Today was the first day of the Annual Scientific Meeting (ASM) of the Canadian Pain Society (CPS), which will run through to Friday afternoon. This conference is “a forum in which scientists, healthcare professionals, and trainees from clinical, educational, research, policy and industry settings can meet and exchange up-to-date information on pain mechanisms, pain assessment, and pain management.”(1)
And patients, people who live with chronic pain. This conference has is an accredited “Patients Included”(2) event, which means – more or less – that patient were involved in all aspects of its planning and presentation. There are patient speakers in some of the presentations, a patient co-chairing the Twitter Team Committee, and more.
As with so many conferences and events this year, due to the current COVID-19 pandemic, this conference is being hosted using a virtual conferencing platform – for the first time. Although it is working well, with only a few noticeable glitches today, I really miss the opportunity to meet other attendees in person – for example stopping to chat at an interesting poster or at the coffee bar.
But a virtual conference is better than no conference, particularly as there’s always the hope that the information shared at these meetings will have a trickle-down effect to improve patient care… or create new directions or ideas for research.
As I did for the CPS’s 2018 ASM, which was held here in Montreal, I’ve been live-tweeting the presentations over on Twitter. Although I missed the deadline to join the official Twitter Team for the event, they nevertheless added me to it today – thanks team! This is a good opportunity to mention that I can’t give you a full overview of the conference. Why not? That’s a great question!
I live with a mild cognitive impairment due to Complex Regional Pain Syndrome which makes it very difficult for me to concentrate or focus on anything for much more than an hour at a time. To bel able to follow a session that lasts longer than that, I set up my laptop computer on our kitchen table and have to keep moving around – almost dancing! – to try to keep my brain engaged… I actually have tired legs tonight from doing that so much today!
I don’t know whether I’ll be able to follow any of the conference tomorrow; my brain decides when it has had enough, and at that point there’s not much I can do about it. So I’ll share with you what I can, primarily by looking back at what I’ve posted to Twitter during each session. If you use Twitter, feel free to follow the #CanadianPain21 hashtag where you can see all the comments about this event – not only mine!
Here are some of the highlights – in my view – f rom today’s ASM sessions, in the order in which they occurred. None of these are direct quotations, and there is plenty of information that I missed or didn’t capture. There were also Breakout Sessions this morning and afternoon, during which time several different presentations took place at the same time and I attended only one of them.
So, by default, this is in no way a summary of the entire conference; only of the session that I attended. I hope you still find it interesting.
. The 2021 ASM opened with an appearance by Canada’s Minister of Health, Patty Hajdu, on the importance of finding solutions to the opioid epidemic in Canada – and to the epidemic of chronic pain that affects so many Canadians from coast to coast.
. During the Keynote speech on “‘Applying a multi-modal approach to understanding neuropathic pain: studying small neurons in the era of big data”(3) Dr. David Bennett of Oxford University warned that the incidence or rates of chronic pain are very likely to increase significantly into upcoming decades, while our healthcare systems are ALREADY unable to cope with current levels
. Dr. Bennett also discussed the pathogenesis of peripheral neuropathies, and noted that some of these are hereditary… opening possibilities for screening that could someday prevent military personnel from exposure to specific triggers
. One of Dr. Bennett’s slides was a “Good cop vs Bad cop” view of descending pain modulation, with the “Good cop” as the “Off cell” and the “Bad cop” as the “On cell”
. Dr. Bennett ended his talk with a comment that, after reviewing clinical trials and available treatments for chronic neuropathic pain, we desperately need new treatments. As someone living with a neuropathic pain condition, I found myself nodding along as he was saying this!
. On a more hopeful note, Dr. Bennett believes that genomics could someday provide personalized pain medicine approaches for neuropathic pain and to better target existing treatments to patients who would be most likely to respond well to them
. The first breakout session that I attended, this morning, was on altered cognitive processing of bodily sensations in pain presented by several European researchers. Dr. Dimitri Van Ryckeghem noted that the concept of Attention Bias Modification (ABM) training was somewhat paradoxical for chronic pain in that although it had seemed useful at first, more recent research showed that there was either a null effect or an opposite effect. Other issues with research in this area included; a) small population sizes; b) healthy volunteers vs actual chronic #pain patients; and c) a lack of consistent effects on pain intensity-severity-tolerance, task interference, disability, and distress
. Then, as part of the same Breakout Session, Dr. Aline Wauters explored whether how parents discuss pain and – how they interact with pain – can have a direct impact on how their children react to it; the short answer is yes
. The final presenter in this Breakout Session was Dr. Tanja Hechler, but by this time my cognitive issues had kicked in and I needed to let my brain rest… luckily it was then the lunch break right after this session!
. After resting my brain during the lunch break, and spending some quiet time outside in my gardens, I was ready for the next Breakout Session on the different types of microglia and what their involvement is in pain. The first speaker was Dr. Michael Salter, explaining that his team’s research on peripheral nerve injury and pain hypersensitivity showed sex-based differences in mice. In technical terms, he noted that pain sensitivity reversed in male mice only and that P2rx4 upregulation differed in female mice. In plain English, there are physiological differences in how female and male mice microglia react to pain.
. Like Dr. Bennett, Dr. Salter concluded his talk by saying that the future of pain medicine may be a move towards genomics and precision medicine which would address this sex-specific variability in microglia
. Next up Dr. Shannon Tansley, from McGill University here in Montreal, continued the talk on microglia and pain by sharing her research showing that male mice show an increased proliferation of Ki67 microglia in comparison to female mice and that there are other measurable sex-based differences in microglia in relation to pain
. One really interesting portion of. Dr. Tansley’s talk was on the research question of whether ApoE is associated with chronic pain. We know that ApoE-epsilon4 is a genetic risk factor for the development of Alzheimer’s, and that APOe-epsilon2 may be protective for this disease
. The next presenter for this Session was Dr. Simon Beggs from University College London, who talked about the post-natal development of spinal microglia in mice and the neonatal disruption of A-fibre terminal refinement
. Once again by the time the last speaker in this Breakout Session began his talk my cognitive issues had begun to kick in, so I was unable to focus on much of the talk by Dr. Arkady Khoutorsky. I was able to catch a funny portion of the Question and Answer session; in response to a question on microglia morphology, Shannon Tansley replied that: “It’s like the microglia see something that they can’t unsee & are forever changed by it”… so I spent the rest of the afternoon imagining microglia watching TV, or videos on social media!!
On that note, it’s time for me to let my brain rest once again. In any event, that was the final session of the day. There were some fantastic posters, including one on watercolour painting and chronic pain, but I’ll have to tell you about those tomorrow or perhaps on Friday. The poster on watercolour painting and pain is one I’ll definitely visit, as I’ve been learning to paint with watercolours as part of my own pain management plan!
As always, thanks so much for stopping by. Stay well, keep safe, and remember to take some time today to do something just for you – for your own well-being.
References
(1) Canadian Pain Society. 2021 Annual Scientific Meeting. Webpage. Undated. Accessed 25 Apr 2021:
https://www.canadianpainsociety.ca/event-4092807
(2) Patients Included™ conference charter. Lucien Engelen. Webpage. May 2015: https://patientsincluded.org/conferences/
(3) Canadian Pain Society. Agenda at a Glance: Canadian Pain Society’s 2021 Annual Scientific Meeting. 21 Feb 2021. PDF. Details:
https://patientsincluded.org/conferences/