APS JUL22 eNews

Volume 42, Issue 5, July 2022

Editor’s Note

Australian Pain Society Newsletter

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Contents

Contents

Editor’s Note

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painSTAR

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ASM 2023

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BPR SIG Journal Watch

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Recent Publications

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Member’s Spotlight

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Successful MRFF Grant Recipients

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Scholarships

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Surveys

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New eBook

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Relationships Committee

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Events

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FYI

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New Members

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Calendar of Events

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Vision, Purpose & Priorities

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APS Directors

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Office Bearers

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Australian Pain Society Newsletter

Volume 42, Issue 5, July 2022

Editor’s Note

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.

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 heart sing.

BEmakes W GOLyour B 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

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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.

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.

BLOG WEB 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

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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

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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

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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.

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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 BEW Award GOLBSubmission 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.

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Understanding and Reducing Drug-Related Harms: A Chat with Suzanne Nielsen Associate Professor Suzanne Nielsen, PhD MPS, is the Deputy Director of the Monash Addiction Research Centre in Melbourne and an NHMRC Career Development Fellow.

Nielsen has been a registered pharmacist for over 20 years, and her research has led to a greater understanding of how to identify and respond to prescription and over-the-counter drug-related problems. Nielsen delivered a plenary at the 42nd Annual Scientific Meeting (ASM) of the Australian Pain Society, held in Hobart from April 10-13, 2022. In the lead up to the ASM, Nielsen spoke with Lincoln Tracy, a research fellow from Monash University, Australia, about her journey through researching drug-related harms, her secret life as a volunteer bike mechanic, and more. Below is an edited transcript of their conversation.

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What was your path to becoming an 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

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got a real taste for research and how this field could go beyond methadone dosing. When I returned to Australia, I continued doing specialist clinical work in addiction treatment, but also started honors and then a PhD around treatments for opioid dependence.

How significant of a problem is opioid use disorder in Australia?

I think the best way to describe it is to say there are two problems side by side. On one side of things, Australia is a very high opioid prescribing country—in the top 10 in the world at times. Over the years there was a shift from predominantly using opioids in acute pain or palliative setting to it being commonly used for chronic pain. It took a while for the problems with long-term opioid use in chronic pain to emerge, and now [opioid prescribing] is starting to come down, as there’s been a lot of work focusing on quality opioid use. We 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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identifying who those patients might be and supporting other patients to safely cease opioids with appropriate supports.

What are some of the other challenges associated with researching opioid-related harms?

One of the biggest challenges is determining what works, particularly in the opioid policy space. There’s been a bunch of policies and interventions rolled out to respond to concerns around opioids. That makes it challenging to do research because you want to try and work out what is going on with multiple simultaneous interventions.

For example, if we see opioid prescribing go down, which is the bit that worked? If we’re seeing people ending up being cut off their medicines, what is contributing to that? Can we do a better job of implementing policies and evaluating them as we go? If so, we will be better able to know what contributes to better outcomes.

Another thing which is really challenging is being fast enough to pick up unintended harms that may happen with these rapid changes in policy. If we see a shift towards increased prescribing of less monitored 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

where we’ve seen unintended consequences in the US. Prescription monitoring is now implemented in all, or almost all, states in the US. But we still don’t have good evidence to know what these programs do for opioid prescribing and harms. Part of how we overcome this is having robust evidence.

We are lucky we’ve got good data systems here [in Australia] and we should be able to investigate outcomes from the prescription drug monitoring program use, not just at the population level, but at the patient level to look at what the impacts on individual patients or groups of patients.

We’re also lucky that we have a more accessible treatment system in Australia.

We’ve seen a lot of knee-jerk reactions in the US where at-risk patients suddenly can’t access opioid medication anymore, but there’s not necessarily other ways they can access treatment for opioid dependence. We know that when people are suddenly cut off from opioids there are increases in suicides and sudden mortality for a range of reasons.

So, it’s important that patients—particularly those who we feel might be experiencing BEopioid W GOLdependence—aren’t B cut off from their medicines without being put on a different 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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have been prevented. For example, someone else might have been home and heard signs of respiratory distress, but thought it was just snoring and therefore didn’t do anything.

Naloxone is now available as an intranasal spray, rather than an intramuscular injection.

The spray is much more accessible and simpler to use and has really helped in educational efforts—like having conversations around what to do if someone is displaying signs of opioid toxicity. If those symptoms are not recognised, naloxone won’t work. I hope in the coming years we can learn how to better implement overdose prevention for people who are prescribed opioids.

was controversial at the time, so a lot of effort was made to educate people about the role— or lack thereof—of codeine in chronic pain management. A key part of this was ensuring consumers understood there may be better options out there for them. And all the effort paid off—we’ve seen good outcomes from the codeine rescheduling in Australia. It’s been great to have research and to see policy changes implemented which led to good outcomes for patients. It gives us a lot of confidence moving forward.

