Day 1 :
Keynote Forum
Hee-Jeong Im Sampen
Rush University Medical Center, USA
Keynote: Osteoarthritis – why it hurts?
Time : 10:10-10:40
Biography:
Hee-Jeong Im Sampen is an internationally recognized orthopedic-related research scientist with over 100 peer-reviewed publications and is a Professor with a primary appointment in the Department of Biochemistry and joint appointments in the Departments of Internal Medicine (Rheumatology Section) and Orthopedic Surgery. She also holds an appointment at the Jesse Brown Veterans Affairs (VA) Medical Center as well as at the Department of Bioengineering, University of Illinois at Chicago (UIC). She is a recipient of various awards and honors such as the ANRF Scholar Award, OARSI Investigator Award, and Kappa Delta Elizabeth Winston Lanier Award from the Orthopedic Research Society (ORS).
Abstract:
A key clinical paradox in osteoarthritis (OA), a prevalent age-related joint disorder characterized by cartilage degeneration and debilitating pain, is that the severity of joint pain doesn’t strictly correlate with radiographic and histological defects in joint tissues. Here, we determined whether protein kinase Cï¤ï€ PKCï¤ï€©ï€¬ï€ a key mediator of cartilage degeneration, is critical to the mechanism by which OA develops from an asymptomatic joint-degenerative condition to a painful disease. OA was induced in 10-week-old PKCï¤ï€ null (PKCï¤ï€ ï€ï€¯ï€) and wild type (WT) mice by destabilization of the medial meniscus (DMM) followed by comprehensive examination of the histology, molecular pathways, and knee-pain-related-behaviors in mice, and comparisons with human biopsies. In the DMM model, the loss of PKCï¤ï€ expression prevented cartilage degeneration, but exacerbated OA-associated hyperalgesia. Cartilage preservation corresponded with reduced levels of inflammatory cytokines and of cartilage-degrading enzymes in the joints of PKCï¤ï€deficient DMM mice. Hyperalgesia was associated with stimulation of nerve growth factor (NGF) by fibroblast-like synovial cells and with increased synovial angiogenesis. Results from tissue specimens of from symptomatic OA patients strikingly resembled our findings from the OA animal model. In PKCï¤ null mice, increases in sensory neuron distribution in knee OA synovium and activation of the NGF-tropomyosin receptor kinase (TrkA) axis in innervating dorsal root ganglia were highly correlated with knee OA hyperalgesia. Increased distribution of synovial sensory neurons in the joints, and augmentation of NGF/TrkA signaling, causes OA hyperalgesia independently of cartilage preservation.
Keynote Forum
Donna Urquhart
Monash University, Australia
Keynote: Could low grade bacterial infection contribute to low back pain? A systematic review
Time : 10:40-11:10
Biography:
Donna Urquhart is a National Health and Medical Research Fellow in the Monash University Department of Epidemiology and Preventive Medicine and a physiotherapist with over 15 years of experience in the management of chronic pain. She has published more than 70 peer-review papers and has been awarded 5 prestigious national grants (2 as CIA). She has authored an invited book chapter in an international text and has been awarded an international investigator award for her novel work on body composition and pain. She is on the International Editorial Board for Journal of Physiotherapy and a reviewer for international/national treatment guidelines, grants and conferences.
Abstract:
Introduction: Recently, there has been both immense interest and controversy regarding a randomised, controlled trial which showed antibiotics to be effective in the treatment of chronic low back pain (disc herniation with Modic Type 1 change). While this research has the potential to result in a paradigm shift in the treatment of low back pain, several questions remain unanswered.
Purpose/Aim: This systematic review aims to address these questions by examining the role of bacteria in low back pain and the relationship between bacteria and Modic change.
Materials and Methods: We conducted electronic searches of MEDLINE and EMBASE and included studies that examined the relationship between bacteria and back pain or Modic change. Studies were rated based on their methodological quality, a best-evidence synthesis was used to summarise the results, and Bradford Hill's criteria were used to assess the evidence for causation.
