rescheduling. We saw that hydrocodone rescheduling in the US led to mixed outcomes. Codeine rescheduling

they’ve got affordable transport. It’s completely unrelated to my research, but a really rewarding part of my life.

Lincoln Tracy is a postdoctoral research fellow in the School of Public Health and Preventive Medicine at Monash University and freelance writer from Melbourne, Australia. He is a member of the Australian Pain Society and enthusiastic conference attendee. You can follow him on Twitter (@lincolntracy) or check out some of his other writing on his website.

Related Reading

Lam T, Kuhn L, Hayman J, et al. Recent trends in heroin and pharmaceutical opioid-related harms in Victoria, Australia up to 2018. Addiction. 2020;115(2):261-269. doi:10.1111/add.14784

I have a secret life as a volunteer bike mechanic.

APS2022: Debate: Will a Cannabis Crisis Replace the Opioid Crisis?

The following is a summary from the 42nd Annual Scientific Meeting of the Australian Pain Society, which took place from April 10-13 in Hobart, Tasmania. This year, the Meeting featured a new item on the program—a debate. The inaugural debate focused on whether medicinal cannabis is the next opioid crisis. The evidence (or lack thereof) for medicinal cannabis use in the pain sector was discussed, with unique insights from political and consumer perspectives in addition those provided from clinicians and researchers. Read on to see how the debate played out.

The use of medicinal cannabis for chronic pain is a hotly debated topic and has been so for several years. Locally, the use of medicinal cannabis made headlines again in February when Australian basketball great Lauren Jackson hinted at making a surprise comeback from retirement.

Jackson represented Australia in four Olympics but was unable to compete at the 2016 Rio games due to an anterior cruciate ligament (ACL) injury. Since her retirement, Jackson has advocated for medicinal cannabis use for chronic pain based on her own experiences post-injury. Obtaining an exemption to continue using medicinal cannabis while competing was a key for Jackson’s comeback plans.

But is medicinal cannabis the next opioid crisis waiting to happen?

Current usage exceeds evidence base

Professor Iain McGregor, Academic Director for the Lambert Initiative for Cannabinoid Therapeutics at the University of Sydney, opened the debate by discussing the performance of medicinal cannabis since its prescription as an unregistered medication was legislated in late 2016

McGregor highlighted there had been over 240,000 medicinal cannabis product prescriptions for 90,000 patients, with the majority of these occurring in the last two years. Most prescriptions (over 60%) were for

chronic pain; more than all other indications combined—including anxiety and sleep. Approximately 4,000 prescribers—mostly GPs—have issued a prescription for one of the more than 240 products available for prescription. It was here that McGregor delivered the first punch of the debate, citing that 4% of medicinal cannabis prescribers were “naughty” members of the Faculty of Pain Medicine (FPM). Prescribing cannabinoid products for chronic non-cancer pain outside of a registered clinical trial goes against Faculty recommendations on this matter.

McGregor went on to cite data from the recently completed but unpublished Cannabis as Medicine Survey 2020. Of the more than 1,600 respondents who had used cannabis— illicit or prescribed—for medical reasons in the past 12 months, over 80% reported their condition as much better or very much better due to cannabis use.

But it isn’t just patients who support the use of medical cannabis. In another recent survey of Australian GPs, McGregor highlighted that more than half of the 505 respondents supported the prescription of medicinal cannabis. However, GPs felt medicinal cannabis should only be available for certain patient groups and lacked confidence in discussing its use with their patients.

Attendees were reminded of the “grotesque carnage” caused by opioids as McGregor moved onto describe the associations between prescribing and harms for both opioids and medicinal cannabis. Although a similar number of people used an opioid or cannabis in 2016/17—approximately three million people each—the number of hospitalisations, emergency department visits, and deaths related to opioids were far higher than that of cannabis. But McGregor didn’t shy away from discussing the side effects of medicinal cannabis—such as dizziness, vertigo, and increased appetite— nor that the quality of published evidence for medicinal cannabis is poor.

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McGregor concluded by reminding the audience that in 2015 numerous families were facing criminal charges for using medicinal cannabis to treat their severely epileptic children, despite the remarkable therapeutic benefits the treatment was having. But today, these products have been legalised. Furthermore, they are also subsidised as part of the Pharmaceutical Benefits Scheme. McGregor predicts a similar path for the use of cannabis for pain.

Learning from past mistakes

Associate Professor Mick Vagg, Director of Pain Matrix, provided the opposing view. Vagg emphasised the need to look at the learnings from the opioid crisis to help determine whether the medical cannabis movement should be handled in the same way.

Vagg didn’t deny that too many opioids are prescribed within Australia. Rather, he asked the audience to consider the multitude of GPs who can’t access proper pain management such as personalised cognitive behavioural therapy. Vagg described how many GPs are put between a rock and a hard place when faced with the choice of prescribing low-value therapies such as opioids.

Like McGregor, Vagg discussed the lack of quality research regarding the use of medical cannabis for pain. Citing evidence from a recent randomised, placebo-controlled crossover study, Vagg highlighted that an 800mg dose of cannabidiol did not affect pain, hyperalgesia, or allodynia in healthy volunteers during an experimentally induced model of acute pain. This dose far exceeds what would typically be prescribed to patients. Vagg is concerned about the lack of effect despite the large dose, and questioned why it should be used for neuropathic pain when efficacy is yet to be demonstrated?

The lack of data regarding the effects of long-term medical cannabis use was also highlighted. Adverse effects of cannabis include anxiety, suicidal tendencies, and psychotic symptoms. This could cause issues for the many patients with pain who are prescribed tricyclic antidepressants. There is a known interaction that will and does occur when taking these medications concurrently, but it is unclear whether the antidepressant dose needs to be raised or lowered when using cannabis.

Another area concerning Vagg is the advertising and regulation of medicinal products. In recent times advertisements for medical cannabis have gathered the secondhighest number of complaints to the TGA, behind only fake COVID cures. He felt there was reckless promotion in the absence of both safety and efficacy data, and poor regulation of advertising.

Vagg concluded by stating the pain community was being “the right amount of sceptical” about medical cannabis and warned of being sucked in by confirmation bias. He acknowledged the anecdotes about cannabis being useful as a last resort treatment for pain but reminded the audience of the importance of finding the evidence for a new treatment before deciding it works, not the other way around.

What’s in a name?

Following the debate, McGregor and Vagg were joined on stage by the Honourable Ruth Forrest MLC (Independent Member for Murchison, Tasmania) and Ms Allison Park (consumer representative) for a panel debate led by facilitator Professor Mark Hutchinson.

Hutchinson also posed the question of whether more specific naming conventions for medical cannabis products—such as moving away from the word ‘cannabis’—would benefit things. The panel had mixed views on this suggestion.

Vagg was indifferent to what current or potential products were called, provided they were safe and effective. Forrest and Park didn’t think changing the name would influence consumers who were in favour of the product nor fool naysayers who were opposed to its use. In contrast, McGregor felt changing the cannabis name would have an effect, claiming a similar process had occurred for “marijuana”, which is now rarely used in scientific discourse.

Hutchinson then asked the panel to think about the scale of the problem. Specifically, given the large number of people affected by pain, what is the problem if some people benefit from medical cannabis, and these individuals can be identified?

Vagg felt the issue came down to the individual cost of benefiting from a particular treatment and whether they could get similar benefits elsewhere for the same cost. He pointed to

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will have moved onto other treatments. The debate and panel discussion certainly provided the Australian pain community with much to think about. It will be interesting to see these conversations continue to unfold at future meetings.

Lincoln Tracy is a postdoctoral research fellow in the School of Public Health and Preventive Medicine at Monash University and freelance writer from Melbourne, Australia. He is a member of the Australian Pain Society and enthusiastic conference attendee. You can follow him on Twitter (@lincolntracy) or check out some of his other writing on his website

Pain response to cannabidiol in opioid-induced allodynia using a model mimicking acute pain in healthy adults in a randomized trial (CANAB

Mohiuddin M, Blyth FM, Degenhardt L, et al. General risks of harm with cannabinoids, cannabis, and cannabis-based medicine possibly relevant to patients receiving these for pain management: an overview of systematic reviews. Pain. 2021;162(Suppl 1):S80-S96. doi:10.1097/j.pain.0000000000002000

Schneider T, Zurbriggen L, Dieterle M, et al. Pain response to cannabidiol in induced acute nociceptive pain, allodynia, and hyperalgesia by using a model mimicking acute pain in healthy adults in a randomized trial (CANAB I). Pain. 2022;163(1):e62-e71. doi:10.1097/j. pain.0000000000002310

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Annual Scientific Meeting Travel Grant Recipient Report

Author: Jacqueline Iredale

Jacqueline Iredale is a third year PhD candidate in Associate Professor Brett Graham’s Spinal Cord Connections Lab, part of the Preclinical Neurobiology Research Group at the University of Newcastle and the Brain Neuromodulation program at the Hunter Medical Research Institute. Her research focuses on investigating the spinal cord circuits involved in pain processing, focusing on exploring macrocircuit level activity and connections in the dorsal horn using microelectrode arrays and patch clamp electrophysiology.

