APS JUN24 eNews

Volume 44, Issue 4, June 2024

Editor’s Note

Australian Pain Society Newsletter

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Contents

Contents

Editor’s Note

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Vale Prof Michael Cousins AO

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ASM 2024

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ASM 2025

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Mentorship Program

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painSTAR 2024

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PinC SIG Journal Watch

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Surveys

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Recent Publication

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Opioid Toolkit Reference

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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 44, Issue 4, June 2024

Editor’s Note

Editor’s Note Dr Lincoln Tracy

Hello hello!

I hope everyone (particularly those who sweated it out on the Gala Dinner dance floor) has recovered after several action-packed days in Darwin for the ASM. It was a great opportunity to reconnect with old friends and meet new ones. The plenary presentations from Professor Cheryl Stucky were a fascinating insight into neuropathic pain. Professor Christine Chambers also presented on the challenges of translating research into practice. A huge congratulations and thank you to everyone from the Society and DC Conference & Association Management for putting on another incredibly successful event.

It was also great to hear that painSTAR will be returning later this year, with Professor Jeff Mogil (McGill University, Canada), attending as the keynote speaker. I spoke briefly with Jeff about his upcoming trip a few weeks ago and he is definitely looking forward to contributing to the program.

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But we’re not quite ready to move onto the 2025 ASM in Melbourne just yet, with the return of the travel grant recipient reports! The first two submissions feature in this edition of the eNewsletter and other submissions will appear throughout the remaining editions of 2024. These reports are always extremely well-written, which reflects the quality and enthusiasm of up-and-coming members of the Society.

On a sadder note, Professor Michael Cousins AO, founding President of the Australian Pain Society, passed away shortly after the ASM. Professor Michael Nicholas and Professor Fiona Blyth AM, who worked with Professor Cousins for more than two decades, have penned a tribute summarising his extensive career. I encourage all members, particularly younger members who may not have had the opportunity to meet and work with Professor Cousins, to take a moment to learn more about the incredible contributions he made to the pain field both at home and abroad. Vale, Michael.

Finally, if you’re an experienced pain researcher, clinician, or educator looking to help nurture the next generation of the Society, you’ve got until June 15 to register your interest in the APS Mentorship Program. Thank you to those members who have already indicated their interest.

Until next time, Lincoln

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Vale, Professor Michael Cousins AO

Vale, Professor Michael Cousins AO

By Professor Michael Nicholas and Professor Fiona Blyth AM

As Australian Pain Society (APS) members may have heard, Professor Michael Cousins AO passed away April 27, 2024.

Many obituaries have already appeared, and his incredible achievements are well-known in the academic pain and medical worlds. Many readers will have gained fleeting impressions of him at conferences and meetings, in the media, as well as in the pain and anaesthesia literature, but fewer have worked BLOG WEB alongside him for an extended period, and we hope this account from two of us who have will provide a closer perspective on Michael as a clinician, researcher, teacher, leader, collaborator, medical politician, fund raiser ‘extraordinaire’, and colleague. It is fitting that this perspective should appear in the Australian Pain Society’s acknowledgement of Michael.

In our view, one of Michael’s most remarkable characteristics was his ability to convert dreams into realities – realities most of us mere mortals considered dreams. He didn’t do this alone, of course, but he was always in the vanguard.

Consider these achievements:

multidisciplinary pain management centres at the Flinders Medical Centre in 1976 and the Royal North Shore Hospital (RNSH) in 1990.

• Even before his arrival at RNSH in 1990, he envisaged the existing pain clinic as evolving into an entity similar to the original University of Washington Hospital pain management centre where Bonica, Loeser, and Fordyce had led the development of multidisciplinary pain management in the 1970’s and 80’s. He renamed the pain clinic at RNSH as the Pain Management and Research Centre (PMRC).

Fittingly, prior to his retirement, it was again renamed to the Michael J Cousins Pain Management and Research Centre.

• In 1995 he extended the role of the PMRC to incorporate post-graduate education within the Sydney Medical School. He launched this as the University of Sydney Pain Management Research Institute (PMRI) and, with colleagues at PMRC/PMRI and the University of Sydney, in 1996 he launched the world’s first postgraduate university course in multidisciplinary pain management. This program was later recognised by IASP as consistent with its interprofessional pain curriculum, and it continues to this day in an online format. To date, it has produced over 800 graduates from Australasia and beyond.

• With Sir Sydney Sunderland and Dr Connie Peck, Michael played a key role in establishing the Australasian Chapter of the IASP in 1978 and the creation of the APS, of which he was the founding President (1979-80).

• A decade later he became IASP President (still the only Australian to have achieved this).

• Michael was instrumental in bringing the IASP World Congress to Australia (Adelaide) in 1990, another first.

• He was the founding Professor of two university departments of Anaesthesia and Intensive Care/Pain management (Flinders, SA in 1975 and Sydney, NSW in 1990), and with the help of like-minded clinical colleagues he established 4

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Michael Cousins with John Bonica at the 1990 IASP World Congress in Adelaide

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Vale, Professor Michael Cousins AO

• In 1998, the institute was recognised by the National Health and Medical Research Council as one of only eight Centres of Clinical Excellence in hospital-based research, and in 2012 the NSW Ministry of Health named it as the lead site for pain research and education in the state.

• In conjunction with colleagues at the Australian and New Zealand College of Anaesthetists (ANZCA) and other medical colleges, he played a leading role in the establishment of the world’s first Faculty of Pain Medicine (FPM), serving as the founding Dean from 1999-2002.

• His commitment to training the pain medicine physicians of the future saw him not only act as editor of three editions of the text Neural Blockade and Pain Management which has become a key reference internationally, but also facilitate and mentor pain medicine training for many anaesthetists at PMRC who have gone on to play leading roles in the FPM and pain medicine generally in Australia and Southeast Asia. Some have also followed his footsteps onto the Council of IASP. The lasting impact of his mentorship for pain medicine physicians and their patients in our region cannot be underestimated.

• In 2008 the APS proudly recognised Michael Cousins as a Distinguished Member • In 2010 he led collaborators from around Australia in the creation of Australia’s (and the world’s) first National Pain Summit, a key event in the history of pain in Australia. This subsequently led to the establishment of Painaustralia as well as the Pain Management Network within the Agency for Clinical innovation, NSW Ministry of Health in 2013.

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To achieve even one of these outcomes would be considered quite enough for most of us, but after working with him for over 20 years, we can truly say Michael Cousins had no peer. All of us in the APS, and uncounted numbers of people living in pain around the world, are in his debt and we mourn his passing. We should not forget the extraordinary contribution of Michael’s family, in so many ways, they made Michael’s achievements possible. We honour them as well.

• He went on to chair the first International Summit on Pain (representing 68 countries) in Montreal, Canada, and this led to the publication of the Declaration of Montreal, proclaiming access to pain management to be a fundamental human right. This declaration is now embodied internationally as a key platform for all pain societies.

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BPR SIG ASM 2024 Journal Watch

Thank you for attending APS 2024!

Thank you to those who joined us at the 2024 Australian Pain Society 44th Annual Scientific Meeting held in Darwin.

APS 2024 Photos The conference photographs are now available to view and can be downloaded here: DOWNLOAD PHOTOS BLOG WEB

APS Conference Recordings are Now Available We've got you covered if you missed out on the conference!

EverTechnology recorded all 38 sessions at APS 2024. These are now available in MP3 Audio and MP4 Video format. Check out the various packages below:

This recording is optimised for listening on portable audio players.

Whether you listen in the car or on your portable player, the voice will be clear and present.

Features crystal clear audio with the added benefit of seeing a full-screen presentation of the speakers’ slides presentation.

PURCHASE RECORDINGS HERE

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BPR SIG Journal Editor’s ASM Watch Note 2024

Post Conference Review of the Australian Pain Society's 44th Annual Scientific Meeting

By Cindy Wall, Local Organising Committee Convenor, Scientific Program Committee Member and NT Director The April gathering of over 450 delegates for the 44th Annual Scientific Meeting of the Australian Pain Society had a distinctly Top End vibe, especially for those who kicked off their pre-conference agenda by experiencing the magic of Litchfield National Park. The theme continued with the excellent diversity of the scientific program supported by a fabulous social program, and carefully considered scheduling to allow delegates full immersion in the conference experience.

The IASP Global Year theme of Sex and Gender Disparities in Pain was explored from a range of perspectives both internationally and more locally in plenaries, workshops, and topical sessions across the meeting. Being in one of Australia’s largest and most sparsely populated locations also demanded shining a spotlight on rural, remote, and Indigenous pain management as an enduring feature of the meeting.

