Symposia Session #3 Friday May 20th 2pm- 3:30pm ET. 


Pain Inequities and Disparities: The Importance of Intersectionality

Kate Nicholson, JD, National Pain Advocacy Center
Understanding What’s Lacking from Public Health Policy On Pain: Applying An Intersectional Lens and
Including Diverse Patient Perspectives
Tamara Baker, PhD, School of Medicine at the University of Carolina at Chapel Hill in the Department of Psychiatry
What Intersectionality Means for Equitable Access to Clinical Care
Monica Mallampalli, PhD, MSc, Healthy Women
Strategies for Addressing Intersectionality and Inclusivity in Pain Research
Samina Ali, MCDM, FRCP(PEM), Faculty of Medicine & Dentistry at the University of Alberta, Edmonton University of Alberta, 
Edmonton; Stollery Children's Hospital and the Women and Children's Health Research Institute
The Global and Intersectional Burden of Pain in Children

Session Description: 

Inequities and disparities in pain experience, treatment, and research are well acknowledged in such public health initiatives as the Institute of Medicine’s, Relieving Pain in America, the National Pain Strategy, and the Interagency Pain Management Best Practices Task Force Report. 

Yet too often the discussion is siloed, focusing on distinct populations, while failing to conceive the problem as an intersectional one. Intersectionality is important because people are not just Black or Indigenous, male or female, children or older persons, disabled or Veterans. Those at the intersection of multiple identities too often fall through the cracks in research, translational research, and clinical care.

In the first talk, Kate Nicholson, JD, a pain patient and health policy attorney, will provide an overview of the national policies and introduce the concept of intersectionality, underscoring the importance of considering populations not typically centered in conversations about equity and disparities. Her talk will be, “Understanding What’s Lacking from Public Health Policy On Pain: Applying An Intersectional Lens and Including Diverse Patient Perspectives.” She will serve as moderator.

Next, Tamara Baker, PhD, an expert on d pain in older persons, racial disparities, and designing equitable clinical programs will present, “What Intersectionality Means for Equitable Access to Clinical Care.” Tamara will address common themes that apply to care across the spectrum of marginalized patients. 

Monica Mallampalli, PhD, MSc, a scientist and health policy expert, will then turn to the topic of research, using the case study of sex and gender as it applies to other intersecting identities with the talk, “Strategies for Addressing Intersectionality and Inclusivity in Pain Research.” Monica will focus on including diverse perspectives in research design. 

To complete the range of perspectives, ideally, a fourth panelist, Samina Ali, MCDM, FRCP(PEM), who is an expert in pediatric pain, will address the “Global and Intersectional Burden of Pain in Children,” and discuss how our perceptions of age, disability, and gender inform pain research and care in children.  

If we are allowed four panelists, each will speak for 15 minutes. Otherwise, panelists will talk for 20 minutes, leaving 30 minutes for robust discussion with the audience using Q and A and polling.



When pain becomes toxic: The experience of a life with pain as a unique source of intolerable stress.  


Sarah Nelson, PhD, Boston Childrens Hospital and Harvard Medical School
The history and application of toxic stress across the lifespan
Melanie Noel, PhD, University of Calgary, Alberta Children’s Hospital Research Institute, Hotchkiss Brain Institute
The (re)conceptualization of pain as a toxic stressor: Applications and avenues for future research and practice
Laura Simons, PhD, Stanford University School of Medicine
Neurobiological correlates of stress and pain: What we know to-date
Keith Meldrum, AScT, RTMgr 