Author contact details: jacqueline.iredale@uon.edu.au

Report:

Being fortunate enough to receive a travel grant for this year’s APS Annual Scientific Meeting meant I was given the opportunity to present my work, plus meet and network with colleagues, something that has not been feasible for most of my PhD due to COVID. As I approach the end of my PhD this opportunity has been invaluable and such an important step in preparing to progress to the next stage of my career. I would like to thank APS immensely for providing this opportunity.

I am a basic scientist and presented some of my most recent work on diabetic neuropathy, which effects nearly half of people with diabetes. My work focuses on changes in the network activity of the spinal cord dorsal horn pain processing circuits using a mouse model of type 2 diabetes.

The findings of my study suggest that although spinal pain circuits do not generate spontaneous pain signals in diabetic conditions, if these circuits are hyperexcited under diabetic conditions this region may amplify

pain signals and miscode touch signals as pain. By understanding more about how diabetic neuropathy induces hyperalgesia and allodynia we may be able to develop more targeted and effective approaches to treatment.

I presented this work in both poster and rapid communication format, and also presented some of my other PhD work at the Basic Pain Research Pre-Conference Workshop in a 3-minute thesis format. These presentations provided the opportunity to speak to a variety of delegates from a range of fields. This is one of the things I like the most about the APS annual meeting, it brings together delegates from a wide variety of specialties; from clinicians to basic researchers; who would typically not have the opportunity to interact and share ideas. I received very positive feedback and was also posed some interesting questions about my work that I had not yet considered.

Other than presenting my work, the opportunity to network, particularly in sessions such as the ‘Pick the Brain of a Pain Researcher: Trainee Session’ were invaluable. To talk to both senior colleagues and other junior researchers was fantastic and highlighted that my PhD experiences are very similar to others, with the advice of senior researchers reassuring us that they too were once in our position. Following on from this session, having a drink with some of the fellow junior researchers I met led to a potential collaborative project, which we are now working on. The gala dinner presented a similar opportunity and I even managed to have a discussion with a potential future supervisor. I will now be visiting their laboratory and giving a presentation at their research institute later in the year. Overall, I had a fantastic experience and look forward to continuing to interact with the APS community over the coming years.

Thank you again to APS for the opportunity to attend the APS annual meeting.

Declaration:

Jacqueline Iredale has nothing to declare.

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Annual Scientific Meeting Travel Grant Recipient Report

Author: Vida Nazemian

Vida Nazemian is a third-year PhD student of Neuroscience at the University of Melbourne, where she studies in the Pain and Sensory Mechanisms lab under the supervision of Professor Jason Ivanusic and Dr Michael Morgan. She holds a Bachelor’s degree in Cellular and Molecular Biology - Microbiology and a Master’s degree in Medical Physiology.

Author contact details: vnazemian@student.unimelb.edu.au

Report:

I received an Australian Pain Society (APS) travel grant to participate in the Australian Pain Society’s 42nd Annual Scientific Meeting 2022, which was held in Hobart, Australia. With this travel grant, I had the opportunity to participate in the Basic Pain Research (BPR) workshop and present my PhD research in the 3-minute thesis competition. I also had the chance to present some of my research findings as a poster entitled “proBDNF and TrkB are differentially expressed in early vs late stages of MIA-induced osteoarthritis”, which I also presented in one of the Rapid Communication Sessions. The aim of the work I presented was to characterize the expression of proBDNF in synovial tissue, cartilage, and bone, and the BDNF receptor tropomyosin receptor kinase B (TrkB) in lumbar dorsal root ganglia, and to determine if their expression levels are altered at different timepoints, in an animal model of Monoiodoacetate (MIA)induced osteoarthritis (OA) pain. My findings suggest BDNF may contribute in different ways to the pain associated with early vs. late stages of MIA-induced OA. Further elucidation of the role of BDNF in OA may lead to improved mechanism-based pharmacologic treatment, which may result in reduced pain and improved quality of life for patients with OA pain.

The APS2022 conference was my second experience in participating in the APS conferences, although it was my first in-person experience after the COVID-19 outbreak. I’ve

participated in a number of pain conferences in different countries before and found the APS2022 conference one of the most informative. It was really interesting to find scholars working in the same research area and to discuss their goals and the impact of their research on patients’ quality of life. My favourite presentation was given by international keynote Professor Andrew Rice. I was lucky to sit with him at the BPR dinner, and he generously shared ideas about academia, industry, and basic and clinical pain research studies. I’m looking forward to participating in the APS2023 conference and presenting my research findings in different formats. In the meantime, I’m working on my thesis and analysing data to publish in highimpact journals.

Declaration:

Vida Nazemian has received the Melbourne Research Scholarship fund.

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2022 Discipline Subgroup Meetings Summary

By Dinah Spratt and Trudy Maunsell

The Australian Pain Society (APS) Board held their seventh subgroup forum meetings following the well-attended pre-conference workshops at the 2022 Hobart Annual Scientific meeting on Sunday 10th April. The six disciplines were physiotherapy, psychology, pharmacy & pharmacology, medical, occupational therapy and nursing, and the forums were held in order to facilitate a twoway communication between the Board and the Membership.

Of the 226 registered to attend their specific discipline meeting, 96 attended a session with a “response rate” of 42%. Thank you to all those attendees for your valuable feedback. Your feedback is used by the Scientific Program Committee in planning future annual scientific meetings and by the Board when strategic planning for future APS activities.

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The Society received overwhelmingly positive feedback from attendees with many commenting on the multidisciplinary approach and inclusiveness of the APS and its role in bridging the gap between the many professions involved in pain management care; the quality of the conference; the role we played in advocacy and research (including clinical research grants such as the Cops for Kids series), a great newsletter (especially in the PDF format), the President video messages and a helpful website.

Attendees were asked by group facilitators if these sessions were helpful and the responses were that the sessions are as they gave each group a chance to get together to discuss common issues (some related to the Society and other issues which are specific to the discipline), to offer suggestions for future conference topics and speakers and to see each other. A suggested improvement was to send out an agenda (“even a loose one”) prior to the subgroup meetings.

Suggestions for inclusion in future conferences (either as part of preconference workshops, topical sessions or plenary sessions) included:

> Pain management in diverse groups and indigenous populations and addressing the social determinants of pain

> “Stress inoculation” training

> Aspects of psychologically informed practice

> Developing improved communication skills and strategies to deal with challenging patients

> Case based discussions in preconference workshops and / or short vignettes via videos or role plays to keep sessions highly practical and interactive

> How to wean patients off medications

> Post-operative and post injury management of medications

> The role of opioid stewardship pharmacists

> Acute pain concurrent sessions

> The inclusion of experienced nurses in preconference and topical workshops

> The role of occupational therapy in pain management

> A preconference workshop on interdisciplinary care

> More on the use of virtual reality for occupational therapists working in pain

> Workshops for limited participants at extra cost

Other feedback and suggestions for the APS included:

> Changing the pharmacy & pharmacology preconference workshop to a morning rather than afternoon session and to provide greater clarity as to who the target audience is - pharmacologists or pharmacist or both (and content to reflect the group(s)

targeted)?

> Catering to all learning styles and to be aware of those learning styles when developing content and presenting

> Building better relationships with members

> Improved promotion with other groups including SHPA / PSA, the Pharmacy Guild, the Australian Physiotherapy Association, Pain Nurses Australia, OT Australia and local networking events

> Continued advocacy in the aged care sector Many groups outlined the challenges related to pain management education and curriculum development; credentialling and competency assessments; the role of each discipline in pain management and

the development of position papers (such as the Psychology Position Paper 3rd Edition); pain management in the disability sector; the problems related to renumeration for allied health practitioners; funding for pain services and the perceived lack of importance when finances are tight; staff recruitment and retention (public and private services); the difficulties in gaining ethics approval (“ethics accreditation process sucks”) and the difficulties obtaining funding and leave to attend annual scientific meetings. Thanks again for attending and providing valuable suggestions.

We look forward to seeing you in Canberra in 2023.