Opportunity to engage in and connect with the broad multidisciplinary offerings of the preconference workshops were enthusiastically taken up by delegates, as were the opportunities later in the day to

L to R: Mrs Joyce McSwan, Dr Charlotte Elder, Dr Christine Chambers

attend disciplinespecific meetings.

Our international speakers ushered in the scientific program with passion, knowledge, talent, and showed generosity of spirit through their contributions over the course of the meeting. Dr Christine Chambers Bhighlighted EW GOLB the challenges and Prof Cheryl Stucky importance of effective dissemination and implementation of pain research and delivered insights into the critical factors of moving from the research lab to the real world. Professor Cheryl Stucky raised awareness of cutting-edge research to uncover the pain mechanisms in common genetic disorders associated with lifelong episodic and chronic neuropathic pain.

Our national speakers presented a rich and vibrant snapshot of the amazing scientific, clinical, novel, and future-focussed developments in pain. Dr Charlotte Elder gave a compelling presentation on the systematic neglect of women’s pain in both medical care and research.

In the Global Year of Sex and Gender Disparities in Pain, the relevance of her presentation could not be understated. She provoked us all to reflect on how such inequities are perpetuated and offered some possible steps toward solutions.

Inequities in health services and research were also highlighted in the outback pain management panel discussion. Our panel of medical and health professionals from North Queensland and Alice Springs invited delegates to see the challenges and opportunities of working in rural and remote settings through their eyes and encouraged them to deliver culturally sensitive and appropriate care to Aboriginal people with pain.

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Fittingly, Professor Toby NewtonJohn reminded us that “No (person) is an island” and rounded out the plenaries with an exploration of interpersonal relationships in chronic pain.

Dr Nicholas Veldhuis

A/Prof Tasha Stanton

Associate Professor Tasha Stanton’s Bonica lecture invited delegates to consider evidence for perceptual biases in chronic pain, while Dr Nicholas Veldhuis’ lecture posed the question BLOG WEB of whether nanotechnology can overcome barriers to analgesic delivery. The Sunderland lecture saw Professor Stucky focus on mechanisms of neuropathic pain, specifically the active contribution of skin cells to this process. The richness of the delivered lectures was absorbing.

For the clinically focused, Professor Louise Sharp offered evidence on mindfulness versus cognitive behavioural therapy for chronic pain, while James McAuley suggested some new directions for psychologically informed management of low back pain. Professor Helen Slater challenged delegates to flip the pain care disparity lens when it comes to young people by presenting an AI-enabled digital solution for young people.

Congratulations to our APS rising Dr Jane Chalmers, Rising star award winner Star Award Recipient Dr Jane Chalmers, whose leadership in understanding the many aspects that differentiate persistent pelvic pain from other persistent pain conditions has resulted in developing pain science education that is optimised for women with persistent pelvic pain.

The stellar offerings of workshops and plenaries were supported by equally thoughtful and innovative topical sessions and free papers.

The meeting also had the largest ASM poster display, to date. Whilst too numerous the cover here, my single regret is that it was not possible to attend them all! The high quality also made the allocating of prizes a real dilemma.

Congratulations to all our prize winners – the future of our field looks bright. Congratulations to the following prize winners: Best free paper: Brian Pulling - “Development and validation of the osteoarthritis conceptualisation questionnaire” Best rapid communication: Sophie Crouch – “Representation of pain and injury in children’s picture books – A qualitative analysis” Best Poster: Caroline Zanussi – “What does propa co-design really look like? A collaboration between an Aboriginal community controlled organisation (IUIH) and Queensland Health to create a persistent pain service for mob”

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ASM 2024

The ASM in Darwin was thoughtfully programmed to enable delegates ample opportunity to engage with the local community, history, and vibrancy of Darwin, while also offering social and networking events such as morning Qi Gong, drinks at the Precinct, the amazing Gala Dinner under the stars, as well as tours of the Royal Flying Doctors Centre and Croc Cove.

Thank you to the Scientific Program Committee and Chair Professor Kevin Keay, whose energy and enthusiasm never wanes.

Thank you also to the Local Organising Committee – Dr Gavin Chin and Ms Sara Kirwan – whose local knowledge and generosity were greatly appreciated, and to Tracy Hallen & Kylie Dark (our APS Secretariat team), Conference Manager Alex Robertson, as well as Dianna Crebbin and all the amazing team at DCC&A who work tirelessly to ensure that all runs smoothly and looks effortless. I also extend gracious thanks to the delegates, presenters, and wider pain community for being so giving of your time, expertise, and comradery. Thank you for joining us in Darwin and sharing the experience that was the 44th APS Annual Scientific Meeting.

Gala Dinner

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Mrs Joyce McSwan, APS President

Save the Date It's time to save the date for next year's conference in Melbourne from 13-16 April 2025, which will bring another exciting and inspiring program. Looking forward to seeing you all there!

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Moving the Needle in Paediatric Pain Management A Conversation with Dr Christine Chambers Dr Christine Chambers has a lot of roles and responsibilities – clinical psychologist, Canada Research Chair (Tier 1) in Children’s Pain, Professor of Psychology & Neuroscience and Pediatrics at Dalhousie University, Scientific Director of Solutions for Kids in Pain, Scientific Director of the Canadian Institutes of Health Research (CIHR)’s Institute of Human Development, Child and Youth Health (IHDCYH), mother of four, and Associate Director of the North American Pain School. She is an international leader in children’s pain and is an innovator in patient engagement, partnerships, and knowledge mobilisation.

Chambers was an international keynote speaker at the 44th Annual Scientific Meeting (ASM) of the Australian Pain Society, held in Darwin BLOG WEB from April 21-24, 2024. In the lead-up to the ASM, Chambers spoke with Lincoln Tracy, a researcher and writer from Melbourne, Australia, discussing the variety of hats she wears, the importance of building relationships, and why she’s looking forward to coming back to Australia for the first time in a decade. This interview has been edited for clarity and length.

What was your path to becoming an international leader in children’s pain research?

When I was 12 years old, I read a book about a child psychologist who helped troubled children. After reading that book, I became very focused on the idea that I wanted to be a child psychologist when I grew up. When I made it to university at Dalhousie, where I’m now a faculty member, I went and spoke to an advisor and explained I was doing a psychology degree and wanted to become a child psychologist. They filled me in on all the things that I would need to do, including recommending that I get involved in research, as this would help when I was ready to apply to grad school.

I said, ‘well, that’s great – what areas of research do you have in child psychology here at the university?’. They only had one child psychologist in the department, and he studied children’s pain management. I had no idea what that was at the time. But when I reached out to him, we had a great meeting. I ended up buying his book and quickly became fascinated by the world of 10

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children’s pain management and the opportunity to make a difference through research.

After that meeting I became really active in research throughout my undergraduate degree, which continued when I transitioned into my PhD at the University of British Columbia with Dr Ken Craig, another leader in children’s pain management. And I’ve followed that path for 30 years after falling into it by accident – but I’m incredibly grateful for the opportunity because I’ve been fortunate enough to work in such an interesting and important area where I’ve been able to connect with many different people and feel like our work is making a difference.

Does the fact you can clearly see the impact of your work help keep you motivated after all these years?

Absolutely. The improvements we’ve seen in children’s pain care over the 30 years I’ve been involved in research, in hospitals and in other settings, are incredible. What’s also amazing is how the volume of literature and knowledge in this space has expanded. I remember when I first moved out west for grad school, I could fit every article that had been published about children’s pain into one file box! I’ve always been committed to children and love working with children, so being in a field where you can make a difference has certainly helped sustain my motivation and my interest in the work we do. And while we’ve come a long way, nothing is ever complete and there is still so much more that needs to be done.

What projects are you and your team currently working on?

I’m fortunate enough to run three different teams because of all the different hats I wear, and two of them operate in the research space. The first is my research lab, where I work with trainees and staff to answer the full range of research questions in children’s pain management and psychosocial factors that influence children’s pain using various research methodologies. I have couple of a new trainees working with me to help increase our understanding of how equity, diversity, and inclusion relates to children’s pain.

It’s always exciting to work with new research trainees and staff.

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President’s ASM Report 2024 The other team I run in the research sphere is Solutions for Kids in Pain, or SKIP, which is a national knowledge mobilisation network that spun off from my research lab and has been funded by the federal government’s Networks of Centres of Excellence. This has been a fascinating experience because we’re not allowed to use any of our grant money for research or training – it’s all to support moving the research we already have into practice and policy. But we’ve learned a lot about where the gaps are in our existing research knowledge and what areas we need to focus on. Getting the opportunity to collaborate with partners outside of academia – whether they’re not-for-profit organisations or patients – to make sure our research doesn’t just sit on the shelf has been exciting.

