Topical Sessions

Please click below for session outlines and confirmed speakers - 
Topical Sessions 1 - Monday 16 March 2015, 1.30 pm - 3.00 pm

Topical Sessions 2 - Monday 16 March 2015, 3.30 pm - 5.00 pm

Topical Sessions 3 - Wednesday 18 March 2015, 1.30 pm - 3.30 pm

Topical Sessions 1 - Monday 16 March 2015
1.30 pm – 3.00 pm

1A Neuromodulation – Multidisciplinary assessment and patient selection  

Chair: Amal Helou, Pain Management Centre, Royal Prince Alfred Hospital, Sydney, NSW 

Do we have the numbers, is there scientific evidence contributing to patient selection?  Making decisions about who, when and what to implant can be a challenge. Psychological evaluation and patient education are key factors to successful implantation of SCS.

This is a practical session looking at the decision making process in patient selection for Spinal cord stimulation. Patient education and preparation including selection of the most appropriate technologies to use will be discussed. Patient follow-up and measurement – “What has been effective?”, "What have been the lessons learned both positive and negative?" This will also include pitfalls for the new implanter.

Presenters:
Dr Timothy Deer, Saint Francis Hospital, West Virginia
Dr Michael Jennings, Royal Prince Alfred Hospital, NSW
Dr John Ditton, recently retired from Royal Prince Alfred Hospital, NSW
Dr Richard Sullivan, Precision Brain, Spine and Pain Clinic, VIC 

1B Chronic pain and Indigenous Australians – Beginning the journey

Chair: Dr Tim Semple, Pain Management Unit, Royal Adelaide Hospital, SA

Indigenous Australians experience chronic pain to at least the same extent as non-Indigenous Australians but are under-represented both in the access to multidisciplinary pain services and in the health science literature to allow evidence-informed culturally-appropriate approaches to management. This session will provide insights across the spectrum of research, provision of education to remote community providers and application of pain management programs in the urban setting for Indigenous Australians.

Professor Alex Brown will utilise his academic experience from the Baker Institute and in researching the interplay of chronic conditions and quality of life to provide guidance in working with Indigenous health organisations to achieve successful research outcomes. Dr Tim Semple will describe the experience of application of the “Essential Pain Management” teaching program for Aboriginal health practitioners in Central Australia and explore future options to improve the knowledge and understanding of pain management in rural and remote Australia. Emma Campbell and Tabinda Basit from the Institute for Urban Indigenous Health have implemented the first pain management program “PainHeroes” specifically for urban Aboriginal and Torres Strait Islander people and will provide outcomes, insights and guidance from their innovative work.

Presenters:
Professor Alex Brown, Leader, Aboriginal Research Unit, South Australian Health and Medical Research Institute Professor of Population Health/Research Chair Aboriginal Health School of Population Health, University of South Australia, SA
Emma Campbell, Work it Out Program - Institute for Urban Indigenous Health, QLD
Tabinda Basit, Work it Out Program - Institute for Urban Indigenous Health, QLD
Dr Tim Semple, Pain Management Unit, Royal Adelaide Hospital, SA

1C Inflammatory cytokines and pain – Effects, mechanisms and potential role in persistence of pain

Chair: Professor Michele Sterling, CONROD, Griffith University, QLD

There is considerable evidence about the role of inflammatory mediators in neuropathic pain with emerging evidence also implicating a role of inflammatory mediators in common musculoskeletal conditions such as back and neck pain. This topical session will cover recent advances in understanding the role of cytokines in neuropathic and musculoskeletal pain both at the periphery as well as interactions in the CNS, and the potential for this knowledge to provide novel treatment approaches. The speakers will describe evidence from both preclinical experiments and from studies in patients.

Dr Paul Austin will present his findings from rats with chronic constriction injury, a common model of neuropathic pain. He will focus on the expression of immune cells and cytokines at multiple levels of the neuraxis, and their involvement in both sensory and affective symptoms of neuropathic pain.

