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6 PSYCHOLOGICAL INTERVENTIONS FOR CHRONIC PAIN: EVIDENCE, OPPORTUNITIES AND CHALLENGES
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INVITED PRESENTATIONS: PLENARY & SPECIAL LECTURE ABSTRACTS / European Journal of Pain Supplements 5 (2011) 1–3
is 3%. Cluster headache together with other so called trigeminal autonomic cephalalgias is 0.1%. Medication overuse headache is perhaps the biggest iatrogenic problem of any and affects between 1 and 3% of the population. In a big European wide study, only migraine had the necessary data to allow a calculation of its costs. With 27 billion Euros per year in Europe, migraine came in together with stroke as the second most costly neurological disorder after dementia. In a new cost study, we are able to include non-migraine headaches. Based on previous Danish epidemiology studies this will probably double the cost to approximately 50 billion Euros per year. It is difficult to attribute cost to the secondary headaches. In conclusion, headache disorders are well classified and epidemiologically well described. The cost of headache disorders is high. Cost figures are important in the further struggle to improve the funding of headache research and the care of headache disorders. Disclosure: None declared
5 ANIMAL PAIN MODELS AND DRUG DISCOVERY A. Eschalier *. UMR 766 Inserm, Universit´e d’Auvergne, ClermontFerrand, France Several current analgesic drugs are old compounds with, often, an unsatisfactory benefit/risk ratio. Moreover, some pain syndromes are poorly improved by these drugs. Innovation is therefore necessary. Despite progress in the understanding of pain neurobiological basis, they have been few novel drug concepts and chemical entities proposed on the market. Among proposals to solve this issue, a new development pathway of analgesics based on patients characteristics or the abandonment of animal pain studies in favor of more extensive testing in humans have been suggested. Indeed animals’ models are frequently questionable and considered to have an inadequate predictive validity for human painful pathologies. It is such an important point to discuss and to think what could be proposed to improve this situation. First, it is important to note that several breakthroughs in the pain field, including pharmacological aspects, come from animal studies suggesting that they can be somewhat clinically relevant. However, regarding drug discovery we must agree that for the last decade, data from animal studies failed to generate novel major pharmacological breakthroughs. The aim of this lecture is to try to understand this statement, to describe caveats and to think of ways to improve animal models, considering several issues (animal, pathological model, pain assessment, modalities of drug administration...). Finally, we need to determine how to progress. Disclosure: None declared
6 PSYCHOLOGICAL INTERVENTIONS FOR CHRONIC PAIN: EVIDENCE, OPPORTUNITIES AND CHALLENGES C. Eccleston *. Centre for Pain Research, The University of Bath, Bath, UK Severe chronic pain has widespread negative effects on both patients and their families. Pain repeatedly disrupts thinking, planning, and one’s ability to act independently. Repeated interruption provokes depression, and many people develop selfdefeating patterns of behaviour characterized by failed attempts to escape inescapable pain. Psychological interventions focus on the promotion of independence and effective problem solving skills marshalled toward an overall goal of living a full live despite pain. Most of these treatments are communication based and aim to achieve improvements through behaviour change. This lecture is in four parts. First, a ‘normal’ psychological model of chronic pain is outlined, explaining how and why some people come to suffer severe disability and distress. Second, the evidence
for psychological interventions is reviewed for both adult and adolescent methods. In particular data from the current Cochrane Systematic Reviews in this field are presented. Third, the problems with the current status of psychological interventions are outlined, with a focus on the possible solutions. Finally, new developments are briefly reviewed including a focus on co-morbid presentations, e-health innovation, and work with family members. Examples from both adolescent and adult interventions are drawn. For chronic pain management there is some truth in the adage “it is good to talk”. But the wrong talk can be damaging, and the right talk can help people transform their lives. Evidence based psychology has established a number of promising treatments, but this field is still scientifically young, and we call for the next generation of more powerful interventions. Disclosure: None declared
