Australian Pain Society Newsletter
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Editor’s Note
Dr Joanne Harmon
Hi everyone,
The winter chill has really set in. So why not sit back, relax and check out the action-packed newsletter for you all. Looking forward to the next APS 2025 conference in Melbourne! As a starter, both topical and abstract submissions are now open. Also get your nominations in now for the Rising Star and Distinguished Member awards. Check out the inspirational articles by Marina Vygonskaya, Erin MacIntyre and Meredith Smith on the benefits they gained from being awarded an APS Travel Grant.
Speaking of Travel Grants, if you qualify, remember to indicate your Expression of Interest (EOI), when you submit your abstract, for APS 2025 Travel Grants and check out the brand new Professor Michael Cousins AO Allied Health Practitioner Travel Grant.
In other news, the partnership between the APS and Cops for Kids is continuing with the announcement of the eighth Clinical Research Grant Program. Don’t miss out on your opportunity to apply for this great initiative, details can be found on page 12.
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It is exciting to read that the new painACT ‘train the trainer’ pain management education program for residential aged care and aged care providers has been launched.
While the weather remains cool, warm up by reading about what the Basic Pain Research SIG have provided for us all. It’s worthwhile to be able to review these summaries of complex papers and the critical perspectives provided are worthwhile and considered. We also have two new publications for you all to check out, one is a book chapter on pain management in vulnerable populations: Pain in infants and children. The other is a systematic review, which is a cracking good read on the effectiveness of pain science education on caregiver and children’s knowledge beliefs, attitudes, and behaviours.
We like to showcase new publications by our APS members in our newsletters, it provides a fabulous opportunity for our members to be able to communicate their recent publications. Our members are asked to remember to submit abstracts of their articles as they come to hand.
Stay warm and keep sharing your stories,
Until next time, take care
Joanne Harmon
Important Dates for Your Diary
Topical Session Submissions Now Open
Rising Star Award Applications Now Open
Tuesday 2 July 2024
Free Paper/Poster Abstract Submissions Open
Monday 9 September 2024
Topical Session Submissions Close
Tuesday 1 October 2024
Rising Star Award Applications Close
Tuesday 15 October 2024
Free Paper/Poster Abstract Submissions Close
Tuesday 19 November 2024
Registrations Open!
Save The Date
APS 2025 will be held from 13 - 16 April 2025 at the Pullman Melbourne Albert Park, VIC Please visit the conference website here: www.dcconferences.com.au/aps2025
If you have any questions, please contact the APS Conference Secretariat: apsasm@dccam.com.au
TOPICAL SESSION SUBMISSIONS NOW OPEN
Submissions Deadline: Monday 9 September 2024
On behalf of the Scientific Program Committee and the Local Organising Committee, we are pleased to advise topical session submissions for APS 2025 are now open.
The deadline for Topical Session submissions is: Monday 9 September 2024
Put on your creative thinking caps and consider proposing ideas beyond the traditional, formal three speaker format. We are looking for innovation – your session can be a healthy debate or an in-depth discussion. We encourage sessions to be interactive, like including an audience poll or awarding prizes. This is your chance to tackle big topics like pain philosophy, ethics in research and pain, controversial conversations in pain, or go niche, exploring one area from numerous perspectives. Proposed symposia that include a range of experience (early career to senior) and professional expertise will be prioritised.
View the topical session submission guidelines and submit via the conference website.
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 NOW OPEN
Submissions Open: Tuesday 2 July 2024
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 15 October 2024
Please click here to view the Abstract Submission Guidelines.
There are THREE categories for Abstract Submissions. Please visit these portals below: Experimental Studies & Clinical Trials Abstract Guidelines Clinical Practice & Service Delivery Abstract Guidelines Case Reports Abstract Guidelines
We look forward to receiving your submissions. Should you have any queries regarding your submission or the process, please contact the Conference Secretariat
RISING STAR AWARD APPLICATIONS NOW OPEN!
This award showcases rising star pain researchers in Australia and may be awarded annually subject to the application of suitable candidates.
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The Rising Star Winner will receive a return domestic airfare, accommodation, and complimentary registration to attend the 45th Annual Scientific Meeting, where they will give a plenary presentation to showcase their work and ideas.
The deadline for Rising Star Award submissions is: Tuesday 1 October 2024
Please click here to view the Rising Star Award Submission Guidelines. To submit an application, please complete the form online here.
We look forward to receiving your submissions. Should you have any queries regarding your submission or the process, please contact the Conference Secretariat.
Nomination for Australian Pain Society Distinguished Member Award – 2025
The Board of Directors is seeking nominations from all Australian Pain Society (APS) members for candidates to be considered for the Distinguished Member Award(s) to be presented at the APS 45th Annual Scientific Meeting to be held in Melbourne from 13 - 16 April 2025.
Eligibility criteria:
Candidates must be APS members who generally have had a lengthy career in the field of pain and have:
• Made major contribution1 towards the Society, and
• Significantly contributed to the science of pain management, and/or
• Played a significant clinical, educational or research role in the field of Pain Management in Australia
1 Major contributions include, but are not limited to:
• Scientific Program Committee involvement
• Pain research
• APS projects
• Subcommittee involvement
• Board liaison
• Contributions to ASM presentations
Nomination Guidelines:
• A ‘Nomination for Distinguished Member Award’ form must be completed.
• As a guide, it is desirable that nominees have held continuous APS membership for over 10 years.
• Nominations must include an 800-900 word biography of the nominee. The Board will not consider incomplete nomination forms.
• Unsuccessful nominations are not automatically put forward in subsequent years.