Professor Paul Hodges will present data from recent human and animal studies that highlight the potential role of cytokines in the transition from acute to chronic back pain and the contribution of cytokines to structural changes in spinal muscles following spine injury

Professor Michele Sterling will present recent data on the potential role of inflammatory mediators in the development of chronic pain, muscle changes and central nervous system responses following whiplash injury. 

Presenters:
Dr Paul Austin, Discipline of Anatomy & Histology, School of Medicine, University of Sydney, NSW
Professor Paul Hodges, CCRE:Spine, The University of Queensland, QLD
Professor Michele Sterling, CONROD, Griffith University, QLD

1D Pain: Communicating? 

Chair: Dr Frank New, PainLang, Royal Brisbane and Women's Hospital, Professor Tess Cramond Multidisciplinary Pain Centre, QLD

Pain presents special challenges to communication. A highly subjective experience needs to be communicated to health care professionals in different contexts. Diagnostic tools for acute pain are often difficult to interpret and apply, and chronic pain presents uniquely complex challenges. In both types of pain a wide range of variables can affect communication between patients and health care professionals: culture, language, age, educational level, religion and value systems, stereotypes, power dynamics, and much more.

This topical session will present an overview of the key issues affecting communication about pain. The four participants have been working in this domain with a focus on the PainLang group at the University of Queensland (www.uq.edu.au/painlang). The participants cover the range from research to social work to professional practice. They will address issues from the current literature on pain and pain language, pain practice in diagnosis and treatment, understanding pain and supporting those in pain, the pain patient's perspective, and the social, psychological and interpersonal variables like those listed above which relate to the effectiveness of communication between professionals and patients. 

Presenters:
Professor Jenny Strong, PainLang, School of Health and Rehabilitation Sciences, University of Queensland, QLD
Professor Roland Sussex, PainLang, School of Languages & Comparative Cultural Studies, University of Queensland, QLD
Dr Mandy Nielsen, PainLang, School of Health and Rehabilitation Sciences, University of Queensland, QLD

1E A "how to guide" for human pain genetic studies

Chair: Associate Professor Mark Hutchinson, University of Adelaide, SA

Persistent pain is the sum of an initiating disease and individual contributing factors, such as genotype and environment. These unique individual combinations of mechanisms create the distinct persistent pain phenotype seen in each patient. Genetics is a quantifiable factor in this variability. As such, genetics is increasingly being examined to identify risk factors and measures to improve treatment outcome.

Clinical pain genetics presents an exciting and under-utilised approach in Australian pain research. However, this fast paced, technology driven research area can appear daunting. Moreover, given the increasing need for large multi-centre samples the initial reaction might be to put this research into the too-hard basket. This topical workshop will provide a walk through of the basics of conducting a clinical genetics study so as to understand what it takes a clinician (hospital or private practice) to contribute to such research.

First, we will cover the latest concepts in pain genetics, using examples from drug clearance to response. Secondly, key aspects of a clinical genetics study will be outlined and explained, including ethics, sample collection and processing. Finally, the future opportunities and challenges that face pain medicine with the knowledge (or lack there of) that genetics bring will be discussed.

Presenters:
Dr Daniel Barratt, University of Adelaide, SA
Dr Janet Coller, University of Adelaide, SA
Associate Professor Mark Hutchinson, University of Adelaide, SA

1F Protective responses in pain: The role of threat, associative learning, and perception

Chair: Dr Tasha Stanton, University of South Australia, SA

Learning to predict danger is critical to human existence; it assists us to both anticipate and avoid harm. Perhaps unsurprisingly then, people in pain are often very protective of their painful body part – they limit movement and avoid activities that are perceived as being threatening or that may be pain-provoking. This topical symposium will discuss the role of protective responses in pain, specifically how initially adaptive responses may become mal-adaptive in chronic pain.

Dr Ann Meulders will discuss new evidence that suggests that benign sensory input, such as movement, may become a predictor of pain through simple associative mechanisms.

Daniel Harvie will provide novel evidence suggesting that the influence of learned predictors of pain on behavioural and perceptual responses can be experimentally manipulated – confirming their critical role in protective responses.