You’ve previously published on observing increases in heroin-related deaths following the introduction of a harder to inject form of oxycodone. What changes have come about because of that work?

I have a secret life as a volunteer bike mechanic.

I learned a lot of these skills during my postdoc at UCLA, where we worked to provide bicycles as an affordable form of transport for undocumented workers and people who were homeless. I currently work with a non-profit we’ve established in Melbourne called the St Kilda Bike Kitchen, and we teach people how to fix and maintain their bicycles. We have run several programs in Sydney and Melbourne where we provide bikes to underserved communities, such as asylum seekers, so they’ve got affordable transport. It’s completely unrelated to my research, but a really rewarding part of my life.

That study used both ambulance and emergency department data and was pivotal in identifying this previously unobserved trend. Specifically, when oxycodone was BLOG WEB reformulated, we saw a shift from prescription opioid overdoses to heroin overdoses. This 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.

Finally, what’s something most people don’t know about you?

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

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

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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 BEcondition W GOLB 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 BLOG WEB 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.

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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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the use of neuromodulation for pain as an example of the need to demonstrate products and treatments are safe and effective. While neuromodulation systems are highly expensive and are associated with a risk of infection, they are carefully introduced into practice if the benefits and harms are carefully monitored through rigorous monitoring.

McGregor addressed the role of patients in this discussion, citing surveys from the Lambert Initiative where cannabis users reported great benefits with next to no side effects. Forrest also touched on the patient issue, emphasising the need for informed consent with new treatments. This requires prescribers to have a good understanding of the benefits and risks.

Forrest felt the only way to get to the point where prescribers were fully informed was through testing these products in randomised controlled trials—to which Vagg was very quick to jump in and remind everyone this was the position of the FPM. Finally, Hutchinson asked the panel for a one word answer on whether we would still be having this debate a decade down the track.

Forrest and Vagg suspected yes, Park hoped not, and McGregor cheekily responded with “psilocybin”—possibly implying that the debate 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.

Related reading Dieterle M, Zurbriggen L, Mauermann E, et al.

Pain response to cannabidiol in opioid-induced hyperalgesia, acute nociceptive pain, and allodynia using a model mimicking acute pain in healthy adults in a randomized trial (CANAB II) [published online ahead of print, 2022 Jan 24]. Pain. doi:10.1097/j.pain.0000000000002591 Fisher E, Moore RA, Fogarty AE, et al.

Cannabinoids, cannabis, and cannabis-based medicine for pain management: a systematic review of randomised controlled trials.

Pain. 2021;162(Suppl 1):S45-S66. doi:10.1097/j. pain.0000000000001929 Karanges EA, Suraev A, Elias N, Manocha R, McGregor IS. Knowledge and attitudes of Australian general practitioners towards medicinal cannabis: a cross-sectional survey.

BMJ Open. 2018;8(7):e022101. doi:10.1136/ bmjopen-2018-022101 Lintzeris N, Mills L, Suraev A, et al. Medical cannabis use in the Australian community following introduction of legal access: the 2018-2019 Online Cross-Sectional Cannabis as BEMedicine W GOLB Survey (CAMS-18). Harm Reduct J. 2020;17(1):37. doi:10.1186/s12954-020-00377-0 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 BLOG WEB 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

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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.

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:

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Vida Nazemian has received the Melbourne Research Scholarship fund.

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

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ASM 2022

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.

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Australian Pain Society Newsletter

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)

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ASM 2022

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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BPR SIG Journal Watch

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

Reviewer’s critique & take home message from the article

Study group

BLOG WEB 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 18

Australian Pain Society Newsletter

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.

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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BPR SIG Journal Watch

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 BEtwo W weeks GOLB 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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BPR SIG Journal Watch

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 BLOG WEB 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).

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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

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BPR SIG Journal Watch

(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.

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 BEmay W Gproduce OLB 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.

Reviewer’s critique & take home message from the article This study is the first to identify and characterise a subset of glutamatergic Australian Pain Society Newsletter Volume 42, Issue 5, July 2022

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Recent Publications

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

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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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Recent Publications ASM 2022

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.

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

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

Implications/Discussion

Setting

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.

Hospital surgical ward.

Declaration

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).

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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Recent Publications

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.

PHN program managers of community-based pain programs Methods

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/

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

Setting

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.