• The nominator must be prepared to present a brief summary of the Distinguished Member biography in the ASM program, or arrange a suitable alternate for the presentation segment.
Submission
• All nominations to be submitted to the APS Secretariat by 31 October 2024.
Notification:
• The APS Board will notify successful nominees by 31 December 2024.
• Distinguished Member recipients are actively encouraged to attend the Annual Scientific Meeting in order to receive their award in person from the APS President.
The nomination form and a listing of past recipients of the Distinguished Member Award, including their biographies, can be found on the APS website.
Annual Scientific Meeting Travel Grant Recipient Report
Erin MacIntyre
Erin MacIntyre is a PhD candidate at the Persistent Pain Research Group at the University of South Australia. Her PhD focuses on the links between pain and visual perception in people with knee osteoarthritis.
Author contact details: erin.macintyre@mymail.unisa.edu.au
Changing Outcomes with Novel Interventions
I was very grateful to be awarded an APS travel grant, which allowed me to travel to Darwin to present my PhD work during the “Changing Outcomes with Novel Interventions” free paper session. As a final-year PhD candidate, this financial support is invaluable to my future career, and facilitated my attendance at the conference. Attending the 2024 ASM allowed me to not only share my work with a receptive audience, but also network with a fantastic group of passionate academics, pain researchers, and clinicians.
I presented my systematic review, which explored the influence of threat on visual perception, affordances, and behaviour. Our meta-analysis indicates threatening objects/ environments are visually exaggerated, and that threat reduces affordances, or perceived actioncapabilities. Together, this has implications for the efficacy of current treatments (e.g., exposure therapy), as well as paves the way for new treatments (e.g., using virtual reality to train this bias). However, the links between visual perception and affordance outcomes and behaviour remains elusive, which is a gap in the existing literature. During and after the free paper session, I was asked many insightful questions about the implications of this research on pain populations. It was wonderful to see that my work was well-received by the audience, and I really valued the many conversations about my work during and since the conference.
This engaged and collegiate atmosphere was present throughout the conference. I enjoyed attending the topical session “From Theory to the Coalface: A hands-on symposium exploring cognitive bias modification, predictive processing and graded sensorimotor retraining”. It was fascinating to hear Professor Louise Sharpe discuss her cognitive bias retraining program. Given that the program has moderate effects on pain, and is low burden for practitioners and participants, it shows great translational promise. I’m excited to see it further tested and integrated into clinical practice! In addition to the speakers themselves, the audience also contributed to the discussion, prompting further discussion about the topics. In line with the IASP Global Year theme, I also enjoyed the conference’s focus on sex and gender disparities in pain. Dr Charlotte Elder’s opening plenary was fantastic. I enjoyed her honesty and her perspective as a clinician. Her calls for further research into the conservative management of persistent pelvic pain were echoed by Dr Jane Chalmers, who won the Rising Star Award and gave a fantastic plenary on the final day of the conference. As a female early career researcher, it was empowering to watch two women talk openly about these topics.
It was a pleasure to attend the ASM in Darwin. Thank you again to the APS for your support and for the fantastic conference programme. I can’t wait to see everyone again next year in Melbourne!
Declaration: Erin MacIntyre’s PhD work was supported by a University of South Australia Post Graduate Award (USAPA) and by a National Health & Medical Research Council Project Grant to A/Prof Tasha R Stanton (ID1161634).
Annual Scientific Meeting Travel Grant Recipient Report
Meredith Smith
Meredith is a PhD candidate, physiotherapist, and lecturer in physiotherapy at the University of Adelaide. Meredith’s research focusses on adapting chronic pain assessment for children and young people with cerebral palsy. Meredith also works clinically at Novita and the Women’s and Children’s Hospital.
Author contact details: Meredith.smith@adelaide.edu.au
2024 Australian Pain Society 44th Annual Scientific Meeting
It was fantastic to receive an APS travel grant to enable me to attend the APS conference in Darwin. I was really excited to present as part of a workshop on ‘Pain assessment in children and young people with cerebral palsy: challenges and solutions’. The other presenters in the workshop were colleagues from around Australia – Nadine Smith from Perth, Adrienne Harvey from Melbourne, and Abi Thirumanickam from Adelaide.
The workshop was a wonderful opportunity to share some of the work we have been doing in developing a framework for chronic pain assessment in cerebral palsy, as well as presenting the initial versions of the modified assessment tools we have developed and tested for young people with cerebral palsy. We had an excellent discussion with those who attended the workshop about the possible next steps
and clinical/research uses for the developed assessment framework and modified tools. I was also able to present a poster which explained the specific adaptations needed to the tools. These adaptations were identified from a qualitative study with people with lived experience of cerebral palsy and their parents.
This is the second APS conference I have attended, and yet again I was impressed with the high quality of presentations and the warm welcome from the APS community. It was lovely to reconnect with those I met last year, and to see some of the progress in their research work. I really enjoyed the keynote talks this year, particularly Christine Chambers’ presentation on knowledge translation in paediatric pain. I have been reflecting on this as I feel it is core to our role in promoting best practice to the wider community. For our work in cerebral palsy, this looks like involving people with lived experience from the very beginning of the projects (including helping to decide what is important to research). It also prompted me to reflect on creative strategies that might be useful in distributing research knowledge.
Outside of conference time, it was great to be able to see Darwin and explore Litchfield National Park! After such a wonderful time this year, I am really looking forward to attending the Annual Scientific Meeting again in 2025.
Declaration: Meredith Smith has nothing to declare.
Would you like to be featured in an APS member spotlight?