Results: Eleven studies were identified. The median (range) age and percentage of female participants was 44.7 (41-46.4) years and 41.5% (27-59%), respectively, and in 7 of the 11 studies participants were diagnosed with disc herniation. Nine studies examined the presence of bacteria in spinal disc material and all identified bacteria, with the pooled estimate of the proportion with positive samples being 34%. Propionibacterium acnes was the most prevalent bacteria, being present in 7 of the 9 studies, with median (minimum, maximum) 45.0% (0-86.0) of samples positive. The best evidence synthesis found moderate evidence for a relationship between the presence of bacteria and both low back pain with disc herniation and Modic Type 1 change with disc herniation. There was modest evidence for a cause-effect relationship.
Conclusion(s): We found that bacteria were common in the spinal disc material of people undergoing spinal surgery. There was moderate evidence for a relationship between the presence of bacteria and both low back pain with disc herniation and Modic Type 1 change associated with disc herniation and modest evidence for causation. However, further work is needed to determine whether these organisms are a result of contamination or represent low grade infection of the spine which contributes to chronic low back pain.
Keywords: Bacteria, Disc, Infection, Low back pain, Modic changernrnFundingrnDU is the recipient of an NHMRC Career Development Fellowship (1011975). This work was funded by the Monash University Strategic Grant Scheme (SPG-L 070).
Keynote Forum
Hee-Jeong Im Sampen
Rush University Medical Center, USA
Keynote: Title: Osteoarthritis – why it hurts?
Time : 10:10-10:40
Biography:
Hee-Jeong Im Sampen is an internationally recognized orthopedic-related research scientist with over 100 peer-reviewed publications and is a Professor with a primary appointment in the Department of Biochemistry and joint appointments in the Departments of Internal Medicine (Rheumatology Section) and Orthopedic Surgery. She also holds an appointment at the Jesse Brown Veterans Affairs (VA) Medical Center as well as at the Department of Bioengineering, University of Illinois at Chicago (UIC). He is a recipient of various awards and honors such as the ANRF Scholar Award, OARSI Investigator Award, and Kappa Delta Elizabeth Winston Lanier Award from the Orthopedic Research Society (ORS).
Abstract:
A key clinical paradox in osteoarthritis (OA), a prevalent age-related joint disorder characterized by cartilage degeneration and debilitating pain, is that the severity of joint pain doesn’t strictly correlate with radiographic and histological defects in joint tissues. Here, we determined whether protein kinase Cï¤ï€ PKCï¤ï€©ï€¬ï€ a key mediator of cartilage degeneration, is critical to the mechanism by which OA develops from an asymptomatic joint-degenerative condition to a painful disease. OA was induced in 10-week-old PKCï¤ï€ null (PKCï¤ï€ ï€ï€¯ï€) and wild type (WT) mice by destabilization of the medial meniscus (DMM) followed by comprehensive examination of the histology, molecular pathways, and knee-pain-related-behaviors in mice, and comparisons with human biopsies. In the DMM model, the loss of PKCï¤ï€ expression prevented cartilage degeneration, but exacerbated OA-associated hyperalgesia. Cartilage preservation corresponded with reduced levels of inflammatory cytokines and of cartilage-degrading enzymes in the joints of PKCï¤ï€deficient DMM mice. Hyperalgesia was associated with stimulation of nerve growth factor (NGF) by fibroblast-like synovial cells and with increased synovial angiogenesis. Results from tissue specimens of from symptomatic OA patients strikingly resembled our findings from the OA animal model. In PKCï¤ null mice, increases in sensory neuron distribution in knee OA synovium and activation of the NGF-tropomyosin receptor kinase (TrkA) axis in innervating dorsal root ganglia were highly correlated with knee OA hyperalgesia. Increased distribution of synovial sensory neurons in the joints, and augmentation of NGF/TrkA signaling, causes OA hyperalgesia independently of cartilage preservation.
Keynote Forum
Donna Urquhart
Monash University, Australia
Keynote: Could low grade bacterial infection contribute to low back pain? A systematic review
Time : 10:40-11:10
Biography:
Dr Donna Urquhart is a National Health and Medical Research Fellow in the Monash University Department of Epidemiology and Preventive Medicine and a physiotherapist with over 15 years of experience in the management of chronic pain. She has published more than 70 peer-review papers and has been awarded 5 prestigious national grants (2 as CIA). She has authored an invited book chapter in an international text and has been awarded an international investigator award for her novel work on body composition and pain. She is on the International Editorial Board for Journal of Physiotherapy and a reviewer for international/national treatment guidelines, grants and conferences.
