IASP Insight Magazine June 2013

Page 1



VOL.2, NO.1

JULY 2013

How Much Pain Is Too Much



Also in this issue: n n

JULY 2013


To learn more about the core features of visceral pain, download these fact sheets:

Epidemiology of visceral pain


Neurobiology of visceral pain

Bladder Pain Syndrome

Acute vs. chronic presentations of visceral pain

Male Chronic Pelvic Pain Syndrome

Psychological aspects of visceral pain

Chronic chest pain

Functional abdominal pain

Visit the IASP website to learn more: www.iasp-pain.org/GlobalYear/VisceralPain

Telephone: +1-202-524-5300 Fax: +1-202-524-5301 Email: iaspdesk@iasp-pain.org Web: www.iasp-pain.org



JULY 2013 A13-4



International Association for the Study of Pain 1510 H Street N.W., Suite 600 Washington, D.C. 20005 USA iaspdesk@iasp-pain.org www.iasp-pain.org IASP Insight Advisory Board

INSIGHT Features 8

The Booker Prize-winning English writer chronicles her challenges with pain—and those of the doctors who treated her—as well as her efforts to cope with intractable, confounding questions.


Beverly Collett (UK) Editor-in-Chief Huda Huijer Abu-Saad (Lebanon) Antoon de Laat (Belgium) Michael Nicholas (Australia) Graciela Rovner (Sweden) Yasuo Sugiura (Japan) IASP Secretariat Kathy Kreiter Executive Director Daniel J. Levin Director of Publications IASP Insight is published biannually and distributed to members by the International Association for the Study of Pain. Copyright © 2013 International Association for the Study of Pain. All rights reserved. Please contact the IASP Secretariat for more information on submissions or e-mail insight@iasp-pain.org. The International Association for the Study of Pain is a nonprofit, tax-exempt organization incorporated in Washington, D.C. IASP is recognized by the World Health Organization as a nongovernmental organization (NGO) affiliate. Timely topics in pain research and treatment have been selected for publication, but the information provided and opinions expressed have not involved any verification of the findings, conclusions, and opinions by IASP. Thus, opinions expressed in IASP Insight do not necessarily reflect those of the association or the officers or councilors. IASP assumes no responsibility for any injury or damage to persons or property as a matter of product liability, negligence, or otherwise or from any use or operation of any methods, products, instruction, or ideas contained in the material herein. Because of rapid advances in the medical sciences, the publisher recommends independent verification of diagnoses and drug dosages. For permission to reprint articles, please contact IASP.

How Much Pain Is Too Much Pain? BY HILARY MANTEL

PAIN OUT offers clinicians Web-based tools to measure and gain feedback from postsurgical patients so they can make good decisions in managing pain.

Story Behind the Grant: 16 The Screening for HIV-Associated Neuropathy An IASP Collaborative Research Grant enabled two doctors to train local investigators to screen HIV patients for neuropathy. They also taught courses in epidemiology and statistics to staff and students of the University of Witwatersrand in South Africa.



Asia Pain Management 4 Southeast Camp Attracts Devoted Group


Professionals and practitioners from developed and developing countries spark spirited discussions.



European Pain School Meets in Tuscany BY MARSHALL DEVOR Can you think of a better place to talk science and connect with top faculty investigators, research students, and postdocs from around the world? Lebanon Establishes First National Task Force for Pain Relief and Palliative Care BY HUDA ABU-SAAD HUIJER The task force has developed a national plan to deliver change in pain relief and palliative care focusing on education, practice, research, and public policy.


“Do You See What I Feel,” by Dana Harrell-Sanders, represents those who suffer from fibromyalgia/ chronic fatigue syndrome. A person suffering with the disorders seems so healthy on the outside that others have a hard time perceiving what’s going on inside. www.painexhibit.org

JULY 2013

New SIGs Offer Ways to Network and Learn Join a SIG to network with peers and stay current in your field.


British Pain Society: In Pain Management, the Patient Matters Most BY PETER GORMAN The June meeting of the chapter’s SIG on Philosophy and Ethics explored how the loss of an ethic of care affects pain management.



IASP HQ Hosts Open House in Washington, D.C. Officials toast opening just steps from the White House.


Mark Your Calendar: World Congress on Pain, October 6-11, 2014 World Congress on Pain to meet in Latin America for the first time.



Southeast Asia Pain Management Camp Attracts Devoted Group Professionals and practitioners from developed and developing countries spark spirited discussions.


welve faculty members from eight countries and 27 delegates from 11 nations convened in Singapore in late April at the IASP Pain Management Camp for Southeast Asia. Participants hailed from Bangladesh, Bhutan, Indonesia, Laos, Malaysia, Myanmar, Nepal, Philippines, Singapore, Thailand, and Vietnam. Most delegates were doctors with varying specialties, though the group included nurses, psychologists, physical therapists, a dentist, and a pharmacist. Ji Kwan Lee, of University Putra Malaysia, says the experience was fantastic and the program impressive. The course structure provided good coverage of pain management, he reports, and the lectures were informative and interesting. “As a clinical psychologist, I found the lectures on the biopsychosocial model of pain as well as the psychological management of pain given by Prof. Lance McCracken and Dr. Zubaidah Jamil Osman were most beneficial.”



Dr. Myo Thuzar Khin, a consultant in the Physical Medicine & Rehabilitation Department at Yangon General Hospital in Myanmar, enjoyed Prof. Troels Jensen’s lecture on the assessment of chronic pain, which included two live patients. His session “clearly demonstrated the importance of dealing with the patients not only to get a correct diagnosis but also to give proper management.” Lee says he was inspired by Dr. M.R. Rajagopal’s lecture on cancer pain. Dr. Rajagopal displayed a photo of a patient who had been in a crouching position for three weeks, unable to unfold because of severe cancer pain. Eventually, the patient was able to enjoy his first cup of tea after taking six cents’ worth of morphine. Dr. Rajagopal reminded participants that many people suffer from pain needlessly, and one tablet can make a big difference. The session prompted Lee to ask himself: “For someone who has no right to prescribe that one magical pill, what would I have

done for that patient?” A quick search using keywords such as “psychological treatment” and “cancer pain” in any academic search engine certainly would reveal a substantial number of references, says Lee. However, in reality, the application of psychological techniques for pain management in Malaysia today is very much limited to chronic nonmalignant types. “I believe psychology has much more to offer,” he says, “and I pledge to expand the realm of

knowledge and inspired her to promote pain management in her country. She says she especially appreciated the group’s visit to the Pain Management Centre at Singapore General Hospital. “This was an amazing experience that showed us how to manage patients with acute and chronic pain.” Lee says every conversation with delegates and faculty members yielded valuable insights. “Their stories and experiences with patients in pain substantiated the importance of good The most meaningful multidisciplinary pain management. aspect of the Our discussions program to me was helped me understand the gaps that witnessing dedicated need to be addressed to improve the quality people from the of pain management developed countries in my country, and it is because of this showing their experience that I realize I, too, have a role interest and concern to play.” Both particifor people from my pants say they made cherished friendships part of the world.” and connections that will help advance pain management in psychology in field of pain their respective countries management in Malaysia.” and throughout the world. Dr. Khin, one of three Khin calls herself “lucky” to representatives chosen to be able to attend the Pain attend the Pain ManageManagement Camp and ment Camp by the Myansays she believes “it could mar Society for the Study be a small building block of Pain, says the gathering in promoting health” in “greatly improved” her Myanmar.