Was it challenging to enter the world of knowledge mobilisation?

I think it was a natural transition because we’d been experimenting with the idea of knowledge mobilisation in my research lab for five or six years before we were able to secure funding to make it a separate thing. In fact, the last time I was in Australia was a few months after I had launched the It Doesn’t Have to Hurt video on YouTube, which was a small project where we filmed a little girl telling parents about evidence-based things they should or shouldn’t do to help manage their kids fear of pain and distress about getting needles.

I like to joke my lab had a bit of an identity crisis during this time because we were already doing all these creative projects – they weren’t research projects – and we could see we were getting a lot of traction with them. I also joke that I almost bankrupted my lab because you only have so much capacity and energy to put into new things when you also have to keep the lights on and keep doing the research. And then when the federal government launched their call for national knowledge mobilisation networks, it just felt like the perfect thing do to because we were already doing something more than just research.

You also serve as a scientific director with the Canadian Institute of Health Research – how did the opportunity to move into this space come about?

I have been applying to the CIHR for funding since I was an early career investigator and previously served on their peer review panels. But as you progress through your career, you have opportunities to serve on advisory boards for the

13 different institutes that cover the full range of human health. I was serving on the advisory board for one of the institutes and was standing in the buffet line between meetings one day when the director of the institute I was working with tapped me on the shoulder and said, ‘you’re good – you should consider applying for a job with the Institute for Human Development and Child Youth Health when the opportunity comes up’.

I felt I could do the job, so when the scientific director position was posted, I applied and am grateful I was selected and started in January 2020 just before the pandemic. The roles are two four-year terms, and it’s hard to believe that it’s already been four years. But I’ve enjoyed the role immensely and get to work with an incredible team that has allowed me to drive impactful research and foster collaborations in a broader way than just exclusively on pain in children.

What are you hoping to achieve in your second four-year term as a scientific director?

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There are several things I want to continue to move forward over the next four years. One is our Healthy Youth Initiative, where we are showing the value of bringing the voices of youth and into health. We’ve formed a youth BEtheir W Gparents OLB advisory council and had several youth-led events.

The other thing I, along with colleagues in other institutes, have been championing for is a lifecycle approach at the CIHR – developing inclusive policies and approaches to make sure children are not excluded from research, which often happens.

What have you learned about yourself as you have progressed through your career?

I’ve learned about the importance of resilience, adaptability, and effective leadership. The qualities that make for a world-class researcher are not necessarily the same qualities that make good leaders in administrative roles. I’ve reflected a lot on how we could do a better job of supporting and developing researchers and leaders – and it’s all about relationships, particularly when you’re balancing important or tough decisions.

I’ve also learned it takes more than writing papers and grants to really move the needle for patients in pain. The academic environment is a hypercompetitive system, and I don’t think that always brings out the best in people. People often say to me, ‘I love the direction you’ve taken your career and all the knowledge mobilisation work you do – it’s very different and creative’. But I was only able to take that leap into exploring

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ASM 2024 different ways to make a difference because I was a tenured professor with a very solid scientific background. I was critiqued and teased for doing it, but we need to be more open minded to different pathways we can take so our work can be impactful and help people.

impact. It was the least amount of grant money I’d ever had, but it was by far the most impactful project I’d been involved in to that point in my career. It really catalysed so much of what has followed and laid a lot of the groundwork for SKIP.

So knowing what you know about yourself now, what advice would you give to your younger self?

What did being able to help other parents and their children mean to you, as a parent?

I would emphasise the importance of building a strong support network by surrounding yourself by mentors, collaborators, and a diverse team that will help amplify your creativity and success.

I think that’s obvious. But the part I really wish I had known when I was younger is that you will need different people at different points in time.

We often don’t think about the evolution of our relationships, but in hindsight I can certainly say different people have played different roles in my professional life at different times – but at the time I felt that things should be more constant.

And I feel accepting that things are more fluid would have been helpful. But I was veryBLOG stubborn WEB when I was younger, so I probably wouldn’t listen to myself if I went back and tried to give any advice [laughs].

It was incredibly meaningful, as a parent of four kids. It was becoming a mom and having my own experiences with the healthcare system with my children – whether it was surgeries, emergency department visits, or hospitalisations – that sparked my interest in knowledge mobilisation. These experiences made me realise all the great evidence I had dedicated my career to – everything I’d published in journals and presented at conferences around the world – wasn’t being used to help my own children. And if the science I had generated isn’t being used to help my own kids, then it’s definitely not helping others.

Has there been a paper or project from your career that you’re particularly proud of, or that is somehow special to you?

This would have to be It Doesn’t Have to Hurt, which was a partnership grant funded by the CIHR in 2015 to launch a social media partnership to mobilise research evidence about children’s pain. It was so radically different to anything I had done before. I partnered with a Canadian celebrity and businesswoman who ran an online mother’s forum. We brought leading experts in children’s pain management together with a panel of parent partners who let us know what Canadian parents wanted to know about children’s pain.

And we worked with these incredible digital content creators at this online forum to marry the evidence and parent narratives into compelling digital content. It went viral in Canada over the two years we worked on the project. And the most incredible thing was that the parents became the primary disseminators of the research evidence through their own social media platforms and networks. That experience took me out of my world and showed me the power of partnership and how we could better position ourselves, so our work had better 12

Australian Pain Society Newsletter

That made me realise I needed to go about things in a different way. I didn’t get into research just to publish papers and get invitations to do talks. I wanted to get into research to make a difference for kids. I’d always felt like I had a tremendous sense of purpose. But it wasn’t until I became a mother that my perspective changed, and I realised what I wanted my purpose to be.

And that really motivated me. It’s incredibly fulfilling to hear parents and kids talk about how our work has helped them or made a difference in their lives.

Is there a particular paper or book you would recommend people read to gain an understanding of the importance of managing pain in children?

There’s so many great articles and videos. But the one paper I always come back to is an article from 2014 that was written by André Picard, one of Canada’s leading health reporters, called ‘Why does children’s pain get the short shrift?’. This was around the time where I was just starting to innovate and try things with knowledge mobilisation. I’d just joined Twitter to promote the It Doesn’t Have to Hurt video we had created for parents and became very connected with a variety of people, including André.

I used to tweet about new papers I had read, where I would provide a one sentence summary of the paper and link to it. One Sunday I tweeted

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President’s ASM Report 2024 about an article from a Canadian colleague of mine about inadequate pain management in the paediatric emergency department when André sent me a message out of the blue, asking if I could send him the article. I thought it was wild that Canada’s leading health reporter didn’t have access to the scientific literature, but I sent him the article, along with a few of our own. He immediately wrote back and said, ‘I’m going to write an article about this’.

The next morning, he asked if he could speak with me. So, we did an interview, and two days later this incredibly powerful two-page story appeared in our national newspaper and ignited a real firestorm of conversation. I reread the article recently, and it’s still one of the best articles I’ve ever read. Every time I read it, I just feel like he really understood the issues in the literature and presented them in a way that was so important – but still brought a real human lens to it.

The story itself is excellent, but I also love to share the story of how it happened. Talk about shrinking the gap between research and practice, policy, and public awareness! One tweet took a paper that was behind a paywall to a national forum over the course of a weekend – all because of a relationship that had formed from putting myself out there in a non-traditional way.

What are you looking forward to the most about coming back to Australia for the ASM? There are so many things! I’ve always felt this incredible collegiality among Australians, and even the Australian Pain Society itself has been enormously supportive over the past 10 years since I last visited. They even wrote a letter of support when we were applying for our initial SKIP grant. I’ve always felt like I had this strong supporter base in Australia, so I’m looking forward to connecting with the people. I’m also excited to learn what’s going on and share what we’ve been up to. We were all pretty siloed during covid, so we’ve really been focused on improving pain management in children in Canada – I can’t wait for the opportunity to share, reconnect, and maybe find some new collaborative opportunities.

Lincoln Tracy is a postdoctoral research fellow at Monash University and freelance writer from Melbourne, Australia. He is a member of Pain Society and enthusiastic Bthe EW Australian GOLB conference attendee. You can follow him on X (@lincolntracy) or check out some of his other writing and interviews on his website.

