Symposia Abstracts

Abstract

Symposium Abstract: Females are disproportionately affected by chronic pain compared to males, with a higher prevalence of pain conditions including arthritis, migraine and fibromyalgia, among others. Seminal work from various laboratories has shown that differing inflammatory responses underlie some of the sexual dimorphism observed in the regulation of pain. While it is now clear that interactions between the nervous and immune systems are critical mediators of both acute and chronic pain responses, the underlying molecular and cellular mechanisms controlling these differences remain poorly understood. We will present evidence from our respective laboratories showing how sexually dimorphic responses in neuroimmunity help control pain using models of multiple sclerosis (Dr. Bradley Kerr), complex regional pain syndrome (Dr. Vivianne Tawfik), and in the baseline control of nociception (Dr. Nader Ghasemlou). Abstract Activated myeloid-lineage cells, macrophages peripherally and microglia centrally, contribute to the acute-to-chronic pain transition, however, the details on the timing and possible sex-specificity of such involvement remains a matter of debate. For example, there is evidence that CNS microglia may contribute to chronic pain only in males. In this talk I will discuss data from my laboratory using complementary pharma-cologic and transgenic approaches in mice to more specifically manipulate myeloid-lineage cells using a model of the pain condition, complex regional pain syndrome. I will discuss a novel spatiotemporal transgenic mouse line, Cx3CR1-Cre ERT2 -eYFP;TLR4 fl/fl (TLR4 cKO) that we used to specifically knock out toll-like receptor 4 (TLR4), only in microglia and no other myeloid-lineage cells. Using this transgenic mouse, we find that early TLR4 cKO results in profound improvement in chronic, but not acute, allodynia in males, with a significant but less robust effect in females. In contrast, late TLR4 cKO results in partial improvement in allodynia in both sexes, suggesting that downstream cellular or molecular TLR4-independent events may have already been triggered. I will further discuss new data using a transgenic mouse that allows for microglia-specific depletion, Cx3CR1-Cre ERT2 -eYFP;iDTR lox-STOP-lox (microglia cKO). We performed microglial depletion at multiple time points after peripheral injury and see the most striking decrease in mechanical allodynia in males and females when depletion is performed several weeks after injury. Overall, Symposium Abstract: Observing the pain of brings about a cascade of biological and psychological in the self For caregivers and loved ones of individuals in pain, the ability to adaptively manage these reactions is closely related to the ability to provide appropriate pain assessment and pain management behaviours. This three-part symposium examines the psychological, physiological, and neural responses of individuals observing their loved ones as they undergo a range of painful experiences, across the lifespan. The workshop will be introduced with a personal reflection by session Riddell, a pain scientist with lived experience in supporting a spouse with chronic pain. on the toddler period, mechanisms physiological psychological sub-optimal behaviours. In the second talk, focused Symposium Abstract: With the increasing demands on clinical pain specialists and ever-growing waitlists in pain clinics across Canada, there is a need to find innovative ways for patients to access support in managing their pain and mental health. The internet has provided many people with access to information and treatment applications in several different areas of health, and with the COVID-19 global pandemic, there has never been a greater need to deliver care virtually. There is growing interest in online, self-directed pain management programs by both govern-ing structures and patient populations, with the goal to deliver timely interventions to people that is both evidence-based, accessible, and easy to understand. Various options for internet-based multidisciplinary pain management are currently being created and tested in Canada for both adult and pediatric populations. The Power Over Pain portal aims to provide Canadians with rapid access to bilingual empirically-based, stepped care resources for the management of pain, mental health, and substance use across the lifespan. One of the proposed programs in this portal is the Internet-based Multidisciplinary Acceptance and Commitment Therapy (IMPACT) program for Abstract Title : Feasibility study: Improving access to pain interventions for adult patients with chronic pain through the IMPACT (Internet-based Multidisciplinary Acceptance and Commitment Therapy) Program Speaker 2 Abstract : Background/Aim Accessing pain clinic services can be challenging, with long waitlists delaying patients from receiving any form of pain management treatment. We sought to create and evaluate the Internet-based