World Pain Congress Buenos Aires Argentina October 2014

Dr Dawn Carnes summarises her attendance at the World Pain Conference in Buenos Aires, Argentina, in October 2014.

Recently I attended the World Pain Congress in my role as a senior researcher at Barts and The London School of Medicine and Dentistry. I deliver and develop pragmatic trials, these are trials that are done in real world situations rather than clinically controlled environments. Pragmatic trials often involve complex interventions (like osteopathic treatment) in primary care (first point of contact for patients) and usually involve lots of participants. My research generally focuses on musculoskeletal treatments particularly chronic musculoskeletal pain.

The world pain congress is massive, over 5,000 people attend from all over the globe and the programme covers five days. The 2014 congress was held in Buenos Aires, Argentina. The structure of the conference day centres around three types of research presentation: two plenary presentations one in the morning (starting at 08:15) and the other at 14:00. There are two themed workshops each day typically consisting of three presentations each and a discussion afterwards. Plenaries and presentations are where leaders in the field present a summary of their own and others research to give an overview of current perspectives in their area of research. The remainder of the day is where researchers present their work (single studies) using posters. You stand by your poster for as much of the day as possible so others can ask you about your research. Each delegate is given a list of posters so you can choose and plan who you want to visit in advance.

I was presenting a research project I managed called COPERS for Barts and The London School of Medicine and Dentistry and Warwick Medical School. This was a randomised controlled trial of a pain self-management course for people with chronic musculoskeletal pain. The COPERS course was designed to help people manage their pain better. We recruited 703 people into the trial some of whom were randomised to the COPERS course and the others to a control group (usual care an education leaflet and a relaxation CD). The trial showed that people who did the COPERS course were less anxious, less depressed, more confident, coping better and more socially integrated at six months compared to people in the control group. At one year those who had done the course were still less depressed and more socially integrated. The course was also cost effective. These were good results. Osteopaths were trained (along with other health care professionals) to deliver the COPERS course which was based on cognitive behavioural principles. COPERS could be a useful adjunct treatment in the management of those with chronic musculoskeletal pain.

Congresses like this enable researchers to find out the latest innovations. A big theme at this congress was about the issues with opioid prescribing for chronic pain and patients becoming dependent. Opioid can have debilitating side effects and affect quality of life, depression is common. An interesting workshop focused on chronic pain, depression and suicide. The risk factors for predicting suicide in chronic pain patients were:

  • Type of pain: migraine with aura, headaches, abdominal pain, fibromyalgia and chronic widespread pain
  • Duration of pain (longer more likely)
  • Increasing pain severity
  • Insomnia
  • Access to means of suicide (often opioid overdose)
  • Negative thoughts: includes catastrophising (ruminating, magnification, hopelessness), depression and mental defeat.

Mental defeat is an interesting concept, described as a psychological state where the person no longer fears the pain associated with suicide and dying.

The non-chronic pain specific predictors are: past suicide attempt, having a suicide plan, family history of suicide, comorbid depression, history of abuse and being male.

Common forms of suicide are: hanging, pesticides, guns, jumping, and overdose. The incidence rates vary in different parts of the world for example pesticide related suicides are more common in lower income countries and rural areas whilst suicide using guns more common in the US and South America an overdose more common in the UK and Scandinavian countries.

Protective elements include: faith, family support (not letting the family down), future thinking, and fear of failure.

Another workshop of interest focused on the powerful placebo effects in pharmacological studies for pain. Placebo effects have been shown in MRIs at both cortical and brainstem levels and seem to be modulated by endogenous opioids. Other research showed that chronic pain and aging leads to accelerated grey matter loss and that exercise (particularly yoga) can slow this rate down, decrease pain perception, and increase pain tolerance. More shocking was a presentation about understanding infant pain and ethics surrounding clinical practice and research in infants where analgesics are not used for example circumcisions, heel prick tests, and the insertion of cannulas.

The conference was certainly enlightening, it was good to network but overall the valuable thing about going to these events is that it broadens your outlook and helps give a perspective about the wider health care community in which we work.