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IASP Global Year Lecture: Uncomfortable Conversations about Carrots, Nomenclature, and Cosmetic Surgery The following is a summary from the 44th Annual Scientific Meeting (ASM) of the Australian Pain Society (APS), which took place in Darwin from April 21-24, 2024. Since 2019, the ASM has featured a named plenary lecture drawing inspiration from the International Association for the Study of Pain’s (IASP) Global Year Against Pain, an advocacy effort to raise awareness of pain. The IASP chose 2024 to be the Global Year about Sex and Gender Disparities in Pain.

Dr Charlotte Elder, an obstetrician and gynaecologist from the Mercy Hospital for Women, the Royal Children’s Hospital, and the Austin, was given the honour of delivering the named lecture in 2024. Staying true to the 2024 Global Year theme, Dr Elder’s talk, entitled “Flipping the Script: BLOG WEB Sex and Gender Disparities in Pain”, discussed several topics related to sex, gender, and pain that normally wouldn’t be discussed at an APS ASM. Dr Elder was open with the fact that writing parts of the lecture made her uncomfortable; a feeling she hoped those in the audience would share.

Dr Elder started her lecture with a series of polls for the audience. While there were only a handful of gynaecologists and pelvic floor physios in the audience, there were a greater number of researchers who concentrate on women and/or trans and gender diverse people.

However, many more attendees had either had a period, breastfed, or been breastfed. The latter polls, according to Dr Elder, proved the themes presented throughout the lecture would be relevant to everyone on some level.

The (unnatural) truth about periods (and carrots) Between 30 and 80% of adolescents have period pain, yet only a small proportion of these seek medical advice. Unfortunately, many who seek medical advice are told their pain is normal – that periods are meant to hurt – and that it will go away eventually.

Almost all cases of adolescent period pain are primary dysmenorrhea, where there is no specific pathology. But the absence of an underlying pathology doesn’t mean the pain isn’t real, according to Dr Elder.

“The inside of the uterus has skin in it. It’s about three millimetres thick and about the size of your 14

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index finger. When you have a period, you’ve got to shed about that much skin. Basically, the uterus strips off the lining and then squeezes it out, which is often as painful as it sounds,” Dr Elder explained.

The squeezing of the uterus is accompanied by the release of prostaglandins and other inflammatory cytokines, which can cause nausea, vomiting, diarrhoea, and dizziness – symptoms frequently accompanying periods.

Dr Elder then presented an interesting thought experiment about periods, using carrots as an analogy. Most people would think the normal colour of a carrot is orange, but not know why they thought this was the case.

“Carrots are orange because the Dutch liked orange carrots, so they put them everywhere and bred out all the other ones. But you can still get other beautifully coloured carrots,” said Dr Elder.

“If we think about what a normal number of periods is for someone to have in their entire life, you might say something like, ‘you get your first period when you’re 12, and you have a period every month. Maybe you have a couple of kids along the way, then you go through menopause when you’re 50’. I don’t do maths, but that’s a lot,” Dr Elder continued. “[But] if you went back six or seven generations and talked to people about what their periods were like, they would have got their first period when they were 17, 18, 19 – the end of their teenage years, rather than the beginning – and then they would have had a bunch of kids and breastfed for ages.

“Most people in the breastfeeding stage don’t get periods, and they can often get pregnant again without getting their period back. And they didn’t live long enough to go through menopause in their fifties. So, these women would have had less periods in their entire life than what today’s average teenager will have while they’re at high school.”

Dr Elder described it as being in a weird situation, where women are having an abnormal number of periods compared to generations gone by – and that these periods are painful because of the prostaglandin release – but that people aren’t listening to them because there’s no underlying pathology.

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President’s ASM Report 2024 What’s in a name?

However, some people do have something “real”: endometriosis.

“I think the word endometriosis is really loaded,” said Dr Elder.

“It means a lot of different things to different people. From a purely physiological or pathological perspective, endometriosis is endometrial tissue that sits outside the uterus. It can be microscopic or extensive, and it’s implicated in persistent pelvic pain and [in]fertility. “[But] endometriosis as a concept has come to reclaim a space because it’s real. Interestingly enough, the guidelines for pelvic pain aren’t ever called pelvic pain guidelines. They’re called endometriosis guidelines because that’s where the funding is. Everything is hanging on this concept of endometriosis.”

Dr Elder reminded delegates there was rarely a direct correlation between endometriosis symptoms and pelvic pain.

“I once saw a patient who presented because her poo was skinny. It turned out the reason her poo was skinny is because her entire pelvis was completely shut down with scar tissue from endometriosis, and [consequently] her bowel was really skinny. She’d had no pain [and] had kids – everything was fine. She was in her midforties and skinny poo was her only presenting complaint,” Dr Elder said.

“Despite all of the guidelines for endometriosis, which are written by clinicians, saying we can do surgery in some people, we don’t need to do surgery in everyone. [But] we really don’t know the people that we should – or shouldn’t – do surgery in.”

Hormonal therapies can reduce pelvic pain, as suppressing periods works really well at getting rid of the prostaglandin-associated symptoms.

However, there is pushback against hormonal therapies as some people claim they aren’t natural.

Dr Elder’s response to these claims?

“Well, having periods every month from age 12 to age 50 probably isn’t natural [either], depending on your definition of natural.”

Dr Elder also has a counterpoint to claims that hormonal therapies were not designed to treat pain.

“Heaps of medications women use weren’t designed [for what they’re being used for]. If you look at obstetrics medications, they’re almost all used for off-label purposes because people don’t research on women, which makes it really hard to get this for on-label use.

“So yes, hormonal medications were designed for big ticket money items like contraception, [but just because] they weren’t designed for endometriosis [or pelvic pain] doesn’t mean that they don’t work.”

Walking the line of cosmetic surgery The topic of genital cosmetic surgery makes Dr Elder uncomfortable, as it’s an area where she doesn’t always believe women when they talk about their pain.

While women can sometimes experience physical discomfort from their genitals whilst wearing underwear and will consequently seek surgery to address this discomfort, Dr Elder pointed to data from the UK, where a series of women who had surgery to alter the size of their labia later admitted they lied to their doctors about experiencing pain or discomfort so they could get the surgery for purely cosmetic reasons.

“Why is it okay for someone to get a boob job, but not get genital surgery? And why is it not okay to do female genital mutilation, but it is okay for Bpeople EW Gto OLBhave [the size of] their labia reduced because of their appearance?” pondered Dr Elder.

“It’s an area where I really do feel uncomfortable.”

Let’s not forget about breastfeeding

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Dr Elder concluded her lecture by returning to the topic of breastfeeding, reminding delegates of the importance of thinking about the medications administered to breastfeeding women or chest feeding trans men. Dr Elder said the most common – although somewhat misguided – advice, especially after receiving an anaesthetic, is to “pump and dump” for the safety of the baby.

“That is never benign advice. You might have a really tenuous breastfeeding relationship. [Or] you might have a baby who’s a bottle refuser. Telling someone to just discard milk without checking whether the medication they’ve had is safe can be a potentially damaging thing,” Dr Elder said, before highlighting useful resources from the Royal Women’s Hospital and the Infant Risk Center on this topic.

“Pretty much everything you give in a standard anaesthetic is okay with breastfeeding. If the patient can hold the baby, they can probably breastfeed.

[But] so many people are not given that advice.”

Lincoln Tracy is a postdoctoral research fellow 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 X (@lincolntracy) or check out some of his other writing and interviews on his website.

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Volume 44, Issue 4, June 2024

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Recent ASM 2024 Publications

APS 2024 - Travel Grant Recipients Watch out for the Travel Grant recipients' reports in this and following eNews editions PhD Travel Grants Miss Alice Mitchell Ms Marina Vygonskaya Ms Erin Macintyre Ms Monique Wilson Ms Sophie Crouch Miss Crystal Li Mr Brendan Mouatt Ms Yun Huang Mr Fernando Tinoco Ms Grace Ferencz

Gynaecology Science Research Physiotherapy Physiotherapy Psychology Science Research Exercise Physiologist Neurology Science Research Physiotherapy

VIC QLD SA SA SA VIC SA NSW NSW SA

Science Research

NSW

BPR SIG Travel Grant Mr Jackson Karrasch Allied Health Travel Grant

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Dr Pene Wood Ms Meredith Smith

Pharmacy Physiotherapy

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Volume 44, Issue 4, June 2024

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ASM 2024

Annual Scientific Meeting Travel Grant Recipient Report Brendan Mouatt Brendan is a PhD Candidate in the Persistent Pain Research Group at the University of South Australia. Brendan’s research investigates the implicit and explicit factors occurring during clinical interactions for pain and their influence on patient outcomes, perceptions, and behaviours.