JULY 2013

“The most meaningful aspect of the program to me,” says Lee, “was witnessing dedicated people from the developed countries showing their interest and concern for people

from my part of the world.” But he adds that “My soul was not the only thing being fed during the Pain Camp. The Pain Association of Singapore showed us the meaning of hospital-

Delegates from several Southeast Asian countries made valuable connections and new friends in Singapore.

ity by making sure that we lost count of our calorie intake! Every dinner was planned with the intention of giving us a different taste of Asia.”

European Pain School Meets in Tuscany BY MARSHALL DEVOR It would be difficult to find a better venue to meet with top scholars to learn new approaches and discuss ways pain affects the lives of sufferers.


earning about pain involves more than just searching PubMed. Now and again we all need to get out of the lab and interact with people and ideas that reach beyond our specialties. Now in its tenth cycle, the European Pain School (EPS) at the University of

JULY 2013

Siena in Italy is the first place (and still the best place) to spend a week immersed in your favorite subject. The school takes place in a spectacular informal setting at a converted Carthusian monastery in Tuscan wine country. It provides a week of talking science and connecting with top faculty

investigators and 30 of the best research students and postdocs from around the world. Pain Science and Medicine is a discipline in ascent. The obsolete concept that pain is “just a symptom of disease” is on its way out. What lies ahead is the need to crack one of the

most intellectually challenging problems in all of neuroscience, one that not only spans from molecule to mind but also embraces an enormous potential for helping people. It is only beginning to dawn on decision makers that pain— particularly chronic pain— has a huge impact on the



Prof. Manfred Zimmermann chats with Prof. Giancarlo Carli of the University of Siena, one of the founders of EPS.

quality of life of sufferers, their loved ones, their employers, and society. Science is the solution. Supported by the IASP, the Federation of European Neurosciences,

the International Brain Research Organization, and colleagues in industry, EPS emphasizes cutting-edge concepts, critical thinking, and excellence in basic and clinical research. Each year,

Students at this summer’s European Pain Management School tour the historic city of Siena during a break in the formal program.



the school focuses on a particular pain-related theme. Topics in past years have included “Hyperexcitable Neurons as Pain Generators,” “Molecular Mechanisms of Pain Response,” “Translating Pain Science into Pain Medicine,” and “Chronic Pain a Disease: The Role of Genes.” No matter what the focus, knowledge is brought to bear from psychology to molecular genetics, with attention at each level to what is known and what remains mysterious. The most recent school, EPS2013, convened June 9-16 to consider the topic “Brain Modulation of Pain Experience.” As in previous years, the faculty consisted of core investigators and a rotating constellation of pain stars from around the world. Contributors to EPS over the years have included John Loeser, Peter Reeh, Chris Eccleston, Eija Kalso, Allan Basbaum, Jeff Mogil, Irene Tracey, Geert Crombez, Troels Jensen, Vania Apkarian, Jon Levine, Catherine Bushnell, Herta Flor, Giandomenico Iannetti, John Wood, and many other leaders of our discipline. In class, EPS schedules plenty of time for clarifying facts, discussing methods, and expanding on (and challenging) ideas—much more time than typical conference or department lectures. Students also have

a chance to present their own work in a supportive atmosphere and to debate central dilemmas in the pain arena. One of the best things about EPS is that faculty members volunteer to attend for at least three days, and some stay for the whole week. This means lots of opportunities for informal discussions while sitting on the lawn, over coffee, on countryside strolls, while visiting the fireflies in the adjacent vineyard, and over pasta and Chianti at mealtime. The most important of our resources, however, are EPS Scholars, the elite and growing club of young basic science and clinical investigators who attend the school. Though begun in Europe and based there, EPS accepts young scientists from around the world. Beyond learning a lot and having a great time, they form connections and friendships at EPS that last a lifetime. EPS Scholars are the folks you’ll see at conferences, whose papers you’ll read, and who eventually will look for colleagues to form research collaborations. They are the future leaders of IASP and of Pain Science and Medicine. Marshall Devor is Alpert Professor of Pain Research at the Hebrew University of Jerusalem and a member of the EPS board.

JULY 2013


Lebanon Establishes First National Task Force for Pain Relief and Palliative Care BY HUDA ABU-SAAD HUIJER


ignificant developments in education, practice, and research have taken place in the field of pain relief and palliative care in Lebanon. The minister of health issued a decree in 2011 to appoint a National Task Force on Pain Relief and Palliative Care, and the group was formally launched during a conference organized by the Lebanese Society for the Study of Pain (LSSP). Since then, the task force has developed a national plan to deliver change in pain relief and palliative care across the life span that will focus on four broad areas: education, practice, research, and public policy. The plan was created out of a need to address significant challenges in the profession. In Lebanon, many health-care professionals lack the knowledge and skills to perform their duties or have inappropriate attitudes and behaviors for pain treatment and care. Practice and system challenges include a lack of resources, inadequate financial coverage for treatment, poor coordination of care, problems with drug availability and accessibility, and a lack of legislation and recognition of the specialty areas. The task force is led by the director general of the

JULY 2013


THE NATIONAL TASK FORCE ON PAIN RELIEF AND PALLIATIVE CARE WILL FOCUS ON FOUR AREAS EDUCATION n Recommend a core curriculum to be used in the training of health-care professionals with emphasis on knowledge, attitudes, and skill development n Recommend specialization trajectories of physicians and nurses in the field n Institute the importance of continuing professional education in the field as a requirement for recertification and licensure n Develop strategies for public education in the field PRACTICE n Develop national standards and competencies for pain relief and palliative care n Develop strategies to engage professionals from different disciplines in the care process such as the use of multidisciplinary care pathways n Recommend models for service delivery, such as home care and residential care, and the use of palliative care teams in hospitals n Develop mechanisms to empower the family and the patient to be actively involved in the care process, emphasizing the importance of family and patient-centered care. RESEARCH n Develop national research priorities for the field of pain relief and palliative care that target gaps in treatment, knowledge transfer, education, and policy n Recommend research methods to address the gaps in information related to pain relief and palliative care PUBLIC POLICY n Develop strategies to ensure the availability, accessibility, and prescription rights of opiates n Recommend strategies that will ensure the practice of interdisciplinary palliative care teams in the care process n Recommend appropriate legislation for the regulation of pain relief and palliative care for adults and children n Recommend models for cost allocation and reimbursement for pain relief and palliative care services n Recommend the institution of pain relief and palliative care as integral parts of the health-care system

Ministry of Health with Dr. Huda Abu-Saad Huijer, president of the Lebanese Society for the Study of Pain, and Dr. Michel Daher, president of the Lebanese Cancer Society, as vice presidents. Multidisciplinary subcommittees will address the four areas of the task force’s mandate. Initial reports of these groups were presented at the task force launch in October 2012. The LSSP Council and membership continue to be actively involved in this effort, and many LSSP members serve on these committees; Dr. Huijer chairs the committee on research. It is important to note that the Ministry of Health, based on the recommendations of the task force, has approved a new opiate list for Lebanon. More work is currently being done on prescription rights and accessibility issues. A special issue on pain relief and palliative care based on the reports of the subcommittees was published in Human Health in July 2012. And a special issue of the Lebanese Medical Journal dedicated to pain relief and palliative care is due to be published in 2013.