Dinah and Trudy

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RNA

Profiling

of Neuropathic

Pain-Associated Human DRGs Reveal Sex-differences in Neuro-immune Interactions Promoting Pain

Pradipta R. Ray, Stephanie Shiers, Diana TavaresFerreira, Ishwarya Sankaranarayanan, Megan L. Uhelski, Yan Li, Robert Y. North, Claudio Tatsui, Gregory Dussor, Michael D. Burton, Patrick M. Dougherty, Theodore J. Price. RNA Profiling of Neuropathic Pain-Associated Human DRGs Reveal Sex-differences in Neuro-immune Interactions Promoting Pain bioRxiv 2021.11.27.470190

DOI: https://doi.org/10.1101/2021.11.27.470190

Reviewer: Wendy Imlach, Head of the Pain Mechanisms lab in the Department of Physiology and Monash Biomedicine Discovery Institute, Monash University.

Review of Article

Study group

This study investigated gene expression in Diagnosis Related Groups (DRG) of 40 neuropathic pain patients undergoing thoracic vertebrectomy, where the DRG was removed as part of the surgery.

Aims of study

The aim of this study was to characterize the mechanistic drivers of neuropathic pain in male and female patients, by identifying changes in gene expression in the affected DRGs.

Brief methodology

Prior to surgery, neuropathic pain was determined in specific dermatomes, allowing comparison of DRGs associated with neuropathic pain to those not associated with pain. Gene expression of 70 isolated ganglia were analysed using RNA-seq allowing comprehensive identification of the molecular changes in neuropathic pain states. Cellular expression profiles were validated in human DRG sections using RNAscope in situ hybridization for genes of interest.

Brief summary of the results and conclusions

Pain-induced changes in gene expression were found to be vastly different in males and females. In males, the mechanisms driving pain appeared to involve cytokines, including Tumor Necrosis Factor (TNF), Interleukin-1-beta (IL1b) and Oncostatin M (OSM). These are likely to originate from macrophages, but may also be released from

neurons themselves. The data from males was similar to previous studies using animal models, where macrophages have been implicated in development of chronic pain. In females the expression patterns were very different, with a network of genes associated with type I and II interferons. Although interferons have been previously linked to pain sensitization and analgesia, their sex-specific role in neuropathic pain have not been studied. Surprisingly, only a handful of the male and female genes with increased expression in pain-associated increases overlapped. In conclusion, the findings from this study show that there are differences in pain signaling in males and females that drive neuropathic pain in patient populations.

Reviewer’s critique & take home message from the article

The preprint makes a strong case for sex differences in the mechanisms driving neuropathic pain at the level of the DRG, with pain-related changes in males associated with inflammatory cytokines and those in females involving interferon stimulated genes. Interestingly, the authors suggest that specific cell types in the blood could be sampled to understand molecular changes in the DRG, without accessing the DRG themselves – in males, a candidate would be monocytes, in females both T cells and monocytes.

One of the strengths of this study is that they were able to use DRG’s that were specifically matched to dermatomes associated with neuropathic pain, which is an advantage over other studies where DRGs from neuropathic pain patients are used with no record of whether they are associated with pain or not.

Although pre-clinical studies in rodents have identified important roles plasticity and neuroimmune interactions in pain states, the molecular and anatomical differences between rodent models and humans may contribute to failures of translation in the pain field. This study highlights the importance of investigating mechanisms in human tissue and in both males and females.

Declaration

Reviewer declares no conflict of interest.

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Microglia-independent peripheral neuropathic pain in male and female mice

YuShan Tu, Milind M Muley, Simon Beggs and Michael W Salter; Pain, 1-16, 2022 https://pubmed. ncbi.nlm.nih.gov/35384869/

DOI: https://doi.org/10.1097/j.pain.0000000000002643

Reviewer: Kelly O’Sullivan, Research Assistant, Pain Mechanisms Lab, Monash Biomedicine Discovery Institute and Department of Physiology, Monash University, Melbourne, VIC, Australia

Review of Article

Aims of study

Over the past two decades microglia have been implicated in being critical cellular mediators of pain hypersensitivity in a diverse range of preclinical models of neuropathic pain. This may lead to belief that peripheral neuropathic pain depends on activation of microglia in the spinal dorsal horn. In this study highlighted, Yushan et al. showed that mechanical, cold and heat hypersensitivity could be induced in mice when nucleus pulposus (NP)- the gelatinous portion of the intervertebral disc, was applied to the sciatic nerve. The authors had used NP in previous studies and shown that it causes the pain arising from herniation of spinal discs. Interestingly, hypersensitivity was found to be independent of microglia in the NP model, which differed to the spared nerve injury (SNI) model where an increase in activated microglia were observed in the dorsal horn. The authors confirmed their finding that microglia were not involved, by inhibiting microglia with minocycline, which did not reverse pain hypersensitivity.

Methodology

To further investigate possible mechanisms of action, the authors looked at other neuro-immune interactions and found an increase in macrophages to the area of NP application indicating an immunological lesion to the nerve. When macrophages were depleted, pain hypersensitivity was reduced, which confirmed the importance of macrophages in this pain model. They also found that irradiated NP from donor mice failed to recruit macrophages to the region and there was no hypersensitivity, confirming that cells contained within the NP are involved in the induction of pain

hypersensitivity. They next used green fluorescent protein (GFP) expressing donor NP and found no migration of cells from the NP to the sciatic nerve, which suggested that the macrophages may be attracted by diffusible factors in the donor NP. The authors also investigated the involvement of neurotrophins, such as nerve growth factor (NGF) and brain-derived neurotrophic factor (BDNF), which are released by macrophages and are known to cause hypersensitivity in peripheral tissue. They found that local application of neurotrophin antagonist Y1036, which sequesters both NGF and BDNF, increased paw withdrawal thresholds to levels comparable to sham mice. This suggests that when the NP is applied to the sciatic nerve, diffusible factors are released that causes upregulation of BDNF gene expression in macrophages, leading to increased neuronal activity and hypersensitivity. The pain phenotype resolves after approximately two weeks in which the macrophage number in the area also decreases, suggesting the mechanism of pain hypersensitivity induced by the NP is subject to viable cells in the donor NP.

Finally the authors compared male and female mice and verified no differences in time courses of pain hypersensitivity or cellular and molecular mechanism.

Brief summary of the results and conclusions

In conclusion, the results of this study demonstrate a promising new neuropathic pain model independent of microglia involvement. All experiments were thoroughly planned and included a wide variety of methods and animal models to confirm the likely mechanism of action.

Reviewer’s critique & take home message from the article

This study highlights the possibility that microglia independent forms of neuropathic pain in humans may be common and may be a reason for some clinical trials inhibiting microglia have only had limited success. This study highlights the importance of developing new diagnostic tests in humans to differentiate neuropathic pain that is microglia dependent or independent.

Declaration

Reviewer declares no conflict of interest.

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A novel spinal neuron connection for heat sensation

Hongsheng Wang, Wenbing Chen, Zhaoqi Dong, Guanglin Xing, Wanpeng Cui, Lingling Yao, Wen-Jun Zou, Health L Robinson, Yaoyao Bian, Zhipeng Liu, Kai Zhao, Bin Luo, Nannan Gao, Hongsheng Zhang, Xiao Ren, Zheng Yu, James Meixiong, Wen-Cheng Xiong, Lin Mei. A novel spinal neuron connection for heat sensation. Neuron, 110, 1-19 (ePub ahead of print)

DOI: https://doi.org/10.1016/j.neuron.2022.04.021

Reviewer: Dr Bryony Winters, Lecturer, School of Pharmacy, University of Sydney

Review of Article

Study group

Transgenic male mice, 2-5 months old, including a range of cre-dependent lines for conditional expression of alleles of interest in the spinal dorsal horn.

Aims of study

To genetically identify subsets of spinal cord neurons that are activated by noxious heat.

Brief methodology & summary of the results

The authors used green fluorescent protein (GFP)-labelled cFOS mouse line to identify spinal cord neurons that were activated after the mice were placed on a 52ºC hotplate. They then performed single cell reverse transcription polymerase chain reaction (RT-PCR), which found activated neurons primarily contained the glutamate transporter VgluT2 (77% of all neurons) but were otherwise heterogenous. Most prominently, ErbB4 (a tyrosine kinase receptor of the epidermal growth factor family that is activated by neuregulin 1, NRG1) was contained in 32% of activated neurons (41% of VgluT2 expressing neurons); somatostatin (SST) was in 14% and Cholecystokinin (CCK) in 18% of activated neurons. Using retrograde tracers delivered to brain regions known to be targeted by spinal cord projection neurons, they showed LI/LII ErbB4+ neurons were primarily excitatory interneurons (i.e. they do not project to the brain).

