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Canadian Pain Society Conference May 12 – 15, 2010, Calgary, Alberta Canadian Pain Society Conference May 12 – 15, 2010, Calgary, Alberta WEDNESDAY MAY 12, 2010 1C BREAKTHROUGH IN TREATING BREAKTHROUGH CANCER PAIN – A NEW THERAPEUTIC OPTION 5:15 PM – SYMPOSIUM Neil Hagen, MD 1 Head, Cancer Pain and Symptom Control Clinic, Tom Baker Cancer BREAKING BARRIERS IN BREAKTHROUGH CANCER PAIN Centre, Professor and Head, Division of Palliative Medicine, University of Calgary, Calgary, Alberta Chair: Neil Hagen Speakers: Neil Hagen, MD; Dr Dwight Moulin, MD; Dr Bruno Gagnon, MD PAIN EDUCATION DAY Neil Hagen, MD, Head, Cancer Pain and Symptom Control Clinic, THURSDAY MAY 13, 2010 Tom Baker Cancer Centre, Professor and Head, Division of Palliative Medicine, University of Calgary, Calgary, Alberta; Dwight Moulin, MD, Professor, Departments of Clinical Neurosciences/Oncology, 9:15 AM – KEYNOTE SPEAKER Earl Russell Chair Pain Research, University of Western Ontario; Medical Director of Pain and Symptom Management, London 2 Regional Cancer Program, Head of the Division of Neurology, PHENOMICS OF PAIN IN HUMANS AND RODENT MODELS Victoria Campus, London Health Sciences Centre, London, Ontario; Chair: Michael McGillion Bruno Gagnon, MD, Assistant Professor, Department of Medicine, Speaker: Ze’ev Seltzer Clinical Scientist, Division of Clinical Epidemiology, McGill Ze’ev Seltzer, Professor of Genetics, Faculty of Dentistry, Professor University, Montreal, Quebec of Physiology, Faculty of Medicine (X-appt), University of Toronto Centre for the Study of Pain; University of Toronto Centre for Learning Objectives: International Health (Dalla Lana School of Public Health); Toronto 1. Review the pathophysiology and characteristics of breakthrough cancer pain, its Rehabilitation Institute, Toronto, Ontario prevalence and its distinction from baseline pain. 2. Discuss the current management of breakthrough cancer pain in Canada, its Learning Objectives: strengths and its limitations. 1. Attendants will learn that the Human Genome Project has the capacity to revolu- 3. List attributes of a new class of drugs - rapid onset opioids - and outline how tionize pain medicine in our lifetime, if sufficiently supported. This presentation will they are used in clinical practice. highlight the potential gains that pain patients may expect in the post genomic era. BRIEF DESCRIPTION: Breakthrough cancer pain is phenomenologi- 2. Attendants will learn that without appropriately collected pain phenotypes – this cally distinct from persistent chronic cancer pain, and requires different costly operation may fail. This stresses the need for a rigorous study on pain phe- management strategies. While baseline cancer pain is typically fairly nomics. Moreover, a consensus must be reached soon about the phenotyping tools steady, breakthrough cancer pain is commonly sudden in onset, typically that interested research groups should use in order to facilitate replications, com- reaching peak intensity after about 3 minutes. Episodes of breakthrough parisons and meta-analysis. cancer pain can be predictable, but in approximately 80% of patients, 3. Attendants will be acquainted with suggested phenomic guidelines, tools and data breakthrough pain occurs unpredictably. (1) Physicians treating cancer collection strategies for genetic dissection of neuropathic pain in human and rodent patients need to undertake a proper assessment of pain in order to ensure models. appropriate pain management. Results from one survey suggested that only BRIEF DESCRIPTION: The vast majority of the reported studies on pain 25% of patients with breakthrough pain are satisfied with pain control genetics used “having/not having chronic pain” or “pain intensity (using compared to 78% of patients without breakthrough pain. (1) Difficulties in VAS or NRS)” as the only phenotypes used in the genetic association analy- identifying breakthrough pain, and the availability of new emerging ther- sis. While patients would certainly appreciate having pharmacogenomically apy justify the need for attention to gaps in current diagnosis and treat- based novel treatments that could diminish the intensity of their pain, chronic ment, and implementation of measures to reduce these gaps. pain, however, is a much more complex experience than the intensity of the REFERENCES pain. Patients complain about many other sensory discriminative aspects of 1. Portenoy RK, Payne D, Jacobsen P. Breakthrough pain: characteristics the pain that bother them and that they wish their doctor could treat, such and impact in patients with cancer pain. Pain. 1999;81(1-2):129-134. as the frequency and duration of pain episodes, the area where the pain is felt. Likewise, patients would appreciate if some medicine would prevent the 1A pain from appearing spontaneously