Dr. Huda Abu-Saad Huijer is president of the Lebanese Society for the Study of Pain.


How Much Pain Is Too Much Pain? By Hilary Mantel



JULY 2013


learned early in my life that a pain is almost never just

because of its association with old soaks and “rich liv-

a pain. The ripples spread from the nervous system

ing.” But there it was, quickly recognized, quickly dealt

into the sufferer’s whole life. If you stub your toe or

with. Within a few weeks, I was established on allopurinol

burn your finger, it hurts but it’s quickly over. Anything

and largely free from attacks. I was amazed and grateful.

more complicated—and especially the kind of pain that

Usually, when I‘ve had a pain, a doctor has told me that I

is recurring or chronic—has an impact on the patient’s

hadn’t really got it, and/or that I’d just have to put up with

personality and relationship with the world. Pain does not

it, and that anyway it wasn’t as bad as I thought.

happen in a laboratory. It happens to an individual, and

Gout is, of course, recognizable in a straightforward

there is a cultural context that informs the individual’s

way. It’s also, and I say this ruefully, largely a man’s disease.

experience. What a pain is, and whether it matters, is not

It trails some cultural baggage, and it involves some

just a medical question.

shame, but it doesn’t raise the same issues as those pains

I have suffered from three painful conditions: gout,

distinctive to women, which are to do with forbidden parts

migraine, and endometriosis. The way I’ve experienced

of the body. And no one would say to a patient with gout,

them, and the way they’ve been dealt with, says a good

“Perhaps you have a low pain threshold.”

deal about medical practice and how society deals with sick people.

The esteemed English writer chronicles her challenges with pain — and those of the doctors who treated her — as well as her efforts to cope with intractable, confounding questions.


ain cannot easily be divided from the emotions surrounding it. Apprehension sharpens it, hopelessness intensifies it, loneliness protracts it by making hours

seem like days. The worst pain is unexplained pain. Gout is explicable and it’s visible; the hot and throbbing joint illustrates the inner pathology. It’s not frightening, like a pain in the body cavity. It’s a pain you have, not a pain you are. But one thing interests me, and I’ve never seen it mentioned in the patients’ handbooks I’ve read. In the cartoons, the earl sits with his swaddled gouty foot raised on a stool; his teeth are clenched, and lines of stress strike out from his coronet. The gout sufferer feels intensely vulnerable. If a pet or a small child comes within a room’s distance, he is sure he is about to be trampled. The sufferer is in a state of high alertness and of anger looking for a cause. What strikes me is that (in my case anyway) anger


out is a comedy ailment to those who haven’t got it,

comes before the pain: a wash of strong, predictive, irra-

but to those who have it’s a source of dread. It struck,

tional emotion that I don’t feel at any other time. Luckily,

memorably, on my 55th birthday, the attack start-

it dissipates with the attack; and anyway, you won’t find

ing in textbook fashion in the small hours, when I woke up and had the impression I had somehow sprained my

gout sufferers fighting in the streets.

This was recognizably gout as I knew it from cartoonists.


The young doctor I saw the next day bounced down to ex-

our crusty old family doctor, who also ministered to the

amine my foot with an athleticism that illustrated every bit

nuns at my convent school and would have been horrified

of the difference between her and me. “I think it’s...gout?”

if a young girl had mentioned anything below her waist.

ankle while lying in bed. I didn’t know what it was. It hurt intensely for some hours but cleared by evening. The next attack, a few weeks later, struck at the joint of my big toe.

The hesitation came, I think, because she wondered if I’d say, “Gout? Me? Never!” It is a stigmatizing illness

JULY 2013

y experience with endometriosis has been almost lifelong. I can never forget the pain and distress of my first menstrual period. I suffered badly through

my teenage years but dared not broach the matter with

Menstruation was not something young girls thought they could discuss with each other. In those years, the late


sixties, we were caught up in a cultural shift. A few years

of involvement through my pelvis. It led to the loss of my

earlier, a schoolgirl like me would have been “off games”

womb and ovaries. I was told that I was cured. This was

for a week every month. But the new idea was that, since

not the case. I now know that endometriosis is not so

menstruation wasn’t an illness, you should carry on as if

easily eradicated. It’s not enough to remove what’s eas-

it wasn’t happening. For most young women it’s a good

ily seen. It needs a specialist surgeon with time and skill.

enough approach, but it was hard on me. I lost confidence

When, two years later, I was in pain again, I had to re-

even in my own pain; I thought I wasn’t tough enough. My

peat the whole sorry saga. I couldn’t have that pain, I was

mother would not have let me see a doctor alone, and as

told. I’d had surgery, hadn’t I? Didn’t I know that endome-

she had never been troubled in that way, the whole matter

triosis doesn’t grow back? In fact, my intestines were badly

seemed trivial to her. Regrettably, in my long career with this

affected. In subsequent years, I also had to cope with the

condition, women doctors were no more helpful to me than

knock-on effect of having lost my ovaries. Thyroid failure

the men. Their attitude was, “I’m a woman, so I know; you’re

was predictable, though for years it was denied because

making a fuss about what we all have to endure.”

“the lab tests show your levels are normal.” Never mind

When I was 18 I went on the pill, and my period pain

that I was obese, always cold, and losing my hair and my

eased. And when I began to develop other debilitating

memory. I was normal. It was only by a private consulta-

symptoms—pain in my legs, nausea, fatigue—I didn’t

tion with an endocrinologist that I was able to get out of

associate them with anything gynecological. I began to

this vicious loop.

ask for help when I was 19, but the doctors at my student

But that’s another story. This time I was better in-

health service didn’t really listen. No one suggested I keep

formed, so I was able to cut through the process by which

a chart or record. No one even examined me physically. I

my experience was being denied. I was given drug treatment

was told I was neurotic.

for the endometriosis that remained, but the drugs had


alarming side effects and didn’t work very well. In the mid-

s a young working woman, I sought help from my GP,

eighties, I decided to learn to live with the pain. It helped

though my major complaint now was my continual

me a great deal that around this time a group for sufferers

tiredness, and I appreciate that’s a complaint so vague

had formed, and information became more freely avail-

that it’s hard for any doctor to address. I would get a test

able to the laywoman. I learned the “autogenic technique”

for anemia, but I wasn’t anemic, and at that point I would be written off. I was offered tranquilizers and antidepressants. When I reached 24, I came off the pill. I sensed that the diverse and baffling symptoms had something to do with my cycle, and I wondered if the pill was to blame. In fact, as I understand now, it had retarded the condition. My pain quickly became much worse: the kind of pain that doubles you up and knocks the breath out of you. A new doctor, in another country, offered me help. “My dear,” he said, “you don’t have to suffer like this.” I almost cried. He was the first doctor to speak to me with