 An abundance of research has found acutely stressful experiences (adverse childhood experiences [ACEs]; e.g., abuse, neglect, etc.) to be common in chronic pain populations. However, in clinical settings many individuals report the experience of pain as a source of significant ongoing stress in and of itself relating to a variety of individual and ecological factors. Outside of pain, toxic stress has been proposed to be “the most threatening kind of stressful experience” with prolonged activation of the body’s stress response in the absence of adequate coping. Longitudinal studies show that the impact of toxic stress can be lifelong with both physical and psychological consequences.  However, no study to-date has examined the experience of chronic pain as a unique source of toxic stress. This session will build up to and culminate in pain being proposed as a toxic stressor. Presentations will also highlight the important gaps in our understanding relating to the inherent stress associated with living with pain, especially in marginalized groups. Overarching goals of this symposium include broadening the scope of our understanding of pain and related suffering and shifting the lens of ownership surrounding pain-related disability from the individual/patient to the larger system of support and care that can lead to a toxically stressed and undertreated pain state.  

The proposed session is a cohesive symposium with three speakers (SN, MN, LS) presenting for 20 minutes each on related structured and research-based topics. The session will end with a 15-minute presentation on lived experience and patient advocacy in the context of stress and pain (KM) and a 15-minute moderated general discussion (KM). 

The Science of Acupuncture Analgesia: from mechanism to clinic


Dr. Richard E. Harris, University of Michigan
Insular Excitatory/Inhibitory Imbalance Links Chronic Nociplastic Pain with Acupuncture Analgesia
Dr. Vitaly Napadow, Massachusetts General Hospital
Neuroimaging Psychosocial Mechanisms Underlying Acupuncture and the Patient - Clinician Interaction
Dr. Jun Mao, Memorial Sloan Kettering Cancer Center
Evidence-Informed Acupuncture for Pain in Oncology Patients

Session Description:

Acupuncture is a 2000-year-old medical technique that originated in China. By inserting thin needles into the body at specific anatomical locations, improvements in a range of symptoms, especially painful conditions, have been reported empirically and by many meta-analyses of clinical trials, including thousands and even tens of thousands of patients.  However, the therapeutic value of acupuncture for pain management is fraught with controversy, largely due to difficulty to dissociate specific effects of acupuncture needling techniques from non-specific therapeutic effects such as placebo effects and context effects of social interaction. Moreover, there is ambiguity in acupuncture’s effects on both clinical outcomes and physiological mechanisms.  As the United States is combating an opioid crisis and the underlying challenges of pain management, acupuncture has emerged as a potential non-pharmacological option.  Better understanding of how and whether acupuncture works for pain relief is even more critical as we consider the possibility of its broader usage for pain management.  

This session will bring together three experienced researchers: Dr. Richard E. Harris, Dr. Vitaly Napadow, and Dr. Jun Mao all experts in the interface of pain and acupuncture research.  They will present new research findings and discuss these findings in regard to implementation challenges for acupuncture treatment of chronic pain.  Dr. Richard E. Harris is a Professor in the Department of Anesthesiology at the University of Michigan and has had key contributions to the neurobiology of chronic nociplastic pain and its response to acupuncture.  In his talk he will highlight the excitatory/inhibitory imbalance in brain neurotransmitters in nociplastic pain and their role in acupuncture analgesia.  Dr. Vitaly Napadow is a prolific acupuncture neuroimaging researcher and Director of Pain Research at Spaulding Rehabilitation Hospital.  His talk will explore the neurobiology of the patient – practitioner interaction in acupuncture analgesia and the role of the central nervous system.  Dr. Jun Mao is the Chief of the Integrative Medicine Service at the Memorial Sloan Kettering Cancer Center and has published influential clinical trials of acupuncture for cancer pain.  His presentation will focus on the efficacy of acupuncture in clinical cancer pain populations and clinical acupuncture research more broadly. This symposium will contain broad content: encompassing the basic neurobiological underpinnings of pain in regard to its response to acupuncture, as well as evidence assessing acupuncture efficacy in the clinical setting.