Email the APS Secretariat (aps@apsoc.org.au) if you would like to complete a short interview to introduce yourself and your work to the broader membership.
Annual Scientific Meeting Travel Grant Recipient Report
Marina Vygonskaya
Five years’ experience as a doctor-Neurologist in pain management clinic in Russia; clinical research project (four years): Bio-psycho-social approach in treatment of low back pain; currently PhD candidate in UQ with interest in complement system in chronic neuropathic pain.
Author contact details: m.vygonskaya@uqconnect.edy.au
C5A in Chronic Neuropathic Pain Development
I recently attended my first APS conference, a significant event for professionals dedicated to studying and treating pain. The conference was an invaluable opportunity for me to present my research on the complement component C5a in mice plasma following Chronic Constriction Injury (CCI). My findings demonstrate C5a levels increase from day four to day seven post-injury and remain elevated during the chronic stage of neuropathic pain, a discovery that could have significant implications for understanding and managing chronic pain.
The conference experience was made possible through a travel grant. This financial support allowed me to fully engage with the event, participate in various workshops, and expand my knowledge in my field. I am profoundly grateful for this opportunity, as it not only enabled me to share my research findings but also to immerse myself in a community of likeminded professionals and researchers.
One of the most rewarding aspects of the conference was the chance to present my research and receive feedback from experts in the field. Sharing my results was an exciting experience, and the constructive discussions that followed provided me with new perspectives and ideas for future investigations. Engaging with professionals who showed genuine interest in my work was both motivating and enlightening.
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In addition to presenting my research, I had the pleasure of meeting many new people. As I am relatively new to this field, almost everyone I encountered was a new acquaintance. The interactions were incredibly enriching, allowing me to build a network of contacts who are passionate about pain research and management. I found meeting other PhD students during the rapid poster presentations was particularly impactful. Connecting with peers who are on similar academic journeys was encouraging and inspiring. These interactions fostered a sense of camaraderie and mutual support, which is crucial for navigating the challenges of academic research.
I also had the opportunity to reconnect with existing collaborators to discuss potential projects. Prior to the conference, I hadn't had the chance to present my latest results to them, so it was a great opportunity to do so during the event. These discussions were productive and opened up possibilities for future collaborative work.
The conference featured numerous presentations, workshops, and posters, all of which were impressive and informative. One of the sessions that stood out to me was on pain management education. It was clear that the program is run by individuals who are deeply passionate about improving pain management, particularly in rural areas where access to care can be limited. The dedication and enthusiasm of these professionals were truly inspiring, and their work highlighted the critical importance of education in enhancing patient outcomes.
Another session that caught my attention was on the role of diet in pain management, which turned out to be incredibly interesting. The presentations discussed how dietary choices can influence pain perception and management, providing a holistic approach to treatment that complements traditional medical interventions. This session broadened
my understanding of pain management and underscored the importance of considering multiple factors in developing effective treatment plans.
Overall, the conference was an enriching experience that provided me with a wealth of new ideas and perspectives. The atmosphere was vibrant and intellectually stimulating, filled with passionate individuals committed to advancing the field of pain research and treatment. I left the conference feeling inspired and motivated, with a renewed sense of purpose in my research.
Looking ahead, I am eagerly anticipating next year's APS conference. I am excited to return
to this dynamic community, to see the latest research developments, and to continue discussing my work with peers and experts. The opportunity to engage with such a diverse and knowledgeable group of professionals is invaluable, and I am looking forward to the new insights and ideas that will undoubtedly emerge from future interactions. The APS conference has not only enriched my current research but has also laid the groundwork for future investigations and collaborations, and I am grateful for the experience.
Declaration: Marina Vygonskaya has nothing to declare.
Announcing the APS/CFK Clinical Research Grant #8
The Australian Pain Society (APS) is a multidisciplinary association whose purpose is to advance pain management through education, research, and advocacy for transformational improvements in clinical care. Our vision is that all people will have optimal pain management throughout life.
Cops for Kids (CFK) is a South Australian based charity focused on supporting initiatives that strive to improve the lives of children in that state. Part of the CFK mandate includes the provision of funds for research to assist in the care of sick children and/or enhance the life quality of a child.
APS is pleased to announce our partnership with Cops For Kids is continuing with an eighth Clinical Research Grant Program
In brief, the award is to enable clinical research meeting the following criteria:
• Approach a meaningful conclusion in one year
• Conducted in Australia and must be relevant to the South Australian population
• The applicant must be an Australian citizen or permanent resident
• The applicant and their supervisor (if applicable) must be members of the Australian Pain Society and its Pain in Childhood Special Interest Group
• The funded project can be related to any aspect of a childhood pain complaint - including theoretical, mechanistic, diagnostic, treatment, epidemiological and/ or sociological approaches; and
• The grant funding of $40,000 (inclusive of GST) will be paid quarterly in arrears upon the submission and acceptance of a combined Progress Report-Acquittal Form
Further information about the Clinical Research Grant can be obtained from the APS Secretariat.
Clinical Research Grant Application forms are available online and must be submitted by: 5pm on Wednesday 11 September 2024.
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painACT – building capacity about pain management in residential aged care and aged care provider organisation staff
The Australian Pain Society (APS), in collaboration with the National Ageing Research Institute (NARI), developed a ‘trainthe-trainer’ pain management education program (painACT) for use by staff in residential aged care and for those who provide staff for aged care organisations. This project is part of a consortium project, funded by the Department of Health and Aged Care (DoHAC), Australian Government grant (2020-24; GO2810) Pain Management - Health Professional Education and Training as part of the Chronic Conditions Prevention and Management program in response to the National Strategic Action Plan for Pain Management
The consortium includes the University of Sydney (Pain Management Research Institute – lead), Curtin University, University of South Australia (Pain Revolution) and the Australian Pain Society/National Ageing Research Institute.