Pain cannot easily be divided from the emotions surrounding it. Apprehension sharpens it, hopelessness intensifies it, loneliness protracts it by making hours seem like days.

kindness, not dismissive scorn. He gave me effective pain relief, and for two years I felt better. Of course, what he should have asked is, “Why do you have this pain?” Though he saw I needed help, he assumed it was “normal” pain and that it was enough to alleviate it. I was 27 when I first read about endometriosis and realized I fit the textbook description. But there was scant pleasure in being right, as the subsequent surgery found a wide area



JULY 2013

of relaxation, and that enabled me to contain the pain where it was, instead of letting it tense up my whole body and make everything hurt.


continued in this way, with pain crises of varying severity, until recently. Sometimes in a strange city I

would wonder if I should turn myself

My neurologist’s history-taking was so structured, so searching, so thorough, that I felt that, for the first time, my pain was being listened to. The consultation was, in itself, therapeutic.

in at the nearest A&E [accident and emergency] department. This raises the questions I could never solve: How much pain is too much pain? How do you know when

in my life was not instant, and I have to manage my body

you are in danger? How do you know if your stoicism is ad-

carefully, as I now have a number of different conditions to

mirable or ridiculous? How do you recognize an emergency?

cope with. But I am not afraid any more.

not an empty vessel, filled temporarily with a sensory ex-


perience that can be emptied out like water and leave no

to diagnose, with a dazing variety of presentations. The

trace. Pain changes us. It takes more than a pill to reverse

key, as always, is listening. Then, the giving of informa-

or manage that change.

tion, the sorting out of options because this is a condition

From day to day, I got some relief from over-thecounter remedies. Daily life was hard because the workings of my gut were so unpredictable. You will wonder why I didn’t demand help more urgently. But a person in pain is

I was aware that my condition was exacerbated by

adly, the diagnosis of endometriosis is not much more efficient than it was when I was a teenager. I still hear stories just like mine, though thankfully they

don’t usually end so disastrously. It is a difficult condition

that affects fertility, career and family life, and the obvious

stress, and I knew that if I confessed to this, stress would

solutions to the doctor may not be ones best suited to the

be blamed for everything, and my career success (the only

individual. Then, after diagnosis, after treatment, the suf-

thing I could cling to) would come to look like an aspect

ferer still needs help, both pain management and psycho-

of my pathology. Besides, every visit to every doctor would

logical support. And above all, as in many conditions, a

begin with a lecture about my weight. Since I was often

sufferer needs a way of talking about pain—permission to

unable to eat, and as I’d gained weight in the first place

talk about it—without feeling judged, without the implica-

as a consequence of the drug treatment for endometriosis, I

tion that you lack moral fiber, or are exaggerating, or that

found this unbearable—less bearable than the pain, in truth.

you are in some way rebelling against your femininity.

In the end it was the weight problem that forced a crisis. For six months, I took Reductil under medical guidance. I lost very little weight but gained intractable constipation. In 2010, I saw a surgeon who said I had diverticulitis and needed an operation quickly. Scans failed to show


began to suffer from migraine when I was 18. It came as a “replacement” condition, a substitute for what had dogged my childhood. My family has a complex of allergies. In my

case, allergic rhinitis eased, and migraine began. It seemed

anything unexpected, and the operation was scheduled as

too neat to be coincidence. My mother suffers from mi-

routine, but it turned into an eight-hour marathon as the

graine, but I didn’t at first recognize my complaint as hers. I

surgeon picked apart the adhesions caused by endometri-

thought migraine was a bad headache. I didn’t realize how

osis. It was some years since the disease had been active,

diverse the symptoms can be. I managed it with over-the-

but what was hurting was the damage it had left behind.

counter medication and by paying attention to my life—

The recovery from the operation was complicated and

learning, for example, that fasting and lack of sleep put me

prolonged, but now for the first time since I was a child I

in danger of an attack and eventually learning to feel the

am almost free from abdominal pain. The transformation

warning signs and take avoiding action by resting if I could.

JULY 2013


A few years ago, when the pattern of pain had become more insistent and less easily managed, I was referred to a neurologist. My hour with him stays with me as a shining example of good practice. His history-taking was so structured, so searching, so thorough, that I felt that, for the first time, my pain was being listened to. The consultation was, in itself, therapeutic. At the end of it he offered me three options. I chose to try the simplest, and it worked. So I have about 75 percent success in aborting an attack, and what’s left, I feel I can live with.


owadays, migraine to

If I had a health service to run, I would devote attention and resources to pain management to help patients remain physically and economically active and catch them before they fall into a pattern of chronic suffering— before pain erodes their personality and intellect.

me is less a pathology than a way of liv-

ing a life. Sometimes I feel my head is going to explode,

reassured by the book. Migraine aura is often described in terms of visual disturbances. But those phenomena are usually short-lived and easy to recognize for what they are. More subtle and complex are the disturbances of thinking and feeling: the “daymares” and nightmares, prolonged episodes of déjà vu, the creepy sense of a presence. Once I understood these oddities to be part of the condition, I could cope with them. I have two continuing areas of concern, and they are not personal. One is to do with our understanding and treatment of longterm pain. If I had a health service to run, I would devote attention and resources to pain management to help patients remain physically and economically active and catch them before they fall into a pattern of chronic suffering—before pain erodes their personality and intellect.


y other concern is with the doctors and nurses who have to deal with patients who are in pain. I think

it must be a depressing and unsettling

in the face of an uncontrol-

business, unless you are well-trained and

lable overflow of creativ-

supported. Sometimes medics seem cal-

ity or when I have become

lous, and I often wonder if they are frozen

drawn into a feat of empathy. Then my body will arrange

because they are afraid. People who are suffering often

for me the need to withdraw to a dark and silent place,

have an aura of unapproachability. They are cut off, turned

where my brain will be turned down from boiling point

inward, preoccupied with their inner experience. Pain

to a slow simmer. I realize migraine is part of my inner

requires a kind of concentration, and it’s easy to feel helpless

economy. I am subject to a lengthy and tortuous lead-in

and useless in the face of the patient’s otherness. What heal-

syndrome, an aura that can last for a week before the pain

ers need to do is muster their own resources of personality

manifests. And sometimes, if I am in control of my own

and professional knowledge and address the fear as well as

time and not running on other people’s schedules, the

the pain: to provide reasoned reassurance, information, and

aura will dissolve and the attack is over without a crisis.

above all, hope.

I think the family and friends of sufferers don’t understand how many faces migraine has. They think, “Surely,

Hilary Mary Mantel is an English writer whose work ranges

either you have a headache, or you haven’t.” The notion of

in subject from personal memoir and short story to histori-

a pre-headache is hard to grasp until you’ve experienced

cal fiction and essay. She has twice been awarded the Booker

it. Until I read Oliver Sacks’s book Migraine, I did not real-

Prize, a literary prize awarded each year for the best original

ize how diverse and individual the manifestations of the

full-length novel written in the English language by a citizen

aura could be. For a patient, knowledge is power, and I felt

of the Commonwealth of Nations, Ireland, or Zimbabwe.



