Seven early-career pain researchers took part in the PRF Correspondents program during the 7th International Congress on Neuropathic Pain (NeuPSIG 2019), which took place May 9-11, 2019, in London, UK. This unique science communications training program provides participants with knowledge and skills needed to communicate science effectively to a wide range of pain researchers and to patients and the broader public. The Correspondents conducted interviews with plenary speakers, wrote summaries of scientific sessions—and provided live blogging, too! Take a look at their blog posts below.
Day 3: Saturday, May 11, 2019
Leaving NeuPSIG Feeling Reinvigorated
Mentally Stretched, Intellectually Stimulated, and Lots of Stairs
An Inspiring Workshop on the Spinal Cord Circuitry of Neuropathic Pain
Lots of Posters, Many Questions, and a Great Finale
Some Reflections on Science Communication
Leaving NeuPSIG Feeling Reinvigorated
The final day of NeuPSIG started early, but thankfully my head wasn’t too sore after the trainee reception the night before, as Prof. Makoto Tsuda’s plenary lecture was not to be missed! Using a channelrhodopsin targeted to low threshold mechanoreceptors, Prof. Tsuda’s group has been able to optically stimulate Aβ fibers and specifically analyze their function in mechanical allodynia after peripheral nerve injury. They have used this approach combined with chemogenetic modulation of inhibitory interneurons to delineate the changes in spinal circuitry permitting Aβ fiber stimulation of lamina I projection neurons. This work has revealed important details regarding the sufficiency of Aβ fiber activity to produce nocifensive behaviors after nerve injury.
In terms of content, I found the meeting very interesting and learned a lot. My PhD work has mostly related to traumatic nerve injury and its preclinical models, so the focus on diabetic and chemotherapy-induced peripheral neuropathy was a welcome change and highlighted two important clinical challenges. The quality of science was outstanding, not only from the topical workshops but also from the 300 posters presented by predominantly early-career scientists.
I’ve met some lovely people and had a number of impassioned discussions over the last few days. The PRF Correspondents program has been a really worthwhile experience, not only for the opportunity to meet some of the key movers and shakers in the pain field, but also because writing this blog has kept me the most consistently engaged that I’ve ever been at a conference. I would find myself paying extra close attention throughout the day for soundbites that might liven up a post. We’re presented with so much data at these meetings that it can be hard to digest or remember it all―the blog has been a great opportunity to review my notes, reflect on the implications of what’s been discussed, and clarify my own thoughts. It’s been fun to write freely and, in particular, to meet my fellow PRF Correspondents―a great group of enthusiastic young scientists. I will return to work reinvigorated and ready to implement some of the ideas that have been inspired in me this week at NeuPSIG.
Liam Peck, MB-PhD student, University of Oxford, UK.
Mentally Stretched, Intellectually Stimulated, and Lots of Stairs
NeuPSIG has officially ended, and I certainly feel like I’ve been mentally stretched, intellectually stimulated, and walked up and down a lot of stairs. But even though it was the last day, this did not mean that anything slowed down at all. One of my highlights today was Makota Tsuda’s talk on optogenetics. This has been an emerging method in the literature, with the ability to target specific types of nerve fibers―something that von Frey cannot do, as Makuto showed at the beginning of his lecture. He also made the point that if morphine can return rodent paw withdrawal thresholds back to baseline in chronic pain models, but is not an effective treatment for chronic pain in humans, why are we still using von Frey to assess reduction of pain? This was an argument that von Frey is not necessarily a good measure of allodynia in neuropathic pain. Makuto offered evidence that optogenetics can selectively target Aβ fibers, which may provide a better way to understand and assess chronic pain in the future.
The conference officially finished with a debate as to whether quantitative sensory testing or the more newly established brain imaging is better in predicting chronic pain. Despite talk of "the gloves coming off" and both debaters presenting excellent points to support their preferred method, Karen Davis and Rolf-Detlef Treede acknowledged that QST and brain imaging each have a pivotal part to play in predicting chronic pain. This was an apt end to a conference that often focused on how many different types of experimental approaches can ultimately come together to help solve the issues that we at NeuPSIG are concerned with: understanding the mechanisms, preventing the occurrence, and improving the treatment of chronic pain. I’ve really enjoyed the feeling of researchers and clinicians from a wide variety of institutions, countries, and research areas coming together to discuss and work toward these common goals.
I’ve loved every minute of NeuPSIG and have learnt so much; I very much look forward to coming back to this conference and hopefully many others. I would also like to thank Neil Andrews for facilitating the PRF Correspondents program and the other Correspondents for being some friendly faces in the busy conference setting. The Correspondents program has been an invaluable experience and definitely helped me get the most out of the conference. I look forward to working on my interview with Nadine Attal and my article on one of the sessions, to be published on the Pain Research Forum very soon …
Laura Pusey, third-year undergraduate student, BSc medical sciences (neuroscience) with professional training year, University of Exeter.
An Inspiring Workshop on the Spinal Cord Circuitry of Neuropathic Pain
Today was the final day of NeuPSIG 2019, and it was one where I presented my research on "Windup pain inhibition with CT fiber stimulation in humans." I also went to the most fascinating workshop of the conference. It covered spinal cord circuitry and neuropathic pain. Sarah Ross, Rebecca Seal, and David Hughes, all of whom I have admired during my research career, presented their stories, with all three deriving conclusions from transgenic animal models of pain. Sarah spoke about windup due to temporal summation―right up my alley. Becky spoke about VGLUT3+ transgenic mice and labeling C-LTMRs, which are the animal equivalent of the CT fibers I am studying in humans. Meanwhile, David started with a humorous analogy, likening his work to a bride on her wedding day. Like a bride, his work had something old, something new, something borrowed (the funding), and something blue (his immune histology figures). The research they presented was both elegant and inspiring. Becky also talked about how she is taking her work into the macaque monkey population, and I was immediately blown away, hoping to become involved in this project myself.
Until the next conference…
Sumaiya Shaikh, postdoctoral fellow, Linköping University Hospital, Sweden.
There is a lot of discussion about the survival of academic societies, particularly as there are fewer early-career researchers joining. Scientific societies have been established for centuries, with the eldest being the Royal Society, set up in 1660 to “promote science and its benefits, recognize excellence, support outstanding science, and provide scientific advice for policy, foster international and global co-operation, education and public engagement.” In more recent years there has been widespread criticism of academic conferences. They have been described as not useful, poor value for the money, and failing to deliver their hoped-for benefits such as building new collaborations, presenting advances, developing new research ideas, and the ability to come together to inform policy. Disappointingly, the high cost of attending a conference often precludes early-career researchers (ECRs) from attending, though I was pleased to learn that IASP does offer grants for ECRs to attend. ECRs, aka the workhorses, are the future, so there is much to be gained from their inclusion.
Despite the proliferation of web-based communication, I believe we should still place value on attending meetings, in part because of the informal opportunities to interact with other scientists. Conferences provide the opportunity to:
- present new work to colleagues and receive feedback―a more informal peer review process;
- clarify, share and refine our work;
- have an experience that is essential to learning; and
- share new research tools and techniques.