Dr Tasha Stanton will discuss exciting findings from chronic back pain that suggest that the perception of threat may extend beyond pain and also create and/or modulate other symptoms such as stiffness.

Presenters:
Dr Ann Meulders, University of Leuven, Belgium
Daniel Harvie, The University of South Australia, SA
Dr Tasha Stanton, The University of South Australia and Neuroscience Research Australia, SA

Topical Sessions 2 - Monday 16 March 2015 
3.30 pm – 5.00 pm 

2A  Interventional management of pain as part of contemporary multidisciplinary care

Chair: Dr Richard Sullivan, Precision Brain, Spine and Pain Centre, VIC

Interventional pain management has been an established part of caring for patients with chronic pain for decades.  This session explores the way interventional therapies can integrate to support a broader, multidisciplinary approach to pain management.  Topics covered will include the role of interventions in multidisciplinary care, the timing of interventions to maximise outcomes for patients and the functional rehabilitation of patients post intervention using wearable sensor technology.

Presenters:
Dr Leo Kapural, Chronic Pain Center, Wake Forest University Health Sciences, USA, North Carolina
Dr Marc Russo, Hunter Pain Clinic, NSW
Mr Andrew Ronchi, CEO DorsaVi, USA 

2B Self-management, self-managing or self-determination: What makes a successful pain management program?

Chair: Professor Julia Fleming, Professor Tess Cramond Multidisciplinary Pain Centre, Royal Brisbane & Women's Hospital, QLD

After analysis of the historic outpatient-based pain management program revealed little sustained benefit, a revised outpatient pain management program (LIFE) was developed and introduced at Professor Tess Cramond Multidisciplinary Pain Centre in mid-2012.  Analysis of this LIFE program is demonstrating very high attendance and completion rates, sustained benefits after 12 months, and praise from participants.  Representatives from the multidisciplinary team, together with consumer advocacy group Australian Pain Management Association Inc (APMA), and the Population and Social Health Research Programme, Griffith Health Institute, will explore factors that have led to success of this LIFE program.
Carolyn Ehrlich will discuss key aspects of the LIFE program that promote sustained change in the context of the self-management, self-managing and self-determination theories and whether these success factors could be utilised in other chronic disease management. 
Linda Atkinson and Nicole Andrews will highlight the work done to develop an evidence-based curriculum, promote motivation and commitment of potential participants, and to maintain gains achieved.
Paul Murdoch will describe what consumers want before and after a pain program, and examine the APMA pain support group model using these theories, in relation to empowering consumers and reducing distress and loss of functioning capacity accompanying long-term pain.

Presenters:
Dr Carolyn Ehrlich, Centre of National Research on Disability and Rehabilitation (CONROD), Griffith University, QLD
Linda Atkinson, Professor Tess Cramond Multidisciplinary Pain Centre, Royal Brisbane & Women's Hospital, QLD
Nicole Andrews, Professor Tess Cramond Multidisciplinary Pain Centre, Royal Brisbane & Women's Hospital, QLD
Paul Murdoch, Vice-President, Australian Pain Management Association Inc (APMA), QLD

2C The brain in chronic orofacial pain: The importance of psychological variables and how neuroimaging can advance the field

Chair: Dr Sylvia Gustin, School of Psychology, University of New South Wales and Neuroscience Research Australia, NSW

This session will discuss psychological factors associated with chronic pain, with a focus on orofacial pain conditions. In addition, new evidence from neuroimaging studies will be presented which will highlight how neuroimaging can help inform psychological research in chronic pain.

This session will begin with Dr Toby Newton-John, who will present a comparison of psychological factors associated with Burning Mouth Syndrome and Temporomandibular Joint Disorders (TMD).

Dr Sylvia Gustin will discuss the differences of TMD and painful trigeminal neuropathy (PTN) subjects in affective-motivational, cognitive-evaluative and social factors, as well as personality traits. She will also discuss how brain imaging can enlighten psychological research in chronic orofacial pain by presenting state and trait brain imaging studies.