Multidisciplinary Pain Acceptance and Commitment Therapy (IMPACT) Program to address this gap in pain services. Methods With patient partners’ input, we developed a multi-disciplinary, online, self-directed pain management program based on Acceptance and Commitment Therapy. The IMPACT program content contains multi-media and interactive components, including videos, audio recordings, and reflective questions. Some program videos consist of patient partners reflecting on their experiences with program themes (e.g., acceptance, values, committed action). The program also includes additional units related to exercise, medications, sleep, and communication and relationships. We conducted a feasibility study with people waiting for treatment at a tertiary pain management centre in Winnipeg, Canada. Participants completed baseline measures before accessing the program, and follow-ups immediately after completing the program and at 6-months post-completion. They provided feedback on the content throughout the program. Results Seventy-one people consented to participate, and 63 completed program enrollments. Average age of enrolled participants was 55 years (range 23-83); 76% identified as female. Seventeen participants have completed the full program and 27 participants have completed follow-up measures. Between 75% and 100% of participants recommended the various units they completed. Further outcome data and program feedback will be presented. Conclusion Based on study results, the IMPACT program shows promise in supporting individuals with chronic pain, including those who may not have timely access to pain specialist services. of Symposium Abstract: Chronic pain is a public health concern affecting 21% of the Canadian population. Symposium Abstract: In September 2018, the Minister of Health directed Health Canada to establish a Canadian Pain Task Force to help the Government of Canada better understand and address the needs of Canadians who live with chronic pain. Between March 2019 and May 2021, the Task Force reviewed the literature and conducted national consultations, which led to the publications of three reports that provided an overview of the gaps, challenges and opportunities towards an improved approach to the prevention and management of chronic pain in Canada. The Task Force’s final report entitled Action Plan for Pain in Canada and released in May 2021, provides a series of recommendations towards specific and targeted actions to prevent pain, improve health outcomes for people living with chronic pain, and to address its impacts on families, communities and society. This session will involve members of the Canadian Pain Task Force Symposium Abstract: The biopsychosocial model of chronic pain suggests that psychological and social factors must be considered in addition to biological factors to understand an individuals’ pain experience. It follows that these factors should also be considered to develop the most effective treatment plans. In this symposia, Dr. Stone will begin with a brief summary of the current biological understanding of musculoskeletal pain with a focus on fresh insights from human and animal studies on the role of epigenetic drivers in chronic low back pain. Since epigenetic modifications are potentially reversible, the therapeutic implications will be emphasized. Dr. Massieh Moayedi will present an overview of the psychological factors that contribute to chronic pain and will present new data on the interaction between pain and cognition, and how these could potentially be leveraged as novel Speaker Abstract Title : Social drivers and consequences of musculoskeletal pain with from a patient’s perspective Speaker 3 Abstract : Dr. Hovey has defined expertise in bridging gaps between theory and practice in areas such as patient centered care and communication in healthcare. His research approach utilizes philosophical hermeneutics in strengthening our understanding of the experiences of vulnerable and underserved populations, like those living with chronic pain and illness, cancer, disability, or the effects of medically induced trauma. He also brings the perspective as a person who has lived in chronic pain for 10 years. Learning Objective 1 : Integrate new knowledge on the molecular drivers of low back pain. Learning Objective 2 : Explain how pain competes for resources, and novel potential therapeutic targets for pain management. Learning Objective 3 : Describe the lived experience of pain from the perspective of a patient consultant. Symposium Abstract: Single-entry models consisting of a centralized referral and triage system have shown to improve wait times, reduce duplicate referrals and prevent cancelled appointments, in tertiary clinical settings. The Toronto Academic Pain Medicine Institute (TAPMI) is a comprehensive, interdisciplinary, tertiary pain program in Toronto. It is the only provincially funded program in Ontario to successfully implement a single-entry system for chronic pain