JULY 2013



By Ruth Zaslansky, C. Richard Chapman, and Winfried Meissner

A unique tool for improving management of postoperative pain provides clinicians with Web-based feedback on the quality of care and researchers with data to conduct clinical studies.


tudies evaluating management of acute pain continue to show that pain-related patientreported outcomes (PROs) have not improved substantially in recent decades. In industrialized countries, 30 percent to 50 percent of patients report moderate or severe postoperative pain,

even after minor or moderate surgical procedures. In low-resource countries, little is known, and the situation is likely more dire. Despite the general availability of medications and equipment to manage pain after surgery and a growing body of evidence-based knowledge, the situation persists. Some fields of medicine are successfully using audit and feedback techniques to improve the quality of care. Registries collecting longitudinal data are useful tools to provide feedback to care providers. A national, multicenter registry, called QUIPS, was developed in Germany and is being used in 170 hospitals. PAIN OUT is an international acute pain registry, funded by the European Commission’s 7th Framework Programme. Clinicians and scientists from 17 institutions in Europe and Israel developed the program. A salient feature of PAIN OUT is that it incorporates PROs—assessments of the patient’s health that come directly from the patient, without interpretation from health-care providers. These are particularity relevant when assessing conditions related to pain, which require self-report.

JULY 2013


How it works PAIN OUT supports clinicians with Web-based tools to assist in treatment decisions at the point of care. The system for immediate feedback and benchmarking relies on asking patients to fill in the validated International Pain Outcomes (IPO) questionnaire on the first day after

PAIN OUT gives clinicians the opportunity to create national networks, enabling them to meet and discuss findings with colleagues in their own country.

treating postoperative pain. The summaries derive from authoritative sources published during the last decade and are presented in electronic format with hyperlinks to the original citations. Offline analysis allows inquiry into all the variables in the database. This feature is aimed primarily at researchers, as it provides opportunities to plan, design, and conduct epidemiological and clinical

surgery. The questionnaire is available

studies that will contribute to scientific

in 16 languages and is adapted from

knowledge regarding prevention and

the American Pain Society’s Patient Outcomes Questionnaire.

management of pain related to surgery. Hospital admin-

It assesses features such as intensity of pain, interference

istrators can use the data to estimate costs of services,

of pain with activities in and out of bed, side effects related

thereby facilitating rational allocation of resources for pain

to anesthesia and opioid analgesics, and perceptions of care.


Once the data are entered into the Web-based server, clinicians

By the summer of 2012, 50 hospitals from 16 coun-

can receive feedback about the PROs of patients in their ward.

tries had contributed to the database, and 35,000 datasets

They can also compare these outcomes with those of patients

became available for analysis from a variety of surgical dis-

undergoing similar procedures in other wards. User-friendly

ciplines, such as general surgery, orthopedics, obstetrics,

filter functions allow clinicians to analyze outcomes by specific

and gynecology. Now, more than 200 hospitals take part in


PAIN OUT and QUIPS, having together collected almost

In addition, an “Electronic Knowledge Library” provides succinct summaries of recommendations for

300,000 datasets. An interesting feature of the PAIN OUT program is

For total knee replacement, patients at Carlos Haya University Hospital reported the lowest average score for “worst pain since surgery.” (Note, the different ranks do not necessarily indicate that the differences between hospitals are clinically significant.)





JULY 2013

that it gives clinicians the opportunity to create national

Guadalix and his colleagues will analyze types of analge-

networks, enabling them to meet and discuss findings with

sics, doses, and methods of administration and monitor

colleagues in their own country. Margarita Puig, a professor

effects of interventions and changes of daily routine.

in the Department of Anesthesia at Barcelona’s Hospital del

To summarize, PAIN OUT offers standardized, vali-

Mar, created such a network in Spain. The network has been

dated tools to measure and gain feedback on outcome

operational for three years and includes 13 hospitals. Physi-

quality. Clinicians, researchers, and hospital administra-

cians and nurses participate in the network because it offers

tors can all use the information to improve outcomes for

them an opportunity to improve the quality of care in their

patients experiencing pain.

institution and provides a platform for research. Partners of the Spanish network met in March in

Ruth Zaslansky is scientific manager of PAIN OUT at Uni-

Malaga, during the conference of the Spanish Society of

versity Hospital in Jena, Germany. C. Richard Chapman is

Anesthesiology. Dr. Jose Ignacio Guadalix from the Depart-

a professor in anesthesiology at the Pain Research Center at

ment of Anesthesiology at the Carlos Haya University

the University of Utah in Salt Lake City. Winfried Meissner is

Hospital in Malaga presented findings from his hospital.

director of the Palliative Care Department and Pain Clinic

Dr. Guadalix and his team collected data from patients

and coordinates PAIN OUT and QUIPS at University Hos-

undergoing orthopedic or general surgery and used the

pital in Jena, Germany. The research leading to these results

Web-based feedback and benchmark tool to analyze and

received funding from the European Community’s Seventh

compare results from his hospital with similar wards in

Framework Programme.

other hospitals in Spain and abroad. For example, after knee replacement surgery, patients at Carlos Haya University Hospital reported lower pain intensity and pain interference scores compared with patients in 15 other wards. However, for hip replacement surgery, the or-


facilitates rational discussion of strengths and weak-


nesses of care in a specific setting. It avoids discussions

and their institutions are welcome to join the

based on “gut feelings,” thus appealing even to partners

PAIN OUT network for a small fee. For more

who do not give pain management high priority. Ad-

information, please check the project’s website

ditionally, this form of assessment helps identify areas

at www.pain-out.eu.

thopedic department ranked relatively high out of 16 wards, with patients reporting moderate to high scores. The standardized assessment of quality indicators

AIN OUT is a nonprofit academic project that works in collaboration with IASP to improve the quality of clinical pain manage-

ment, education, and research. IASP members

with the greatest need for improvement and allows allocation of limited resources to the right places. Hospitals

IASP’s International Pain Registry and Devel-

with good results share their practices with other sites,

oping Countries working groups are soliciting

thereby promoting “learning from the best.”

proposals for five grants for up to $1,300 within

What’s next Dr. Guadalix says PAIN OUT enabled his hospital not only to assess deficits, such as occurred after hip surgery, but also to identify excellent quality, as was the case after knee surgery. He reports that the results motivated staff to implement additional improvements and concludes that

its Pain Management Improvement Program. The purpose of the program is to test the feasibility of using feedback and benchmarking for the purpose of improving management of postoperative pain in hospitals in low-resources countries. For more information, visit the grants section of the IASP website.

the PAIN OUT database provides reliable data about quality indicators of pain management. In the next phase, Dr.

JULY 2013


The Story BEHIND THE GRANT A n IASP Collaborative Research Grant enabled Dr.

validated the tool against objective measures of peripheral

Catherine Cherry to join Dr. Peter Kamerman

nerve pathology and function, and trained staff at several

in Johannesburg, South Africa, for two weeks in

international sites (including Dr. Kamerman and one of

January. The only physician on the project team,

his staff members) in its use.