The pain management education program painACT has been informed by the Australian Pain Society Pain in Residential Aged Care Facilities: Management Strategies, 2nd Ed1 (2019) and Pain Management Guide (PMG) Toolkit for Age Care, 2nd Edition2 . The training program is informed by the principle of patientcentred care reflected in the consumer pain care priorities framework (Listen to me. Learn from me) and developed as part of the larger consortium DoHAC project.3
Aims of painACT
The painACT pain management education program aims to:
• Increase the training knowledge and skills among registered nurses within aged care to educate and upskill residential aged care staff (from a range of roles and professions) about pain management that aligns to patientcentric and biopsychosocial models of care.
• The training program aims to build ‘in-house’ capacity at residential aged care facilities and within aged care provider organisations without the need for further resources such as external educators.
• The aim is that all staff are exposed to pain concepts relevant for aged care settings, and to encourage staff to reflect on pain in the workplace, to be more vigilant about pain, and to act accordingly in response.
painACT is available on the APS website and consists of train-the-trainer learning module documents, short training video clips, and participant handout material.
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About painACT
A self-taught program, painACT allows Aged Care registered nurses to select and run premade education modules. These modules are designed to teach a diverse range of staff roles with an emphasis particularly on nonclinical staff such as lifestyle services and personal care workers.
In total, eight (8) pain education modules were developed for painACT: one module for the trainer called “How to use the painACT trainer program”, and seven modules for the trainer to train their staff. Each module is designed to take about 10 minutes to teach to staff.
The following modules are included in painACT:
1. Introduction to pain in aged care
2. Impact of pain on the person, family and staff
3. Conversations about pain
4. Dementia and cognitive impairment
5. Pain and non-pharmacological management
6. Documentation
7. Pain assessment
1 https://www.apsoc.org.au/publications
2 https://www.apsoc.org.au/PMG2Toolkit
3 Slater H, Jordan JE, O'Sullivan PB, Schütze R, Goucke R, Chua J, Browne A, Horgan B, De Morgan S, Briggs AM. 'Listen to me, learn from me': a priority setting partnership for shaping interdisciplinary pain training to strengthen chronic pain care. Pain. 2022 Apr 6. https://pubmed.ncbi.nlm.nih.gov/35384928/
Distinct local and global functions of mouse Aß low-threshold mechanoreceptors in mechanical nociception
Gautam, M., Yamada, A., Yamada, A.I., Wu Q, Kridsada K, Ling J, Yu H, Dong P, Ma M, Gu J, Luo W. Distinct local and global functions of mouse Aẞ low-threshold mechanoreceptors in mechanical nociception. Nat Commun 15, 2911 (2024).
Reviewer: Dhanya Shanmuganathan, PhD student, Pain Mechanisms Lab, Monash Biomedicine Discovery Institute, Department of Physiology, Monash University, Melbourne, Australia
DOI: 10.1038/s41467-024-47245-6
Review of article
Study group
Mouse lines used in this study include AdvilFlpO, SplitCre, Ai9 tdTomatof/, TaudsDTR , RosaReaChR, TrpV1Cre and C57BL/6J. They consist of both male and female sexes aged 6-20 weeks old.
Aims of study
Aẞ low-threshold mechanoreceptors (AẞLTMRs) are large-diameter, highly-myelinated, and fast-conducting primary somatosensory neurons. They transmit information such as tactile, discriminative touch, and vibration sensation to the Central Nervous System (CNS). Specifically, Aẞ-LTMRs are involved in transmitting or alleviating mechanical hyperalgesia of chronic pain, both locally (peripheral) and globally at the dorsal column of the spinal cord (central). However, these neurons also play important roles in “gating” or inhibiting other somatosensory pathways to generate the appropriate sensation. AẞLTMRs are further distinguished by rapidly adapting (RA) and slowly adapting (SA) types based on their firing patterns in response to a sustained mechanical stimulus. The main aims of this study are to specifically examine functions of Aẞ-LTMRs in SplitCre labelled mice and to understand differences in mechanical and thermal sensations when Aẞ-LTMRs
are manipulated locally and globally. Other aims include differentiating touch-related non-nociceptive behaviour from nocifensive behaviour in these mice.
Brief methodology
The authors used intersectional mouse genetics by breeding together mice with the SplitCre and AdvilFlpO strains, in which the Flippase (Flp) expression was restricted to peripheral ganglion neurons. Subsequently, these double heterozygous mice were then crossed with a Cre and Flp double-dependent Red-activatable Channelrhodopsin (ReaChR) reporter allele (RosaReaChRf/f ) to generate triple heterozygous SplitCre;AdvilFlpO;RosaReaChRf/+ (SplitCre-Aẞ ReaChR) mice. The authors strategically performed intersectional genetics to selectively ablate Aẞ-LTMRs or optogenetically activate them either locally or globally. A series of high-speed imaging behavioural assays to probe mechanical and thermal sensations was done to understand behavioural outcomes in baselines and chronic pain conditions.
