Symposia Session #2 Friday May 20th 10:00am- 11:30am ET

 

Rita Allen Award in Pain Scholars Panel 

Andrew J. Shepherd (2020)
The University of Texas, MD Anderson Cancer Center
Neuro-immune Interactions in Pain Associated with Cancer and Chemotherapy

Peter Grace (2019)
University of Texas MD Anderson Cancer Center
Antibody Receptor Signaling via Astrocytes: A New Pathway for Neuropathic Pain
In conjunction with the Open Philanthropy Project

Sarah Linnstaedt (2020)
University of North Carolina at Chapel Hill
FKBP51 Inhibition to Prevent Chronic Pain Following Traumatic Stress
In conjunction with the Open Philanthropy Project

Jordan McCall (2019)
Washington University in St. Louis
Using Persistent Homology to Model and Predict Spontaneous Pain Behavior
In conjunction with the Open Philanthropy Project



Risk and Resilience Factors Predicting Adaptation to the COVID-19 Pandemic in Individuals with Chronic Pain Across the Lifespan 

Speakers:

Emily Law PhD, University of Washington School of Medicine & Seattle Children's Research Institute
Adaptation to the COVID-19 pandemic among adolescents and young adults with chronic Pain:
A mixed methods approach
Gabrielle Pagé PhD, Université de Montréal
Between stress and resilience: Understanding the heterogeneous impacts of the COVID-19 pandemic on
individuals living with various chronic pain conditions
Chung Jung Mun (“Moon”) PhD, Arizona State University & Johns Hopkins School of Medicine
One-year trajectories and individual differences in pain, emotional distress, and prescription opioid misuse
among adults with chronic pain during the COVID-19 pandemic

 

Session Description:

Growing evidence indicates the COVID-19 pandemic is negatively impacting mental health for many people, with epidemiologic studies showing increasing prevalence of anxiety, depression, insomnia, and substance use in the general population. However, less is known about condition-specific impact for individuals with chronic pain, including impact on the experience of pain and disability. Emerging data are mostly from cross-sectional studies which suggest similar negative impacts on mental health, but equivocal effects on pain. This session will address gaps in understanding by sharing data from six novel longitudinal studies (presented by Drs. Law, Pagé and Mun) examining adaptation to the pandemic among individuals with chronic pain across the lifespan. Risk and resilience factors predicting trajectories of mental health and pain symptoms will be examined. In an interactive Q&A session (moderated by Dr. Palermo), future directions for clinical care and research will be discussed.

Dr. Law will present two longitudinal studies examining adaptation to the pandemic among treatment-seeking adolescents and young adults with chronic pain from the U.S. Results showed that clinically elevated and persistent anxiety, depression, and insomnia symptoms were common, while pain interference remained relatively stable. Using mixed linear modeling, minority ethnicity and pandemic-related economic stress were identified as risk factors for poor outcomes. Qualitative data revealed both perceived benefits and harms of the pandemic on pain. Clinical and research implications for adolescents and young adults with chronic pain will be discussed. 

Dr. Pagé will present data from three Canadian studies. First, a pan-Canadian online study aimed to measure the impact of the pandemic on pain, treatment access, stress and psychological distress during the first two waves. Second, a longitudinal study on a cohort of individuals with chronic pain aimed to identify pre-pandemic psychological factors associated with pain deterioration during the pandemic. Finally, a longitudinal study of back pain aimed to explore the role of stress and its biological markers on the evolution of pain and psychological distress during the pandemic. 

Dr. Mun will present data from a large (N=1,453) online sample of adults with chronic pain in the U.S. who were assessed three times across one year (04/2021 – 05/2022). This study investigated the impact of the COVID-19 pandemic on the trajectories of pain severity and interference, emotional distress (i.e., anxiety and depressive symptoms), and opioid misuse behaviors across one year. Potential moderating effects of socio-demographic factors and individual differences in pain catastrophizing, pain acceptance, and sleep disturbance on outcome trajectories are also examined. 