Dr. Cherry trained local investigators to screen

HIV patients for the presence of neuropathy. She

The visit included a quality-assurance session to confirm

that previously trained nonmedical staff members continue

also undertook quality-assurance activities with personnel

to administer the ACTG BPNS correctly. Other staff members

previously trained in these procedures, visited the facilities

who will assess patients in the new study underwent training

where study recruitment occurred, met with local clini-

in the use of the ACTG BPNS, and the doctors confirmed that

cians, and taught a course in epidemiology and statistics

all staff obtained consistent results when administering the

to staff and students at the University of Witwatersrand.

tool to individuals with a range of peripheral nerve function.

The Chris Hani Baragwanath (CHB) Hospital is an

Dr. Cherry also oversaw the inclusion of an additional test in

enormous (approximately 3,200-bed) public hospital in

this study—the use of a standardized examination of lower

Soweto that houses the extremely busy Nthabiseng HIV/

limb pin-prick sensation—and supervised training of all

AIDS Clinic. Drs. Cherry and Kamerman met with the

study staff members in this new protocol.

physician who heads the clinic to discuss logistical details of the study and confirm his support for enrolling patients. They also spent time in the Greenhouse Pharmacy, where

Training in epidemiology and statistics

study assessments will occur, meeting staff and ensuring

Dr. Cherry presented a series of workshops on epidemiol-

that study rooms are available and appropriately set up

ogy and statistics, including training in the use of Stata

for the patient consent and assessment process. The time

(version 12), a statistical package available to University

Dr. Cherry spent at the hospital provided valuable insights

of Witwatersrand staff and students that few in the Brain

into conducting research in a resource-poor environment.

Function Research Group (BFRG) are experienced in using. Topics ranged from basic statistics and epidemiology to more advanced discussions of clinical epidemiology

Guiding nonclinicians in HIV-neuropathy assessments

and statistical analyses, including receiver operating char-

Assessment of patients in the study will include a clinical

by an enthusiastic group of staff and students of the BFRG

assessment for the presence of HIV-associated sensory

as well as others from the university’s School of Physiology.

neuropathy (HIV-SN) using the AIDS Clinical Trials Group

acteristic analysis and fundamentals of logistic and linear regression modeling. These workshops were well attended

Dr. Cherry gained professional as well as recreational

Brief Peripheral Neuropathy Screen (ACTG BPNS). The

benefits during her visit. She presented a seminar, “HIV-

ACTG BPNS was specifically designed for use by nonclini-

Associated Neuropathy: The First 30 Years and Beyond,”

cians following some training. Dr. Cherry has used it in pa-

taught workshops, and worked individually with several

tient assessments in all her HIV-SN epidemiology studies,

BFRG personnel. She also assisted Ph.D. candidates with



JULY 2013

Dr. Catherine Cherry teaches a class at the University of Witwatersrand in South Africa. Far right: Three members of the Neuropathy Study Team: Prinisha Pillay, Florence Mtsweni, Antonia Wadley

data analyses, discussed project design and feasibility issues, and became acquainted with others involved in the broad range of projects within the BFRG. She believes these new relationships will foster helpful discussions and collaborations in the future.

IASP Collaborative Research Grant for Developed or Developing Countries

Thanks to the wonderful hospitality of her local hosts, Dr. Cherry also was privileged to spend time seeing some beautiful parts of South Africa. She spent one weekend on

IASP annually awards two grants of up to

a private conservation farm belonging to the family of a

US$15,000 to encourage and support

BFRG staff member in the Waterburg, a mountain plateau

collaborative, multidisciplinary research

area north of Johannesburg that is known for its biodiversity. She also was able to join a site visit by senior BFRG researchers to the Karoo area of the Eastern Cape to view some of their work with animals. The trip to this spectacular region gave her more opportunities to see native South

between two or more laboratories working on the same topic in developed or developing countries. In 2012, the topic of

African fauna at close quarters and provided valuable

one collaborative grant was “Incidence of

discussion time with Dr. Kamerman regarding ongoing and

and Risk Factors for Developing

future collaborative work. Overall, this trip was a valuable opportunity for Dr. Cherry to visit South Africa to get to know her colleagues

HIV-Associated Sensory Neuropathy (HIV-SN) in the Post-Stavudine Era.”

at the University of Witwatersrand and to view the clinical facilities where patients are recruited. Her visit enabled South African staff to receive formal training in assessing HIV patients for neuropathy using the ACTG BPNS and a

Granted to: Dr. Catherine Cherry

standardized assessment of pin-prick sensation. It also al-

Infectious Diseases Unit, the Alfred Hospital,

lowed confirmation that staff who had previously received

Centre for Biomedical Research, Burnet

opportunistic training would continue to administer the

Institute and Monash University, Australia

ACTG BPNS correctly. The collaboration supported through this grant formed part of a successful application to the South African Medical Research Council for funds to cover the costs over the next three years of the HIV-neuropathy study that is about to commence in Johannesburg. Dr. Kamerman and Dr.

Dr. Peter Kamerman Brain Function Research Group, University of Witwatersrand, Johannesburg, South Africa

Cherry thank IASP for funding this trip and look forward to presenting results from the study at future IASP meetings.

JULY 2013



Join a SIG to Network With Peers and Stay Current in Your Field


s IASP membership grows and the knowledge base in pain research and patient care expands, clinicians and researchers need ways to discuss highly specific issues in depth. A Special Interest Group (SIG) provides opportunities for IASP members to focus discussions in their special areas of interest and to share their knowledge and

expertise with their peers worldwide. IASP members recently have established several new SIGs, bringing the total to 20. The new Clinical Trials SIG aims to promote understanding of analgesic clinical trial design, share and disseminate new knowledge about clinical trial design, evaluate and discuss training initiatives, and foster innovation in the clinical trial process, among other goals.

Formed in 2011, the SIG on Cancer Pain now has nearly 400 members. It seeks to advance cancer pain research by creating networks, organizing courses, and disseminating information in developed and developing countries worldwide. With nearly 250 members in three dozen countries, the SIG on Neuromodulation is involved in such exciting projects as creating Web-based training and educational videos on neuromodulatory techniques in pain management,

assembling an online database and library, conducting an international survey of clinical practices, developing a proposal for a satellite symposium of the 15th World Congress on Pain, and many other activities. And the Pain Education SIG, formed in 2010, aims to promote strategies to address the inadequacy of pain education in various disciplines and countries.

For more information or to join a SIG, visit www.iasppain.org.