Abstract:
IntroductionrnRecently, there has been both immense interest and controversy regarding a randomised, controlled trial which showed antibiotics to be effective in the treatment of chronic low back pain (disc herniation with Modic Type 1 change). While this research has the potential to result in a paradigm shift in the treatment of low back pain, several questions remain unanswered.rnrnPurpose/AimrnThis systematic review aims to address these questions by examining the role of bacteria in low back pain and the relationship between bacteria and Modic change.rnrnMaterials and MethodsrnWe conducted electronic searches of MEDLINE and EMBASE and included studies that examined the relationship between bacteria and back pain or Modic change. Studies were rated based on their methodological quality, a best-evidence synthesis was used to summarise the results, and Bradford Hill\'s criteria were used to assess the evidence for causation.rnrnResults rnEleven studies were identified. The median (range) age and percentage of female participants was 44.7 (41-46.4) years and 41.5% (27-59%), respectively, and in 7 of the 11 studies participants were diagnosed with disc herniation. Nine studies examined the presence of bacteria in spinal disc material and all identified bacteria, with the pooled estimate of the proportion with positive samples being 34%. Propionibacterium acnes was the most prevalent bacteria, being present in 7 of the 9 studies, with median (minimum, maximum) 45.0% (0-86.0) of samples positive. The best evidence synthesis found moderate evidence for a relationship between the presence of bacteria and both low back pain with disc herniation and Modic Type 1 change with disc herniation. There was modest evidence for a cause-effect relationship.rnrnConclusion(s)rnWe found that bacteria were common in the spinal disc material of people undergoing spinal surgery. There was moderate evidence for a relationship between the presence of bacteria and both low back pain with disc herniation and Modic Type 1 change associated with disc herniation and modest evidence for causation. However, further work is needed to determine whether these organisms are a result of contamination or represent low grade infection of the spine which contributes to chronic low back pain.rnrnKeywordsrnBacteria, Disc, Infection, Low back pain, Modic changernrnFundingrnDU is the recipient of an NHMRC Career Development Fellowship (1011975). This work was funded by the Monash University Strategic Grant Scheme (SPG-L 070).rn
- Basics of Pain Management and Rehabilitation
Location: Mississippi Amph
Chair
Donna Urquhart
Monash University, Melbourne, Australia
Co-Chair
Hee-Jeong Im Sampen
Rush University Medical Center, USA
Session Introduction
Abraham Flores Vargas
Hospital General de México, Mexico
Title: OCD in animal models using quinpirole as dopaminergic inductor of perseverative behaviour
Time : 11:30-11:55
Biography:
Abraham Flores Vargas has completed his medical studies from Universidad Autonoma de Estado de México and recently stared residency in anesthesiology from Hospital General de México “Dr. Eduardo Liceaga “ at Mexico city and signed up in the medical program of the Universidad Nacional Autonoma de México. He has done his research social service last year publishing a review article named OCD in animal models using quinpirole as dopaminergic inductor of perseverative behavior at the “Revista medica del Hospital General de México” last year now-a-days working in the continuation of the second article related with quinpirole. He is with total willingness to continue investigating and bringing in issues related to anesthesiology.
Abstract:
In the reviewed articles, quinpirole is used as a dopamine D2 and D3 receptor agonist to induce persistent behavior in animal models. Dopamine has been related to perseverative behavior also has been related with the perseption of pain and relief. The perseverative behavior was observed in an open field with objects of different shapes and sizes. The main structures studied with this methodology are the orbitofrontal cortex, striatum, thalamus, basolateral amygdala and nucleus accumbens. The animal models studied comply with the face, predictive and construct validity. We think this topic is important because the content of the article shows the right structure and methodology also how to evaluate and compare the information in different articles this method can be applied at any topic; we have focused in the face, predictive and construct validity. It is important to mention that this reviewed article had and extensive search in the website of Pubmed although there were only a few information of the topic which it is a reason for us to continue investigating and providing new information related.