7 RESILIENCE AND PAIN: MECHANISMS AND CLINICAL IMPLICATIONS M. Peters *. Clinical Psychological Science, Maastricht University, Maastricht, The Netherlands During the last decades it has become increasingly clear that psychological factors are important in determining an individual’s reaction to the experience of pain. Most research has focused on vulnerability factors for chronic pain and on maladaptive pain behaviours that may play a role in pain persistence and increased disability. The role of resiliencies for chronic pain – defined as states or traits that promote recovery from acute pain and lead to better adjustment – have only recently been examined. Optimism, positive affectivity and an accepting attitude may protect against high levels of disability and distress in patients with longstanding pain. Recent findings suggest that resilience factors may also be important in the recovery from acute pain and prevention of pain chronicity. This talk will present an overview of the research on resilience and pain and also discuss potential mechanism by which these factors may operate. These include cognitive, behavioural and physiological pathways. Moreover, clinical implications will be discussed. Understanding why some people are better in adjusting to and overcoming pain than others may open the way to novel interventions, both for the prevention of chronic pain and for adjustment to pain in patients with persistent pain. Currently we are exploring the effectiveness of resilience building interventions for increasing wellbeing in patients with chronic pain complaints and for promoting physical recovery from injury. Disclosure: None declared
8 IS SPINAL MICROGLIA A REAL ENEMY IN PATHOLOGICAL PAIN? M. Pohl1 *, A. Meunier2 , E. Dominguez1 . 1 CRICM, Pains Group, INSERM UMRS975; UPMC, 2 IBENS, INSERM U1024; CNRS UMR8197, Paris, France In several forms of pathological pain, infiltrating immune cells and resident glia, especially in the spinal cord, are closely associated with emergence and persistence of pain. The major role of “activated” spinal glia in pain has been largely documented during the past decade. Thus, in relation with central or peripheral nerve lesions, the modification of microglia and astrocytes functional status results in their sensitivity to many signaling molecules and, in response, production and release of molecules with a broad spectrum of effects. Considered at first sight as playing globally a detrimental role, especially owing to their inflammatory function, their harmful impact on pain may also result from a loss or alteration of their protective role. Indeed, activation of the innate immune response in the nervous system, locally mediated by microglia and astrocytes, also leads to a detoxifying action through the phagocytic role of microglia and production of antiinflammatory molecules. Moreover, it appears that the way in
INVITED PRESENTATIONS: PLENARY & SPECIAL LECTURE ABSTRACTS / European Journal of Pain Supplements 5 (2011) 1–3
is 3%. Cluster headache together with other so called trigeminal autonomic cephalalgias is 0.1%. Medication overuse headache is perhaps the biggest iatrogenic problem of any and affects between 1 and 3% of the population. In a big European wide study, only migraine had the necessary data to allow a calculation of its costs. With 27 billion Euros per year in Europe, migraine came in together with stroke as the second most costly neurological disorder after dementia. In a new cost study, we are able to include non-migraine headaches. Based on previous Danish epidemiology studies this will probably double the cost to approximately 50 billion Euros per year. It is difficult to attribute cost to the secondary headaches. In conclusion, headache disorders are well classified and epidemiologically well described. The cost of headache disorders is high. Cost figures are important in the further struggle to improve the funding of headache research and the care of headache disorders. Disclosure: None declared
5 ANIMAL PAIN MODELS AND DRUG DISCOVERY A. Eschalier *. UMR 766 Inserm, Universit´e d’Auvergne, ClermontFerrand, France Several current analgesic drugs are old compounds with, often, an unsatisfactory benefit/risk ratio. Moreover, some pain syndromes are poorly improved by these drugs. Innovation is therefore necessary. Despite progress in the understanding of pain neurobiological basis, they have been few novel drug concepts and chemical entities proposed on the market. Among proposals to solve this issue, a new development pathway of analgesics based on patients characteristics or the abandonment of animal pain studies in favor of more extensive testing in humans have been suggested. Indeed animals’ models are frequently questionable and considered to have an inadequate predictive validity for human painful pathologies. It is such an important point to discuss and to think what could be proposed to improve this situation. First, it is important to note that several breakthroughs in the pain field, including pharmacological aspects, come from animal studies suggesting that they can be somewhat clinically relevant. However, regarding drug discovery we must agree that for the last decade, data from animal studies failed to generate novel major pharmacological breakthroughs. The aim of this lecture is to try to understand this statement, to describe caveats and to think of ways to improve animal models, considering several issues (animal, pathological model, pain assessment, modalities of drug administration...). Finally, we need to determine how to progress. Disclosure: None declared