Here’s a list of the IASP SIGs: o Abdominal and Pelvic Pain

o Pain and Movement

o Acute Pain

o Pain and Pain Management in Non-Human Species

o Cancer Pain o Clinical-Legal Issues in Pain o Clinical Trials o Genetics and Pain o Musculoskeletal Pain

o Pain Related to Torture, Organized Violence, and War o Placebo

o Pain Education

o Sex, Gender, and Pain

o Pain in Childhood

o Sympathetic Nervous System (PSNS)

o Pain in Older Persons

o Systematic Reviews in Pain Relief

o Neuromodulation o Neuropathic Pain o Orofacial Pain



JULY 2013



In Pain Management, the Patient Matters Most Pain medicine has become so dominated by finance, managerialism, and politics that we’re neglecting patients’real interests. By Peter Wemyss-Gorman


he June meeting of the British Pain Society’s SIG on Philosophy and Ethics, titled “Changing the Culture of Pain Medicine,” explored how the loss of an ethic of care affects pain management. Several sessions challenged participants to consider possible remedies for this situation. Our distinguished speaker, Dr. John D. Loeser, professor of neurological surgery and anesthesiology at the University of Washington, spoke mainly from an American perspective but maintained that the same problems in varying proportion existed worldwide regardless of the scope of the country’s health-care system. He described the situation in the United States, where at least ten pain societies exist, each with its own agenda and each representing the interests of the practitioners of a particular intervention. These bodies are often in conflict with one another and issue contradictory guidelines. In the UK, an acrimonious dispute within the British Pain Society over guidelines for back pain management led to the resignation of the president. Loeser said he doubted whether

JULY 2013

The British Pain Society’s SIG on Philosophy and Ethics met at Launde Abbey in Leicestershire in June.

a single unifying medical culture exists any longer; rather, it appears that this has given way to chaos in which everyone has different viewpoints and approaches to patient care. In many cases, the patient receives only the perspective and treatment of the doctor he happens to consult rather than what he or she actually needs. Moreover, he noted, in the United States distribution of pain management and medicine is largely dictated by what insurance providers will pay for rather than by individual patient needs. In the UK, we are in danger of going down the same road, as the pressures of trying to run the National Health Service as a profit-making business threaten to undermine the professional integrity of doctors. Loeser identified two particularly deplorable situations in the United States. One is the impending demise of multidisciplinary management of chronic pain in the face of routine resort to intervention. This often occurs with little or no attempt to assess

patients’ real needs, as if chronic pain were a purely medical problem and psychological and social factors of no account. The second challenge concerns the huge rise in prescriptions of opiate analgesics. At best, such treatment in many cases is inappropriate, and at worst is dangerous, with many reported deaths. But the basic problem, Loeser said, is the failure of doctors to recognize and deal with suffering in their preoccupation with treating pain. Education is key to establishing a proper understanding of the nature of chronic pain (and its differences from acute pain) and its appropriate management. The latter should be the responsibility of primary care physicians, rather than specialists in one type of intervention. Health professionals, not insurance providers or managers and politicians, must once again be in charge of medical planning and decision making. We need to recognize the social dimension of chronic pain and poverty as its major



Dr. John D. Loeser addressed the demise of multidisciplinary management of chronic pain.

Origins of the British Pain Society’s Philosophy and Ethics SIG

T cause—and that health care alone will not solve the problem. Above all, the focus of the provider must be on the care of the patient. The conference also addressed other topics such as the nature of compassion, which demands practical action as well as empathy, and the imperative to restore compassion to its proper place as the chief motivator of health professionals. Participants discussed the importance of values-based medical education and the challenges of relieving pain and suffering in countries with limited medical resources. One session explored the potential of social media for education. We acknowledged that the task of changing the culture of pain medicine faces almost insurmountable obstacles, but we remain encouraged by the words of Margaret Mead: “Never doubt that a small group of thoughtful, committed citizens can change the world. Indeed, it is the only thing that ever has.” We recognize that progress will be slow and incremental but trust that many members of IASP will share our vision and want to join us in advancing it.

he idea for the Philosophy and Ethics SIG originated in 1999 at the IASP 9th World Congress on Pain in Vienna. At that meeting, the drug industry bombarded us with the message that no effort or expense should ever be spared in the battle to defeat pain. Yet there seemed to be relatively little relevance to the everyday realities of dealing with distressed human beings in the pain clinic. Some attendees thought it might be useful to arrange a meeting to reflect on what we were trying and realistically expecting to achieve as well as how to accept and cope with our relative impotence in the face of so much unrelieved pain. So in summer 2001, a group of doctors, nurses, psychologists, and others working with people in pain met to tackle these issues. This meeting was intended as a “one off,” but the need for a forum for further discussion became immediately apparent. The result was a series of annual gatherings. In recognition of the importance of this activity, the core group was recognized in 2004 as a Special Interest Group of the British Pain Society. In addition to tackling unconventional subject matter, these meetings have been unusual in the amount of time dedicated to discussion, and our speakers have certainly stimulated debate. The venues—retreat centers in the Yorkshire Dales, Leicestershire, and the Lake District—are in areas of famed natural beauty and provide an atmosphere particularly conducive to contemplation and reflection as well as the physical and spiritual recreation so needed by people wearied by their daily work with human pain and distress. The SIG’s discussions have been recorded and the transcriptions published as booklets, which are available by contacting Peter Gorman (pwgorman@btinternet.com.). A book of essays by previous speakers, Pain, Suffering and Healing, Insights and Understandings, was published by Radcliffe in 2011. For more information about this SIG and its meetings, contact Sarah Dixon (sarah@sarahdixon.com). Information about the group, future activities, and downloads of previous transcripts are available on the British Pain Society website, www.britishpainsociety.org.

Peter Wemyss-Gorman is a retired consultant in anesthesiology and pain medicine.



JULY 2013


IASP HQ Hosts Open House in Washington, D.C.

After many months of planning and preparation, IASP welcomed members of the executive committee, Futures Task Force, and all those involved in the planning, design, and construction of the new office headquarters to an open house on April 19, 2013. All of those involved in the process were thrilled to tour the new office space. Photos and artwork of IASP members from around the world, as well as posters of every World Congress, adorn the office. IASP President Fernando Cervero, Past President Eija Kalso, and Executive Director Kathy Kreiter toasted the occasion during a ribbon-cutting ceremony that officially welcomed all past, current, and future IASP members.

Visit IASP headquarters at 1510 H Street, N.W., Suite 600, Washington, D.C. 20005. We are just steps from the White House.

JULY 2013



Many people with chronic pain avoid activities that they fear may result in harm. T provides a guide to the treatment of pain-related fear based on the principles of e International experts provide practical advice on assessment, treatment goals, an exposure behavioral experiments that may be easily applied in routine clinical pra

“This is the definitive handbook on fear avoidance. It is essential readin all clinicians and researchers in the field and will serve as an excellent for students learning how to apply exposure-based treatments for chron pain. A tremendously valuable contribution!”

Warren Nielson, PhD, St. Joseph’s Health Care, London, ON, Ca

“This book is an indispensable tool for clinicians and researchers intere in how pain-related fear affects pain and disability. It is loaded with practical tips on how to assess and treat pain-related fear. The authors have played a key role in the development and testing of both assessm and treatment approaches.” Francis Keefe, PhD, Duke University, Durham, NC,

Stephen Morley, MPhil, PhD, is a professor in Clinical Psychology Institute of He Sciences, University of Leeds, and Department of Clinical Health Psychology, St J University Hospital, Leeds, United Kingdom.