Author contact details: brendan@noigroup.com 44th Annual Australian Pain Society (APS) Meeting The 44th annual APS meeting was – as usual – one of my favourite scientific gatherings of the year, supported by an incredible community of individuals. I had the opportunity to present some of my PhD work that delved into the acceptability, credibility, and burden of an online vignette study.

Vignette studies are brief, descriptive narratives used to examine participants' reactions or decisions in hypothetical scenarios. Our findings showed the scenarios were largely credible and acceptable, with minimal burden. Elements such as videos, actual clinicians, and guidance proved beneficial for participants to engage as if they were in the scenario. There were no significant demographic differences between those who completed and those who did not, except for non-binary individuals, who were less inclined to complete the study, prompting consideration for enhancing inclusivity in future research.

Following the free paper session, it was wonderful to converse with several delegates who found the methodology intriguing and posed insightful questions about its application. These studies often inform decision-making for funding and treatments; thus, obtaining higher quality data with a representative sample is crucial.

Presenting during this free paper session provided an excellent opportunity to emphasise this importance.

As always, there were numerous engaging topical sessions and plenary talks. Some noteworthy highlights included Ms Natalie Barthel, Dr Nathalia Costa, Ms Miriam Dillon, and Dr Leanne Rath, who led a topical session on understanding and navigating uncertainty in persistent pain.

The session underscored the necessity of acknowledging uncertainty for both patients and practitioners, emphasising the potential harm of neglecting this aspect. Ms Barthel powerfully

exemplified this by sharing her experience with persistent pain. A nice paper by Dr Costa and colleagues that explores this in the context of back pain is here.

Equally fascinating was Professor Louise Sharpe's discussion of her work on cognitive bias modification, using a simple intervention (which patients can completely undertake remotely via an app) that appears to have profound impacts on pain interference and intensity at two-weeks follow-up. A link to her paper can be found here.

Talks like these showcased innovation, scalability, and potentially impactful benefits, which felt particularly significant this year.

Beyond the academic agenda, Darwin provided

BaEWunique GOLBbackdrop for the event. Any conference

where shorts, boat shoes, and short-sleeved shirts are appropriate receives a big tick in my book. The Gala was a highlight, as always with the APS. Set on the waterfront outside the conference centre, I wasn't as bold as many who ventured onto the dance floor, considering the humidity had already reached close to 100%. However, the strong sense of community that always characterises the Gala was palpable. Although it's a chance to relax, the Gala always leaves you feeling more connected, and your work more appreciated, even if you attempt to ruin this with some sub-par karaoke skills at the after-party!

Next year, the conference moves to Melbourne.

Without a doubt, I'll be there, hoping to present more of my PhD work while seizing the chance to reconnect with the numerous individuals from recent years who also regard this conference as the highlight of the year. I anticipate meeting new people, encountering students with fresh, thoughtprovoking ideas, all while exploring Melbourne's alleyways.

To all the event organisers at APS: Well done on once again creating a fantastic program that supports researchers and clinicians.

Declaration: Brendan Mouatt receives renumeration from Noigroup for management and provision of education content. Brendan is supported by a Leadership Investigator Grant from the National Health & Medical Research Council of Australia to GL Moseley (ID 1178444).

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ASM 2024

Annual Scientific Meeting Travel Grant Recipient Report Alice Mitchell Alice is a physiotherapist and final year PhD Candidate from the University of Melbourne. Her work aims to develop a new patient-reported outcome measure for use in endometriosis clinical trials to assess for the ‘most impactful symptom’ of the condition.

Author contact details: alice.mitchell@student.unimelb.edu.au Identifying the most impactful symptoms of endometriosis: Insights from the 2024 Annual Scientific Meeting I am very thankful to have been given the opportunity to attend this year’s Annual Scientific Meeting in Darwin with the assistance of a BLOG WEB generous travel grant. I was fortunate enough to present a poster on an international survey study which aimed to identify the symptoms of endometriosis that are perceived to be the most impactful by people with lived experience.

We found that the symptoms of endometriosis are incredibly varied, and there is no single predominant symptom that impacts people the most. These findings have helped to inform the development of a new patient-reported outcome measure (PROM) for clinical trials which assess for ‘change in the most impactful symptom’ of endometriosis. This PROM is being developed to fulfil a core outcome set, which identified this as a priority outcome.

I would like to thank everyone who visited my poster and who displayed interest in this work. It was a real privilege to present these findings, particularly in the IASP Global Year about Sex and Gender Disparities in Pain. The positive feedback I received has reinforced the importance of continuing research into understudied populations. It was also helpful to hear so many different perspectives about this work and the PROM we are developing.

I attended a number of interesting and thoughtprovoking sessions which were delivered by experts in various fields. It was particularly exciting to see work presented in the area of pelvic pain, including Dr Charlotte Elder’s opening lecture and Dr Jane Chalmers’ plenary.

I also thoroughly enjoyed Professor Louise Sharpe’s session on cognitive bias modification.

It was also great to see the work of so many other research students from across the country.

I left the conference feeling very inspired.

By far the best part of attending this conference was having the chance to connect with others. I feel so fortunate to have met so many inspiring individuals and establish some meaningful connections. Attending the evening social events, including the Gala Dinner, were personal highlights. I would like to give special thanks to the team from University of South Australia who were so welcoming of me – I really enjoyed spending our social time together.

I am incredibly thankful for the generous financial support provided to me through this travel grant. Whilst I do recognise that attending any conference to present my work is an invaluable opportunity, it does unfortunately come with considerable financial costs. As a fulltime PhD student, this travel grant significantly eased some of those financial pressures.

I would like to extend my thanks to everyone who made this event possible. I look forward to seeing what research developments are made in the next year and seeing everyone again at the next APS Annual Scientific Meeting in Melbourne.

Declaration: Alice reports no conflicts of interest.

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

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

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Australian Pain Society Newsletter

Volume 44, Issue 4, June 2024

ASM 2024

Plant-a-Tree Program THANK YOU! This is to recognise

The Australian Pain Society on behalf of

2024 Australian Pain Society 44th Annual Scientific Meeting Delegates

for contributing 771

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Proudly restoring Australia’s

native trees and shrubs in the Yarra Yarra Biodiversity Corridor.

natural habitat through biodiverse reforestation of degraded land.

Thank you for supporting biodiverse reforestation and

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habitat restoration within Australia’s largest carbon sink project.

ƌ WŚŝů /ƌĞůĂŶĚ ͮ ŚŝĞĨ džĞĐƵƚŝǀĞ KĨĨŝĐĞƌ

Issue Date: 21 May 2024 ĂƌďŽŶ EĞƵƚƌĂů WƚLJ >ƚĚ ŝƐ ƌĞŐƵůĂƚĞĚ ďLJ ƚŚĞ ƵƐƚƌĂůŝĂŶ ^ĞĐƵƌŝƚŝĞƐ ĂŶĚ /ŶǀĞƐƚŵĞŶƚƐ ŽŵŵŝƐƐŝŽŶ ĂŶĚ ŚŽůĚƐ ƵƐƚƌĂůŝĂŶ &ŝŶĂŶĐŝĂů ^ĞƌǀŝĐĞƐ >ŝĐĞŶĐĞ EƵŵďĞƌ ϰϱϭϬϬϰ

Thank you to all APS 2024 delegates who contributed to the plant-a-tree program this year.

In conjunction with Carbon Neutral the APS continues to plant a tree for each delegate who attends the ASM. Additional trees were available for delegates to purchase through the registration form.

Thanks to recent rainfall, planting is now underway – we hope you enjoy these recent images of your trees!

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ASM 2025 2024

Get Ready for APS 2025!

We'll be holding our 45th Annual Scientific Meeting at the Pullman Melbourne Albert Park, Victoria from 13 - 16 April 2025.

Visit the conference website: BLOG WEB https://www.dcconferences.com.au/aps2025/ Further information on APS 2025 will be sent out in the coming months.

Express your Interest Please click below to register your interest in APS 2025. You will be notified of important milestones – such as when abstract portals and registrations open.

I AM INTERESTED

We look forward to seeing you in Melbourne!

Should you have queries, please contact the Conference Secretariat.

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Australian Pain Society Newsletter

Volume 44, Issue 4, June 2024

Recent Publications ASM 2025

TOPICAL SESSION SUBMISSIONS NOW OPEN 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.

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

The online topical session submission portal will be available via the conference website from Monday 3 June 2024.

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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The pilot APS Mentorship Program for 2024 will be launched at the APS 2024 Annual Scientific Meeting.

Unlock your potential with the Australian Pain Society Mentorship Program!