They next genetically ablated the ErbB4 expressing neurons in the dorsal horn or used an inhibitory Designer Receptors Exclusively Activated by Designer Drugs (DREADD) (hM4Di) to inactivate ErbB4 neurons, which reduced heat sensitivity and responses to capsaicin. They extended this using a Tri-cre mouse, which contained Cre-recombinase in SST, CCK and ErbB4 expressing neurons. By ablating or inhibiting all 3 neuronal subsets, this dramatically reduced heat responsivity on the hotplate and Hargreaves tests but not on the capsaicin test. Since capsaicin activates transient receptor potential vanilloid 1 (TRPV1) receptors (heat sensing receptors), this indicates ErbB4 expressing neurons may receive direct inputs from nociceptors that express TRPV1 receptors. They confirmed this by expressing channelrhodopsin (ChR2, light-activated channel) in TRPV1-expressing nociceptors and fluorescently labelled ErbB4 expressing dorsal horn neurons in the spinal cord. Using whole cell patch clamp electrophysiology they found ~42% of ErbB4+ neurons responded to the light stimulus with an excitatory current, the majority of which were monosynaptic responses. Using a similar strategy but with a transgenic mouse that restricted virally delivered of ChR2 to mechanosensitive DRGs, only 13% of ErbB4+ dorsal horn neurons responded to a light stimulus and the majority of these were polysynaptic responses (i.e. not a direct synaptic connection). They then used a semiintact ex vivo preparation of a portion of the spinal cord, together with lumbar roots, DRGs saphenous nerve and hindlimb skin. They were able to patch onto ErbB4+ dorsal horn neurons and stimulate the skin with either a mechanical or heat stimulus. They found 9/16 ErbB4+ neurons responded to a heat stimulus (52ºC), while only 2/16 neurons responded to a mechanical stimulus.

They next inhibited NRG1-ErbB4 signalling and tested heat sensitivity and capsaicin responses by intrathecally injecting transgenic mice a specific compound that inhibits a mutant ErbB4 receptor or wildtype mice with Afatinib

(a pan-antagonist of the ErbB receptor family), in both cases heat sensitivity was reduced. Similarly, they targeted NRG1 by intrathecally injecting the interfering peptide ecto-ErbB4 into wildtype mice or generating a conditional knockout mouse that lacked NRG1 in DRGs. In both cases they found phosphorylation of ErbB4 was reduced and behavioural responses to heat stimuli, but not mechanical stimuli were reduced compared to controls. They then recorded from ErbB4- dorsal horn neurons while selectively stimulating ErbB4+ neurons using optogenetics. They found of those that responded (~28% of all neurons tested), approximately half were monosynaptic excitatory responses and NRG1 could increase the amplitude of this response while the panErbB4 antagonist decreased it.

Finally, they used a confirmatory factor analysis (CFA) model of inflammatory pain (CFA injected intraplantar to the hindpaw) or a chronic constriction injury (CCI) model of neuropathic pain. In both cases they found increased NRG1 protein level and an increased phosphorylation of ErbB4, indicating elevated NRG1-ErbB4 signalling in the spinal cord. If the interfering peptide or pan-antagonist were intrathecally injected, this reduced hyperalgesia to a heat stimulus in the injured paw/hindleg.

Conclusions

This study identifies the tyrosine kinase receptor, ErbB4, as a marker of heat sensitive LI/LII dorsal horn spinal-cord neurons. ErbB4+ neurons are primarily glutamatergic interneurons that respond to heat stimuli and receive direct monosynaptic inputs from nociceptors that express the noxious heat receptor TRPV1. Genetic ablation or chemogenetic inhibition of these ErbB4+ neurons reduced heat sensitivity. Activation of NRG1-ErbB4 signalling pathway increases excitatory transmission between ErbB4+ and other dorsal horn spinal cord neurons and it played a role in heat sensation since inhibiting this signalling pathway reduces heat sensitivity. In models of inflammatory and neuropathic pain, NRG1-ErbB4 signalling was elevated and by inhibiting this signalling, this could decrease hyperalgesia to a heat stimulus.

Reviewer’s critique & take home message from the article

This study is the first to identify and characterise a subset of glutamatergic

interneurons in Lamina I/II of the dorsal horn spinal cord that express ErbB4 and play an integral role in noxious heat sensation. The experiments are convincing given the various differing methods used to confirm the function of this subset of interneurons. Since deletion or chemogenetic inactivation of CCK/SST and ErbB4 expressing interneurons provided a greater reduction of the behavioural responses to noxious heat compared with inactivation or deletion of ErbB4 alone, the authors argued this is evidence for a ‘population-coding or pattern theory’ of sensory modality. That is, contrary to the ‘labelled line’ hypothesis (i.e. sensory information of individual modalities is processed by more than one neuronal circuit). It should be noted however that monosynaptic inputs from TRPV1 expressing primary inputs were primarily observed in ErbB4 expressing LI/LII spinal cord neurons. Since TRPV1 is the main noxious heat receptor (activated by heat of ~42ºC), perhaps recruitment of CCK+ and SST+ neurons reflect the high temperature used as a stimulus (52ºC), which is likely to cause tissue damage and thus introduce other sensory modalities. Thus, while the additive activity of three distinct population of neurons may produce a more graded behavioural response to noxious heat, presumably the more noxious the stimulus, the higher the recruitment of a more heterogenous population of spinal cord neurons.

This paper demonstrates the advantage of using highly sophisticated genetic strategies to profile the function of specific populations of neurons. Of course, the caveats that come with these strategies (transgenic mice, issues around DIO specificity) must not be ignored. Nevertheless, given antagonists of NG1ErbB4 signalling were able to reduce heat hypersensitivity in wild-type mouse models of inflammation and neuropathic pain, this is compelling evidence to indicate ErbB4 as a functional marker of heat-sensitive neurons. Further, targeting NRG1-ErbB4 signalling may be a viable strategy to combat heat hypersensitivity and allodynia in chronic pain patients.

Declaration

Reviewer declares no conflict of interest.

Thank you to APS member Kevin Wernli and his colleagues Peter O’Sullivan, Anne Smith, Amity Campbell and Peter Kent for sharing the following recent publication.

Article first published online: 04 July 2020

Journal Reference: European Journal of Pain

DOI: https://doi.org/10.1002/ejp.1631

Link: https://pubmed.ncbi.nlm.nih.gov/32621351/

Abstract

Background

Movement and posture are commonly believed to relate to non-specific low back pain (NSLBP). While people with NSLBP appear to move and posture themselves differently from those without NSLBP, changes in movement and posture infrequently relate to improvements in NSLBP when analysed at a group-level. Additionally, little is known about how movement or posture change when clinical outcome improves.

Methods

Within-person relationships were investigated using a replicated, repeated measures, singlecase design in 12 people with persistent, disabling NSLBP. Individually relevant movement and posture were captured using wearable sensors on up to 20 occasions over a 22-week period (5-week baseline, 12-week physiotherapy-led intervention, 5-week followup), while pain and activity limitation were collected concomitantly. A series of crosscorrelation analyses estimated the presence, strength, and direction of relationships.

Results

Many participants (n = 10/12) had strong (e.g. r = 0.91, p = <0.001) relationships between changes in movement or posture and changes in pain and activity limitation, while some showed no strong association.

Where relationships were observed, clinical improvement predominantly (93% or 57/61 relationships) related to increased spinal movement range and velocity during forward bending and lifting, reduced lumbar muscle electromyography (EMG) activity at maximum voluntary flexion, and increased posteriorpelvic-tilt during sitting and standing.

Conclusion

Within-person changes to individually relevant movement and posture appear to often relate to clinical outcome, but not always. When changes were related, movement and posture appear to return towards being ‘less protective’, however causal directions remain unknown. Important activities, movements, and postural parameters varied across the participants, highlighting the potential importance of individualized management.

Implications/Discussion

Changes to individually relevant movement and posture appear to often relate to clinical outcome, but not always. Patient-specific activities, and movement or postural parameters that related to improved pain and activity limitation, varied across the 12 participants, highlighting the potential importance of individualised management. Where clinical improvements were related to changes in movement or posture, participants consistently returned towards being ‘less protective’ (increased range and speed of movement, increased posterior-pelvic-tilt during sitting and standing). Mechanisms and generalizability remain unclear.

Declaration

The study was funded by a Physiotherapy Research Foundation (PRF) Project Grant from the Australian Physiotherapy Association. An Australian Government Research Training Program Scholarship was received by the lead author to support his capacity to undertake this research.