Johan Vlaeyen, PhD, is a professor in Research Group Health Psychology, Facu Psychology and Educational Sciences, University of Leuven, Belgium; Departmen Psychological Science, Faculty of Psychology and Neuroscience, Maastricht Univ Netherlands

Steven J. Linton, PhD, is a professor in the Center for Health and Medical Psych Örebrö University, Örebrö, Sweden

Katja Boersma, PhD, is a lecturer in the Center for Health and Medical Psycholo University, Örebrö, Sweden

Jeroen de Jong, PhD, is a researcher at the Department of Rehabilitation, Maas University Hospital, Maastricht, The Netherlands

ISBN 978-0-931092-87-9


9 780931 092879

International Association for the Study of Pain

IASP Takes the World Congress on Pain to Latin America for the First Time

ers and clinicians in many scientific disciplines.

oin your colleagues at the 15th World Congress on Pain in Buenos Aires, Argentina, on October 6-11, 2014. This is the first World Congress to meet in Latin America, and it reflects the international makeup of our membership. Conveniently located in the heart of Buenos Aires, La Rural Convention Center has an impressive array of venues to serve delegates. It will provide an excellent forum to meet industry representatives as well as research-




As the cultural and economic center of Argentina, Buenos Aires

plays a vital role in Argentine culture, and Congress delegates can choose among many tango bars in the city. In addition to its exciting attrac-

will captivate delegates. The country

tions, Buenos Aires is an emerging

incorporates Spanish, Italian, British,

global market in science and re-

German, and French influences in

search. Anchored by Argentina’s top

its environment and cuisine. Del-

universities, Buenos Aires has seen

egates will encounter Victorian and

growth in bioscience, engineering,

cosmopolitan architecture surround-

and technology in both the private

ing beautiful parks, restaurants, and

and public sectors.

shops that blend a European perspec-

IasP scientific Program Committee

Each Congress year, the Scientific Program Committee of the International Association for the Study of Pain creates, under the direction of its Chair, a benchmark publication of articles by noted experts. This collects in one place the most current information on many key topics about the study and management of pain throughout the world.

In 2012, Irene Tracey, the Director of Oxford Centre for Functional Magnetic Resonance Imaging of the Brain (FMRIB) Centre and Nuffield Professor of Anaesthetic Science at the University of Oxford has brought together many of the foremost authorities on pain to write about the latest thinking in their specific fields.

As always, the World Congress on

While not intended to be comprehensive, PAIN 2012 collects the presentations that these experts will give at the refresher courses that precede the biannual World Congress on Pain in Milan, Italy, in August 2012. The International Association for the Study of Pain is publishing all of these articles in one book for use at the refresher courses themselves, as well as for medical,pain researchers and clinicians everywhere who are unable to come to the Congress.

tive with the modern sensibilities of

Pain will include workshops spon-

Latin America. Local food is famous

sored by IASP Special Interest Groups

for its quality and quantity (espe-

(SIGs). In addition, two refresher

cially beef), and as Argentina is the

courses will be taught in Spanish, a

world’s fifth-largest producer of wine,

first for a World Congress.

popular varieties of Malbec, Syrah,

Copies are available for purchase from the IASP Bookstore online at the IASP website: http://www.iasp-pain.org, through an email to IASPdesk@iasp-pain.org, or by telephone to +1-206-283-0311.

ISBN 978-0-931092-93-0


9 780931 092930

International Association for the Study of Pain

We hope to see all of you in Bue-

Tempranillo, and Cabernet Sauvignon

nos Aires October 6-11, 2014! Please

are widely available. Buenos Aires also

visit www.iasp-pain.org/BuenosAires

gave birth to the tango! The dance

for up-to-date information.

JULY 2013

The Latest Word on Pain Pain Comorbidities Understanding and Treating the Complex Patient D














































































The occurrence of multiple, concomitant medical conditions is very common and is becoming increasingly more frequent as the population ages. Pain Comorbidities provides a contemporary understanding of the nature, modalities of diagnosis, and treatment of complex clinical situations involving multiple concurrent diseases and their influence on the experience of pain. Important attention is paid to therapeutic aspects of the comorbid patient, ranging from the role of the multidisciplinary pain clinic and of pharmacological treatment—with particular emphasis on antidepressants—to the role of physical training and rehabilitation and of a psychological management approach. Price: US$85.00 (IASP Members: US$70.00)

Pain-Related Fear: Exposure-Based Treatment of Chronic Pain by Johan Vlaeyen, Stephen Morley, Steven J. Linton, Katja Boersma, and Jeroen de Jong. ISBN 978-0-03109287-9, paper.

Many people with chronic pain avoid activities that they fear may result in harm. This book provides a guide to the treatment of pain-related fear based on the principles of exposure. International experts provide practical advice on assessment, treatment goals, and graded- exposure behavioral experiments that may be easily applied in routine clinical practice. This is the definitive handbook on fear avoidance. Price: US$75.00 (IASP Members: US$60)

Maria Adele Giamberardino, MD, and Troels Staehelin Jensen, MD, PhD Editors

This book exposure. nd gradedactice.

Vlaeyen Morley Linton Boersma de Jong

ng for text

Pain-Related FeaR Exposure-based Treatment of Chronic Pain




ealth James’

ulty of nt of Clinical versity, The


ogy, Örebrö


Pain-Related FeaR



by Johan Vlaeyen, Stephen Morley, Steven J. Linton, Katja Boersma, and Jeroen de Jong

The enon Phenom of

Pain by Serge Marc

Irene tracey, Editor


Pain Comorbidities: Understanding and Treating the Complex Patient edited by Maria Adele Giamberardino and Troels Staehelin Jensen. ISBN: 978-0-93109292-3, paper.


The Phenomenon of Pain by Serge Marchand. ISBN 978-0-93109291-6, paper.

Pain 2012

RefResheR CouRses 14th World Congress on Pain

Pain 2012 RefResheR CouRses

Pain 2012: Refresher Courses, 14th World Congress on Pain edited by Irene Tracey. ISBN 978-0-93109293-0, paper.

Irene tracey, Editor

The Phenomenon of Pain clearly describes the physiological and psychological mechanisms involved in the development and persistence of pain. Serge Marchand provides practical details on treatment methods, outlining pharmacological as well as nonpharmacological options and presenting a case for an interdisciplinary approach. This adaptation of the original French version helps the reader understand the various factors surrounding the complex phenomenon of pain. Price: US$70.00 (IASP Members: $55.00)

An informative collection of articles by noted experts that gathers in one place current information about the study and management of pain throughout the world. Edited by Irene Tracey, Pain 2012 brings together the presentations that these experts will give at the refresher courses that precede the biennial World Congress on Pain in Milan, Italy, in August 2012. These articles are published in one book for use at the refresher courses, as well as for medical researchers and clinicians who want an overview of contemporary pain research and management. Price: US$40.00

InternatIonal assoCIatIon for the study of PaIn

IASP Press® JULY 2013

To order your books, go to the IASP Bookstore on the IASP website at www.iasppain.org/books. See the website for more information, or contact the International Association for the Study of Pain at books@iasp-pain.org or +1-202-524-5300.

International Association for the Study of Pain®



La Rural

Buenos Aires Argentina October 6-11, 2014 1 5 t h W o r l d C o n g r e s s o n P a i n速





JULY 2013