or following a natural stimulus, and pre- PATHOPHYSIOLOGY AND CHARACTERISTICS OF venting pain induced or aggravated by movement, sympathetic arousal, sleep BREAKTHROUGH CANCER PAIN deprivation, and certain moods. Furthermore, if a painkiller could affect the Dwight Moulin, MD quality of the pain by substituting the unbearable quality they have, say, ter- Departments of Clinical Neurosciences/Oncology, University of rible electrical shocks paroxysms, by another bearable quality, that alone Western Ontario; Medical Director of Pain and Symptom might be appreciated no less than affecting the intensity alone. So, limiting Management, London Regional Cancer Program; Medical Director the genetic association to intensity alone – misses much on the treatment of Pain and Symptom Management, London Regional Cancer potential genetics could bring to pain medicine, by addressing patients’ Program, Head of the Division of Neurology, Victoria Campus, needs in the emotive/aversive and cognitive/evaluative aspects of the pain London Health Sciences Centre, London, Ontario that affect functionality, participation, and quality of life. Pain phenomics is the research field that asks what the pain phenotypes for genetic association 1B should be. While this research field has not been born as of yet, investigators MANAGING BREAKTHROUGH CANCER PAIN – CURRENT comprising multi-center groups invest years and financial resources to collect PRACTICE, GAPS IN TREATMENT MANAGEMENT a sufficiently powered cohort for a genetic study, followed by years on geno- Bruno Gagnon, MD typing and analysis, without a comprehensive phenotypic coverage of the Assistant Professor, Department of Medicine, Clinical Scientist, syndrome under study. The presentation by Dr. Seltzer will address this prob- Division of Clinical Epidemiology, McGill University, Montreal, lem, and offer phenomic guidelines, tools and data collection strategies for Quebec genetic dissection of neuropathic pain in human and rodent models. Pain Res Manage Vol 15 No 2 March/April 2010 ©2010 Pulsus Group Inc. All rights reserved 73 Abstracts 11:00 AM – PLENARY responses. Finally, the issue of disease-driven brain plasticity versus pre-ex- isting vulnerabilities related to personality traits such as pain catastrophiz- 3 ing and neuroticism in IBS will be discussed in light of new structural imaging data. CONTRIBUTIONS OF THE CNS TO FUNCTIONAL PAIN SYNDROMES 3B Chair: Petra Schweinhardt PSYCHOBIOLOGICAL ASPECTS OF CHRONIC PAIN IN Speakers: Karen D Davis, PhD; Herta Flor, PhD; Petra Schweinhardt, CHILDREN MD, PhD Herta Flor, PhD Karen D Davis, PhD, Toronto Western Research Institute, University Central Institute of Mental Health and University of Heidelberg Health Network, Toronto, Ontario; Herta Flor, PhD, Central Institute BRIEF DESCRIPTION: Psychobiological approaches to the understand- of Mental Health and University of Heidelberg; Petra Schweinhardt, ing of pain emphasize that the development of recurrent pain involves MD, PhD, McGill University, Montreal, Quebec activity-induced alterations in pain sensitivity and related central nervous WORKSHOP OBJECTIVE: Chronic pain syndromes that are not primar- system changes and is promoted by hypervigilance to pain as well as mal- ily nociceptive or neuropathic in nature, i.e. for which no clear underlying adaptive cognitions such as catastrophizing. In a series of studies, we have cause can be found, affect a large proportion of chronic pain patients. investigated changes in pain sensitivity using quantitative sensory testing Different classification systems refer to such chronic pain syndromes with entailing two pain modalities and two testing sites (thenar, pain site) as well unclear origin as “functional”, “somatoform”, or “psychological”. Functional as electroencephalographic measures or functional magnetic resonance pain syndromes affect a variety of different body parts and organs, such as the imaging. In children with recurrent migraine and abdominal pain we have gastrointestinal track (irritable bowel syndrome), the urinary tract (intersti- observed changes in pain sensitivity, which were rather specific for the type tial cystitis) or the musculoskeletal system (fibromyalgia). In recent years, of pain the children and adolescents were experiencing. Children with neuroscientific research has made important progress in the conceptualiza- migraine showed thermal and mechanical hyperalgesia. By contrast, there tion and understanding of functional pain syndromes. Through the use of was no evidence for altered somatic pain sensitivity in children with recur- brain imaging methods, such as Positron Emission Tomography (PET) and rent abdominal pain. In light of previous reports, this suggests that children Magnetic Resonance Imaging (MRI), substantial evidence for CNS altera-
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