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Movement, posture and low back pain. How do they relate? A replicated single-case design in 12 people with persistent, disabling low back pain

Innate Immune and Neuronal Genetic Markers Are Highly Predictive of Postoperative Pain and Morphine Patient-Controlled Analgesia Requirements in

Indian but Not Chinese or Malay Hysterectomy Patients

Thank you to APS member Andrew Somogyi and his colleagues Daniel Barratt, Alex Sia and EC Tan for sharing the following recent publication.

Article first published online: May 20, 2021

Journal Reference: Pain Medicine. 2021 Nov 26;22(11):2648-2660.

DOI: https://doi.org/10.1093/pm/pnab172

Link: https://academic.oup.com/painmedicine/ article-abstract/22/11/2648/6279101

Abstract

Objective

Pain severity and opioid requirements in the postoperative period show substantial and clinically significant inter-patient variation due mainly to factors such as age, surgery type, and duration. Genetic factors have not been adequately assessed except for the neuronal OPRM1 rs1799971 and COMT rs4680, whereas the contribution of innate immune signaling pathway genetics has seldom been investigated.

Setting

Hospital surgical ward.

Subjects

Women (107 Indian, 184 Malay, and 750 Han Chinese) undergoing total hysterectomy surgery.

Methods

Morphine consumption, preoperative pain, and postoperative pain were evaluated in relation to genetic variability comprising 19 singlenucleotide polymorphisms (SNPs) in 14 genes involved in glial activation, inflammatory signaling, and neuronal regulation, plus OPRM1 (1 SNP) and COMT (3 SNPs).

Results

Pre- and postoperative pain and age were associated with increased and decreased morphine consumption, respectively. In Chinese patients, only 8% of the variability in consumption could be explained by these nongenetic and genetic (BDNF, IL1B, IL6R, CRP, OPRM1, COMT, MYD88) factors. However, in Indian patients, 41% of morphine consumption variability could be explained by age (explaining <3%) and variants in OPRM1 rs1799971, CRP rs2794521, TLR4 rs4986790, IL2 rs2069762, COMT rs4818, TGFB1 rs1800469, and IL6R rs8192284 without controlling for postoperative pain.

Conclusions

This is the highest known value reported for genetic contributions (38%) to morphine use in the acute postoperative pain setting.

Implications/Discussion

Our findings highlight the need to incorporate both genetic and nongenetic factors and consider ethnicity-dependent and nonadditive genotypic models in the assessment of factors that contribute to variability in opioid use.

Declaration

The study was supported by the National Health and Medical Research Council of Australia (Project Grant 1011251), the SingHealth Foundation (Grant No. SHF/FG2007/2004), and NMRC Centre Grant Programme (NMRC CG/ CG/M003/2017) administered by the Ministry of Health’s National Medical Research Council, Republic of Singapore.

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Community-based pain programs commissioned by primary health networks: key findings from an online survey and consultation with program managers

Thank you to APS members Simone De Morgan, Fiona Blyth, Michael Nicholas and their colleagues Pippy Walker and Andrew Wilson for sharing the following recent publication.

Article first published online: 22 March 2022

Journal Reference: De Morgan S, Walker P, Blyth FM, Nicholas M, Wilson A. Community-based pain programs commissioned by primary health networks: key findings from an online survey and consultation with program managers. Australian Journal of Primary Health. 2022 Mar 22.

DOI: https://doi.org/10.1071/PY21195

Link: https://pubmed.ncbi.nlm.nih. gov/35314023/

Abstract

Objective

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There is an increasing demand for tertiary pain services, with long waiting times compounded by limited reach to regional and remote areas. Community-based pain programs are a feasible evidence-based model of care to improve access to multidisciplinary care. Australian primary health networks (PHNs) are well placed to commission pain programs to reduce the growing burden of chronic pain. The aim of this study was to support PHN decision-making by: (1) describing current PHN community-based pain programs; (2) assessing their alignment to key elements and implementation enablers of pain programs identified by an expert consensus process; and (3) describing PHN pain program adaptations during the COVID-19 pandemic.

Design

Online survey and consultation with PHN program managers

Setting

PHNs across Australia

Subjects

PHN program managers of community-based pain programs

Methods

PHN program managers of communitybased pain programs (n = 9) were invited to participate in an online survey and follow-up email consultation about their pain program. Six PHN program managers (representing South Eastern NSW PHN, Nepean Blue Mountains PHN, North Western Melbourne PHN, Gold Coast PHN, Adelaide PHN and the WA Primary HealthAlliance) participated in the study with three PHNs commissioning two different types of pain programs.

Results

PHN community-based pain programs are multidisciplinary programs underpinned by a biopsychosocial model of pain, and focus on self-management (e.g., exercise, psychological strategies) and pain education. Most PHN pain programs are group-based programs that target adults with chronic non-cancer pain, provide individual allied health referrals as required and are evaluated as part of the electronic Persistent Pain Outcomes Collaboration. Gaps include pain programs for Aboriginal and Torres Strait Islander people, and people from culturally and linguistically diverse backgrounds, with one notable exception of a PHN pain program for people from culturally and linguistically diverse and refugee backgrounds co- designed with consumers and relevant services. Programs targeting subacute pain to prevent progression to chronic pain are, with one exception, another gap area. PHN pain programs demonstrated a high level of alignment with expert-agreed key elements and implementation enablers. The COVID-19 pandemic precipitated the rapid adaptation of PHN pain programs using available methods for the delivery of digitally enabled care.

Conclusions

The findings provide a greater understanding

for researchers and PHN decision-makers of the key features of PHN community-based pain programs, their alignment with expert-agreed key elements and implementation enablers, the target-population gaps, and the types of program adaptations during the COVID-19 pandemic. The findings also illustrate the potential for using digitally enabled delivery methods to increase accessibility to pain programs with further research warranted.

Implications/Discussion

PHNs are well-placed to commission pain programs to reduce the growing burden of chronic pain. Current barriers for PHNs to commission pain programs, identified in Phase 1 of the study, include competing priorities and limited resources, and a lack of reimbursement under Medicare (Australia’s national public health insurance scheme) for group-based programs. A possible solution to improving the capacity of PHNs to commission pain programs is co-commissioning with state and territory health departments, Local Health Networks, Aboriginal Community Controlled Health Organisations, and other agencies.

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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Meet a Member

Karalyn Huxhagen BPharm FPS AACPA

Karalyn is a community pharmacist and an accredited consultant pharmacist who performs locum services, medication reviews, and delivers quality use of medication programs mainly in rural and regional Australia. Karalyn is also a prolific writer, reviewer, presenter, and consultant for many pharmacy organisations, industry and government bodies and training programs sponsored by manufacturers and health providers.

How did you get into pain research/clinician practice?

I’m a community pharmacist, but I’m also credentialed. So, I work not only in the community, but I work as a consultant with GPs and other groups. It turned out that pain touched a lot of areas of my work. I was doing a lot of one-on-one work with patients and consumers in wound care. One of the big things in wound care is the pain associated with it. I was also working in aged care, and there were problems for managing pain in these patients without causing drowsiness or falls. I was gathering this sensation that pain wasn’t well managed, which was leading to issues such as addiction and constipation. One day my dear friend Joyce McSwan started a pain support group. I was already involved with quite a few of the patients in the group, so I supported Joyce with the group. The group developed to include a whole suite of allied health professionals. Then when Joyce moved on, I took over the group.

What do you think will be the next “hot topic” in your area of research or practice?

I hope we use the lessons learned during COVID to do therapeutic monitoring and pain management better. For example, other practitioners—not just a GP or a medication specialist—could play a larger

role in therapeutic monitoring. The patient doesn’t need to get back to a GP every three or four days to have their pain management monitored and adjusted. This can be done remotely or using technology under the surveillance of a practitioner. Similar things have been happening for years in diabetes and IVF, so why not pain?

How and why did you join the APS Board?

I was driving in the pouring rain one day— it was so heavy I couldn’t see where I was going—and I get this phone call from Trudy [Maunsell] saying, “Joyce is going to be the incoming President, which means someone needs to take over her role in Queensland. I think you should do it.” I said “Trudy, whatever you need me to do I will do, but I need to go now so I can keep my eyes peeled for what else is out there on the road.” So, she signed me up and that was that. I enjoy being part of the Board and the APS—it’s a lovely society that bubbles along by the hard work of a lot of people who are driven by their passion to manage pain better.

If you could offer one piece of advice to a younger you, what would it be and why?