At NeuPSIG 2019, being a PRF Correspondent was my highlight. Knowing that each day I would write a blog changed my approach; I engaged more diligently and deeply with areas of research that are different from my own. In addition, I got to experience the challenge of distilling my thoughts from the jam-packed days into a short blog, which helped me hone my science communication skills. I loved the trainee drinks and meeting other ECRs to discuss aspects of our research and general academic life! The benefit of being a "small" SIG was that it did not take long to feel that you were really getting to know people.
It’s important that conferences are an environment where one can thrive and grow professionally, and as such I think it is paramount that we continue to challenge traditional ways of working to get the best out of everyone so that we as a community can progress more effectively and efficiently. The NeuPSIG program had a very traditional approach to conferences and relied heavily upon a one-way method of communication with limited audience participation.
How will conferences secure their place in the future? I think there is merit to incorporating the suggestions below.
- Be more innovative with the program design to allow greater participation, for instance, games such as The Publishing Trap. The Society for the Improvement of Psychological Sciences has some great ideas on their Open Science Framework (OSF) page, ranging from hack-a-thons, lightning talks, and workshops to "unconference" sessions.
- Be broader with the program to increase opportunity for multidisciplinary approaches and crossover. I think it is likely that most attendees went to the workshops that were closest to their area of research―great, but are we missing a trick by not learning from each other and continuing to work in isolation?
- Be broader with the speakers and not only rely on the “old and bold.” Create more opportunity for ECRs (the fresh talent) to shine on a larger platform―for example, a trainee plenary. The four ECRs who presented their posters were great and engaging speakers; why can’t we have more?
- Use technology to encourage further debate, and ensure that all questions and answers are heard. For example, during a plenary, attendees could use an online platform (e.g., Twitter) to share their questions for the speakers, and some of these could be addressed immediately during the Q&A and/or the debate could continue online.
- Have a stronger focus on open science themes and how we can incorporate them.
- Have more tangible outputs, such as a hack-a-thon to write a guidance note/opinion piece.
- Prizes and awards beyond only "best poster." These don’t have to be monetary but an opportunity to recognize exciting and/or innovative contributions.
- Look for ways to be open and accessible to all.
After a few intellectually stimulating and challenging days, I have gotten over the fact that this year’s NeuPSIG was in my hometown and that I did not get to bolt on a holiday. I leave NeuPSIG 2019 feeling that despite many challenges yet to overcome, and we are some way from providing patients with adequate pain management options, I am inspired and motivated. My message to other ECRs is to take advantage of every chance where you can discuss science with people. Do not act as an audience simply there to receive knowledge; talking with people offers more opportunities, and through establishing professional relationships we will cement our place as researchers.
Thanks to all the attendees, presenters, and IASP staff for making it a great experience! Looking forward to Madrid 2021!
Nadia Soliman, PhD candidate, Imperial College London, UK.
Lots of Posters, Many Questions, and a Great Finale
Hello from Day 3, the final day of NeuPSIG 2019. This has been such a fantastic event! To start our day, Dr. Makoto Tsuda gave an informative lecture on the investigation of neuropathic allodynia by using optogenetics in rats. This was followed by another great set of posters on many topics, including precision medicine, translation, new treatments, and genetics. There is so much to think about: 1) how to use aggregate data for individualized or precision medicine; 2) where the science is headed in terms of understanding how genetics contributes to risks/benefits of treatment; 3) what the best measure is of neuropathic pain—self-report questionnaires or objective measures. (If the latter, then which ones?)
Today I also had an opportunity to speak with a colleague from the UK about current research in the cannabis field―a conversation that then segued into a discussion of politics and societal norms in the UK versus the US, as well as differences in health payer systems in the two countries: Is healthcare a basic human right or a privilege? We did not have solutions, but we engaged in an earnest and interesting discussion.
This final day of NeuPSIG 2019 ended with a rousing friendly debate between Dr. Karen Davis and Dr. Rolf-Detlef Treede titled “QST versus imaging for the prediction of chronic pain.” The debate questioned the usefulness of QST in the clinical setting as well as the practicality of imaging in the clinical setting. If I were to judge the debate, I would call it a tie. Members of the audience engaged the speakers with questions at the end of the session, making this a great finale to the conference.
Brenda W Dyal, PhD, DNP, APRN, postdoctoral associate, University of Florida, US.
Some Reflections on Science Communication
The last day of NeuPSIG was spent at WCAPP, an IASP conference on the study of abdominal and pelvic pain, where I had the opportunity to present a poster on my work on pelvic and widespread pain in endometriosis. While at this conference, I had the chance to reflect on my time as a PRF Correspondent at NeuPSIG. Above all, I am so fortunate to have been a part of this program. Not only was it an incredible meeting and to be working alongside the other Correspondents, but this role taught me a lot about science communication.
Prior to NeuPSIG, I was a novice tweeter who liked to talk to people about my research, and science more generally, in person; now I’d like to think that I’ve advanced to the ranks of intermediate tweeter. I’ve also heard my voice on the podcasts that I’ve done―something that I was terrified of―and even in the midst of laughter and fumbles, I am now keen on developing my podcast skills to talk about endometriosis-associated pain in a way that can be easily understood by the non-endo fiends of the world. I’ve also blogged about my experience at NeuPSIG and about the highly controversial topic of cannabis as a potential treatment option for pain.
All in all, I couldn’t be more thrilled with my experience as a Correspondent. I learned a lot about neuropathic pain―something that I wasn’t quite sure I fully understood prior to the conference. I feel more confident as a (new) member of the pain field, and am so excited to continue my research career. Thank you, NeuPSIG, for opening my eyes to a new realm of research (I will now frantically be trying to read papers by the presenters), for confirming that science communication is a passion of mine worth pursuing, and for introducing me to so many outstanding researchers.
Danielle Perro, DPhil candidate, University of Oxford, UK.
The final day. The “rush” you get when you want the pride of having participated in pretty much all the congress activities, aiming to get to everything on time and feeling how exhausted you are—it’s kind of odd. Thankfully, I arrived right on time to hear Prof. Makoto Tsuda’s lecture. It’s amazing how new technology is allowing us to answer questions that previous studies would have just set aside; it gives you the feeling that, nowadays, nothing is impossible in pain research. Such feelings are increased when you have the chance to meet and chat with other attendees (I especially want to acknowledge Prof. Roberto Guiloff, who expresses his ideas in an amazingly clear way and enlightened me several times over the course of the conference).
In my experience, you try to find the answers in different ways: from the people that surround you, in nearby facilities, or just from the people that you know, and you get the feeling that there are walls you must try to break through; after so many experiments, you start to become weary. But at meetings like NeuPSIG, problems can be solved and there are no walls to break through―you just need the right ladder and then you reach for your answers. When meeting people, I always remember Isaac Newton’s words, “If I have seen further it is by standing on the shoulders of Giants.”
While in the UK for NeuPSIG, I’ve also been able to visit many inspirational places. Coming from Chile, I really want to mention some of the most amazing places I’ve visited and things I’ve seen.