PHNs across Australia

Conclusions

Subjects

The findings provide a greater understanding

Abstract

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Objective 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

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Recent Publication ASM 2022

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.

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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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Member’s Spotlight

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 BLOG WEB 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 26

Australian Pain Society Newsletter

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.

Volume 42, Issue 5, July 2022

Successful MRFF Grant Recipients ASM 2022

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 Bidentification EW GOLB and appropriate treatment of chronic lower limb pain.

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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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.

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.

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

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.

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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

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

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.

Volume 42, Issue 5, July 2022

Successful MRFF Grant Recipients

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.

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. BEW GOLB

Report 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.

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“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

> 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.

> At any recognised Australian University

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Volume 42, Issue 5, July 2022

Scholarships / Surveys

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

BEW Gin OLarrears B > The grant funding (inclusive of GST) will be paid quarterly 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.

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Vital reference for both Residential and Community Aged Care settings.

Publications

BUY NOW Now available in eBook! $39.99 AUD Get your copy here!

NEW eBook!

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

In this edition: Chapter 1: Chapter 2: Chapter 3: Chapter 4: Chapter 5: Chapter 6: Chapter 7: Chapter 8: Chapter 9: Chapter 10:

About Pain Identification and assessment of pain in aged care residents Beyond medication: psychological and educational approaches to pain management Movement and physical activity Complementary approaches to pain Pharmacological treatments Dementia and cognitive impairment: special considerations Pain at the end of life Pain and nutrition Quality and systems issues

PURCHASE YOUR COPY NOW FROM: books2read.com/painRACF2 32

Australian Pain Society Newsletter

Volume 41, Issue 10, January 2022

Relationships Committee

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.

> 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 and pain can alter an AEPs Bphysical EW GOLactivity B 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.

Understanding 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

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.

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Relationships Committee

Individualised exercise prescription

Promoting behaviour change

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.

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.

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 BLOG WEB 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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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.

Volume 42, Issue 5, July 2022

Events

PSA’s premier conference is back in Sydney face to face!

What to expect:

SYDNEY 2022

29 – 31 JULY

HYAT T REGENCY DARLING HARBOUR PSA22.COM.AU | #PSA22SYD

PSA22 Early Bird registrations now open.

View the program and register at www.psa22.com.au

Australian Pain Society Newsletter

PSA5728

Join the leaders in pharmacist education at PSA’s premier annual conference

PSA5728

PSA’s National Conference BEW

• Hear from leaders and experts in the industry • Remain at the forefront of practice and policy changes • Cutting edge clinical updates and masterclasses • Discover new roles and emerging opportunities • Learn with experts, mentors and peers GOL•B Join the conversation and shape the future of pharmacy

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Events

Established by the Australian Pain Society – Pain School for Translation And Research

13-17 November 2022

Novotel Barossa Valley, South Australia Applications Open: 17 May 2022 www.dcconferences.com.au/painstar2022

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2023 AUSTRALIAN PAIN SOCIETY 43RD ANNUAL SCIENTIFIC MEETING 2 - 5 April 2023 National Convention Centre Canberra, ACT

Expressions of interest online at www.dcconferences.com.au/aps2023

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Australian Pain Society Newsletter Volume 42, Issue 5, July 2022

Join us online #auspainsoc

FYI

FYI 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:// BEW digitalhealthguide.com.au/Account/LogOn? GOLB 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

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FYI / New Members

> 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:

> 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

> 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/painBLOG management/resources

> 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

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Dr John Baranoff

Psychology

Dr Martine Holford

Pain Medicine Physician

Dr Kelsi Dodds

Science Research

Dr David Holloway

Nursing

Ms Reihaneh Ferooz

Physiotherapy

Ms Renee Rankin

Education

Ms Peta Flynn

Occupational Therapy

Dr Dinberu Shebeshi

Epidemiology

Mrs Nicole Goatley

Occupational Therapy

Australian Pain Society Newsletter Volume 42, Issue 5, July 2022

Calendar of Events

Calendar of Events 29-31 July 2022

14-16 August 2022

PSA 22 PSA National Conference 2022

Dietitians Australia 2022 Be Bold

Hyatt Regency Darling Harbour, Sydney, NSW

Adelaide Convention Centre, Adelaide, SA

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

https://da2022.com.au/

29 July 2022

1-4 September 2022

GATE Pain Management Interest Group Victoria

ANZSPM 2022 Better Care For All: Inclusivity, Equity and Collaboration

Translating Pain Knowledge into Practice Online, Virtual, Online Conference https://www.gatevic.org.au/events