Brief summary of the results
Histological and electrophysiological characterisations of SplitCre-Aẞ ReaChR mice confirmed that SplitCre preferentially recombined in Aẞ-LTMRs. RNAscope of dorsal root ganglion (DRG) sections validated that almost all Eyfp + (tagged to ReaChr) neurons expressed iCre, demonstrating the intersectional effect of this split Cre strategy. Immunohistochemistry of the DRG sections reveals an increased overlap of EYFP expression with myelinated neuron marker, NF200 and an Aẞ-LTMR marker called RET. Immunostaining of plantar skin of mice reveals increased NF200 in peripheral axons which are involved in innervating large numbers of Meissner’s corpuscle (a type of RA Aẞ-LTMR). Specifically, RA Aẞ-LTMRs were prominently labelled in the
glabrous skin, but RA and some SA Aẞ-LTMRs were labelled in the hairy skin of these mice. Electrophysiological recordings show firing patterns consistent with RA Aẞ-LTMRs and SA Aẞ-LTMRs.
Ablation of SplitCre-Aẞ-LTMRs was successfully done by injecting (DTA) in the mice. Ablation with DTA reduced gentle touch sensation but increased mechanical sensations. This was highlighted by the reduction in sensitivity of dynamic gentle touch in the ablated mice, which was measured as the percentage paw withdrawal in response to dynamic cotton swabs. When testing their reactivity with different floor textures, ablated mice preferred to stay in smoother surface compartments. This shows that these DTA-treated mice experienced significant functional disruption of Aẞ-LTMRs. However, mechanical nociception was increased in these mice as placing an alligator clip at the plantar skin induced licking a response, reflecting mouse nociception. This also suggests that Aẞ-LTMRs function to inhibit mechanical nociception and that disruption of Aẞ-LTMR functions results in mechanical hyperalgesia.
Optogenetic stimulation of SplitCre-Aẞ ReaChR mice in a small area of the skin (peripheral) activated a small population of Aẞ-LTMRs innervating that area. This was evident from increased hind paw withdrawal responses in both inflammatory and neuropathic mouse models suggesting that local activation of Aẞ-LTMRs triggers nociception in both chronic
inflammatory and neuropathic pain conditions. Under chronic inflammatory conditions, electrophysiological characterisation reveals increased SplitCre-ReaChR+ Aẞ-LTMRs firing of action potentials in the hind paw glabrous skin in response to mechanical forces. Dorsal column activation of SplitCre-ReaChR+ AẞLTMRs would preferentially activate the spinal cord dorsal horn inhibitory interneurons and alleviate mechanical hyperalgesia in the chronic inflammatory pain model.
Conclusions
The results from this study support that global activation of Aẞ-LTMRs could attenuate mechanical hyperalgesia in chronic pain. The data reveals that both global ablation and local activation of Aẞ-LTMRs promoted mechanical hyperalgesia, whereas their global activation alleviated it. This suggests that the global activation plus local inhibition of Aẞ-LTMRs would be an effective strategy for treating mechanical hyperalgesia.
Reviewer's critique & take home message
This model proposes a more effective strategy to target Aẞ-LTMRs for treating mechanical hyperalgesia and chronic pain: activating them globally or 3-4 dermatomes away from the injury site and combining with local inhibition of the affected Aẞ-LTMRs.
Declaration
No conflict to declare.
A central mechanism of analgesia in mice and humans lacking the sodium channel Nav1.7
MacDonald DI, Sikandar S, Weiss J, Pyrski M, Luiz AP, Millet Q, Emery EC, Mancini F, Iannetti GD, Alles SRA, Arcangeletti M, Zhao J, Cox JJ, Brownstone RM, Zufall F, Wood JN. A central mechanism of analgesia in mice and humans lacking the sodium channel NaV1.7. Neuron. 2021 May 5;109(9):1497-1512.e6.
Reviewer: John (Shen) Chen, Postdoctoral Fellow, Pain Mechanisms Lab, Department of Physiology, Monash Biomedicine Discovery Institute, Monash University, Melbourne, Australia.
DOI: 10.1016/j.neuron.2021.03.012
Review of article
Study group
Transgenic mice (including Advillin-Cre Nav1.7 KO, Wnt1-Cre Nav1.7 KO, Advillin-Cre Nav1.7 KO PirtGCaMP3, Wnt1-Cre Nav1.7 KO Pirt-GCaMP3 and OMP-Cre Nav1.7 KO), adult or late juvenile stage, both male and female mice were used; Two Nav1.7 null human subjects (aged 32 and early 30s) and two age and gender matched healthy controls.
Aims of study
Lack of expression in Nav1.7 causes profound pain insensitivity and anosmia in both humans and rodents. When Nav1.7 deletion is restricted to nociceptors, pain is also abolished, which suggests that the peripheral sensory neurons are the site of analgesia. By using in vivo calcium imaging and extracellular recordings, the authors show that a lack of expression in Nav1.7 does not alter nociceptor activity, but they found that synaptic transmission from these neurons to the spinal cord is greatly reduced through an opioid-dependent mechanism.
Methodology
To understand the role of Nav1.7 in pain transduction pathways, the authors investigated the responses and properties of sensory neurons in their Nav1.7 knockout mice through electrophysiological recordings and pain behavioral studies. To measure peripheral neuron responses to noxious stimuli, the authors performed calcium imaging studies of the L4 dorsal root ganglia (DRG) of live anesthetised animals. To further investigate mechanism, the authors virally transfected afferent neurons with the fluorescent glutamate sensor, iGluSnFR, allowing direct measurement of glutamate release from first order neurons onto dorsal horn neurons.
Brief summary of the results
In experiments using in vivo calcium imaging of DRG, the authors discovered that Nav1.7deficient mice show little differences in nociceptor excitability and no changes in maximum calcium response, when applying either heat, cold or mechanical stimuli. This phenomenon was also seen in multi-unit extracellular recordings, where they show no change in action potential firing in response to noxious stimuli or responses to inflammatory sensitization following PGE2 injection in the Nav1.7 KO. These results suggest that deletion of Nav1.7 does not abolish the peripheral sensitisation of nociceptors.