In Cambridge, I visited The Eagle Bar, where Watson and Crick used to meet, and the place where the Cavendish Lab was, which is where J. J. Thompson discovered the electron. I also went to Trinity College and walked around the same gardens that Newton visited at some point. Later, in Oxford, I visited several colleges, as well as great places like the Turf Tavern, one of the oldest pubs in Oxford, where people like Stephen Hawking and Bill Clinton have been. Finally, in London, at the Science Museum, I saw some things I really didn’t expect: J. J. Thompson’s cathode ray tube―the one he used for the electron discovery―the first two patented transgenic mice, and a moon stone. A moon stone!
This fantastic trip really blew my mind, and I hope I have the chance to go to future NeuPSIG meetings and meet again with amazing friends and colleagues, in places as enlightening and inspiring as London has been. After all, coming to this meeting is not only a matter of science, but also cultural enrichment. That’s really what you take home in your backpack.
Soon I’ll be hopping on a plane back to my side of the world, with a strengthened sense of responsibility and hope for the future of pain research.
Luis Martin González-Gómez, PhD candidate, Pontificia Universidad Católica de Chile.
Day 2: Friday, May 10, 2019
On the Importance of Finding the Right Mentor
The Predictive Validity of Animal Models
A Disconnect Between Pain Conferences and Pain
On the Importance of Finding the Right Mentor
I started my uncaffeinated morning by interviewing the incredible Dr. Harriet Kemp. We had the chance to talk about many important things―we continued the conversation about cannabis use in pain management, specifically as it applies to her field of anesthesia; discussed gender equality in STEM (science, technology, engineering, and mathematics); and considered her experience with science communication as a PRF Correspondent at the North American Pain School. Our chats continued post-podcast as we talked about mentors and the importance of finding the right one for you.
Since starting my DPhil, I’ve come to learn that without mentors and support from those I admire, remaining motivated during the inevitable trials and tribulations associated with the DPhil would be far more challenging than it already is. When I asked Harriet about her experiences with mentors, she brought up a point that I think is important for all of us, particularly those of us early in our training or career: Mentors don’t have to be the obvious ones. Some of the best mentor-mentee relationships that Harriet has established have been with those outside of her lab and research field. In many cases, having someone in your corner like a former employer or someone you’ve met at a conference can be more beneficial to our growth as scientific researchers and, of course, as people. These individuals are able to act as a soundboard without interjecting their previous experiences as a template to navigate our own. Both Harriet and I agreed on the importance of finding a mentor with whom you get on personally and in many other ways; someone who can relate to your life experiences or general interest is what we should be striving for.
Yes, of course, we all want to be mentored by the big names in our respective fields, and I’m sure this isn’t unique to science. We want those who lead successful careers, and who appear to balance it all, to give us their secrets and guide us to similar successes.
At the end of the day, we need mentors who are candid with us about their experiences. In particular, this vulnerability is important to hear as early-career researchers. When leaders in the field, the ones who we aspire to be, fail to show their "human" side and discuss their lived realities and barriers they’ve encountered on their academic or clinical journey, it is detrimental in many ways. First, it makes their accolades seem unattainable. Additionally, if only the good and happy things are discussed, how can we come to terms with and openly discuss our own insecurities that we may be feeling? As we continue to grow our networks here at NeuPSIG and beyond, let’s try to keep these things in mind when seeking out those who will shape our training, impact the opportunities we engage with, and provide us with support during the highest of highs and lowest of lows on our career trajectories.
Danielle Perro, DPhil candidate, University of Oxford, UK.
One of the subthemes of this conference has been how to close the gap between preclinical success and effective treatments in humans―avoiding the “rodent trap” as Prof. Angelika Lampert refers to it. How many times have we seen that graph―you know the one―showing complete reversal of von Frey hypersensitivity from spared nerve injury?
Do our injury and neuropathy models suffer from confirmation bias, designed (consciously or not) such that we will see the greatest possible effect of our chosen interventions in rodents?
I was impressed with Rohini Kuner’s dedication to the reverse translational approach today. She discussed elegant work using locally and genetically targeted, bidirectional chemogenetic modulation of M1 motor cortex activity to mimic and interrogate the circuit mechanisms of transcranial direct current stimulation―shown to be analgesic in human neuropathic pain conditions. As well as producing bidirectional modulation of neuropathic pain using this system, projections of layer-specific motor cortex neurons were depicted beautifully. When I asked about a descending corticospinal tract recently shown to modulate spinal cord processing of tactile allodynia, her reply stated that she didn’t believe this tract had been defined in humans, so why pursue this when trying to recapitulate and understand human mechanisms? Fair point!
Similarly, the plenary lecture delivered by Steve Waxman was a fantastic example of the insights we can gain from reverse translating rare genetic pain disorders to in vitro models. Making iPSC-derived nociceptors from patients carrying fully penetrant Nav1.7 mutations causing inherited erythromelalgia (IEM), Prof. Waxman has been able to identify variants sensitive to an existing anti-convulsant drug, carbamazepine (CBZ), in a real step towards personalization of treatment for this excruciating condition. On the basis of three-dimensional structural analysis of the Nav1.7 channel, one more mutation (S241T) shared by a mother and son was identified that had potential to confer CBZ sensitivity. Characterization of iPSC-derived nociceptors from these patients indeed showed hyperexcitable properties including depolarized resting potential. Interestingly, the mother’s cells exhibited a less severe phenotype, indicating that something in her genetic background, presumably an ion channel, was providing some degree of pain resilience. Sure enough, whole exome screening found a gain-of-function in the potassium channel Kv7.2, a known contributor to resting membrane potential. Despite small sample sizes, these dramatic phenotypes can therefore help to identify bona fide resilience genes for further therapeutic targeting. Reverse translation promises to make our models much more relevant to what is seen in the clinic.
Are we even asking the right questions behaviorally?
Prof. Kuner also said to me yesterday that “we can’t study pain in isolation.” We must take into account the complex nature of pain. There is so much going on here―afferent sensation, central modulation, affect, cognition, learning and memory, motivation, stress―and so simple withdrawal reflexes can’t be held up as a gold standard. There has been a positive push in recent years towards more ethological outcome measures, advocated for by Andrew Rice among others, and its importance was demonstrated today by Ted Price in his exploration of MNK-eIF4E signaling, the effects of which are absent using reflex assays but are observed with conditioned place preference. Ultimately, we need to develop more holistic approaches to investigate the response of the whole nervous system to pain, and the good news is that we are moving steadily in that direction.
Liam Peck, MB-PhD student, University of Oxford, UK.
The Predictive Validity of Animal Models
The translatability of animal models and why success observed in animal models does not translate to patients in the clinic―I can only imagine that this is debated at every biomedical conference and NeuPSIG is no exception. Given the multifaceted complexity of pain and the lack of effective analgesics, this topic is perhaps discussed even more fervently in our field.
It is well documented that many of the drugs prescribed for the management of neuropathic pain were not rationally designed, such as tricyclic antidepressants and anti-epileptics. Dr. Nadine Attal’s plenary gave an extremely comprehensive insight into translational neuropathic pain research―from bench to bedside and/or bedside to bench?!?
Prof. Malcolm Macleod presented evidence from preclinical systematic reviews showing that studies that did not report conducting blinding, randomization or a sample size calculation resulted in an over-estimation of effect. Of concern (including ethical concern) is that many studies are at high risk of bias and therefore the results may not be reliable. In answer to calls to deprioritize the use of animals he also provided empirical evidence to show that the in-vitro situation is worse! Hence, there is a need to improve the rigor of all experiments!