Dr Sophie Wilcox will discuss the role of affective-motivation factors in both adult and pediatric migraineurs, and what functional neuroimaging imaging can tell us about emotional processing in migraine.

Finally, Professor Herta Flor will present a general perspective about psychological factors, chronic pain and brain imaging. She will overview how neuroimaging can enrich psychological research in chronic pain.

Presenters:
Dr Toby Newton-John, Graduate School of Health, UTS, NSW
Dr Sylvia Gustin, Neuroscience Research Australia, NSW
Dr Sophie Wilcox, Harvard Medical School Boston Children’s Hospital, USA
Professor Herta Flor, University of Heidelberg, Department of Cognitive and Clinical Neuroscience, Central Institute of Mental Health, Germany

2D Pharmacogenetic testing in the pain clinic: Translating research into clinical practice - How far are we?

Chair: Associate Professor Carolyn Arnold, Caulfield Pain Management & Research Centre, Alfred Health, VIC

Pharmacogenomics is an emerging field that creates hope that prescribed doses of analgesics and adjuvant pain medications can be individualised for more effective responses. Correlating gene expression or single nucleotide polymorphisms (SNPS) with a drug's efficacy or toxicity, aims to optimize drug therapy and safety. Current review of the scientific literature suggests there is limited research guiding translation into practice, and that genetic factors are not operating in isolation from environmental, physiological, and psychological influences.

Opioid and antidepressant pharmacogenetic testing has become available in Australia through private pathology services, but is not reimbursed under Medicare. In the Pain Clinic we are starting to see patients who are either requesting testing or bringing results with recommendations for their treatments.

Based around a case study of chronic pain, poor medication responses and a pharmacogenomic test result for opioids, and antidepressants the presenters will explore the current state of knowledge of clinical pharmacogenomics for pain management, from the perspective of patients, clinicians in pain medicine and perioperative medicine, from clinical pharmacology and research. Participants are encouraged to contribute their own clinical scenarios for discussion with researchers.

Presenters:
Associate Professor Carolyn Arnold, Caulfield Pain Management & Research Centre, Alfred Health, VIC
Professor Andrew Somogyi, Discipline of Pharmacology, Faculty of Health Sciences, University of Adelaide, SA
Dr Chris Bain, Anaesthesia & Perioperative Medicine, Alfred Health and Monash University, VIC 

2E A safe body and a safe mind: How best to meet the needs of survivors of torture and trauma experiencing pain?

Chair: Mr Lester Jones, La Trobe University, VIC

This session will present cross-disciplinary management of pain experienced by survivors of torture and trauma. A brief overview of the challenges for those from refugee backgrounds and research that has linked pain, depression and post-traumatic stress disorder, will set the scene.

Dr Joanne Gardiner will present from her experience as a counsellor in the Refugee Mental Health Clinic Victorian Foundation of Survivors of Torture and as a General Practitioner and Refugee Health Fellow. This will include comment on the meaning of pain and the role and relevance of natural therapies in conjunction with her practice with this client group.

Melanie Block, Refugee Team Leader at CoHealth, will present on the importance of a shared understanding of pain and its impact on survivors of torture, and the role of interdisciplinary teams in providing a flexible service response. Her presentation will draw on an ongoing project that is developing an effective interdisciplinary approach to the assessment and management of pain.

Diana Truong, a physiotherapist, will present an innovative tool that she has devised for use in refugee health contexts. She will provide the rationale for the interactive tool and demonstrate how it can be applied to individuals or groups experiencing persistent pain.