6 PSYCHOLOGICAL INTERVENTIONS FOR CHRONIC PAIN: EVIDENCE, OPPORTUNITIES AND CHALLENGES C. Eccleston *. Centre for Pain Research, The University of Bath, Bath, UK Severe chronic pain has widespread negative effects on both patients and their families. Pain repeatedly disrupts thinking, planning, and one’s ability to act independently. Repeated interruption provokes depression, and many people develop selfdefeating patterns of behaviour characterized by failed attempts to escape inescapable pain. Psychological interventions focus on the promotion of independence and effective problem solving skills marshalled toward an overall goal of living a full live despite pain. Most of these treatments are communication based and aim to achieve improvements through behaviour change. This lecture is in four parts. First, a ‘normal’ psychological model of chronic pain is outlined, explaining how and why some people come to suffer severe disability and distress. Second, the evidence
for psychological interventions is reviewed for both adult and adolescent methods. In particular data from the current Cochrane Systematic Reviews in this field are presented. Third, the problems with the current status of psychological interventions are outlined, with a focus on the possible solutions. Finally, new developments are briefly reviewed including a focus on co-morbid presentations, e-health innovation, and work with family members. Examples from both adolescent and adult interventions are drawn. For chronic pain management there is some truth in the adage “it is good to talk”. But the wrong talk can be damaging, and the right talk can help people transform their lives. Evidence based psychology has established a number of promising treatments, but this field is still scientifically young, and we call for the next generation of more powerful interventions. Disclosure: None declared
7 RESILIENCE AND PAIN: MECHANISMS AND CLINICAL IMPLICATIONS M. Peters *. Clinical Psychological Science, Maastricht University, Maastricht, The Netherlands During the last decades it has become increasingly clear that psychological factors are important in determining an individual’s reaction to the experience of pain. Most research has focused on vulnerability factors for chronic pain and on maladaptive pain behaviours that may play a role in pain persistence and increased disability. The role of resiliencies for chronic pain – defined as states or traits that promote recovery from acute pain and lead to better adjustment – have only recently been examined. Optimism, positive affectivity and an accepting attitude may protect against high levels of disability and distress in patients with longstanding pain. Recent findings suggest that resilience factors may also be important in the recovery from acute pain and prevention of pain chronicity. This talk will present an overview of the research on resilience and pain and also discuss potential mechanism by which these factors may operate. These include cognitive, behavioural and physiological pathways. Moreover, clinical implications will be discussed. Understanding why some people are better in adjusting to and overcoming pain than others may open the way to novel interventions, both for the prevention of chronic pain and for adjustment to pain in patients with persistent pain. Currently we are exploring the effectiveness of resilience building interventions for increasing wellbeing in patients with chronic pain complaints and for promoting physical recovery from injury. Disclosure: None declared
8 IS SPINAL MICROGLIA A REAL ENEMY IN PATHOLOGICAL PAIN? M. Pohl1 *, A. Meunier2 , E. Dominguez1 . 1 CRICM, Pains Group, INSERM UMRS975; UPMC, 2 IBENS, INSERM U1024; CNRS UMR8197, Paris, France In several forms of pathological pain, infiltrating immune cells and resident glia, especially in the spinal cord, are closely associated with emergence and persistence of pain. The major role of “activated” spinal glia in pain has been largely documented during the past decade. Thus, in relation with central or peripheral nerve lesions, the modification of microglia and astrocytes functional status results in their sensitivity to many signaling molecules and, in response, production and release of molecules with a broad spectrum of effects. Considered at first sight as playing globally a detrimental role, especially owing to their inflammatory function, their harmful impact on pain may also result from a loss or alteration of their protective role. Indeed, activation of the innate immune response in the nervous system, locally mediated by microglia and astrocytes, also leads to a detoxifying action through the phagocytic role of microglia and production of antiinflammatory molecules. Moreover, it appears that the way in