I would say to stretch your knowledge seeking as much as you can when you are younger, so when it comes time to decide when and how you want to practice you have the ability to go, “I really enjoyed doing x or y, and it gave me a reasonable income, and I want to go back and explore that.” I was lucky as my first community pharmacy job was in a diverse environment and I got to experience a lot of different things. As my career progressed, I kept my main job but got more involved in other things, like writing and educating. Now I’m at the stage where I can pick the area of work that makes my heart sing.

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Congratulations to APS Members for their recent MRFF Funding!

MRFF Grant GO5143 – Changing Children’s Lower Limb Pain CLLip

Author: Emre Ilhan

Emre is a physiotherapist, lecturer, and research fellow in the Department of Health Sciences, Macquarie University, Sydney. Emre’s clinical and research area of interest is paediatric pain, particularly pain in younger populations including critically ill neonates and infants.

Report

Chronic pain can affect up to 70% of children and adolescents [1]. When a child is in pain, it can impact their physical, psychological, and social wellbeing. Forty percent of cases of chronic pain are related to the lower limbs, that is the hips, knees, legs, ankles, and feet [2]. In fact, children and adolescents present two times more with lower limb concerns compared to spinal and trunk problems [2]. Chronic lower limb pain experienced during childhood occurs at a pivotal time of physical, social, and personal development. This is a time in which children and adolescents should be physically active, go to school, and build relationships with their peers. This means that chronic pain experienced in these formative years of development can have cascading effects on the lives of children as they grow up and become adults. For instance, reduced levels of physical activity may lead to an increased risk of obesity, mental health problems, and poor bone and heart health.

Personal accounts of children with chronic lower limb pain conditions and their families highlight the often stigmatising and disruptive nature of their pain [3]. For example, in children with juvenile idiopathic arthritis, children note feeling isolated, powerless, stigmatized, being dependent on others, and having a disrupted sense of normality and body image. Families and caregivers are also emotionally, socially, and financially affected by pain in their children. Parents of children with Perthes’ disease, a painful hip condition, report they need to quit their jobs to better manage their children’s symptoms [4]. Additionally, siblings report taking on extra caretaker responsibilities [4].

Many children and adolescents in Australia are “waiting in pain” [5]. Children and their families can wait up to 12 months in pain before being referred to a tertiary pain service [6]. The reasons for the delay in providing the right care at the right time to children and their families is complex. Often, the care of children and their families involve multiple health professionals who have differing levels of expertise, scope of practice, and confidence in managing lower limb pain. This highlights the need to develop solutions that are inclusive of all health professionals to ensure that children’s lower limb chronic pain is better understood, visible, and treated [7]. Consequently, a strong foundation is needed in primary care settings to facilitate a family centred approach in the timely identification and appropriate treatment of chronic lower limb pain.

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The program of research, called Kid’s Leg Pain, is led by Associate Professor Cylie Williams (Monash University) and Associate Professor Verity Pacey (Macquarie University) and will:

1. Develop a consistent set of condition definitions, appropriate diagnostic methods, and core outcome measures that all health professionals can use to assess, treat, and support families in managing kids’ chronic lower limb pain.

2. Create evidence-based and family-centered clinical guidelines to address chronic lower limb pain in children and adolescents in a manner that is equitable.

3. Co-design a research translation and education platform for families, children, health professionals, support staff, and health professional students to maximise guideline access and adoption.

The Kid’s Leg Pain Team consists of clinical and research leaders in paediatrics, including paediatric rheumatology, endocrinology, orthopaedics, and genetics, general practice, podiatry, physiotherapy, psychology, and pharmacology. The Team also has leaders in

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Successful MRFF Grant Recipients

guideline development, outcome measure development, implementation science, and educational design. The Kid’s Leg Pain program of research has also partnered with Musculoskeletal Australia, the Australian Pain Society, and the Australian Podiatry Association to develop a world-leading foundation to empower children, their families, and health professionals to manage chronic lower limb pain in children.

The project will have scholarships available for passionate PhD candidates interested in improving chronic lower limb pain in children and adolescents via Monash University and Macquarie University.

Want to get involved as a health professional, caregiver, or parent? Sign up using the following link or via the QR code below:

Declaration

Emre Ilhan is an investigator on this Medical Research Future Fund grant awarded by the Australian Government.

References

1. King et al. The epidemiology of chronic pain in children and adolescents revisited: A systematic review. Pain. 2011;152:2729-2738.

2. Henschke et al. Musculoskeletal conditions in children and adolescents managed in australian primary care. BMC Musculoskelet Disord. 2014;15:164.

3. Sørensen et al. Adolescents’ experience of complex persistent pain. Scand J Pain. 2017;15:106-112.

4. Leo et al. Perspectives on the social, physical, and emotional impact of living with perthes’ disease in children and their family: A mixed methods study. Glob Pediatr Health. 2019;6:1-10.

5. Bennett. The children who wait in pain. Pain Australia, 2020.

You can also keep abreast of new developments in the program of research by following our social media accounts:

Twitter: @KidsLegPain

Facebook: @KidsLegPain

Instagram: @Kids_Leg_Pain

For enquiries about more information or how you can get involved, please e-mail us on: SPAHC-kidslegpain@monash.edu

6. Shebeshi et al. Electronic persistent pain outcomes collaboration annual data report. Australian Health Services Research Institute: University of Wollongong, 2020.

7. Eccleston et al. Delivering transformative action in paediatric pain: A Lancet child & adolescent health commission. Lancet Child Adolesc Health. 2021;5:47-87.

Congratulations to APS Members for their recent MRFF Funding!

MRFF Grant GO5143 - Research to empower young people with chronic musculoskeletal pain

Authors: Helen Slater, Andrew Briggs & Susie Lord

Professor Helen Slater is a Specialist Musculoskeletal Physiotherapist and Professor in the Faculty of Health Sciences, Curtin University, WA where her research team is leveraging digital technologies to support models of care for young people with musculoskeletal pain.

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Professor Andrew Briggs is a Fellow of the Australian College of Physiotherapists and Professor at Curtin University, WA where he co-leads a health policy and systems research team, with a focus on health systems strengthening for musculoskeletal health and persistent pain.

It’s well recognised that transitioning from adolescence into adulthood is a critical developmental period when pain trajectories can become established and have an enduring impact on young lives. Providing access to trustworthy care, at the right time and by the right team are key issues for young Australians living with chronic musculoskeletal pain.

“Despite the significant burden of chronic musculoskeletal pain in young Australians, an enduring service gap remains,” Dr Susan Lord said. “While primary care services are available to young people with chronic conditions, ageappropriate, accessible, affordable and effective resources to support high-value musculoskeletal pain care across Australia are lacking.”

To address this issue, a team of international researchers, led by Professors Helen Slater and Andrew Briggs from Curtin University, and including Dr Lord, has recently been awarded a Medical Research Future Fund grant of $1,867,210.60 ($1,474,044.60 MRFF with WA Health partner co-funding of $350,000) through the 2021 Chronic Musculoskeletal Conditions in Children and Adolescents Grant Opportunity.

Dr Susie Lord is a Specialist Pain Medicine Physician working with the Children’s Complex Pain Service, John Hunter Children’s Hospital, and is a Conjoint Senior Lecturer in the School of Medicine and Public Health, University of Newcastle, NSW.

This MRFF funding will support an international team to develop, implement and test ‘myPAinhealTH (myPATH): a digitally-enabled adaptive learning system to support quality care of young Australians living with chronic musculoskeletal (MSK) pain.

Chief Investigator Professor Helen Slater, from the Curtin School of Allied Health, said the aim was to support young Australians aged 16-21 years with chronic musculoskeletal pain to take their health into their own hands and improve their health and wellbeing.

The myPATH system will extend ‘youngpainHEALTH’, a digital platform funded by a grant from WA Health and due to be launched later in 2022. This digital platform has been codesigned and created with young people for young people. Cross-discipline clinical experts, including APS members, have been involved in contributing content to the platform.

MyPATH will use Artificial Intelligence built into youngpainHEALTH to offer virtual timely, personalised, quality care for young people living with chronic musculoskeletal pain, in their natural environments.

Successful MRFF Grant Recipients / Scholarships

“This dynamic, interactive system will rapidly learn from young people what pain care they need, when they need it and what works best for them, helping them to understand and better manage their individual care needs by supporting them and prompting healthy habits.”

Professor Briggs, the project co-lead added, “myPATH will function as a ‘virtual clinician and coach’ care model to provide personalised pain care directly to young people. This digital solution is designed to augment clinical care, not replace it. myPATH will help strengthen health services and systems to address the burden of musculoskeletal pain conditions in young Australians.”