Elevate your career in pain management—whether you’re a clinician, researcher, or educator. Gain valuable support and guidance as you navigate new roles. Join us to build an engaged, skilled community and shape the future of pain management together.

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Calling clinicians, researchers, and educators in pain management!

Enhance your skills and join a vibrant pain community.

Whether you’re starting or advancing, our program

Why Join the APS Mentorship Program?

For Mentees: Embark on a transformative journey, gain invaluable insights, and foster professional development under the guidance of seasoned professionals.

For Mentors: Share your wisdom, shape the by contributing to the development of the next wave of pain management clinicians.

Spread the Word!

Share this exciting opportunity with colleagues, contribute to the world of pain management.

Embark on a journey of growth, learning, and impactful contributions with the APS Mentorship Program!

Let’s shape the future of pain management together!

Expressions of Interest Now Open!

Please forward your EOI to aps@apsoc.org.au by 15 June 2024.

For more information >> apsoc.org.au 22

Australian Pain Society Newsletter

Volume 44, Issue 4, June 2024

painSTAR 2024

painSTAR 2024 10 – 14 November 2024 The Australian Pain Society is delighted to announce that painSTAR is returning to the Novotel Barossa Valley Resort, Adelaide Hills, from 10-14 November 2024. painSTAR brings together a group of exceptional clinical and early-mid career academic pain researchers to participate in an intensive program focussed on linking not only from the bench to the bedside, but all the way to the boardroom.

Pain schools such as painSTAR foster interdisciplinary collaboration, accelerated translation of research findings to care delivery, and the development of skills to help influence political/health service systems – all topics that are critical for high quality translational pain BEW GOLB research but are rarely covered in a standard teaching or conference curriculum. Consumer representatives will once again be part of the faculty, providing delegates with exposure to the personal and social consequences of living with persistent pain, and providing inspiration about the importance of translational pain research.

Applications for painSTAR 2024 will close on Monday 10 June. The program is now available, please visit the painSTAR website for further information.

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PinC Journal Watch

The association between parent mental health and pediatric chronic pain: a systematic review and meta-analysis

Pain in Childhood Special Interest Group

Beveridge, Jaimie K et al. “The Association between Parent Mental Health and Pediatric Chronic Pain: A Systematic Review and MetaAnalysis” (2024) 165(5) Pain 997-1012.

well as physical and psychological functioning.

The associations were stronger with current compared to historical parental depression and for clinical rather than community studies.

DOI: 10.1097/j.pain.0000000000003125

Reviewer’s critique and take-home message

Reviewer: Dr David Sommerfield, Pain Specialist and Anaesthetist, Perth Children’s Hospital

Review of article Study group Forty-nine paediatric studies were included in the meta-analysis, which aimed to estimate the prevalence of mental health problemsBLOG amongWEB parents of children with chronic pain and estimate the effect size of this on the presence of childhood chronic pain and on child pain intensity and function. One-third of studies were conducted in community settings (35,713 participants) while two-thirds were clinical studies (4681 patients). Most studies used selfreport measures (94%) and included a mixture of pain conditions. Eighteen percent of studies focused on recurrent abdominal pain.

Brief summary of the results Anxiety and depression were found in 29% and 20%, respectively, of parents of children with chronic pain. This is higher than rates seen in parents in the general population (5-6%) but similar to parents with other chronic childhood diseases (e.g., cancer 22-28%; diabetes (22%).

These findings were independent of tested moderators such as the type of pain experienced by the child, the child’s age, gender, or race, and whether the parent’s mental condition was current or historic.

Parents with self-reported symptoms of anxiety or depression were 1.9 times more likely to have a child who reports chronic pain, while parents reporting parental distress were 1.7 times more likely to have a child who reports chronic pain. There were small, but significant associations between parental mental health or distress scores and the child’s pain intensity as 24

Australian Pain Society Newsletter

This study confirms parents of children with chronic pain have more anxiety, depressive, and distress symptoms, although at rates similar to that of parents of children with other chronic diseases. Parents with a prior or current diagnosis of anxiety or depression are nearly twice as likely to have children who suffer from chronic pain, and this is associated with more physical and emotional dysfunction in their child. There are some limitations based on the included studies. The clinical studies tended to be small, convenience samples recruited from pain clinics, but they did use more stringent criteria and validated questionnaires. In contrast, community studies were more frequently prospective in nature and had larger sample sizes, but were limited by low participation rates, loss to follow up, and parents reporting for children more often.

Most studies included were cross sectional, which limits conclusions about causation, although some of the small prospective longitudinal studies included suggest parental mental health symptoms in early childhood (i.e., while the child is under three years of age) increases the likelihood of childhood pain at later ages. Historic mental health symptoms were not a moderator compared to current symptoms in analyses apart from current parental depression. This study does not disentangle how much childhood pain may be explained by inherited genetic vulnerability to anxiety/depression/distress or to parenting style/attachment or even how much parental distress is a response to a child’s ongoing pain.

The researchers did (/could) not explore other mental health diagnoses like impact of bipolar affective disorder or schizophrenia. Therefore, this study forms a good base for prospective longitudinal studies which would look at specific mental health diagnoses in parents and the intergenerational effects.

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Chronic Pain in Autistic Youth: Clinical Prevalence and Reflections on Tailoring Evidence-Based Interventions from an Interdisciplinary Treatment Team Han, G. T., Heavner, H. S., Rains, T. R., Hoang, A. H., & Stone, A. L. (2024). Chronic Pain in Autistic Youth: Clinical Prevalence and Reflections on Tailoring Evidence-Based Interventions from an Interdisciplinary Treatment Team. Children (Basel, Switzerland), 11(3), 312.

DOI: 10.3390/children11030312 Reviewer: Laura Edmunds, Occupational Therapist, Perth Children’s Hospital

Review of article Study group Ninety-five patients aged eight to 18 years at a pain clinic at Vanderbilt University Medical Centre, Nashville, USA. Nine percent presented to the pain clinic with a prior autism diagnosis.

An additional 21% exhibited clinically significant features and a developmental history consistent with autism, suggesting a more accurate prevalence rate of 30%. Of the patients with autism, 55% presented to the clinic with widespread pain, 69% were assigned female at birth, and 17% identified as transgender.

Aims of study To inform potential biopsychosocial factors affecting the presentation, assessment, and treatment of chronic pain in autistic youth, and to identify adaptations to better serve autistic patients in pain clinics.

Brief methodology Data was collected from a retrospective review of electronic medical records of patients and standardised questionnaires.

Brief summary of the results There were no statistically significant differences, at the initial evaluation, between the autistic and non-autistic groups. There were however qualitative differences with sensory, motor, emotional, cognitive, and social features

Pain in Childhood Special Interest Group

in clinical observations. This led to qualitatively consistent adaptations of the assessment and treatment.

Co-occurring Medical Conditions: Many autistic youths presented with co-occurring central sensitivity syndromes.

Sensory processing: Atypical sensory seeking and avoidance behaviours were identified in all the sensory domains, including interoception.

Many presented with a low threshold that was associated with sensory overwhelm, often described as “painful”, unbearable and BEinterfering W GOLB with daily activities. Many reported school was “too overwhelming” and were spending most of their time in their bedrooms.

Motor Functioning and Primitive Reflexes: Many patients had consistently retained their primitive reflexes which typically remit in infancy. Autistic youth tended to exhibit difficulties with postural control, gross and fine motor coordination, difficulties in grading motor forces, and difficulties with motor imitation.

Emotional Processing: Many autistic youths had difficulty in describing their emotional experiences related to pain. They preferred to describe their emotional experience using metaphors or descriptors that were unique to them and their preferred interests. Most reported significant levels of social and generalised anxiety.

Cognitive Processing: Autistic youth demonstrated cognitive styles that were notably concrete and beliefs about pain were often in the form of all-or-nothing thinking. These thoughts were less responsive to standard pain education and often hindered rapport building and treatment engagement.

Social Functioning and Context: Many of the autistic individuals were assigned female at birth, highlighting the potential importance of pain clinics as a setting for detecting and caring for autistic females, who may be

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underdiagnosed and receive fewer supports.

Seventeen percent of the autistic youth identified as transgender. Most reported social stressors, including bullying and nonacceptance, which contributed to school avoidance.

Adaptations for practice: • Consider if (prior/subsequent) Autism screening is required in all patients.

• Create an environment accepting of neuro and gender diversity. Be mindful of the number of clinicians in the room.

• Understand the patient’s level of cognitive and emotional insight.

• Use multiple modalities and parent reporting during information gathering, including sensory profiling.

• Using concrete descriptors and explanations is more effective.