Marucia Chacur,
University of Sao Paulo
Title: No pharmacological therapies for pain treatment
Time : 11:55-12:20
Biography:
Marucia Chacur has completed her PhD from University of Sao Paulo and Post-doctoral studies from University of Heidelberg, Germany. In recent year, her studies were focused on scientific issues regarding inflammation and pain modulation (hyperalgesia and allodynia) induced by chronic and acute injuries. She has published more than 15 papers in reputed journals and has been serving as an Editorial Board Member of repute.
Abstract:
Therapeutic alternatives for the treatment of neuropathic pain are necessary, since this type of pain does not respond satisfactorily to any conventional intervention as surgery and/or medication. Physical therapy has demonstrated through neural mobilization techniques and laser therapy to be effective for improving the quality of life of patients with this kind of pain. This study becomes important because of the lack of studies demonstrating the molecular effects of Neural Mobilization and laser therapy techniques, as these techniques are able to decrease pain sensitivity in animals with chronic pain (these results, are based on work published by our group).
- Physical and Physiological Approaches in Pain Management
Location: Mississippi Amph
Chair
Donna Urquhart
Monash University, Melbourne, Australia
Co-Chair
Hee-Jeong Im Sampen
Rush University Medical Center, USA
Session Introduction
Donna Urquhart
Monash University, Australia
Title: Body composition is associated with multisite lower body musculoskeletal pain in a community-based study
Time : 12:20-12:45
Biography:
Donna Urquhart is a National Health and Medical Research Fellow in the Monash University Department of Epidemiology and Preventive Medicine and a physiotherapist with over 15 years of experience in the management of chronic pain. She has published more than 70 peer-review papers and has been awarded 5 prestigious national grants (2 as CIA). She has authored an invited book chapter in an international text and has been awarded an international investigator award for her novel work on body composition and pain. She is on the International Editorial Board for Journal of Physiotherapy and a reviewer for international/national treatment guidelines, grants and conferences.
Abstract:
Population-based studies suggest that pain in the lower body is common and that pain at multiple sites is more prevalent than single-site pain. Obesity is a risk factor for multisite musculoskeletal pain, but there are limited data on the role of body composition. Therefore, we sought to determine whether body composition is associated with multisite musculoskeletal pain involving the low back, knee, and foot. A total of 133 participants were recruited for a study examining the relationship between obesity and musculoskeletal disease. Participants completed validated questionnaires that examined levels of pain at the low back, knee, and foot. Body composition was assessed using dual-energy X-ray absorptiometry. Multisite pain was common, with 26.3% of participants reporting pain at 2 sites and 31.6% at 3 sites, and only 20% were pain free. The low back was the most common site of pain (63%). Greater fat mass and fat mass index, but not fat-free mass, were associated with pain at a greater number of sites, independent of age, gender, and fat-free mass (P<0.01). Understanding the mechanism by which increased fat mass is associated with pain may provide important insights into therapeutic strategies for the prevention of pain.
Hee-Jeong Im Sampen
Rush University Medical Center, USA
Title: Astroglial NF-kB activation in chronic knee osteoarthritic pain
Time : 12:45-13:10
Biography:
Hee-Jeong Im Sampen is an internationally recognized orthopedic-related research scientist with over 100 peer-reviewed publications and is a Professor with a primary appointment in the Department of Biochemistry and joint appointments in the Departments of Internal Medicine (Rheumatology Section) and Orthopedic Surgery. She also holds an appointment at the Jesse Brown Veterans Affairs (VA) Medical Center as well as at the Department of Bioengineering, University of Illinois at Chicago (UIC). He is a recipient of various awards and honors such as the ANRF Scholar Award, OARSI Investigator Award, and Kappa Delta Elizabeth Winston Lanier Award from the Orthopedic Research Society (ORS).