Jan Vollert of the EQIPD consortium presented a handy guide to improve animal research, including just five steps:
1. Predefine whether your study is exploratory or confirmatory.
2. Predefine, document and standardize all methods and analyzes.
3. Predefine your statistical analysis plan―determine which tests are most appropriate for your data and ensure you conduct a sample size calculation.
4. Randomize and blind.
5. Document―“not all bias can be prevented but it can be uncovered: use full comprehensive documentation.”
Prof. Andrew Rice addressed the "reproducibility crisis" of animal studies. Proving the concept, a multicenter approach was able to provide high-quality evidence proving burrowing as a robust and reproducible tool to infer the global effect of pain on rodents. He also provided important information for the use and conduct of multicenter studies in the future. Although this approach requires greater project management and is more resource intensive, the quality and reliability of the results are likely to outweigh the additional cost.
The lunchtime session from Transpharmation, a contract research organization, acknowledged the problems of construct validity; of animal models not mimicking the human condition; of animals displaying sensory gain but not the more common sensory loss as experienced by patients, though this was not addressed in their characterization of a diabetic neuropathy model. They advocated use of more ethologically-relevant behavioral assessments and with that presented some interesting data on how, in a diabetic neuropathy model, an animal’s burrowing behavior is significantly reduced when isolated from its social partner(s). And, control animal behaviors are reduced by being housed with animals that are developing pain. It would be useful to know if these findings can be/have been reproduced and if the same effects are observed in other behavioral assessments, so that preclinical researchers can consider/control appropriately for these social interactions when measuring behavioral changes so they can be sure that what they are measuring is attributable to pain.
Animals still have an important role to play. Preclinical studies have been central to many sessions at NeuPSIG, further demonstrating how we are hugely reliant on animal studies for both understanding the underlying pathophysiology and mechanisms of neuropathic pain, and for drug development. But the importance of developing more complex animal models and behavioral assessments that have greater clinical relevance to improve the likelihood of developing effective therapeutic interventions is clear. We need to understand the limitations of our animal models and use the models more appropriately by asking the "right" questions/testing the "right" hypotheses. We must conduct studies with rigor. Studies must be adequately powered, and risks of biases mitigated so that we can be certain the results are reliable. We should be innovative and not just keep doing the same thing because that is “what we have always done”! Be skeptical, challenge accepted norms and consider how things can be done better…
Nadia Soliman, PhD candidate, Imperial College London, UK.
This morning I attended a talk by Fusao Kato, Emiko Senba and Volker Neugebauer about their research into “the active roles of amygdala plasticity in neuropathic pain in diabetes and nerve injury models.” I was somewhat star-struck, as having been fully immersed in research involving fear extinction and the fear avoidance model of pain has meant I have read a lot of research conducted by these speakers. I did, however, restrain myself from asking for autographs, as I realize that it would probably prove that I had spent a little too much time locked up reading articles on PubMed with only my cohort of mice for company.
In any case, I thoroughly enjoyed the talks, and found Emiko’s research on the benefits of exercise on chronic pain particularly intriguing, as this was new to me. Emiko provided evidence that voluntary wheel running improves mechanical allodynia in mice that had underwent partial sciatic nerve ligation. On paper this seems contradictory; shouldn’t running on a limb that had been injured simply cause more pain? However, Emiko’s study showed significant differences in allodynia between mice that had been allowed to run on a wheel compared to sedentary mice whose cage wheels were locked after two weeks. This provides a compelling argument for the benefits of exercise, alone or in combination with other therapies, in the treatment of chronic pain conditions.
After the talk a member of the audience pointed out that some patients have claimed that any form of exercise increases their pain, perhaps leading them to not engage with this treatment, highlighting potential issues with bringing these methods to human patients. It is well documented that mice have an almost addictive relationship with wheel running, something that does not necessarily translate to a motivation to exercise in (most) people. Emiko explained that in some of her other research they have found light-moderate exercise to be the most effective at reducing allodynia, rather than more vigorous exercise. This suggests that even encouraging patients to go for brisk walks may prove beneficial as part of the treatment of chronic pain. For me, this talk provided some interesting evidence that, in the race to help better treat chronic pain, it may involve making a run for it, literally.
Laura Pusey, third-year undergraduate student, BSc medical sciences (neuroscience) with professional training year, University of Exeter.
Day 2 was the busiest day so far for me at the conference. It was a day where I conducted four interviews with conference speakers. I hadn’t anticipated being this busy on the day when I was turning 34. Yes, you heard it right―it was my birthday!
Dr. Rolf-Detlef Treede, from the University of Heidelberg, Germany, was one of the scientists I interviewed. He shared his thoughts about how IASP and its meetings have changed since he first joined the organization in 1982 during his postdoctoral years―to put it in perspective, this was three years before I was born! As the former president of IASP and former chair of NeuPSIG, he had many experiences to share, reflecting upon what can be improved and the future direction of pain research. He also discussed current and upcoming themes from these meetings, in particular the similarities and differences between diabetic and chemotherapy-induced neuropathic pain. There was a lot to talk about. Stay tuned for more insights that emerge from Dr. Treede’s personal and professional history, and from his experiences with IASP…
Sumaiya Shaikh, postdoctoral fellow, Linköping University Hospital, Sweden.
A Disconnect Between Pain Conferences and Pain
Yesterday was a very busy day. Nevertheless, through it all I kept reminding myself, “Today ends with the trainee networking event."
I particularly liked the lecture Stephen Waxman gave. As you might have felt after reading my last post, I’ve been feeling that coming to a congress is usually one of the most rewarding of all of our activities―not only do you have the opportunity to learn about amazing research, but you also get to meet new people and get together with friends you have met or worked with previously. But there is a disconnect between feeling so much joy at a conference and how terrible pain is. But this disconnect disappears upon listening to lectures like the one Prof. Waxman delivered―when the science and patients' wellbeing go hand-in-hand.
The message is a powerful one: We love what we do because it’s not for ourselves.
Luis Martin González-Gómez, PhD candidate, Pontificia Universidad Católica de Chile.
Bench to Bedside, Bedside to Bench
Hello from Day 2 at NeuPSIG 2019, London. The day started with a plenary lecture by Dr. Nadine Attal, who discussed the translation of science into effective treatments for patients. That translation can move both ways, from basic science (the bench) to clinical practice (the bedside) and from clinical practice to basic science. Dr. Attal also discussed research examining examine the connections between neuropathic pain and psychosocial factors, cognition, depression, anxiety and genetic factors.
From the plenary lectures we headed into the exhibit hall for the poster session. There are so many great posters here that illustrate new and ongoing research from around the globe that should result in exciting results for the clinical arena.
This was another interesting day filled with plenary lectures, workshops, posters, symposia, and opportunities for networking. Here it feels as if everyone is working toward the same goal—to understand the mechanisms of neuropathic pain and the best plan for interventions that will improve the quality of life for people suffering from it.
Brenda W Dyal, PhD, DNP, APRN, Post-Doctoral Associate, University of Florida, US.
Day 1: Thursday, May 9, 2019
The Sound of Sensory Afferents!