Professor Slater said an interdisciplinary team of researchers from Curtin, Flinders University and the Department of Health WA, in collaboration with international researchers from New Zealand, Canada and USA, would develop, implement and evaluate myPATH. “We have a highly skilled team and we’re looking forward to working together on what we consider an important program of work.”

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Participating institutions include Curtin University, Flinders University and WA Health. The international research team includes chief investigators (CIs) from Curtin University (Professor Helen Slater, Professor Andrew Briggs, Professor Anne Smith, Professor Peter O’Sullivan and early career researcher (ECR) Dr Nardia-Rose Klem). Our broader research team includes CIs A/Professor Niranjan Bidargaddi (Flinders University), Professor Jennifer Stinson (The Hospital for SickKids Canada), Professor Susan Murphy (Harvard University), Professor Kathy Eagar (the University of Wollongong), Dr Susan Lord (John Hunter Children’s Hospital), Dr Jason Chua (Auckland University of Technology), Dr Marie Deverell and Ms Megan Burley (Department of Health WA), and assistant investigators (AIs): Ms Jennifer Persaud (Arthritis and Osteoporosis WA), Dr Robert Schütze (Royal Perth Hospital/Curtin University), Mr Ben Horgan (WA Health Translation Network), Professor Paul Hansen (University of Otago), and Dr Tim Mitchell (painOptions, Perth).

Declaration

The authors are investigators on this Medical Research Future Fund grant awarded by the Australian Government.

Announcing the APS #6 PhD Scholarship (For funding in 2023)

The Australian Pain Society (APS) is a multidisciplinary organisation whose purpose is to advance pain management through education, research, and advocacy for transformational improvements in clinical care.

The APS is pleased to announce a new scholarship to our flagship PhD Scholarship program that has supported research into pain for over 25 years.

In brief, the award is to enable full time research leading to a Doctor of Philosophy or equivalent:

> Three years full time study from 2023 to 2025 with generous $40,000 annual stipend

> At any recognised Australian University

> The applicant must be an Australian citizen or permanent resident

> The applicant and their supervisor must be members of the Australian Pain Society; and

> The funded project can be related to any aspect of the mechanisms, diagnosis, or treatment of acute or chronic pain.

Further information about the PhD Scholarship, including the Conditions of Award, can be obtained from the APS Secretariat.

PhD Scholarship Application forms are available online and must be submitted by 5pm AEST on Wednesday 27 July 2022.

Announcing the APS/CFK Clinical Research Grant #6

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 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, for the sixth Clinical Research Grant Program

In brief, the award is to enable clinical research meeting the following criteria:

> Approach a meaningful conclusion in one year

> 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 (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 Tuesday 27 September 2022.

NEW eBook!

Pain in Residential Aged Care Facilities: Management Strategies

2nd Edition

The gold standard in Pain Management for Older People is now available in eBook format!

In this edition:

Chapter 1: About Pain

Chapter 2: Identi cation and assessment of pain in aged care residents

Chapter 3: Beyond medication: psychological and educational approaches to pain management

Chapter 4: Movement and physical activity

Chapter 5: Complementary approaches to pain

Chapter 6: Pharmacological treatments

Chapter 7: Dementia and cognitive impairment: special considerations

Chapter 8: Pain at the end of life

Chapter 9: Pain and nutrition

Chapter 10: Quality and systems issues

The Role of an Accredited Exercise Physiologist in Pain Management

Research has shown that exercise is an essential aspect in the treatment of chronic pain. However, it is common for people who experience chronic pain to avoid movement and physical activity, to minimise the risk of pain flare ups. This leaves people dealing with chronic pain to be stuck in a bit of a rut. Over time, continued avoidance of movement and physical activity can lead to a reduced ability to complete meaningful activities that people need and want to do, this can even include general tasks of daily living.

Unfortunately, it is not common knowledge that movement and exercise can reduce the effects of chronic pain. Accredited Exercise Physiologists can help educate, and support people experiencing both acute and persistent pain, working within a multidisciplinary team to help people get back some control of being active to maintain or improve their function.

What is an Accredited Exercise Physiologist?

Accredited Exercise Physiologists (or AEPs) are 4‐year university trained, at a minimum, and nationally recognised allied health professionals. AEPs design and deliver individually tailored exercise interventions to facilitate and optimise the health status, functional capacity and independence of people with complex conditions, including chronic pain.

The Accredited Exercise Physiologist Scope of Practice and Professional Standards outline the knowledge and skills required of AEPs. These include the ability to:

> integrate knowledge of a person’s physiology and function to inform safe and effective exercise interventions

> adopt a person-centred approach to care

> evaluate physiological responses to exercises and incorporate adaptations accordingly

> prevent, treat and manage health conditions, including complex, chronic conditions

> empower and educate people to encourage healthy behaviour change

How do exercise physiologists help manage chronic pain?

AEPs are trained to use a biopsychosocial approach to treatment that acknowledges and aims to address the biological, psychological and social contributors to pain and disability. This involves a person-centred comprehensive assessment to understand the relevant contributors to the person’s pain experience. For example, the influence of the person’s thoughts, beliefs, emotions and behaviours concerning physical activity and pain can alter an AEPs approach to their exercise suggestions. Together with the client, AEPs provide individualised exercise plans and education, to address the identified primary factors contributing to pain and disability, and support behaviour change and self-management practices so that people with pain can move more confidently.

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Understanding pain

AEPs that provide exercise therapy for pain management understand modern pain science concepts, so they are able to engage in meaningful and positive pain dialogue and help the person’s understanding of their pain experience. AEPs help people make sense of their pain, often through the use of education techniques, including experiential learning. This empowers the client to reduce and better manage their pain, with a positive domino effect on health, function and mood. To achieve this, there needs to be a targeted conceptual change from ‘pain as a sign of structural damage or pathology’, to ‘pain as a protective mechanism modulated by all credible evidence of danger and safety’. That is, pain is an output from the brain based on the brain’s perceived need to protect.

Individualised exercise prescription

AEPs work collaboratively with their clients to prescribe individualised exercise that considers the person’s thoughts, beliefs, behaviours and preferences about physical activity. Importantly, there is no ‘one-size-fits-all’ approach to physical activity and exercise for people with chronic pain. Instead, what appears important is that people with pain stay engaged in meaningful activities that align with their goals. This could be structured exercise such as walking, Pilates, lifting weights, or other activities like gardening, surfing or playing with their kids. These activities could be supervised, unsupervised, or a combination of both, depending on the person’s preferences.

There are several mechanisms through which exercise yields positive effects on pain and function. For example, exercise contributes to improvements in psychological status and cognitions (such as increased pain selfefficacy and reduction in fear, anxiety, and catastrophisation). Appropriately tailored exercise can also affect neuroplasticity to reduce a person’s experience of pain. Even a single session of exercise can cause a short-term reduction in pain. This is known as exerciseinduced hypoalgesia, which appears to occur via changes in biological (e.g. opioid and cannabinoid mechanisms) and psychosocial factors (e.g. changes in beliefs and expectations).

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Promoting behaviour change

AEPs are trained to help clients identify effective skills, coping strategies and behaviors to best manage their pain. AEPs do this through various techniques, including, but not limited to, motivational interviewing, goal setting and education. Together with the client, AEPs will formulate a plan including exercise and behavioral or lifestyle change to increase the client’s skills in active pain management, and reduce, prevent or manage flare-ups if they do occur. When combining education and appropriately tailored exercise with this holistic approach to developing skills that the client can use in the longer term, clients are empowered to become more independent in self-managing their pain and overall health.

Working as a member of a multidisciplinary team

AEPs use exercise, education and behaviour change strategies, as described above, to work together with their clients and other care providers in the multidisciplinary pain management team. As per their Code of Professional Conduct and Ethical Practice, AEPs recognise the need for a multidisciplinary approach to optimise pain management and refer to other professionals, working collaboratively with them where appropriate.

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NEW!