Abstract:
Clinical management of chronic joint pain evoked by osteoarthritis is a real challenge due to our limited understanding of the cellular mechanisms that initiate and develop chronic pain. It has been increasingly recognized that glial cells, such as microglia and astrocytes in the central nervous system play an important role in the development and maintenance of chronic pain. Notably, astrocytes make very close contacts with synapses and astrocyte reaction after nerve injury, arthritis, and tumor growth is more persistent than microglial reaction and displays a better correlation with chronic pain behaviors. The transcription factor nuclear factor kappa B (NF-ï«B) is a key regulator of inflammatory processes in reactive glial cells. The objectives were to determine whether inactivation of astroglial NF-ï«B leads to a reduction in pain behavior and inflammation after induction of knee joint osteoarthritis (OA), and joint pathology in an experimental OA model. We utilized a transgenic mouse model (GFAP-Iï«Bï¡-dn in C57BL/6 genetic background) where the classical NF-ï«B pathway is inactivated by overexpression of a dominant negative (dn) form of the inhibitor of kappa B (Iï«Bï¡) in glial fibrillary acidic protein (GFAP) expressing cells, which include astrocytes, schwann cells, and satellite cells of the dorsal root ganglion (DRG). Young adult mice (Tg and WT) were subjected to surgical OA induction by partial medial menisectomy (PMM). Weekly behavioral pain responses were recorded, and glial activation, NF-ï«B and joint pathology were analyzed in DRGs and dorsal horns by histology and immunohistochemistry followed by quantification. Our data suggest that the inhibition of NF-kB signaling in astrocytes as a promising target for the development of therapeutic strategies for OA pain.
- Pain Syndrome
Location: Mississippi Amph
Chair
Donna Urquhart
Monash University, Melbourne, Australia
Co-Chair
Hee-Jeong Im Sampen
Rush University Medical Center, USA
Session Introduction
Rachael Pillay
Mater Misericordiae Hospital, Australia
Title: Predicting venous insufficiency in flaps raised on the deep inferior epigastric system using CT angiography
Time : 14:10-14:35
Biography:
Rachael Pillay is a surgical registrar in Brisbane, Australia with an interest in oncology and reconstructive surgery. She is currently completing a Masters of Philosophy with the University of Queensland looking at the development of patient derived xenograft models of squamous cell carcinoma.
Abstract:
Venous insufficiency occurs in 4% of flaps raised on the Deep Inferior Epigastric System (DIES), typically in perforator flaps. Computed Tomography Angiogram (CTA) has become a routine part of pre-operative assessment of vascular anatomy and design in these flaps. We aim to identify CTA signs that predict venous congestion. This is a retrospective cohort study of flaps raised on the DIES at our institution where a CTA was performed pre-operatively. 98 consecutive patients had 124 DIES flaps raised of which four (3.2%) developed venous congestion. In these flaps, predictors of venous congestion included a type I pedicle (75 vs. 64.2%, p=0.22), a Superficial Inferior Epigastric Vein (SIEV) that did not connect to the depp. system perforations and was larger at origin (5.2 vs. 3.5mm, p=0.007) and less likely to arborise (0 vs. 96.7%, p<0.001), the perforators of congested flaps were less likely to connect to the superficial system (38.1 vs. 88.8%, p<0.001) and an SIEV that was larger in diameter that the DIEV at origin had a correlation coefficient with congestion of 1, suggesting that that a SIEV>DIEV at origin is highly predictive of congestion. We concluded that a CTA is an important pre-operative study for the identification of risk factors for venous compromise. These findings should prompt a robust discussion of the risk of flap failure with patients and contingency planning to augment venous drainage with the superficial system if required.
Niclas Stensson
Linköping University, Sweden
Title: High levels of endogenous PPAR-α activating lipids in woman with chronic widespread pain during acute tissue trauma
Time : 14:35-15:00
Biography:
Niclas Stensson has MSc in Chemistry from Linköping’s University (Sweden) and is at present pursuing PhD studies at Pain and Rehabilitation Center on the University hospital in Linköping. He has been a co-writer to three publications and also had several abstract/poster contributions at international conferences.