The Importance of the Patient Experience
Pain Management: Is There a Role for Medical Cannabis?
The Sound of Sensory Afferents!
Everyone has experienced some form of pain as a sensation in the skin, deep tissue, muscles or bone. There are nociceptive afferents everywhere that enable us to “feel” the discriminatory or emotional components of pain when a stimulus is perceptible enough to evoke a response. On the first day of the NeuPSIG 2019 conference, thanks to a technique called microneurography, workshop attendees could perceive another sensation coming from afferent nerve fibers: they could “hear” the nerve fire. This is something that a only a few people across the world have experienced.
During this hands-on workshop, Jordi Serra, a microneurographer from King’s College Hospital, London, UK, recorded electrical activity of sensory afferent fibers from the nerve in the foot of his workshop co-presenter Mario Campero, also a microneurographer, from Universidad de Chile, Santiago. Both Serra and Campero have been conducting microneurography in awake, conscious humans to record the electrical activity and sound of the firing of an activated single nerve axon.
For this technique, a small needle-like electrode, insulated except for its tip, is inserted into a peripheral nerve—in the case of the workshop, the cutaneous dorsal nerve of the foot of Campero. Then, electrode maneuverer Serra explored the fascicle until an appropriate sound of a single axon fiber was generated upon a stimulus. This stimulus is presented either electrically by switching between the recording setup to the stimulation setup with the same electrode, or by applying a sensory stimulus to the receptive field in the skin corresponding to the fiber. This stimulus could be mechanical, such as a von Frey hair or brushing, heat or cold, air puffs, stretch, skin indentation using a probe, hair follicle bends, etc.
Briefly, the electrode was in the nerve and each time the needle moved, the corresponding receptive field was stimulated until the desired sound became audible—a sound that suggested that a single fiber unit was in contact with the tip of the electrode. This is an extremely time-consuming method that requires a large amount of patience and persistence. On some days, microneurographers find one or more axons, and on some days none. Recording from a particular fiber class that is low threshold or silent is particularly difficult.
Seemingly, the first day of NeuPSIG 2019 was a lucky one, as Serra managed to capture several different classes of afferent units, and one C sympathetic efferent nerve, during the recording session. Both Serra and Campero are C-fiber microneurographers, which means that their focus is on pain fibers—the nociceptors. The workshop audience saw a C high-threshold nociceptive unit, a C silent nociceptor, and a C sympathetic efferent axon recording in action, with each class having a specific style of activation. These three classes were almost overlapping on the histogram (a visual recording of the electrical activity) but the firing pattern was unique, as was the stimulus required to evoke the firing.
A rare afferent class known as low-threshold CT afferents that respond to a gentle, slow, stroking tactile stimulus was also found. Recording from this class is particularly challenging as these afferents are the most difficult to reach, but they have been implicated in neuropathic pain and allodynia.
Finally, there was an A-fiber recording of what appeared to be a Meissner corpuscle, which is a tactile corpuscle end organ of the axon in the skin that responds to light touch. Upon hearing the activation pattern of various A- and C-fibers, there is a distinct difference in the sound that most experienced microneurographers can detect even before they conduct further tests on the axon unit.
The workshop was successful and one-of-a kind where the audience could experience the firing and sound of human nerve fibers up close. Looking forward to many more! Stay tuned for my interview with Dr. Campero…
Sumaiya Shaikh, postdoctoral fellow, Linköping University Hospital, Sweden.
The Importance of the Patient Experience
“ ‘Talking about us without us' is not a way forward”―opening remarks from IASP president Lars Arendt-Nielsen on patient advocacy in pain research.
This statement really set the tone for this meeting and puts into context what we strive to do as pain researchers. It can be easy to get caught up in a "basic science bubble" at times, but the ultimate importance of the patient experience was made poignantly by Prof. Lesley Colvin in describing patients with chemotherapy-induced peripheral neuropathy (CIPN), some of whom would self-reportedly be willing to trade the painful burden of CIPN for a worse cancer prognosis. We really need to improve early diagnostic ability and the translatability of pain research into the clinic, in order to address these unmet needs. Later in the day Dr. Aaron DiAntonio gave a plenary lecture describing promising preclinical efforts to reduce “dying back” axonal degeneration induced by multiple chemotherapeutic agents. If translatable, this could vastly improve dose titration of cancer therapies and avoid the current trade-off between anti-cancer efficacy and pro-neuropathic potential. More mechanistic details to follow in a future post!
As I have unintentionally missed all of Gary Lewin’s guest lectures at my university, I really had to go to this session on novel therapeutic targeting of primary afferents. Sadly there were no stories of naked mole rats this time, but Prof. Lewin presented a really interesting reversal of CCI-induced hypersensitivity by local cutaneous application of a small molecule inhibitor of STOML3, named OB-1. No Jedi mind tricks here though―the mechanism appears to be via disrupted tethering of Piezo2 channels to the primary afferent cytoskeleton and extracellular matrix, thus uncoupling mechanical deformation of distal terminals from electrical depolarization. It was also great to see a novel approach to virally deliver phototoxic compounds to select primary afferent populations from Paul Heppenstall, and the excellent work of my colleagues Greg Weir and Steve Middleton during my supervisor David Bennett’s talk on targeted chemogenetic silencing as a future gene therapy for neuropathic pain.
The afternoon brought back two old debates―firstly between "labelled line" and "pattern" theories of itch encoding by Martin Schmelz, and secondly between central and peripheral driving mechanisms of neuropathic pain. In the latter, Sanne Kikkert presented some nice imaging data showing preserved homuncular representation of phantom hand movement in the primary sensory/motor cortex and long-lasting (1-week) analgesic effects of a 20-minute transcranial direct current stimulation, which came up during my interview with Prof. Rohini Kuner (to be published later on PRF). Simon Haroutounian described the efficacy of peripheral nerve block in providing patients with relief from diabetic and chemotherapy-induced neuropathic pain, but interestingly also from post-stroke pain. Terry Walters followed by showing alteration of peripheral sodium channel expression and sensory neuron hyperexcitability after spinal cord injury, but in both cases it is unclear mechanistically how these central lesions might induce ongoing spontaneous activity in the peripheral nervous system.
I almost forgot―I also presented my poster, comparing two Kv1 potassium channel knock-outs with behavioral hyposensitivity. I tried out the #betterposter format circulating on Twitter (check out @mikemorrison) to communicate the central message more clearly and it worked well―I would recommend!
Liam Peck, MB-PhD student, University of Oxford, UK.
Pain Management: Is There a Role for Medical Cannabis?
This was an extremely interesting lunchtime debate. I chose to attend because I find it difficult to know what to believe, given the strong opposing opinions on cannabis and its potential therapeutic uses, particularly as the waters are muddied by cannabis companies promoting their health benefits.
Chaired by Dr. Mark Ware, the panelists launched into what they described as compelling evidence for the use of cannabis-based medicines in pain management―a great advert for a cannabis-pharma company! However, this evidence was anecdotal, subjective patient-reported outcomes: Patients have reported that using cannabis or cannabis-based medicines has led to a reduction in their pain experience and an improvement in function despite their pain.
