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108 NEUROBIOLOGY OF ADDICTION
Special Lecture II References Goubert L., Craig K.D., Vervoort T., Morley S., Sullivan M.J.L., Williams AC de C., Cano A., & Crombez G. Facing others in pain: the effects of empathy. Pain 2005; 118: 285–288. Goubert L., Eccleston C., Vervoort T., Jordan A., & Crombez G. Parental catastrophizing about their child’s pain. The parent version of the Pain Catastrophizing Scale (PCS-P): A preliminary validation. Pain, In Press.
102 PSYCHOLOGICAL INTERVENTIONS IN THE TREATMENT OF PEDIATRIC CHRONIC PAIN C. Herman ° . Dept. of Neuropsychology & Clinical Psychology, Ruprecht-Karls-University Heidelberg, Central Institute of Mental Health Mannheim, Mannheim, Germany Using well-established psychological interventions for adults as a model, a variety of psychological treatments for pediatric pain have been developed. These include cognitive-behavioral interventions that focus on improving pain and stress coping skills, relaxation techniques such as progressive muscle relaxation or autogenic training, biofeedback and operant treatment approaches with the aim to reduce pain behavior. From a perspective of evidence-based medicine and in light of CONSORT and IMMPACT recommendations, an overview of the empirical evidence for their effectiveness will be given. The literature clearly shows a preponderance of intervention studies for migraine and other headaches with the majority of interventions having to be classified as probably efficacious or promising. The effectiveness of multidisciplinary pain treatment programs for children and adolescents has only recently begun to be investigated. Based on the overview, implications for future research will be discussed. In addition, new developments such as web-based treatment programs and self-help approaches will be outlined.
Topical Seminar: HOW TO CHANGE PUBLIC PERCEPTION OF PAIN? 103 Topical Seminar Summary: HOW TO CHANGE PUBLIC PERCEPTION OF PAIN? D. Niv ° . Israel Nearly 20% of the adult European population reports suffering from one or another form of chronic pain. The associated human and financial burden is enormous. Judging from its impact on society Pain Medicine ought to have the impact, and command the resources, of oncology or cardiovascular medicine. In fact, resources are a tiny fraction of these, and pain is largely ignored as a topic in medical and paramedical education. In most countries Pain Medicine is not even recognized as a legitimate medical specialty. The fundamental problem underlying this distortion is that decision makers and the public at large continue to view pain as a symptom of disease rather than as a biomedical problem in it’s own right. In this topical seminar we will present the facts, discuss means through which the profile of pain might be elevated to its rightful status, and assess the role of EFIC’s “Europe Against Pain” Initiative in resolving this problem. 104 CHRONIC PAIN IS A DISEASE IN ITS OWN RIGHT! – OUR GOAL IS NOT TO CONVINCE THE CONVINCED D. Niv ° . Israel Abstract not available at time of printing.
S31 105 EDUCATION AND CERTIFICATION – KEY ROLES FOR THE SUCCESS OF OUR GOALS M. Zenz ° . Germany Abstract not available at time of printing. 106 HOW TO CHANGE PUBLIC PERCEPTION OF PAIN? A. Vadalouca ° . Anaesthesia, Pain Relief & Palliative Care, University of Athens, Athens, Greece Throughout the world, progress to improve pain relief and palliative care is impeded by regulatory barriers to the availability of pain medication. This requires co-operation between medicine and law enforcement bodies. We all know that particularly in the developing countries a major barrier to pain relief is the insufficient availability of oral morphine for the treatment of moderate to severe pain. According to WHO’s strategy to improve access to opioid analgesics a policy development is needed in order to achieve a more balanced regulatory environment and assessment of needs and resources. There is also a need for research and development of interventional pain relief and palliative care models. We believe that there is a need to increase public awareness disseminating new and old information about pain relief as social priority in view of huge humanitarian and financial costs. Opinion leaders in every country have to inform people continuously through media about pain relief of all forms as a part of a focus on human rights and quality of life. Every pain center must distribute leaflets with information about pain relief. Campaigns should present, from time to time, pain as a big social problem and call upon countries to include a right to pain relief as a part of their consultation. Focus on particular situations such as pain in children, pain in the elderly cancer pain and pain in HIV/AIDS. Undergraduate course and continuing education about pain relief for all health care professionals. 107 CREATING A PIPELINE OF IDEAS AND ACTIONS G. Varrassi ° . Italy Abstract not available at time of printing.
Special Lecture II 108 NEUROBIOLOGY OF ADDICTION H.L. Fields ° . Neurology, University of California, San Francisco, CA, USA Agonists for the mu opioid (MOP) receptor are powerful analgesics, but also have the property of producing a strong rewarding effect. This rewarding effect is the cause of addiction, which is a potential risk when opioids are used clinically for the treatment of pain. Opioids produce pain relief by activation of pain modulating systems and through direct actions in the superficial laminae of the dorsal horn of the spinal cord. Opioids produce reward in part through the activation of mesolimbic dopamine neurons. Furthermore, opioid actions in the mesolimbic reward circuitry contribute to analgesia. In this lecture I will define addiction and discuss the relation of reward and analgesia in the context of a motivationdecision model. This model provides a new approach to thinking about the relationship of addiction and pain treatment.