Hotel Realm, Canberra, ACT https://willorganise.eventsair.com/2022-anzspm/

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/

14-17 September 2022 Wounds Australia 2022 Conference Time to Heal, Time to Unite, Time to Innovate ICC, Sydney, NSW

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http://wounds2022.com.au/home

6 October 2022 RECOVER Conference 2022

6 August 2022

Optimising patient care: from interpersonal to digital connections

Monash University - Department of Obstetrics & Gynaecology

Sofitel Brisbane Central, Brisbane, QLD

Deep Dive into Dyspareunia: a Multidisciplinary Workshop on Sexual Pain

https://recover.centre.uq.edu.au/

Online, Virtual, Online Conference

14-16 October 2022

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

Faculty of Pain Medicine (FPM) 2022 FPM Spring Meeting Peppers Noosa Resort & Villas, Noosa, QLD

13-14 August 2022 2022 Neuromodulation Society of Australia and New Zealand (NSANZ 2022) 15th Annual Scientific Meeting - The Spine and Beyond: New Frontiers

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

Sofitel Melbourne on Collins, Melbourne, VIC https://www.dcconferences.com.au/nsanz2022

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Calendar of Events

21-24 October 2022

25-27 November 2022

NZSA & ASA Combined Scientific Congress 2022 Jointly hosted by the New Zealand Society of Anaesthetists (NZSA) and the Australian Society of Anaesthetists (ASA)

RACGP GP22 Melbourne Convention & Exhibition Centre, Melbourne, VIC https://www.racgp.org.au/gp22/gp22-home

TSB Arena, Wellington, NZ https://www.csc2022.co.nz/

2-5 April 2023

13-17 November 2022

Australian Pain Society 43rd Annual Scientific Meeting APS 2023

Australian Pain Society painSTAR - Pain School for Translation And Research

National Convention Centre National Convention Centre, Canberra, ACT

Novotel Barossa Valley, Adelaide Hills, SA

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

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/

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Vision, Purpose & Priorities

Vision, Purpose & Priorities

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

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

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

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> Research > Education > Services and resources > Good governance and operations > Advocacy

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Directors

Directors

President:

NT Director:

Ms Trudy Maunsell

Dr Rav Harish

Acute Pain Service Princess Alexandra Hospital Woolloongabba QLD 4102 Tel: 07 3176 5547 Fax: 07 3176 5102

Alice Springs Hospital Central Australian Health Service Alice Springs NT 0871 Email: rav.harish@nt.gov.au

President-Elect:

QLD Director:

Mrs Joyce McSwan

Mrs Karalyn Huxhagen

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

KH Pharmacy Consulting Mackay QLD 4740 Tel: 0418 185 972 Fax: 07 4805 6155

SA Director:

Secretary: Mrs Dinah Spratt

Dr Michelle Harris

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

Royal Adelaide Hospital and Lyell McEwin Hospital Adelaide SA Email: michelle.harris2@sa.gov.au

Treasurer

TAS Director:

Dr Laura Prendergast

Ms Bernadette Smith

Pain Service, Northern Health Broadmeadows VIC 3047 Tel: TBA Fax: N/A

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

ACT Director:

VIC Director:

Dr Andrew Watson

Dr Esther Dube

Calvary Hospital Canberra ACT 2617 Tel: 02 6201 6352 Fax: N/A

Austin Health Heidelberg VIC 3084 Tel: New VIC members please contact Dinah Spratt – Secretary 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

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Australian Pain Society Newsletter Volume 42, Issue 5, July 2022

WA Director: Ms Jacintha Bell Lifeworks Occupational Therapy Subiaco WA 6008 Tel: 0451 178 880 Fax: 08 6323 3329

Office Bearers

Office Bearers

Immediate Past President:

Newsletter Assistant Editor:

A/Prof Anne Burke

Dr Joanne Harmon

Central Adelaide Local Health Network Royal Adelaide Hospital Adelaide SA 5000 Tel: 08 7074 2835 Fax: 08 7074 6247

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

SPC Chair:

PhD Scholarship Chair:

Prof Kevin Keay

Dr Michael Farrell

Department of Anatomy University of Sydney Sydney NSW 2006 Tel: 02 9351 4132 Fax: 02 9351 2817

Retired VIC

IASP Liaison:

DC Conference & Association Management Pty Ltd

Secretariat:

Professor Michele Sterling

BEW

Recovery Injury Research Centre University of Queensland Herston QLD 4092 Tel: 07 3346 4793

GOLB

PO Box 637 North Sydney, NSW 2059 Tel: 02 9016 4343 Email: aps@apsoc.org.au Website: apsoc.org.au

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

Australian Pain Society Newsletter Volume 42, Issue 5, July 2022

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