The panelists clearly believe in its potential based on their patients’ experiences, but they were not allowed to rest on their laurels and the concerns about the evidence of efficacy and potential harms were fielded. There was a concession that the evidence from randomized controlled trials was “not the best.” In terms of safety, despite the comment that "nobody has died of a cannabis overdose" (we know that people have died as a result of being under the influence) there was recognition that there is a risk of psychosis and patients with history of some mental health illnesses may not be able to benefit.
In response to “what research and monitoring programs do we need and what are the future research agendas?” there is a long and important to-do list:
- More clinical trials and long-term monitoring (recognizing that this does not serve the patients that may be prescribed the drug now)
- Identification of which patients these drugs could help
- Research to understand how cannabis-based medicines can be taken in combinations with other pain medication as well as other drugs in order to identify and prevent possible drug-drug interactions
- Improved understanding of the mechanisms of action
The unbiased and robust appraisal of the evidence that is currently being conducted by the IASP Presidential Task Force reviewing cannabis-based medicine for pain management will be able to provide conclusions to inform the future research agenda.
As more countries are legalizing medicinal and recreational cannabis we find ourselves in an unprecedented situation whereby patients will have access to these drugs to self-medicate and are doing so in the absence of understanding about how they work and who they work for (and I appreciate that this argument can be made for many other therapeutics) and hence there is a need for regulation and to tread carefully, taking heed of past lessons to prevent a future "cannabis crisis."
Nadia Soliman, PhD candidate, Imperial College London, UK.
Prior to NeuPSIG, attending the company symposium titled "Pain Management: Is There a Role for Medical Cannabis?" was one of my top priorities. While this topic has become increasingly integrated into conversations pertaining to pain amongst patients, physicians, and researchers, the global community is devoid of unanimity on the subject of medicinal cannabis use. Today’s lunchtime session effectively drove this point home. The international representation on the panel effectively highlighted the great strides we have made globally to advance research on cannabis and its use for pain management. However, the discussions between Canadian Dr. Colleen O’Connell, German Dr. Jakob Emrich, and Dr. Andrew Davies of the United Kingdom demonstrated the decade-spanning lag in social understanding and use of medical cannabis in the context of pain.
Being a Canadian national myself, I took particular interest in Dr. O’Connell’s reports of the drastic, albeit unexpected, changes in social attitudes towards cannabis use in Canada. This past October, cannabis was legalized in the country for recreational use. Since I was living in the UK at that time, I was unsure of what the implications of such a social shift would be amongst Canadian citizens. I had prepared to ask Dr. O’Connell during the Q&A what the legalization of recreational cannabis would mean in the context of prescribing cannabis for medicinal pain management, but before I could finish writing down the question she was already answering it. Recreational legalization comes nearly 20 years after the legalization of cannabis for medicinal use. O’Connell reported her shock over the number of people who came to her practice inquiring about the general health effects, both short and long term, of cannabis use. She further explained that the legalization of recreational cannabis has opened the floodgates for conversations and simultaneously dampened the taboos and associated stigma associated with its use. Perhaps something to make note of.
While O’Connell was enthused by the conversations she had been having with patients about cannabis, these are not conversations that are had lightly. When discussing cannabis as a medicinal option, the same precautions and informed conversations are imperative, just as they would be prior to an opioid or other pain management prescription. With potential long-term psychological effects, such as the increased risk of schizophrenia, Dr. O’Connell recognizes that conversations about cannabis use require careful consideration of familial history of psychiatric disorders, current health status, and developmental stage. Cannabis treatment is not for everyone.
Many lunchtime attendees were equally as intrigued and asked some tough questions that not only Canadians, but also members of other countries who adapt their cannabis policies, will be faced with in the not-so-distant future. Firstly, will there come a time when medical cannabis can be used as a substitute for the oversubscription of opioids, and in a North American context, a tool to combat the currently lethal opioid crisis? This feeds into another point about acceptance of cannabis use. If cannabis is to become a viable pain management option, then social attitudes towards its use will have to shift. How are we to do this on a global scale where legalization is not uniform amongst different countries with vastly different health care infrastructures? Conversations like these are ones that we as pain researchers should be taking home to our friends, families, and patients to create a sense of normalcy around the topic. We need to push the scientific agenda to address gaps in our understanding of cannabis. We need standardization of research methodologies and prescription guidelines. While Canada is a great role model in the field of cannabis use and has prepared comprehensive guidelines, and outlined evidence in support of it, the mobilization of this information internationally is in the hands of this scientific community.
If these are the types of conversations that the first day of NeuPSIG is engaging its attendees in, I can hardly wait to see what Day 2 brings.
Danielle Perro, DPhil candidate, University of Oxford, UK.
So, I have successfully navigated my first day at NeuPSIG―and I’ve enjoyed it! I spent my morning learning about topics surrounding the Lancet "Waste Series" and how we can make research more efficient and valuable, with Andrew Rice, Ian Gilron and Malcolm Macleod. The lectures began by detailing some seemingly simple steps to making research efficient, such as the requirement of large sample sizes, the blinding of experimenters and effective randomization. However, it soon became clear that an extremely high percentage of research is carried out and published without ticking some, or all, of these boxes. The speakers then in turn highlighted how the failure to follow these simple steps can lead to certain positive effects becoming exaggerated. I found this talk to be something of a worry. In an attempt to solve the pressing scientific issues more quickly, are we skipping the "basic" steps in order to save time, at the expense of reliable results? It will certainly make me think about how I conduct my research in the future.
During the afternoon I had the opportunity to present my poster, and I really had no reason to be nervous. After spending my time brushing up on my presentation and interpretation of results, I was surprised to find that my biggest challenge at first was trying to gauge whether people wanted to be engaged with, something I was not prepared for! However, it didn’t take me long to begin distinguishing between an interested look, and one that said "I’m sorry I was just wondering where the coffee was." Overall, I really enjoyed the experience and I was able to engage and discuss my work with a lot of researchers from my field. Occasionally, I even found myself in a position where I was more knowledgeable about the topic (a rarity as an undergraduate!). I feel so lucky to have had this opportunity so early in my research career, and I look forward to being able to present more posters in the future.
With the first day of NeuPSIG and my poster presentation done and dusted, I’m looking forward to what the next two days of the conference brings.
Laura Pusey, third-year undergraduate student, BSc medical sciences (neuroscience) with professional training year, University of Exeter.
Hello from NeuPSIG Day 1. Today I attended the Plenary Lecture where Professor Lesley Colvin gave an update on the assessment needs and current status of research in the area of chemotherapy-induced peripheral neuropathy (CIPN). During her lecture, she described risk factors for the development of CIPN and the importance of identifying modifiable and identifiable risk factors to aid in individualized pain treatment. The opening remarks prior to Professor Colvin’s lecture were an inspiring start to a day that was jam-packed with interesting sessions and great networking opportunities.
After the opening plenary lecture, I moved into the Monarch Suite for the poster session. Today was the day to present my poster titled “Sensory Sensitization Groups and Pain Quality Descriptors in Adults with Sickle Cell Disease: Toward Discriminate Validity of a Pain Screening Tool.” The poster was well received with many people stopping by to read the poster and ask questions. Some took photos of the poster and it was great to have such interest in this work from pain researchers. As I walked around the Monarch room I had an opportunity to see so many great research studies that are underway across the globe, all with the intent to better understand neuropathic pain. There was so much research exhibited and discussed today that I have a renewed hope for the future of those who suffer with neuropathic pain—new research is going to improve outcomes soon!