• The level of the chronic and daily sensory BLOG WEB overwhelm at the baseline needed to be addressed first before the patient could fully participate in the treatment model.

• Sensorimotor integration is beneficial to reduce avoidance of settings of sensory overwhelm.

Conclusions Autism is overrepresented among youth with chronic pain seeking treatment in a multidisciplinary pain clinic and requires nuanced alterations in assessment and subsequent management.

Reviewer's critique and take home message The article highlights important practical considerations for working with autistic patients.

It emphasised the role of occupational therapy (OT) and sensorimotor integration to support individuals with distinct sensory processing profiles. An OT can help develop sensory support plans through understanding the patients' sensory thresholds, developing behavioural strategies, and using parent coaching strategies.

This is not yet routinely integrated into outpatient paediatric pain clinics. There is a need for incorporating interventions targeting sensorimotor integration and social support to improve management of pain in this population.

Declaration The reviewer declares no competing or conflicting interests in reviewing this article.

• A general shift from cognitive strategies to behavioural strategies – A graded exposure approach prioritised to reduce the fear of pain and challenge maladaptive pain beliefs.

• Harness the power of special interests to build rapport and treatment engagement.

• Collaboration with referrer on the impact of co-occurring medical conditions and autism on the experience of pain.

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PinC Journal Watch

Predicting the Need for Transition from Pediatric to Adult Pain Services: A Retrospective, Longitudinal Study Using the Electronic Persistent Pain Outcome Collaboration (ePPOC) Databases

Pain in Childhood Special Interest Group

factors associated with transitioning between healthcare services.

Champion, J., Crawford, M., & Jaaniste, T. (2023). Predicting the Need for Transition from Pediatric to Adult Pain Services: A Retrospective, Longitudinal Study Using the Electronic Persistent Pain Outcome Collaboration (ePPOC) Databases. Children (Basel, Switzerland), 10(2), 357.

Brief summary of the results

DOI: 10.3390/children10020357 Reviewer: David Sullivan, Physiotherapist, Perth Children’s Hospital

Review of article Study group The investigated cohort comprised of patients engaged with a paediatric pain service across Australia between 2014-2020 which transitioned to an adult pain service. The ‘transitional cohort’ consisted of 86 individuals with linked paediatric and adult data and was compared to 1541 patients who engaged with a paediatric pain service but did not transition to an adult pain service for ongoing input. Pain complaints were categorised based on the primary site of discomfort reported.

Aims of study The primary aim is to predict the need for transitioning from pediatric to adult pain services based on patient characteristics and pain-related factors at initial assessment.

Pain presentations were distributed evenly across the back, head, and abdomen, each accounting for 19% of recorded pain complaints.

A substantial majority of adolescents (84.6%) characterised their pain as 'always present.'

Analysis of pain aetiology revealed that 46% of cases originated after an injury, while 36.5% had pain emerge following a surgical intervention.

The group of young people transitioning to BEadult W Gpain OLB services exhibited higher healthcare utilisation compared to those who didn't transition, including more visits to family doctors, allied health professionals, emergency departments, and increased use of diagnostic tests and anti-inflammatory drugs.

Moreover, paediatric patients who transitioned to adult pain services reported experiencing more severe pain, greater functional disability, and lower quality of life than their counterparts.

Carers of individuals in the transition group also reported significantly heightened pain catastrophising and feelings of helplessness. The study identified several factors associated with an increased likelihood of transitioning to adult pain services, such as older age at initial clinic referral. Patients involved in compensation cases were more than four times as likely to transition, while those using anti-inflammatory drugs daily were twice as likely.

Brief methodology The study utilised retrospective data from the Electronic Persistent Pain Outcome Collaboration (ePPOC) both paediatric and adult de-identified datasets, incorporating demographic details and results from standardised questionnaires at service entry.

The authors compared those transitioning and the non-transitioning group—with descriptive statistics and comparison with normal population distributions of data.

Logistic regression was employed to examine

Conclusions Young people referred to paediatric pain services who later need to move to adult services face unique challenges. They have higher pain levels, more disability, use healthcare more, and have lower quality of life compared to those who don't transition. The authors found three factors that predict the need for transition: being involved in a compensation case, using anti-inflammatory drugs daily, and being older when first referred to paediatric services. This research suggests

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paediatric pain services could screen for those likely to need adult services and provide early and targeted transition care for them.

Reviewer's critique & take home message This study, while robust in its methodology and data collection, has certain limitations to consider. It only included patients who successfully transitioned to an adult pain services using ePOCC, potentially limiting the generalisability of its findings. There are also many other reasons (other than adequate selfmanagement or resolution of initial pain) why a young person may not have been referred, accepted, or chosen to attend an adult clinic.

The study also didn't explore factors like selfesteem or resilience, or paediatric service input and engagement which could influence treatment outcomes and likelihood of transition.

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However, strengths include its use of a large dataset from multiple centres, standardised tools, and a longitudinal design. The findings shed light on the challenges faced by young patients transitioning from pediatric to adult pain services, suggesting predictive factors such as compensation cases and medication use.

Early identification of these factors could aid in tailored interventions to improve outcomes.

Furthermore, the study highlights the need to support caregivers, who often experience more distress and helplessness compared to parents of other young people in pain clinic, to better assist adolescents in managing their pain.

Declaration The reviewer declares no competing or conflicting interests in reviewing this article.

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Volume 44, Issue 4, June 2024

Surveys

Calling PainResearchers!

Researchers!

CallingAll AllAustralian Australian Pain Share your insights andand current sexand andgender gender variables in pain research.

Share views, your views, insights currentpractices practices on on sex as as variables in pain research.

An international group of 30 research inviteyou youtotocomplete complete a survey to understand An international group of pain 30 pain researchexperts experts invite a survey to understand current methodological approaches for the study of sex and gender as variables in pain, with the aim current methodological approaches for the study sex and gender as variables in pain, with the aim of developing consensus recommendations and a research roadmap in this very important area. of developing consensus recommendations and a research roadmap in this very important area.

This Networking group, termed PAINDIFF,has hasbeen been established (a)(a) identify areas of methodological This Networking group, termed PAINDIFF, establishedtoto identify areas of methodological consensus and best practice on sex and gender in pain research, (b) identify gaps in methodological consensus and best practice on sex and gender in pain research, (b) identify gaps in methodological knowledge and (c) develop consensus recommendations and set out a research road map and priority knowledge (c) develop consensus areas and for further investigation of sex recommendations and gender in pain. and set out a research road map and priority areas for further investigation of sex and gender in pain.

Survey deadline: 14 June 2024

Survey deadline: 14 June 2024 Ethics approval for the survey was obtained from the University of Galway’s Research Ethics Commi<ee (ID no. 2024.01.013).

The researchers respect your privacy, and all responses will be anonymised.

Ethics approval for the survey was obtained from the University of Galway’s Research Ethics Commi<ee (ID no. 2024.01.013).

The researchers respect your privacy, and all responses will be anonymised.

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The Chronic Pain Statewide Clinical Network, in partnership with the Commission on Excellence and Innovation in Health, has launched South Australia's Pain Research and Innovation Hub – raising impact through awareness.

The Hub is a simple solution to fast-paced connection.

It allows the community to see what South Australian pain-related research and/or care improvement is occurring, thereby promoting Australian research and innovation and supporting people to connect around areas of interest.

It aims to help break down silos, reduce duplication of effort and fast-track innovation so that together, we can make a real difference in the lives of people living with pain.

To see what work is happening in this area in SA or to add your research or improvement project, please visit South Australia's Pain Research and Innovation Hub

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Recent Publication

Translation, Contextual Adaptation and Reliability of the Danish Concept of Pain Inventory (COPI-Adult (DK)) – a selfreported outcome measure Thank you to APS member Joshua Pate and his colleagues Bettina Eiger, Christian Straszek, and Michael Skovdal Rathleff for sharing the following recent publication.

Article first published online: 7 March 2024 Journal Reference: Scand J Pain. 2024 Mar 7;24(1). doi: 10.1515/sjpain-2023-0092. eCollection 2024 Jan 1.

DOI: 10.1515/sjpain-2023-0092

Abstract Objectives

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Pain is a growing concern globally, and an individual and societal burden. Pain science education (PSE) is a promising avenue for managing chronic pain, but targeted PSE is needed. The Concept of Pain for Adults Inventory (COPI-Adult) is a newly developed self-reported outcome measure aimed at targeting pain science education. The COPI-Adult is currently unavailable in Danish and has unknown reliability. The aims of this study were (1) translate and contextually adapt to the COPI-Adult to Danish and (2) determine reliability in terms of test-retest reliability, internal consistency, and measurement error.