By transfecting the glutamate sensor iGluSnFR in afferent neurons, the authors were able to show that the minimum stimuli current required to evoke glutamate release was almost 3-fold greater in Nav1.7 KO mice, compared with control wild-type mice. Furthermore, the threshold could be reduced with the opioid antagonist naloxone, suggesting that the deficit in neurotransmission in Nav1.7 null animal is opioid dependent. Moreover, by selectively blocking peripheral or (and) central
opioid receptors, the authors successfully demonstrated that central but not peripheral opioid receptors are important in maintaining the analgesic effect in Nav1.7 deficient animals. Finally, the authors showed that naloxone restored pain sensation in 2 of the 3 human subjects with rare Nav1.7-null mutation, but this did not enhance the effect in healthy human subjects.
Conclusions
In conclusion, the results of this study demonstrate the importance of central Nav1.7 in pain transmission and show that their activity is opioid receptor dependent. These findings may explain why peripheral Nav1.7 inhibitors have previously failed and suggests that central Nav1.7 are a more effective target for pain relief.
Reviewer's critique & take home message
This work showcased the involvement of Nav1.7 in pain transmission, from peripheral to central neurons, using a range of techniques from behavior to electrophysiology and imaging, and from transgenic animals to human subjects. They found that deletion of Nav1.7 leads to analgesic effects via central pathways and is opioid receptors dependent. Loss of these channels did not alter peripheral nociceptor signaling, which provides clarity on how this protein is involved into pain transmission. This work highlights the importance of basic pain research, showing that a known target protein can have unexpected analgesic efficacy through different mechanisms, depending on where it is expressed. This highlights the importance of understanding the mechanisms driving analgesia in drug development.
Declaration
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Reviewer declares no conflict of interest.
Book Title: Pain Management in Vulnerable Populations
Chapter
Title: Pain in Infants and Children
Thank you to APS members Denise Harrison and Nicky Pope and their colleague from the Canadian Pain Society, Mariana Bueno for sharing the following recent publication.
First published: 21 May 2024
ISBN: 9780197649176DOI
Abstract
Introduction
Pain Management. The final section focuses on treatment and remediation of vulnerabilities which includes available knowledge translation strategies co-produced by parents.
Setting and Subjects
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Sick and preterm newborns and hospitalised infants and children are especially vulnerable to pain. Vulnerabilities relate to repeated painful procedures required during hospitalisations, immature developmental stages, parental separation, lack of known effective pain treatment at different ages, and, where evidence exists, lack of consistent use of the evidence. In addition, this population is at risk of long-term pain consequences, including fear and anxiety related to needles and medical care. Reducing the burden of pain and involving parents in pain care are priorities for reducing vulnerabilities in newborns and young children. When painful procedures are required, breastfeeding, skin-to-skin, and small volumes of sweet solutions are recommended for newborns and young infants. Facilitating the use of effective distraction techniques and applying topical anesthetics are recommended for young children. The social communication model of pain and the model of parent involvement in infant pain management are used to understand pain from a biopsychosocial perspective.
Design
This book chapter is based on a review of current evidence relating to factors that make infants and children more vulnerable to pain. This includes burden of pain (number and repeated nature of painful procedures), inconsistent use of known effective pain management strategies, absence of parents or altered parental role during painful procedures and adverse effects of pain. The focus then moves onto impacts of the social environment on a child’s pain, and a discussion about The Model of Parent Involvement in Infant
The focus is on hospitalised newborns and children and acute procedural pain. However it is acknowledged that identifying risks of development of chronic pain, and recognising and treating chronic pain in infants and children is also important. Focusing on the whole family with the support of multi-disciplinary teams is stated to be essential in remediating adverse outcomes of chronic pain in children.
Methods
This was not a single study design but included a review of current published evidence.
Results
Included are two tables with examples of knowledge translation resources of parents of newborns, which include the Be Sweet to Babies suite of videos and The Power of a Parent’s Touch video. Examples are also given of organisational, nationwide and global initiatives aimed at ensuring excellence in pain management and widespread consistent use of known effective pain treatment strategies.
Conclusions
The Lancet Child and Adolescent Health Commission for pediatric pain outlined four goals which need to be actioned for improving pain management in all populations of children globally. These were to Make Pain: matter; understood; visible and better. These broad goals were embedded in this chapter to highlight the importance children’s vulnerabilities related to poorly managed pain.
Declaration
Denise Harrison, Mariana Bueno and Nicole Pope have “nothing to declare” other than being authors of studies referred to in this book chapter.
The effectiveness of pain science education on caregiver and children’s knowledge, beliefs, attitudes, and behaviors– a systematic review and meta-analysis
Thank you to APS members Rebecca Fechner, Joshua W Pate, Mark Alcock and Jennifer Norton and their colleagues Peter Stubbs, Arianne Verhagen and Lauren Harrison for sharing the following recent publication.
Article first published online: 23 May 2024
Journal Reference: Fechner R, Verhagen A, Alcock M, Norton J, Stubbs PW, Harrison LE, Pate JW. The effectiveness of pain science education on caregiver and children's knowledge, beliefs, attitudes, and behaviors- a systematic review and meta-analysis. J Pain. 2024 May 23:104578. doi: 10.1016/j.jpain.2024.104578. Epub ahead of print. PMID: 38796130.