Presenters:
Dr Joanne Gardiner, Royal Melbourne Hospital; Victorian Foundation of Survivors of Torture, VIC
Melanie Block, CoHealth Footscray (formerly Western Region Health Centre), VIC
Diana Truong, Western Hospital, VIC

2F Mix and match: Innovations in meetings the needs of people with pain

Chair: Associate Professor Kathryn Nicholson Perry, Australian College of Applied Psychology, NSW

The combination of high demand for and low supply of pain services is a continuing challenge in Australia, and never more so than in people with less common pain problems such as those with chronic pain related to spinal cord injury (SCI). Two related innovative projects in NSW have sought to address these challenges using a model of care combining online, face-to-face and telehealth delivery methods across public and private sector providers. A specially modified online cognitive behavioural pain management program and pain management website provide people with the opportunity to educate themselves about SCI pain as well as learn specific evidence-based pain management strategies. A combination of face-to-face assessment and initial treatment planning with telehealth follow up is also available for those requiring individual assessment and treatment. The ability to combine elements of these approaches together in flexible ways for different individuals is a key feature. The session will outline challenges faced in providing effective services to people with SCI chronic pain, the different approaches and how they may be combined effectively, as well as identifying opportunities for generalising the approach to meet the needs of other groups affected by pain.

Presenters:
Professor Philip Siddall, Greenwich Hospital, NSW
Lyndall Katte, Agency for Clinical Innovation, NSW
Dr Blake Dear, Macquarie University, NSW

Topical Sessions 3 - Wednesday 18 March 2015
1.30 pm – 3.00 pm

3A Cognitive, motivational and emotional aspects of pain

Chair: Dr Frank New, University of Queensland, QLD

It has been widely recognised that psychosocial factors are very often more important determinants of chronic pain and pain-related disability than any demonstrable organic abnormalities. This is also true for factors that predispose to pain chronicity following injury. This session will deal with the psychosocial determinants of pain persistence and resultant disability, including work incapacity.

Presenters:
Dr Frank New, University of Queensland, QLD
Dr Stephanie Oak, John Hunter Hospital, NSW
Dr Kym Boon, Multidisciplinary Pain Centre, Royal Brisbane and Women's Hospital, QLD

3B Sensorimotor changes from acute to chronic musculoskeletal (knee) pain

Chair: Dr Kylie Tucker, University of Queensland, QLD

One in five Australians is affected by osteoarthritis and other musculoskeletal conditions. Sensorimotor adaptations are widespread in musculoskeletal pain conditions. These adaptations range from obvious changes in movement, such as limping with a painful limb, to subtle changes in the way muscle fibres are recruited when executing simple tasks. We will discuss sensorimotor adaptations observed from acute experimental pain to chronic musculoskeletal pain, with a focus on adaptations in the lower limb with anterior knee pain.

Dr Kylie Tucker will provide an overview of changes in muscle recruitment and muscle stress with acute experimental knee pain. The potential for longer-term consequences following non-resolution of adaptations to acute pain will be considered. Associate Professor Kay Crossley will focus on the immediate effects of acute anterior knee pain on motor function, and biomechanical modelling of muscle and joint forces in anterior knee pain conditions. Professor Bill Vicenzino will discuss sensory changes observed in people with acute and chronic anterior knee pain. Dr Natalie Collins will finish the session discussing the effect of foot orthoses on pain and sensorimotor function in people with anterior knee pain, including patellofemoral osteoarthritis.

Presenters:
Dr Kylie Tucker, University of Queensland, QLD
Associate Professor Kay Crossley, The University of Queensland, QLD
Professor Bill Vicenzino, The University of Queensland, QLD
Dr Natalie Collins, University of Queensland, QLD

3C The value of quantitative sensory testing (QST) in the assessment of pain disorders: Developments and perspectives

Chair: Dr Brigitte Tampin, Sir Charles Gairdner Hospital, Neurosurgery Spinal Clinic, WA

Quantitative sensory testing (QST) involves a series of tests that in combination provide a detailed somatosensory profile of a patient. Careful recording of responses from the skin and underlying structures enables reliable quantitative measures of large and small sensory nerve fibre dysfunction, with the additional ability, in contrast to more conventional testing (e.g. nerve conduction studies) to detect both sensory loss and gain.

This workshop will outline the standards for performing QST and its potential utility in research and clinical practice. While the focus of QST in recent years has been on neuropathic pain, the role of QST in the assessment of other pain disorders will also be outlined (somatic and visceral pain). The place of QST within a broader suite of pain neurophysiology testing will be discussed. Adequate time will be allocated to engage in open discussion of the topics raised.