Methods A dual panel approach was used to translate and contextually adapt into a Danish version.

A heterogenic sample of 150 Danish adults aged >18 years were included in the test-retest analysis with a test interval between seven and 14 days, both answered via REDCap. Based on COSMIN (COnsensus-based Standards for the selection of health Measurement INstruments)

recommendations, following reliabilities were estimated; the test-retest using intraclass correlation coefficient (ICC2.1) and internal consistency using Cronbach’s alpha level.

Measurement error in terms of Standard Error of Measurement (SEM) and Smallest Detectable Change (SDC) were calculated.

Results The first panel reached 100% consensus on the wording of the COPI-Adult (DK), with no alterations by the second panel. Good to excellent test-retest reliability was found with ICC2.1-value (95%CI) 0.88(0.84-0.91) and excellent internal consistency for the 13-item COPI-Adult (DK) with α=0.939, SEM of 2.53, and SDC of 7.02.

Conclusions The COPI-Adult (DK) was successfully translated and contextually adapted. It is a reliable questionnaire with excellent internal consistency.

The COPI-Adult (DK) shows promise in research and clinical practice.

Implications/Discussion Our dual panel translation successfully translated and contextually adapted the English version of the COPI-Adult into a Danish language. The comprehensive test-retest results in a broad sample showed good reliability and the smallest detectable change was seven points on the 0–52-point scale.

Declaration All authors (Bettina Eiger (PT, MSc), Christian L. Straszek (PT, MSc), Joshua Pate (PT, PhD) and Michael Skovdal Rathleff (PT, PhD, dr. med)) have nothing to declare. No funding has been received.

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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Australian Pain Society Newsletter

Volume 44, Issue 4, June 2024

Opioid Toolkit Editor’s Reference Note

New consumer resources to improve health literacy around opioids and encourage keeping naloxone in the home Suzanne Nielsen Professor Suzanne Nielsen (BPharmSc[Hons] PhD MPS) is an NHMRC Investigator Grant Fellow and academic pharmacist who leads a research team at Monash University focusing on reducing opioid related harm.

In August 2024, a new digital toolkit will be launched to increase consumer health literacy around prescription opioid safety. The interactive Toolkit, developed through extensive co-design with consumers, aims to encourage better conversations between health care providers and consumers around opioid safety, and increase naloxone uptake among people BEW GOLB who are prescribed opioids.

The launch and promotion of the toolkit may lead to discussions between people who take opioids for pain and those who prescribe or dispense opioids about the role of naloxone and other aspects around opioid safety.

In the past, a key barrier to naloxone provision has been concerns from healthcare providers about its role, and possible risks with its increased availability. In some cases, these concerns can be addressed with accurate information. We are really keen to hear from APS members about whether you have questions or concerns about naloxone or opioid safety promotion more generally. If you share them with us, we can ensure these are considered as the Toolkit is finalised. We also are planning a Webinar later this year so that people working with people who are prescribed opioids can have their questions answered about the toolkit.

CALL TO ACTION If you have questions or suggestions about key information about the Toolkit that should be addressed in the Webinar we would love to hear from you! Are there patients who you feel should not be offered naloxone? Tell us about it here!

Would you like access to the toolkit when it’s launched, or receive materials that you could use in your clinical work with people who are prescribed opioids?

Get in touch here!

Alternatively, you can contact suzanne.nielsen@monash.edu Declaration This work is funded by the Department of Health and Aged Care.

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Volume 44, Issue 4, June 2024

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Events

SAVE THE DATE

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19 - 21 JULY 2024

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Neuromodulation Society of Australia and New Zealand A chapter of the International Neuromodulation Society

NEUROMODULATION SOCIETY OF AUSTRALIA AND NEW ZEALAND 17TH ANNUAL SCIENTIFIC MEETING (NSANZ 2024) Neuromodulation: Can we do it better?

19 – 21 JULY 2024 HOTEL GRAND CHANCELLOR, HOBART, TAS

www.dcconferences.com.au/nsanz2024

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Volume 44, Issue 4, June 2024

INCLUDES CADAVER WORKSHOP Friday 19 July 2024, University of Tasmania

Events

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FYI

NEW! > ATLAS: Arthritis Training, Learning And UpSkilling for Health Professionals: https:// arthritiseducation.mygo1.com/login?redirect_ url=%2Fp%2F%23%2Fapp%2Fdashboard

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

> 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/ > 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 > 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

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Volume 44, Issue 4, June 2024

New Members

New Members New Members as at 27 May 2024 Miss Diarna Abbott

Nursing

Miss Joyce Anthony Edman

Pharmacy

Dr Divya Kanwar Bhati

Science Research

Mrs Clare Buckley-Wilkshjire

Psychology

Prof Ian Cameron

Rehabilitation Medicine

Dr Shen Chen

Neurology

Dr Courtney Cini

Anaesthesia

Mrs Samantha Corrie

Occupational Therapy

Mrs Danielle Cortes

Nursing

Dr Kirsty Duncan

Physiotherapy

A/Prof Michelle Hall

Science Research

Mr Mitchell Horwood

Physiotherapy BEW

Dr David Klyne

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Science Research

Mrs Remia Kuriakose Panayil

Nursing

Dr Eveline Matthews

Anaesthesia

Mrs Shelby McGuane

Nursing

Miss Keeley McNally

Science Research

Mrs Gabriella Perry

Nursing

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Volume 44, Issue 4, June 2024

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Calendar of Events

Calendar of Events 4-6 June 2024

18-20 October 2024

British Pain Society (BPS)

Faculty of Pain Medicine (FPM)

British Pain Society 57th Annual Scientific Meeting ‘24

2024 FPM Spring Meeting Pullman Auckland Hotel & Apartments, Auckland, NZ

East Midlands Conference Centre, Nottingham, UK https://bpsasm.org/

https://members.anzca.edu.au/anzca/anzca/ EventDetail?EventKey=FPM_2024

13-14 June 2024

31 October-2 November 2024

Occupational Therapy Australia

Australian Physiotherapy Association

2024 OT Exchange

FOCUS24: The business of physiotherapy

Perth Convention & Exhibition Centre, Perth, WA

Crown Perth, Perth, WA

https://www.otausevents.com.au/otexchange2024

https://physiotherapy.eventsair.com/focus24

21-23 November 2024

19-21 July 2024

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2024 Neuromodulation Society of Australia & New Zealand 17th Annual Scientific Meeting (NSANZ 2024)

Royal Australian College of General Practitioners (RACGP) GP24 Perth Convention & Exhibition Centre, Perth, WA

Hotel Grand Chancellor, Hobart, TAS

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

https://www.dcconferences.com.au/nsanz2024/

27-29 November 2024

5-9 August 2024

Australian & New Zealand Spinal Cord Society (ANZSCoS)

International Association for the Study of Pain (IASP)

ANZSCoS 2024

IASP 2024 World Congress on Pain

Esplanade Hotel, Fremantle, WA

Amsterdam RAI, Amsterdam, Netherlands

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

https://www.iasp-pain.org/iasp-2024-worldcongress-on-pain/

19-22 August 2024

13-16 April 2025 Australian Pain Society (APS)

Neurosurgical Society of Australasia (NSA) NSA 79th Annual Scientific Meeting Darwin Convention Centre, Darwin, NT https://2024.nsa.org.au/

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

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/

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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:

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

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Directors

Directors

President:

NT Director:

Mrs Joyce McSwan

Adjunct A/Prof Cindy Wall

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

Clinical Psychology Assessment & Consultancy Fannie Bay NT 0820 Tel: 0488 993 210 Fax: 08 6266 3777

President-Elect:

QLD Director:

Ms Bernadette Smith

Dr Duncan Sanders

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

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

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Secretary: Mrs Dinah Spratt

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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:

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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

Mr Connor Gleadhill

WA Director:

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

Ms Jacintha Bell

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Volume 44, Issue 4, June 2024

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

Office Bearers

Office Bearers

Immediate Past President:

Newsletter Assistant Editor:

Ms Trudy Maunsell

Dr Joanne Harmon

Retired QLD

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

SPC Chair:

Scholarship/Grant Selection Subcommittee Co-Chairs:

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

Em Prof Maree Smith AC

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IASP Liaison:

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Centre for Integrated Preclinical Drug Development University of Queensland St Lucia QLD 4072 Prof Luke Henderson

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

Anatomy & Histology, School of Medical Sciences Brain & Mind Centre University of Sydney Camperdown NSW 2006

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

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

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

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Volume 44, Issue 4, June 2024

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