DOI Link: 10.1016/j.jpain.2024.104578
Abstract
Background
Pain science education (PSE) can be used as part of treatment and prevention for chronic pain in children. We assessed the effectiveness of pain science education on knowledge, beliefs, attitudes, and behaviors in children and the people that care for children.
Methods
We set a minimum criterion for education to address pain biology knowledge. We included studies aimed at both treatment and prevention of chronic pain, and conducted searches using five databases. We assessed the risk of bias using the Cochrane Risk of Bias 2 tool. Data were pooled using a random-effects meta-analysis or assessed using a narrative synthesis. The certainty of evidence was assessed using the GRADE.
Results
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We screened 14,505 records and included seven studies involving 351 caregivers and 1,285 children. Four studies were included in meta-analyses. We found low certainty evidence that PSE has a large beneficial effect on caregiver knowledge and beliefs compared to alternative education (SMD=1.14 (95%CI: 0.88 to 1.42; I²=0%). We found no difference in functional disability in children with chronic pain after PSE (FDI score MD=0.73 (95%CI: -0.81 to 2.27; I=0%). Narrative syntheses showed low certainty evidence for improved knowledge and beliefs in children with preventative and treatment effects.
Conclusions
Overall we found few studies, and along with high risk of bias, this significantly contributed to the low certainty of findings. The effect of learning pain science for both preventative and treatment effects in children, carers and the child/carer dyad remain mostly unknown.
This review was prospectively registered with PROSPERO (CRD42022344382) on 22 July 2022.
Declaration
The authors have nothing to declare.
Have you had an article accepted for publication recently?
The Australian Pain Society (APS) is keen to share publications from our members with their colleagues via our eNewsletter. If you’ve had an article accepted or published recently, please contact our Assistant Editor Joanne Harmon via the APS Secretariat (aps@apsoc.org.au) with the title, authors, and reference (i.e., journal, volume, and DOI) of your article and request the submission template. We would love it if you also supply a short commentary (300 words max) to give our readers the gist of the article.
www.dcconferences.com.au/nsanz2024
NEUROMODULATION SOCIETY OF AUSTRALIA AND NEW ZEALAND 17TH
(NSANZ 2024)
Neuromodulation: Can we do it better? 19 – 21 JULY 2024
GRAND CHANCELLOR, HOBART, TAS
New Member
New Member as at 25 June 2024
Mr Martin Collyer Physiotherapy
> painACT, a new pain management in aged care online learning tool is now available: https:// www.apsoc.org.au/painACT-Online-Learning
Other items of interest for our members:
> Latest opioid data from the Australian Bureau of Statistics: Opioid induced deaths in Australia. https://www.abs.gov.au/articles/opioid-induceddeaths-australia
> Australia’s annual overdose report 2023 from the Pennington institute: https://www. penington.org.au/australias-annual-overdosereport/
> Opioid Podcasts for GPs: These podcasts are produced by David Outridge GP, and FAChAM Trainee as a project under the auspices of Dr Steven Kelly Staff Specialist in Addiction Medicine, Kullaroo Clinic Gosford. A 20 week series from the Hunter Postgraduate Medical Institute (University of Newcastle) : http://www. gptraining.com.au/recent-podcasts
> Airing Pain: Pain resources via an online radio show produced by Pain Concern, a UK registered Charity: https://painconcern.org.uk/ airing-pain/
> Indigenous Resources: New webpage on the APS website aggregating Indigenous resources: https://www.apsoc.org.au/Indigenous-Resources
> Opioids: Communications videos: https://www. nps.org.au/opioids-communication-videos
TGA
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> 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 comanagement 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/
> Codeine information hub: https://www.tga.gov. au/codeine-information-hub-how-and-whereget-advice
NSW Agency for Clinical Innovation resources:
> Brainman and Pain Tool Kit translations, SEP15: http://www.aci.health.nsw.gov.au/chronic-pain/ translated-resources
> Pain Management Resources: https://aci. health.nsw.gov.au/networks/pain-management/ resources
> Quicksteps to Manage Chronic Pain in Primary Care: http://www.aci.health.nsw.gov.au/chronicpain/health-professionals/quick-steps-tomanage-chronic-pain-in-primary-care
> Built into Quicksteps: “How to de-prescribe and wean opioids in general practice”: http:// www.aci.health.nsw.gov.au/chronic-pain/healthprofessionals/quick-steps-to-manage-chronicpain-in-primary-care/how_to_de-prescribe_and_ wean_opioids_in_general_practice
> A list of helpful apps for consumers and clinicians now available at: http://www. aci.health.nsw.gov.au/chronic-pain/healthprofessionals/management-of-chronic-pain
> Chronic Pain in the ED: https://www.aci.health. nsw.gov.au/networks/eci/clinical/clinicalresources/clinical-tools/pain-management/ chronic-pain-in-the-ed
Calendar of Events
19-21 July 2024
Neuromodulation Society of Australia and New Zealand (NSANZ)
2024 Neuromodulation Society of Australia & New Zealand 17th Annual Scientific Meeting (NSANZ 2024)
Hotel Grand Chancellor, Hobart, TAS https://www.dcconferences.com.au/nsanz2024/
5-9 August 2024
International Association for the Study of Pain (IASP)
IASP 2024 World Congress on Pain Amsterdam RAI, Amsterdam, Netherlands https://www.iasp-pain.org/iasp-2024-worldcongress-on-pain/
19-22 August 2024
Neurosurgical Society of Australasia (NSA)
NSA 79th Annual Scientific Meeting
Darwin Convention Centre, Darwin, NT https://2024.nsa.org.au/
16-18 September 2024
National Rural Health Alliance 17th National Rural Health Conference
Perth Convention & Exhibition Centre, Perth, WA https://www.ruralhealth.org.au/17nrhc/
18-20 October 2024
Faculty of Pain Medicine (FPM)
2024 FPM Spring Meeting
Pullman Auckland Hotel & Apartments, Auckland, NZ
https://www.anzca.edu.au/events-courses/ events/anzca-and-fpm-annual-events/fpmannual-events/2024-fpm-spring-meeting
31 October-2 November 2024
Australian Physiotherapy Association FOCUS24: The business of physiotherapy
Crown Perth, Perth, WA https://physiotherapy.eventsair.com/focus24
21-23 November 2024
Royal Australian College of General Practitioners (RACGP)
GP24
Perth Convention & Exhibition Centre, Perth, WA https://www.racgp.org.au/gp24/home
27-29 November 2024
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Australian & New Zealand Spinal Cord Society (ANZSCoS)
ANZSCoS 2024
Esplanade Hotel, Fremantle, WA
https://www.dcconferences.com.au/ anzscos2024/
20-22 March 2025
New Zealand Pain Society (NZPS)
NZPS25 - Weaving our Kete
Te Papa Tonogarewa, Wellington, NZ
https://www.nzps25.nz/
13-16 April 2025
Australian Pain Society (APS)
2025 Australian Pain Society 45th Annual Scientific Meeting
Pullman Melbourne Albert Park, VIC https://www.dcconferences.com.au/aps2025/
Vision, Purpose & Priorities
Vision:
All people will have optimal pain management throughout life.