There was a buzz of excitement in the exhibit hall today; it felt as if everyone was enjoying being together with others who all share their interest in pain research. The exhibitors were kept busy showing off new developments to many researchers stopping by to learn about new and upcoming tools, equipment and books to aid in research and clinical treatment of neuropathic pain. I am looking forward to Day 2; between the plenary sessions, poster sessions, and concurrent workshops, it is expected to be another valuable leaning experience here in London at the 7th International Congress on Neuropathic Pain.
Brenda W Dyal, PhD, DNP, APRN, Post-Doctoral Associate, University of Florida, US.
The congress started very early―and with so many activities. I got to show my poster at the first session and it was impressive how many people were interested; I pretty much talked for the whole 90 minutes the session lasted, so I think it went pretty well. The setting of the poster sessions is excellent, not overwhelmingly crowded nor with too many sessions, so you really have the chance to interact with other researchers. It’s really something to highlight.
After this session I started realizing how tired I was because of all the preparation but luckily the talks later on were great. I went to the workshop on the overlap between mechanisms of peripheral and central pain conditions, and the presenters and the audience had an outstanding disposition. There was so much interesting and back-and-forth discussion, it was inspiring.
Later we had some beers over the reception and on our way home there were some kids singing “Who wants to live forever?” That really got me thinking about pain, and how terrible it must be to live with neuropathic pain, from all the different origins. I just passed out in bed thinking of it…
Luis Martin González-Gómez, PhD candidate, Pontificia Universidad Católica de Chile.
NeuPSIG 2019 Meeting Preview
One More Conference Before Finishing a PhD
A Preclinical Systematic Review on Cannabis for Pain
Learning More About Pain at IASP Meetings
One More Conference Before Finishing a PhD
So NeuPSIG is around the corner and the final push to get some new data is drawing to a close―hopefully some of it will make it on to a poster in time! I am feeling quite nostalgic about this conference as it is (probably) the last meeting I will attend during my PhD, due to be completed in September. I’ve made so many friends for life within this vibrant and enthusiastic community of pain researchers, and conferences are always the highlight of the year―not only for the outstanding quality of science we can expect to discuss but for social purposes as well.
My first conference was the 2016 IASP World Congress on Pain in Yokohama, Japan, and the very first workshop I attended covered the central vs. peripheral contributions in the manifestation and maintenance of chronic pain. Fittingly, there appears to be a "rematch" on Thursday afternoon, so I am looking forward to seeing how the field has progressed on this issue in the last three years. My day-to-day research is heavily focused on the peripheral nervous system, so at these meetings I always enjoy hearing more about the central nervous system. I’ve become interested in the affective component of acute and ongoing pain recently so I hope to hear a little about this, and ahead of my return to studying clinical medicine I am excited about the prospect of patient stratification and personalized treatments, which will be covered on Saturday.
Above all, I’m really looking forward to meeting the other PRF Correspondents and hopefully providing some interesting content for the wider community of pain researchers and patients alike. Stay tuned @LiamJPeck.
Liam Peck, MB-PhD student, University of Oxford, UK.
This is my first-ever conference. And I’m a bit nervous. There, I said it.
Having only been immersed in the world of pain research for the past year, I feel like the three days at the meeting are certainly going to put my newfound knowledge to the test. I am, however, willing to face the challenge (even if it’s with slight trepidation).
Despite my nerves, I realize that this is an exciting opportunity. I’m very much looking forward to hearing about cutting-edge research and ideas in the areas of pain research that I’ve worked in so far, as well as learning about areas I currently have no idea of! I’m especially excited for the sessions that discuss how we could begin to develop more personalized treatment for pain conditions, using a combination of different approaches. I will therefore definitely be attending the "Advances Towards Precision Medicine" and "Optimizing Outcomes of Interventional Therapies for Neuropathic Pain" workshops.
Alongside trying to absorb as much new science as I can, I am also due to present some of my own research during one of the poster sessions. This is yet another new experience. I have created scientific posters previously, but have yet to present one and certainly not to some of the leading researchers in the field. Did I mention that I’m a little nervous? However, I’m sure this will be a valuable learning experience, improving my ability to effectively communicate scientific data, and an opportunity to get feedback from others about how my work could be improved. Ultimately, the best science involves collaboration with others.
If you’re interested in seeing how I get on, or simply to check that I’m not just hiding behind my poster board, I’ll be presenting my research on the effect of dysfunctional CGRP signaling in fear extinction and pain sensitivity during the afternoon session on Thursday at board 91.
I look forward to continuing to write blog posts alongside my fellow PRF Correspondents, summarizing sessions that have interested us throughout the day and providing our own insights on the goings-on at NeuPSIG 2019!
Laura Pusey, third-year undergraduate student, BSc medical sciences (neuroscience) with professional training year, University of Exeter, UK.
Finally in the airport, 1 hour before getting on the plane to start a 30-hour trip all the way from Chile. One hour before finally getting to “rest”, or to at least realize that there’s not much you can do for the next 10 hours. After jamming in work and travel preparations the last days, I feel like I’m mentally writing an abstract of the latest activities. A lot got done, much more was not, and you can start picturing what you’ll do when you get back. And on this last day you actually have to choose what you are doing.
I’m finally going to London.
The first thing that comes to mind is all the bands that have originated there: the Beatles, Led Zeppelin, the Rolling Stones, Bowie, and of course, Pink Floyd. A friend who’s hosting me in Cambridge told me I’ll be getting to visit the Grantchester Meadows (please listen to this song) and the place where High Hopes was filmed. Just thinking of that I remember the music I unconsciously chose to accompany me on the thrill of this last day: starting with some smooth Louis Armstrong, then pepping up with Wham! and ELO, and just before getting on the plane, I turned to Spinetta.
So many feelings, so many new experiences and so much High Hopes on the upcoming meeting. I hope I have a lot of Wham in my head when my poster presentation comes up (Thursday morning, poster PTH22). The poster title is “Contribution of Kv1.6 channels to modulation of spontaneous activity on damaged sensory myelinated axons.” This research has gotten me so electrified (it literally happened), I only want to catch that Last Train to London ASAP!
Bye!
Luis Martin González-Gómez, PhD candidate, Pontificia Universidad Católica de Chile.
Hello from Florida, US! This upcoming week I am scheduled to travel to London, where I will attend the NeuPSIG meeting. This will be an amazing event to learn about the latest developments in pain research. I am looking forward to learning about new methods for pain assessment and new treatments for neuropathic pain. Also, I am excited to have the opportunity to engage in networking activities with experts in neuropathic pain research. The program schedule is full of so many options for learning that I had a difficult time deciding on which of the concurrent workshops to attend. However, I am ready—my itinerary is set so I am off to London.
The topic for each of the Plenary Lectures looks interesting and I expect to learn something exciting at each one. As part of the PRF Correspondents program I will have the opportunity to interview Professor Lesley Colvin (the speaker for Thursday’s 9 a.m. Plenary Lecture). I look forward to speaking with Professor Colvin and reporting to you about her very interesting work in translational research on the topic of chemotherapy-induced peripheral neuropathy.