 

Innovations in the Prevention of Chronic Post-surgical Pain in

Children and Adolescents

Speakers:

Jennifer Rabbitts, MD, University of Washington, Seattle Children’s Hospital 
SurgeryPal: an mHealth cognitive-behavioral intervention to prevent transition from acute to chronic
postsurgical pain in adolescents
Melanie Noel, PhD, RPsych, University of Calgary, Alberta Children’s Hospital Research Institute, 
Reframe the pain: Examination of a novel parent-led intervention to reframe children’s memories of
post-surgical pain to be more accurate and positive
Jennifer Stinson, RN-EC PhD, Hospital for Sick Children
iCanCope with Post-operative Pain (iCanCope Postop): Development and evaluation of a smartphone-based pain
self-management program for adolescents following surgery 



Session Description: 

In the United States and Canada thousands of children undergo surgery each year. Despite evidence-based pain management and clinical standards, moderate to severe postoperative pain in children and adolescents is common. Inadequate postoperative pain management contributes to poor health outcomes, increased opioid use, and the development of chronic postsurgical pain. Psychosocial risk factors in adolescents and their parents elevate risk for poor short- and long-term pain outcomes. Successful postoperative pain management requires regular monitoring and treatment of pain after hospital discharge. Moreover, interventions targeting psychosocial risk factors have potential to interrupt a negative trajectory of persistent pain. The current symposium will discuss novel innovations to reduce acute pain and prevent the transition to chronic postoperative pain. Question/Answer: 10 to 15 Minutes

 

Clinical Trials for Pain: Can We be Pragmatic about Non-Pharmacologic Treatments? 

Speakers:

Steven George PT, PhD, FAPTA, Duke University
What Makes a Trial “Pragmatic”?
Julie Fritz PT, PhD, FAPTA, University of Utah
Why a Pragmatic Trial?  
Qilu Yu, PhD, NIH/NCCIH
Challenges for Pragmatic Clinical Trials
Robert Kerns, PhD, Yale University
Opportunities for Pragmatic Clinical Trials

Session Description: 

Clinical trials range on a spectrum from explanatory (i.e. high internal validity and demonstrating  efficacy) to pragmatic (i.e. high external validity and determining effectiveness). Most randomized trials  of pain treatments are explanatory but more recently pragmatic trial designs have been used for testing  effectiveness of pain treatments. This shift provides exciting opportunities for advancing the pain  research field, but only if pragmatic design elements are better understood by researchers, providers,  and patients.  

This session provides a primer on pragmatic trials for non-pharmacologic treatments of pain. The  session will be divided into three different presentations, followed by an interactive session between  the attendees and presenters. Real world examples from ongoing clinical trials will center the presentations. Presenters will provide perspectives from physical therapy, health services research,  medical sociology, and biostatistics.  

The total presentation time will not exceed 60 minutes and will be followed by a 30 minute moderated  question and answer session. Audience engagement will be through traditional methods (Q&A),  facilitated by the moderator by using audience response polling options (if traditional methods are slow  and there are polling options available at the site).  

 

The impact of stigma and discrimination on pain experiences across the lifespan


Speakers:
 
Hailey Bulls, PhD, University of Pittsburgh
Stigma, the opioid crisis, and cancer pain management: Intersecting challenges
Burel Goodin, PhD, The Alabama at Birmingham
Stigma and discrimination: implications for pain-relevant psychological and physiological processes
Emily Wakefield, PhD, Connecticut Children's Medical Center/University of Connecticut School of Medicine
“Oh, only old people can get that”: Stigma in adolescent chronic pain
 

Session Description:

Stigma and discrimination are widely recognized as fundamental contributors to public health inequities. Pain and opioid-related stigmas present a mechanism by which ineffective and inequitable pain care persists. In this symposium, we will leverage the Health Stigma and Discrimination Framework (Stangl et al 2019) to conceptualize contributors to and consequences of stigma for patients with pain. 

This symposium will provide an overview of the ways in which patients of various ages and pain etiologies experience stigma and discrimination, emphasizing similarities and potential mechanisms for change. Dr. Bulls will discuss the ways in which stigma and discrimination exacerbate existing challenges in cancer pain management across the cancer continuum (from active, advanced disease to survivorship) in older adults. Dr. Goodin will present novel data demonstrating the extent to which stigma and discrimination are related to pain-relevant psychological and physiological (i.e., biomarkers) profiles in children and older adults with chronic pain. Dr. Wakefield will present the experience of stigma unique to adolescent chronic pain populations and its impact on health outcomes and access to support.

Presenters will provide specific recommendations based on their work for about 20-25 minutes each, including research, policy, and potential intervention targets to guide the future of pain and opioid stigma research. For the remaining 20-30 minutes, audience members will be invited to consider barriers and facilitators to system-wide efforts to eliminate stigma and discrimination in pain care through an interactive discussion with the expert panel, and share their proposed solutions with the symposium attendees. 

Justification for inclusion in the 2022 meeting: Biological and psychological variables are well-studied in the biopsychosocial model of pain, while social and interpersonal factors are less often recognized. However, eliminating stigma is critical for moving effective pain care forward. Given gaps in the literature, a discussion of patient experiences, communities, healthcare systems, policies, and the media is instrumental in ensuring that patients with pain are able to move forward, together.