Abstract:
Chronic widespread musculoskeletal pain (CWP) is a significant health problem. The molecular mechanisms involved in developing and maintaining CWP are poorly understood. Central sensitization mechanisms maintained by stimuli from peripheral tissues such as muscle has been suggested. Lipid mediators with anti-inflammatory characteristics such as endogenous ligands of peroxisome proliferator activating receptor-α, oleoylethanolamide (OEA) and palmitoylethanolamide (PEA) are suggested to be regulators of the transmission of nociception from PNS on route towards CNS. In a previous microdialysis (MD) study we reported about levels of PEA and stearoylethanolamide (SEA) in microdialysate collected at 140 min and 180 min after MD probe insertion. In that study no significant difference of lipid concentrations between woman with CWP (N=17) and female healthy controls (CON) (N=19) was observed. The aim of the present study was to investigate the levels of PEA, SEA and OEA in MD samples collected during the first 120 min after probe insertion and explore the association of these levels with different pain characteristics. During sampling of dialysate, pain ratings were conducted using a numeric rating scale (NRS). Pain thresholds were registered from upper and lower parts of the body. OEA and SEA levels were significantly higher in CWP at all time points during the tissue trauma period. NRS correlated with the level of SEA in CWP. The higher levels of the lipid mediators could reflect altered tissue reactivity in response to MD probe insertion or a habitually higher concentration in CWP.
- Pharmacological Approaches for Pain
Location: Mississippi Amph
Chair
Donna Urquhart
Monash University, Melbourne, Australia
Co-Chair
Hee-Jeong Im Sampen
Rush University Medical Center, USA
Session Introduction
Husham Hasan
Al Hussein Teaching Hospital, Iraq
Title: The efficacy of TENS ACUPUNCTURE in management of trigeminal neuralgia as a sole or adjuvant therapy
Time : 15:00-15:25
Biography:
Husham A. Razzaq is chief director of Pain Management Dept. at Al Hussein Teaching Hospital, Al Muthanna Province, Iraq. He is the fellow of World Institute of Pain and had Active participation in international fellowship program in Interventional Pain Management held by Seoul National University Hospital (SNUH).
Abstract:
Trigeminal neuralgia involves nerves supplying head, face, teeth and jaws. Although the aetiology is not always well known, different treatment modalities are being practiced including medical, interventional, and surgical. The main modalities being practiced in my country is medical as there are very few interventional pain clinics available and the surgical modalities are almost never done due to either lack of experience or instruments. TENS acupuncture may be considered a promising adjuvant therapy which helps to decrease or completely stops the medicines used for treatment of TGN. The study was designed to study the efficacy of TENS acupuncture in management of trigeminal neuralgia as a sole or adjuvant therapy.
Ilker Ilhanli
Giresun University School of Medicine, Turkey
Title: The cultural adaptation of the michigan hand outcomes questionnaire in patients with carpal tunnel syndrome: A turkish version study
Time : 15:40-16:00
Biography:
Ilker Ilhanli has graduated from Ondokuz Mayis University School of Medicine in 2004 and has joined the Giresun University (Turkey) in 2011 and established the Department of Physical Medicine and Rehabilitation. He has authored/co-authored more than 50 scientific publications and has been part of many program committees and organization bodies (journals and conferences). He has international books about cultural adaptation studies and vibration at workplace. There are many citations for his research works. He is the vice president of Internal Medicine Sciences, vice director of Traditional and Complementary Medicine Research Center, and Institute of Health Sciences.
Abstract:
The cultural adaptations of questionnaires are important for easy use. Michigan Hand Outcomes Questionnaire (MHQ) is a questionnaire evaluating the hand disorders in different diseases. In this study, we aimed to assess the reliability and the validity of the Turkish version of MHQ in a single homogeneous group of patients with Carpal Tunnel Syndrome (CTS). The MHQ was translated to Turkish for cultural adaptation. A prior study was performed with a small group of patients (N=10) and healthy participants (N=10) for cognitive debriefing. After the prior study last version of the Turkish MHQ was prepared and used for reliability and validity study. For test-retest reliability, the Turkish MHQ and the ‘‘Disabilities of Arm, Shoulder and Hand’’ questionnaire (DASH) which was validated previously were answered by 100 patients with CTS and 50 healthy participants, and were repeated a week later. For internal consistency, the Cronbach’s alpha test was used. For validity, correlations between the subscales of the MHQ and the DASH were measured. Intraclass correlations of the subscales of the MHQ were high for test-retest reliability. The Cronbach’s alphas were found to be high in all subscales. We found significant differences between the patients and controls regarding all subscales of the MHQ. Correlations between subscales of the MHQ and the DASH were significant. This study showed that the Turkish version of the “Michigan Hand Outcomes Questionnaire” is reliable and valid and can be used in the Turkish patients with the Carpal Tunnel Syndrome because it is comprehensible and practicable.