102 PSYCHOLOGICAL INTERVENTIONS IN THE TREATMENT OF PEDIATRIC CHRONIC PAIN C. Herman ° . Dept. of Neuropsychology & Clinical Psychology, Ruprecht-Karls-University Heidelberg, Central Institute of Mental Health Mannheim, Mannheim, Germany Using well-established psychological interventions for adults as a model, a variety of psychological treatments for pediatric pain have been developed. These include cognitive-behavioral interventions that focus on improving pain and stress coping skills, relaxation techniques such as progressive muscle relaxation or autogenic training, biofeedback and operant treatment approaches with the aim to reduce pain behavior. From a perspective of evidence-based medicine and in light of CONSORT and IMMPACT recommendations, an overview of the empirical evidence for their effectiveness will be given. The literature clearly shows a preponderance of intervention studies for migraine and other headaches with the majority of interventions having to be classified as probably efficacious or promising. The effectiveness of multidisciplinary pain treatment programs for children and adolescents has only recently begun to be investigated. Based on the overview, implications for future research will be discussed. In addition, new developments such as web-based treatment programs and self-help approaches will be outlined.
Topical Seminar: HOW TO CHANGE PUBLIC PERCEPTION OF PAIN? 103 Topical Seminar Summary: HOW TO CHANGE PUBLIC PERCEPTION OF PAIN? D. Niv ° . Israel Nearly 20% of the adult European population reports suffering from one or another form of chronic pain. The associated human and financial burden is enormous. Judging from its impact on society Pain Medicine ought to have the impact, and command the resources, of oncology or cardiovascular medicine. In fact, resources are a tiny fraction of these, and pain is largely ignored as a topic in medical and paramedical education. In most countries Pain Medicine is not even recognized as a legitimate medical specialty. The fundamental problem underlying this distortion is that decision makers and the public at large continue to view pain as a symptom of disease rather than as a biomedical problem in it’s own right. In this topical seminar we will present the facts, discuss means through which the profile of pain might be elevated to its rightful status, and assess the role of EFIC’s “Europe Against Pain” Initiative in resolving this problem. 104 CHRONIC PAIN IS A DISEASE IN ITS OWN RIGHT! – OUR GOAL IS NOT TO CONVINCE THE CONVINCED D. Niv ° . Israel Abstract not available at time of printing.
S31 105 EDUCATION AND CERTIFICATION – KEY ROLES FOR THE SUCCESS OF OUR GOALS M. Zenz ° . Germany Abstract not available at time of printing. 106 HOW TO CHANGE PUBLIC PERCEPTION OF PAIN? A. Vadalouca ° . Anaesthesia, Pain Relief & Palliative Care, University of Athens, Athens, Greece Throughout the world, progress to improve pain relief and palliative care is impeded by regulatory barriers to the availability of pain medication. This requires co-operation between medicine and law enforcement bodies. We all know that particularly in the developing countries a major barrier to pain relief is the insufficient availability of oral morphine for the treatment of moderate to severe pain. According to WHO’s strategy to improve access to opioid analgesics a policy development is needed in order to achieve a more balanced regulatory environment and assessment of needs and resources. There is also a need for research and development of interventional pain relief and palliative care models. We believe that there is a need to increase public awareness disseminating new and old information about pain relief as social priority in view of huge humanitarian and financial costs. Opinion leaders in every country have to inform people continuously through media about pain relief of all forms as a part of a focus on human rights and quality of life. Every pain center must distribute leaflets with information about pain relief. Campaigns should present, from time to time, pain as a big social problem and call upon countries to include a right to pain relief as a part of their consultation. Focus on particular situations such as pain in children, pain in the elderly cancer pain and pain in HIV/AIDS. Undergraduate course and continuing education about pain relief for all health care professionals. 107 CREATING A PIPELINE OF IDEAS AND ACTIONS G. Varrassi ° . Italy Abstract not available at time of printing.
Special Lecture II 108 NEUROBIOLOGY OF ADDICTION H.L. Fields ° . Neurology, University of California, San Francisco, CA, USA Agonists for the mu opioid (MOP) receptor are powerful analgesics, but also have the property of producing a strong rewarding effect. This rewarding effect is the cause of addiction, which is a potential risk when opioids are used clinically for the treatment of pain. Opioids produce pain relief by activation of pain modulating systems and through direct actions in the superficial laminae of the dorsal horn of the spinal cord. Opioids produce reward in part through the activation of mesolimbic dopamine neurons. Furthermore, opioid actions in the mesolimbic reward circuitry contribute to analgesia. In this lecture I will define addiction and discuss the relation of reward and analgesia in the context of a motivationdecision model. This model provides a new approach to thinking about the relationship of addiction and pain treatment.