Purpose:
The Australian Pain Society is a multidisciplinary association whose purpose is to advance pain management through education, research, and advocacy for transformational improvements in clinical care.
Priorities:
In order to achieve our purpose, the Australian Pain Society will provide:
> Membership
> Research
> Education
> Services and resources
> Good governance and operations
> Advocacy
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Directors
President:
Mrs Joyce McSwan
Gold Coast Primary Health Network
Persistent Pain Program, QLD and PainWISE
Tel: 0412 327 795 Fax: 07 3539 9801
President-Elect:
Ms Bernadette Smith
Psychology Plus
South Burnie TAS
Tel: 03 6431 9959 Fax: 03 6431 9950
Secretary:
Mrs Dinah Spratt
Physiotas Physiotherapy
Shearwater TAS 7307
Tel: 03 6428 7500 Fax: 03 6424 7811
Treasurer:
Dr Laura Prendergast
Pain Service, Northern Health
Broadmeadows VIC 3047
Tel: 03 8345 5166 Fax: N/A
Work days Mon & Thu
ACT Director:
Dr Andrew Watson
Calvary Hospital
Canberra ACT 2617
Tel: 02 6201 6352 Fax: N/A
NSW Director:
Mr Connor Gleadhill
Department of Health and Aged Care
Primary Care Division
Newcastle NSW 2038
Tel: 0405 203 661 Fax: N/A
NT Director:
Adjunct A/Prof Cindy Wall
Clinical Psychology Assessment & Consultancy
Fannie Bay NT 0820
Tel: 0488 993 210 Fax: 08 6266 3777
QLD Director:
Dr Duncan Sanders
Pain Management Unit, Sydney Medical School, University of Sydney / Managing Pain Clinic and E3 Physio
Gold Coast QLD
Tel: 07 5620 1234 Fax: 07 3009 0420
SA Director:
Ms Heather Gray
Royal Adelaide Hospital
Adelaide SA 5000
Email: heather.gray@sa.gov.au
TAS Director:
Mr Sinan Tejani
Launceston General Hospital
Launceston TAS 7250
Tel: 0469 967 841 Fax: N/A
VIC Director:
Dr Esther Dube
Austin Health
Heidelberg VIC 3084
Tel: 03 9989 1676 Fax: N/A
WA Director:
Ms Jacintha Bell
Lifeworks Occupational Therapy
Mount Lawley WA 6050
Tel: 0451 178 880 Fax: 08 6323 3329
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Office Bearers
Immediate Past President:
Ms Trudy Maunsell
Retired QLD
SPC Chair:
Professor Kevin Keay
Department of Anatomy
University of Sydney
Sydney NSW 2006
Tel: 02 9351 4132 Fax: 02 9351 2817
IASP Liaison:
Professor Fiona Blyth AM
Sydney School of Public Health
Faculty of Medicine and Health
University of Sydney
Camperdown NSW 2006
Email: Fiona.blyth@sydney.edu.au
Communications Coordinator:
Mrs Joyce McSwan
Gold Coast Primary Health Network
Persistent Pain Program, QLD and PainWISE
Tel: 0412 327 795 Fax: 07 3539 9801
Newsletter Editor:
Dr Lincoln Tracy
School of Public Health and Preventive Medicine
Monash University
Melbourne VIC 3004
Tel: 03 9903 0288
Newsletter Assistant Editor:
Dr Joanne Harmon
School of Clinical and Health Sciences
University of South Australia
Adelaide SA 5000
Tel: 08 8302 1442
Scholarship/Grant Selection
Subcommittee Co-Chairs:
Em Prof Maree Smith AC
Centre for Integrated Preclinical Drug Development
University of Queensland St Lucia QLD 4072
Prof Luke Henderson
Anatomy & Histology, School of Medical Sciences
Brain & Mind Centre
University of Sydney
Camperdown NSW 2006
Secretariat:
DC Conference & Association
Management Pty Ltd
PO Box 637
North Sydney, NSW 2059
Tel: 02 9016 4343
Email: aps@apsoc.org.au
Website: apsoc.org.au