> Chronic Pain Australia National Pain Week 25-31JUL22: https://www.nationalpainweek. org.au/

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-induced-deaths-australia

> Australia’s annual overdose report 2019 from the Pennington institute : http:// www.penington.org.au/australias-annualoverdose-report-2019/

> The Third Australian Atlas of Healthcare Variation: 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/

> 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: http://painconcern.org.uk/ airing-pain/

> Digital Health Guide: Developed by Primary Health Network Tasmania, check out the pain resources by accessing the link https:// digitalhealthguide.com.au/Account/LogOn? ReturnUrl=%2fSpecialtyFormulary%2f2 At login, Username: connectingcare, Password: health

> Indigenous Resources: New webpage on the APS website aggregating Indigenous resources: https://www.apsoc.org.au/ Indigenous-Resources

NPS MedicineWise resources:

> Choosing Wisely Australia – News & media: https://www.choosingwisely.org.au/ news-events/media-releases/choosingwisely-resource-addresses-patient-opioidknowledge-gap

> Over the counter codeine – changes to supply: https://www.nps.org.au/medical-info/ clinical-topics/over-the-counter-codeinechanges-to-supply

> Medicines with codeine – what you need to know: https://www.nps.org.au/medical-info/ consumer-info/medicines-with-codeinewhat-you-need-to-know

> Information about opioids and chronic noncancer pain: U-tube clip (5.39mins) https:// www.youtube.com/watch?v=8R4RT0pUCf 4&feature=share&fbclid=IwAR2dbhzgEAcc 7B-ogq2a6Xhud5FDkbciPbdJ9pb94GnQI6p AeifGd1VP-_I

> Opioids: Communications videos: https:// www.nps.org.au/opioids-communication-videos

TGA

> Codeine information hub: https://www.tga. gov.au/codeine-info-hub

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/painmanagement/resources

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New Members

New Members as at 28 June 2022:

Dr John Baranoff Psychology

Dr Kelsi Dodds Science Research

Ms Reihaneh Ferooz Physiotherapy

Ms Peta Flynn Occupational Therapy

Mrs Nicole Goatley Occupational Therapy

> Quicksteps to Manage Chronic Pain in Primary Care: http://www.aci.health.nsw. gov.au/chronic-pain/health-professionals/ quick-steps-to-manage-chronic-pain-inprimary-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/ clinical-resources/clinical-tools/painmanagement/chronic-pain-in-the-ed

Dr Martine Holford Pain Medicine Physician

Dr David Holloway Nursing

Ms Renee Rankin Education

Dr Dinberu Shebeshi Epidemiology

Calendar of Events

29-31 July 2022

PSA

22 PSA National Conference 2022

Hyatt Regency Darling Harbour, Sydney, NSW

https://www.psa22.com.au/

29 July 2022

GATE Pain Management Interest

Group Victoria

Translating Pain Knowledge into Practice

Online, Virtual, Online Conference

https://www.gatevic.org.au/events

2-4 August 2022

National Rural Health Alliance 16th National Rural Health Conference

Bridging social distance; Rural health innovating & collaborating

Brisbane Convention & Exhbition Centre, Brisbane, QLD

https://www.ruralhealth.org.au/16nrhc/

6 August 2022

Monash University - Department of Obstetrics & Gynaecology

Deep Dive into Dyspareunia: a Multidisciplinary Workshop on Sexual Pain

Online, Virtual, Online Conference

https://www.monash.edu/medicine/scs/obgyn/teaching/short-courses-for-professionaldevelopment/deep-dive-into-dyspareunia

13-14 August 2022

2022 Neuromodulation Society of Australia and New Zealand (NSANZ 2022)

15th Annual Scientific Meeting - The Spine and Beyond: New Frontiers

Sofitel Melbourne on Collins, Melbourne, VIC

https://www.dcconferences.com.au/nsanz2022

14-16 August 2022

Dietitians Australia 2022 Be Bold

Adelaide Convention Centre, Adelaide, SA

https://da2022.com.au/

1-4 September 2022

ANZSPM 2022

Better Care For All: Inclusivity, Equity and Collaboration

Hotel Realm, Canberra, ACT

https://willorganise.eventsair.com/2022-anzspm/

14-17 September 2022

Wounds Australia 2022 Conference

Time to Heal, Time to Unite, Time to Innovate ICC, Sydney, NSW

http://wounds2022.com.au/home

6 October 2022

RECOVER Conference 2022

Optimising patient care: from interpersonal to digital connections

Sofitel Brisbane Central, Brisbane, QLD https://recover.centre.uq.edu.au/

14-16 October 2022

Faculty of Pain Medicine (FPM)

2022 FPM Spring Meeting

Peppers Noosa Resort & Villas, Noosa, QLD

https://www.anzca.edu.au/events-courses/ events/major-events/fpm-national-events/2022fpm-spring-meeting

21-24 October 2022

NZSA & ASA Combined Scientific Congress 2022

Jointly hosted by the New Zealand Society of Anaesthetists (NZSA) and the Australian Society of Anaesthetists (ASA)

TSB Arena, Wellington, NZ

https://www.csc2022.co.nz/

13-17 November 2022

Australian Pain Society

painSTAR - Pain School for Translation And Research

Novotel Barossa Valley, Adelaide Hills, SA

https://dcconferences.eventsair.com/painstar

15-16 November 2022

National Rural & Remote Allied Health SARRAH Conference 2022

People, Purpose, Passion: Pathways to Success

Virtual, Online Conference

https://sarrahconference.com.au/

25-27 November 2022

RACGP

GP22

Melbourne Convention & Exhibition Centre, Melbourne, VIC

https://www.racgp.org.au/gp22/gp22-home

2-5 April 2023

Australian Pain Society 43rd Annual Scientific Meeting

APS 2023

National Convention Centre National Convention Centre, Canberra, ACT

https://www.dcconferences.com.au/aps2023/

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.

Priorities:

In order to achieve our purpose, the Australian Pain Society will provide:

> Membership

> Research

> Education

> Services and resources

> Good governance and operations

> Advocacy

Directors

Directors

President:

Ms Trudy Maunsell

Acute Pain Service

Princess Alexandra Hospital

Woolloongabba QLD 4102

Tel: 07 3176 5547 Fax: 07 3176 5102

President-Elect:

Mrs Joyce McSwan

Gold Coast Primary Health Network

Persistent Pain Program, QLD and PainWISE

Tel: 0412 327 795 Fax: 07 3539 9801

Secretary:

Mrs Dinah Spratt

Physiotas Physiotherapy

Shearwater TAS 7307

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Tel: 03 6428 7500 Fax: 03 6424 7811

Treasurer

Dr Laura Prendergast

Pain Service, Northern Health

Broadmeadows VIC 3047

Tel: TBA Fax: N/A

ACT Director:

Dr Andrew Watson

Calvary Hospital

Canberra ACT 2617

Tel: 02 6201 6352 Fax: N/A

NSW Director:

Dr Tim Ho

Inner West Pain Centre

RPA Medical Centre

Newtown NSW 2042

Tel: 02 9517 1764 Fax: 02 9517 1832

NT Director:

Dr Rav Harish

Alice Springs Hospital

Central Australian Health Service

Alice Springs NT 0871

Email: rav.harish@nt.gov.au

QLD Director:

Mrs Karalyn Huxhagen

KH Pharmacy Consulting

Mackay QLD 4740

Tel: 0418 185 972 Fax: 07 4805 6155

SA Director:

Dr Michelle Harris

Royal Adelaide Hospital and Lyell McEwin Hospital

Adelaide SA

Email: michelle.harris2@sa.gov.au

TAS Director:

Ms Bernadette Smith

Psychology Plus

South Burnie TAS

Tel: 03 6431 9959 Fax: 03 6431 9950

VIC Director:

Dr Esther Dube

Austin Health Heidelberg VIC 3084

Tel: New VIC members please contact

Dinah Spratt – Secretary Fax: N/A

WA Director:

Ms Jacintha Bell

Lifeworks Occupational Therapy

Subiaco WA 6008

Tel: 0451 178 880 Fax: 08 6323 3329

Office Bearers

Immediate Past President:

A/Prof Anne Burke

Central Adelaide Local Health Network

Royal Adelaide Hospital

Adelaide SA 5000

Tel: 08 7074 2835 Fax: 08 7074 6247

SPC Chair:

Prof Kevin Keay

Department of Anatomy

University of Sydney

Sydney NSW 2006

Tel: 02 9351 4132 Fax: 02 9351 2817

IASP Liaison:

Professor Michele Sterling

Recovery Injury Research Centre

University of Queensland

Herston QLD 4092

Tel: 07 3346 4793

Communications Coordinator:

Ms Trudy Maunsell

Acute Pain Service

Princess Alexandra Hospital

Woolloongabba QLD 4102

Tel: 07 3176 5547 Fax: 07 3176 5102

Newsletter Editor:

Dr Lincoln Tracy

School of Public Health and Preventive Medicine

Monash University

Melbourne VIC 3004

Tel: 03 9903 0288

Newsletter Assistant Editor:

Dr Joanne Harmon

School of Clinical and Health Sciences

University of South Australia

Adelaide SA 5000

Tel: 08 8302 1442

PhD Scholarship Chair:

Dr Michael Farrell

Retired

VIC

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