10 Things I learned at the Conference for the International Association for the Study of Pain

Hey guys!! I recently traveled to Amsterdam to attend a medical conference put on by the International Association for the Study of Pain. Thousands of people from all over the world came together to talk about pain, the latest research developments, and how to better treat people with pain. I was surrounded by pain physicians, pain psychologists, physical therapists, and researchers. I learned so much and I felt so inspired to keep pursuing my passion of helping people with chronic pain. Now I want to share a few of the things I learned with you guys. Hang onto hope!

1. A new form of treatment that is being researched for treating chronic pain is Cognitive Functional Therapy. 

It sounds a lot like cognitive behavioral therapy, but there are some key differences. This is a patient centered approach that involves making sense of the pain, creating exposure strategies, and integrating lifestyle changes. This is usually done with a clinician whose role is to coach the patient through the treatment. The process starts off with exploring the patient’s story, goals, and expectations. There is also a guided behavior examination. 

Graded exposure to feared activities is a key component to this treatment process. This is usually done with consistent reassurance of safety and acknowledgement that physical activity is not causing further damage. 

Other pain control strategies may be used while doing Cognitive Functional Therapy. It’s important to establish a healthy and trusting relationship with the therapist. 

A recent study was done on 492 people who had experienced chronic back pain for an average of four years. This study evaluated the effectiveness of Cognitive Functional Therapy. Large improvements were seen at 12 months. Participants who had previously stopped working due to pain were able to return to work because they had a significant decrease in pain. Participants expressed high satisfaction rates with the treatment. The treatment was proven to work well for people who had been classified as disabled.

If you want to learn more about Cognitive Functional Therapy and the trial, check out this link: https://www.restorebackpain.com/

2. It is possible to reduce your opioid usage without increasing your pain.

Reducing the amount of opioids you take can be really scary when you’re dealing with constant pain. Opioids are a common way of managing pain, but they are not effective for resolving the pain. It’s estimated that 3.4% of the U.S. population (11 million people) take daily prescribed opioids. Over the years, healthcare systems have become more opposed to opioids and there has been large amounts of pressure placed on doctors to decrease opioid prescriptions. This has led to forced tapering of opioids which has led to an increased rate of suicide among those with chronic pain. 

If possible opioids should be tapered to as low as dose possible because opioids have complications that can be life threatening. However, forced tapering is often ineffective, causes more suffering, and can lead to suicide in some people. 

A recent study was done at Stanford University to determine how to decrease opioid dosages in a way that is safe and does not increase pain. This study took place from 2018 to 2023.

In the study participants worked with their doctor to do a very slow and personalized opioid taper. Participants were allowed to stop the taper at any time. They then took weekly and monthly surveys to monitor their progress. They had regular follow-up appointments with their doctor and a chronic pain self management program for 6 weeks or cognitive behavioral therapy for 8 weeks.

Participants were able to significantly reduce their opioid usage and they did not experience increased pain. Check out this link to learn more: https://empower.stanford.edu/ 

3. People with special needs often struggle with pain but may be incapable of expressing their pain

            Not everyone is capable of verbally expressing their pain. This may be due to intellectual disabilities, Down Syndrome, Parkinson’s Disease, dementia, and so many other conditions. We need to develop tools that can assess pain in those with special needs. 

4. Ketamine has been shown to have anti-itch and anti-inflammatory effects.

Ketamine is still being studied to understand all of its benefits, side effects, and capabilities. When we talk about pain, we commonly talk about neuropathic pain which is pain that occurs when your nervous system is malfunctioning. Yet it is also possible to have neuropathic itching (known as neuropathic pruritus).

A recent study showed that ketamine can be used to decrease itching and inflammation involved in this condition.

Kwatra SG, Kambala A, Cornman H, Reddy SV, Cohen SP. Ketamine Infusions for Treatment-Resistant Neuropathic Pruritus. JAMA Dermatol. 2023;159(9):1011–1012. doi:10.1001/jamadermatol.2023.1772

5. Getting rid of phantom limb pain.

Having a limb amputated can be really traumatic, but it can also be painful for a long time. It’s estimated that 10% of people with traumatic lower limb amputations report having severe pain after 6 months. This pain is often projected to the distal parts of the missing limb such as the feet and toes and is commonly described as burning, stabbing, or pricking. 

There are a few things that contribute to this pain. The nerves within the stump may be creating pain signals in the absence of a specific cause. There may also be changes within the nervous system that have caused enhanced susceptibility and sensitivity to pain signals. Psychological factors do not cause phantom limb pain, but they do exacerbate it.

Current treatments for phantom limb pain include (but are not limited to) sodium channel blockers, tricyclic antidepressants, ketamine, topical lidocaine, capsaicin, mirror therapy, virtual reality, and pain reprocessing therapy.

6. Chronic alcohol use can lead to chronic pain or exacerbate already existing chronic pain.

If you have ever been diagnosed with alcohol abuse disorder (AUD), you are at an increased risk for developing chronic pain. Yet people who have chronic pain without AUD or at risk for using alcohol as a coping mechanism. 

7. Surf therapy can decrease pain

Being in an immersive environment or doing an immersive activity has the ability to decrease pain. To be in an immersive environment/activity means that all of your thoughts and sensations are focused on whatever it is that you’re currently doing.

Surfing is a great example of an immersive environment and activity. A study done in Southern California showed that people who did surf therapy experienced decreases in pain. In the future, a virtual reality simulator may be developed to simulate surf therapy and make it more accessible to people with pain. 

Check out this link to learn more: https://pt.usc.edu/news/scientists-probe-how-surfing-could-help-chronic-pain/

8. 8% Capsaicin can be used to decrease neuropathic pain

This is a topical medication that works really well for different types of neuropathic pain, but especially well for painful diabetic peripheral neuropathy. People with painful diabetic neuropathy have experienced significant pain relief and improved sleep after using 8% capsaicin. 

9. Studies show that there is a connection between doing intrinsically pleasant tasks and pain reduction.

When you’re in pain, it takes up a lot of your attention. Sometimes the pain is all you can think about. Distraction techniques can reduce your pain. 

The goal is to find an activity that induces a flow state which is characterized by complete immersion and enjoyment. This flow state is fueled by a sense of passion that makes tasks effortless and intrinsically rewarding. 

When trying to decrease your pain, look for activities that bring you genuine joy and feel rewarding. 

(Personal note: When I had severe chronic pain, doing watercolor painting would make my pain go away.)

10. Music can be used to reduce pain

There is this misconception that if you want to feel relaxed or reduce your pain, you should listen to classical music. New research is now showing that the genre of music does not matter. What matters is that you listen to music that you really love. 

A study was done in an operating room on patients who were getting procedures done that involve being awake. These procedures can often cause discomfort. Patients who selected music that they enjoyed experienced less pain and anxiety than those who received the procedure without music.

Click here to learn more: https://ostrowonline.usc.edu/music-for-chronic-pain-management/