Presenters:
Dr Brigitte Tampin, Sir Charles Gairdner Hospital, Neurosurgery Spinal Clinic, WA
Dr Paul Wrigley, Pain Management Research Institute, Sydney, NSW
Associate Professor Julia Hush, Macquarie University, NSW
Professor Michele Sterling will join the presenters for discussion at the end of the session.

3D Adolescent persistent pain: Smoothing the transition to self-care

Chair: Dr Kathleen Cooke, St Vincent’s Hospital, QLD

The main impetus of pain management programs is to teach individuals the skills of self-management however, for teenagers who are often faced with many challenges and changes by virtue of the adolescent life stage, pain programs promote more than just pain self-management skills. Adolescent pain programs enable teenagers to gain a deeper understanding about themselves – their bodies, their minds and the way they interact with their environments. They gain confidence to transition from the dependency of childhood to the independence of adulthood, reach expected milestones and develop life skills with the understanding that they can be in charge of their pain.

Presenters:
Jules Richards,  Lady Cilento Children's Hospital (LCCH), QLD
Huong Nguyen, St. Vincent’s Hospital QLD
Dr. Reuben Wurm, CYMS, QLD

3E State focused persistent pain initiatives: Update and lessons learned

Chair: Karl Bagraith, Interdisciplinary Persistent Pain Centre, Gold Coast, QLD

Persistent pain affects approximately one in five Australians. In recent years policy makers have acknowledged the need for expanded pain services with the development and implementation of persistent pain plans and strategies with associated funding. The topical session will provide an overview and update on the roll-out and outcomes of large-scale persistent pain network initiatives in Queensland, New South Wales and Western Australia. Discussion will also focus on the challenges and lessons learned from the various approaches taken to the implementation of large-scale persistent pain service initiatives.

Presenters:
Dr Matthew Bryant, North Queensland Persistent Pain Management Service, QLD
Dr Chris Hayes, Hunter Integrated Pain Service, Newcastle, NSW
Professor Stephan Schug, Anaesthesiology, Pharmacology, Pharmacy and Anaesthesiology Unit, School of Medicine and Pharmacology, University of Western Australia & Pain Medicine, Royal Perth Hospital

3F Systemic lignocaine for the management of pain

Chair: Professor Julia Fleming, Professor Tess Cramond Multidisciplinary Pain Centre, Royal Brisbane & Women's Hospital, QLD

The use of systemic lignocaine for neuropathic pain is not new, but despite a Cochrane review suggesting safety and efficacy, numerous questions remain including mechanisms of action, and optimal patient selection, route of administration, duration and dose. These queries continue to hamper protocol development and approval, particularly for ward-based subcutaneous protocols for which there is a paucity of published pharmacokinetic data or evidence of benefit. This seminar will consider:
1. Professor Julie Fleming: Historical overview and unanswered questions about systemic lignocaine for pain management
2. Dr Irina Vetter: Pain and sodium channels: Potential targets for systemic lignocaine and novel toxins.
3. Dr Jeremy Brammer: Systemic lignocaine for chronic neuropathic pain: When? How much? How often? Dr Brammer will present 4y audit data of a technique using a series of daily brief intravenous infusions, in contract to the popular single-infusion technique.
4. Dr Laurence Weinberg: From perioperative trials to safe and effective ward-based lignocaine protocols. Dr Weinberg will include evidence from a multicentre RCT of IV then SC use for radical prostatectomy, and consider broader mechanisms of action. A panel discussion and questions will follow.

Presenters:
Professor Julia Fleming, Professor Tess Cramond Multidisciplinary Pain Centre, Royal Brisbane & Women's Hospital, QLD
Dr Irina Vetter, Institute for Molecular Bioscience, QLD
Dr Jeremy Brammer, Professor Tess Cramond Multidisciplinary Pain Centre, Royal Brisbane and Women's Hospital, QLD
Dr Laurence Weinberg, Department of Anaesthesia, Austin Hospital, VIC