Translational approaches to categorizing chronic pelvic pain syndromes


Dr. Rui Li, Seattle Children's Research Institute
Phenotypic evidence from a female adult pelvic pain clinic
Dr. Christine Sieberg, Boston Children's Hospital
Endometriosis associated pain in adolescents and young adults: Time for increased rigor
Dr. Julie Christianson, University of Kansas Medical Center
Assessing the translatability of a mouse model of chronic urogenital hypersensitivity


Session Description: 

Chronic pelvic pain (CPP) is estimated to impact 1 in 7 women in the United States and between 30-90% of adolescent females report dysmenorrhea, which negatively impacts daily activities and quality of life. A myriad of etiologies contributes to CPP and a better understanding of these underlying mechanisms, and how they relate to patient-specific measures, can improve treatment options, which currently do not provide widespread or adequate relief. Here, members of the Abdominal and Pelvic Pain Special Interest Group will present data describing phenotypic, diagnostic, and mechanistic characterizations of CPP disorders, in both clinical and preclinical studies. 

Dr. Li will present work from an interdisciplinary gynecological pain clinic that utilizes phenotyping approaches to classify female CPP disorders. The constellation of symptoms from multiple organ systems presents unique challenge for clinical evaluation and treatment of CPP. Deep phenotyping provides a holistic view of patient profiles and is well-positioned to inform etiologic, mechanistic, and interventional research. This presentation will describe two empirically derived CPP profiles that typify distinct pain mechanisms and reflect patients’ social history and health care utilization.

Endometriosis, a debilitating disease affecting millions of women, costs the United States approximately $78 billion annually in pain-related disability, and is the leading cause of CPP. Substantial gaps exist in our understanding of this disease in adolescent and young adult women. Dr. Sieberg will present results on several of her grant-funded projects utilizing innovative methods, including quantitative sensory testing (QST), behavioral measures, as well as resting state and evoked (offset analgesia) neuroimaging techniques (functional magnetic resonance imaging (fMRI) and functional near-infrared spectroscopy (fNIRS)) to elucidate the biobehavioral and neural mechanisms contributing to endometriosis-associated pain in adolescents. 

Dr. Christianson will present work from her laboratory on a mouse model of early life stress that develops chronic urogenital hypersensitivity in adulthood. Early life stress exposure in clinical populations impacts hippocampal development, resulting in structural and functional deficits, that contribute to chronic pain and mood disorders. Here, evidence of reduced hippocampal gene expression, neurogenesis, gray matter volume, and neurochemical response to acute stress exposure, in mice exposed to neonatal maternal separation will be discussed, as well as the impact of diet and exercise on these outcomes. 

Discussion between the panelists, and with audience members, will tie together these clinical and preclinical findings to discover common mechanisms and outcomes that cluster among women with CPP in order to identify specific potential targets for therapeutic intervention. 

Spinal coding of somatosensation 


Bo Duan, PhD, Assistant Professor, University of Michigan
       Peripheral and central mechanisms for mechanical itch 
Tayler Sheahan, PhD, University of Pittsburgh
       Cellular basis of spinal kappa opioid receptor inhibition of itch and pain 
Martyn Goulding, PhD, Salk Institute for Biological Studies
      Genetic approaches to mapping the spinal circuitry for pain and itch 
Mark Hoon, PhD, NIH, 
      Spinal cord circuits required for suppression of pain by cold 

Session Description: 

It is poorly understood how distinct somatosensory  inputs like pain, itch, temperature, and touch are uniquely coded within the spinal cord. The  speakers in this session will share how the application of cutting-edge molecular, genetic, and  imaging approaches have begun to reveal the cells and circuits within the spinal cord that underlie  somatosensation under normal and pathological conditions. Moreover, the symposium will  highlight spinal circuits underlying intriguing phenomena whereby somatosensory modalities gate  one another (e.g., cold suppression of pain). Lastly, the speakers in this symposium are a strong  group of basic scientists at different career stages. 

Format & Audience Engagement: Four 15-minute presentations, each followed by 5 minutes of  questions. The remaining 10 minutes of the workshop will be an open-floor discussion between  the panel members and the audience on matters arising from the preceding talks, with particular  emphasis on how modality specificity may be integrated at the spinal level.