Brenda W. Dyal, PhD, DNP, APRN, postdoctoral associate, University of Florida, Gainesville, US.
NeuPSIG. When I first heard about the conference last term, for a minute, the title reminded me of a soup. Alas, a conference on neuropathic pain. Perhaps less delicious, but far more exciting. Hi, I’m Danielle. I’m a first year DPhil student studying endometriosis-associated pain. While neuropathic pain specifically is not a core area of focus for my DPhil project, I know that because of the intricacies and complex nature of pain, neuropathic pain and my understanding of it will undoubtedly inform my work over the next few years. My curiosity driven towards understanding pain led to my interest in attending this conference, and I’m ecstatic to be attending as one of the NeuPSIG 2019 PRF Correspondents! I have a love for pain―well understanding and researching it, that is―and science communication is a passion that I have developed since commencing my studies.
Aside from having the opportunity throughout the conference to report on amazing talks like Dysfunction in Brain Reward Circuits in Neuropathic Pain (to be delivered by Dr. Vania Apkarian), I will be interviewing leaders in the field of pain research. While I am less keen to hear a recording of my own voice, I’m so excited to be interacting with Dr. Stephen Waxman and with Dr. Harriet Kemp, in the podcast format. Interviewing pain researchers who not only study distinct topics but are at different stages of their careers, I look forward to their insight into the field of pain research from their respective vantage points. To reflect the recent shift in online engagement between scientists and the general public, I will provoke engaging discussions about the importance of science communication in the translation of modern scientific research to sources outside of journal publications. Being a young female scientist myself, I have long been an avid supporter of women in STEM, and issues surrounding gender disparities in STEM are ones that I hope to report on in these podcasts as well.
Aside from having the chance to speak with so many intelligent and creative individuals at the conference during the ample networking events, poster sessions, and the walks to and from the tea-breaks, I’m looking forward to many of the workshops throughout the meeting. Namely, Bidirectional Drivers of Neuropathic Pain: Unexpected Overlap Between Mechanisms of Central and Peripheral Pain Conditions is most definitely on my radar. It’s so easy to think of pain conditions as separate entities, and so I have high expectations that this workshop will initiate conversations surrounding the overlap―conversations that continue long after the conference is over. Additionally, I am Canadian, and this past October, Canada legalized cannabis. Since then, the conversation about the use of cannabis both recreationally and for medical reasons has become a hot topic amongst Canadian policy makers, public health professionals and the science community more broadly. I have read, time and time again, self-reports of the positive impacts of cannabis on pain management, and I would like to hear from Spectrum Cannabis on this matter. I recognize that this may be a contentious subject, but these are important conversations to be had and I cannot think of a place better than NeuPSIG, surrounded by the current and future generation of leading pain researchers, to be having them.
While these are only a few of my pre-conference highlights, this year’s NeuPSIG conference itinerary appears to be packed with opportunities—for impactful discussions via the networking and poster sessions, for learning through hands-on workshops and for the chance to acquire knowledge from international experts that we can critically analyze and apply to our work in ways that we hadn’t previously thought possible. I’ll see you this week, NeuPSIG.
Danielle Perro, DPhil candidate, University of Oxford, UK.
A Preclinical Systematic Review on Cannabis for Pain
This is my first NeuPSIG conference and I'm very much looking forward to what I anticipate being a great meeting. I look forward to meeting for the first time, face-to-face, many people I have been working with remotely, as well as making new connections with other trainees and renowned experts. Chatting over posters, at the trainee network reception and after the workshops will be a delightful chance to find a deeper connection to the neuropathic pain community.
It comes at a fortuitous time for me as I am able to offer an exciting opportunity for scientists to get involved in a project: I am working on a preclinical systematic review for the IASP Presidential Task Force investigating the evidence for cannabis and cannabis-based medicine for pain management. Challenging traditional ways of working, we have just started recruiting a crowd of scientists to help us select and appraise all the preclinical literature in which a cannabinoid or endocannabinoid system modulator was tested in an animal model of injury-related or pathological persistent pain. This project offers an exciting opportunity for early-career researchers (though everyone is welcome!) to contribute to an important area of research while gaining new professional skills. I am excited to be able to present this opportunity at the meeting, and I invite anyone interested in preclinical systematic reviews and/or contributing to this project to reach out and come chat with me.
While I look forward to learning more about chemotherapy-and diabetes-induced neuropathic pain I am particularly interested in how researchers are employing more open science practices to help us overcome the challenges within pain research. My PhD is focused on developing technologies to improve the efficiency and feasibility of preclinical systematic reviews while addressing important areas of pain neurobiology. So, in addition, I am interested in learning about some of the questions and challenges that preclinical scientists would like to address and whether there is potential for systematic reviews to aid.
Nadia Soliman, PhD candidate, Imperial College London, UK.
Learning More About Pain at IASP Meetings
Why do we study pain? After all, almost no one dies from it. Is pain a symptom or a disease, or both? I started getting interested in pain research during my undergraduate degree, recognizing it as something that caused the most amount of human suffering, a problem for which most people have visited their GP. Acute pain is an indication of some broader malfunctioning. It is a sensation that directs you to pay attention to the affected part of the body.
In contrast, chronic pain is maladaptive, and treatments are often limited to containing it. But lowering pain perception permanently is problematic. I remember the first time I read about the genetic dysfunction associated with Nav1.7 that causes congenital insensitivity to pain. I was a graduate student at the time, and this discovery made me realize how dangerous the inability to feel pain is, in the real world. With multiple fractures and other injuries occurring without the patient’s knowledge, not feeling pain at all is hardly a boon. Perhaps this is how the discovery of sodium channel blockers may have appeared at first, with the later realization of the challenge of using them as a long-term treatment approach—something hard to grasp for patients undergoing excruciating pain on a daily basis.
But do we understand pain? Everyone approaches this from their own perspective.
It has been 54 years since Ronald Melzack and Patrick Wall published their first work on the "gate control theory" that described sensory afferent interactions within the touch and pain domain. The theory is still discussed, challenged and counter-challenged in the field. The origins of pain can be molecular, genetic, neural, pathological, psychological, cognitive or all of the above at the same time, and pain specialists, GPs, nurses, physiotherapists, psychologists, researchers, patients and caretakers all have their own views on the matter. Chronic pain is seldom unambiguous, with history, previous experiences and co-morbidities all playing a role. Pain processing in conditions such as fibromyalgia may be completely indecipherable.
That there was so much to learn about pain opened me up to the possibilities of pain research during my first international pain meeting organized by the IASP in Buenos Aires, Argentina, in 2014. The meeting was a crash course in pain science covering almost all disciplines and it enabled me to learn more about pain than I did in a year during my graduate research degree! Over the years since then, I have not missed many IASP events within my reach, as a path to a better understanding of pain. Before we started pain research, we all began with a clean(ish) slate in terms of what we knew about pain, and came to see how little we actually knew about it. Studying pain is a paradox: The more we know, the less we know.
Sumaiya Shaikh, postdoctoral fellow, Linköping University Hospital, Sweden.