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NGAU MAMAENGAU MAMAEAutumn 2015

Quarterly Publication of the New Zealand Pain Society Inc.

Ngau MamaeQuarterly Publication of the New Zealand Pain Society Inc.Instructions to AuthorsNgau Mamae aims to keep clinicians up-to-date in regard to pain diagnosis and management. It will inform on NZ Pain Society (a Chapter of IASP – International Association for the Study of Pain) initiatives and activities. The Editor and Sub-editors seek contributions that will further these aims. Articles, reviews and letters should be submitted by email or supplied on disk to:

EditorDr Gwyn Lewis Auckland University of Technology e: [email protected]

Acting editorHazel Godfrey Victoria University of Wellington e: [email protected]

Sub-editorsDr Leinani Aiono-Le Tagaloa e: [email protected]

Kate McCallum e: [email protected]

Graphic DesignAmanda Sinclair e: [email protected]

TextWe require single spaced typescript, Times New Roman, size 12 font (Word-compatible software where possible). Please write as concisely as possible and include a word count. Subheadings should be used to divide the text. Please underline at least three or four interesting sentences or quotes from the article that could be enlarged to draw attention to the piece. Note that not all of them will necessarily be used. Authors’ names with their professional qualifications job title and affiliation should appear below the article title. Generic names should be used for drugs; if necessary, brand names may follow in brackets.

Literature References References cited in the text should be included in parentheses and should be by author(s) and year in chronological not alphabetical order. Papers written by two or more authors are cited in the text using the abbreviation ‘et al.’ using the name of the leading author, even if the subsequent authors are not the same in all references. All references used in the text must be listed at the end of the paper and arranged alphabetically by author. References must be complete, including initial(s) of author(s) cited, title of paper referred to, journal, year of publication, volume and page numbers. If more than two references with the same year and author(s) are cited, use lowercase letters after the year (Melzack et al. 1984a,b). Journal titles should be abbreviated according to Index Medicus, List of Journals indexed, latest edition. For citations of books the following sequence must be maintained: author(s), title of article, editor(s), complete title of book, place of publication, publisher, year and page numbers.

Examples Pennebaker JW. The psychology of physical symptoms. New York: Springer, 1982.

Philips H. Avoidance behaviour and its role in sustaining chronic pain. Behaviour Research Therapy 1987a; 4: 273-279.

Philips H. The effects of behavioural treatment on chronic pain. Behaviour Research Therapy 1987b; 5: 365-377.

Scharloo M, & Kaptein A. Measurement of illness perceptions in patients with chronic somatic illness: a review. In: Petrie K, Weinman J, editors. Perception of health and illness. The Netherlands: Harwood Academic Publishers, 1997. pp. 103-154.

Photos, Graphics and Illustrations Graphs and diagrams can either be passed on as hard copies so that they can be scanned or they need to be at 300dpi and at approximately postcard size. Files can be accepted in the following formats: jpg, tiff, pdf and eps.

All rights reserved. No part of this publication may be reproduced, stored in a retrieval system or transmitted by means of electronic, mechanical, photocopying, recording or otherwise without prior consent of the publisher. © New Zealand Pain Society Incorporated 2005.

Ngau Mamae (Real Pain) Ngau means to bite or engage in a very real way. Mamae means pain. In combination, the words describe a very real and deeply ingrained, gripping, biting pain.

— Merimeri PenfoldOf Ngati Kuri descent from the Far North. She was born in Te Hapua, educated at Queen Victoria College and qualified as a teacher working in education for many years. Moved to the Maori Studies Department at Auckland University. Was employed by Maori Studies Department at the University of Auckland to provide interpretations for University documents. Passed away in April, 2014.

Contents2 Editorial Hazel Godfrey

4 President’s Corner Dr Brigitte Gertoberens & Dr Frances James

5 President’s Report Dr Brigitte Gertoberens

6 Member Profile Jaap Rigtering

8 Pain Through the Ages – Conference Reports Associate Professor Gwyn Lewis & Catherine Swift

11 Cynthia Mary Miller Bequest

12 Life Membership Awards 2015 Dr Brigitte Gertoberens

13 Broadfoot Trust Prize 2015 Associate Professor Gwyn Lewis

15 A New Era for Developing Improved Opioid Drugs to Treat Pain Dr Bronwyn Kivell

20 Assessing and Modelling Clinical Reality in Pain Therapeutic Studies Dr Simon van Rysewyk

24 New Members 2015

25 NZPS Council Members 2015

26 Registration Form for New Membership

Corporate Members of NZPS

2 NGAU MAMAE Autumn 2015

EditorialHazel GodfreyPhD Candidate in the Cognitive and Affective Neuroscience Laboratory, School of Psychology, Victoria University of Wellington.

This issue of Ngau Mamae has a meeting theme. The 40th Annual Scientific Meeting of the New Zealand Pain Society was held at the end of March at the Langham Hotel in Auckland and 405 delegates attended! The theme was “Pain Through the Ages”. This was my first NZPS Annual Scientific Meeting and I found the talks thought provoking and informative, and a few quite moving. It was great meeting so many members involved in exciting research into chronic pain and its treatment. We have a summary of the meeting from Gwyn Lewis and a personal perspective from Cat Swift. There are also articles about the Broadfoot Trust awards and the Lifetime Membership Awards, both of which were awarded during the meeting.

As a young researcher and a new-ish member of the New Zealand Pain Society, it is easy to forget the hard work that happened before your time. So it was fascinating for me to hear the conversation, between Dr Brigitte Gertoberens and Professor Bob Boas, Dr Bob Large, and Dr Barrie Tait, about the formation and history behind the New Zealand Pain Society. As Dr Fran James suggests in her President’s Corner, now is a good time to be gathering the history of the Society.

At the Annual Scientific Meeting there was a change in leadership. Dr Brigitte Gertoberens is now our Immediate Past President and Dr Fran James is our President. We feature words from them both in the President’s Corner and from Brigitte again in her final President’s Report presented at the recent AGM of the NZPS.

There is also a member profile on Fran in the Spring 2014 issue. In other news announced at the Meeting, the Society recently received a generous bequest from Cynthia Mary Miller and this is to be used for promoting research into the study and treatment of pain in New Zealand. More information is available in this issue and on our website www.nzps.org.

If you missed the Annual Scientific Meeting don’t despair. You can contact our wonderful secretary, Joni Hollows, at [email protected]. Joni will email you a list of powerpoint presentations that are available. There is a fee of half your membership cost. If you were at the meeting, you already have access to these powerpoints. If you would like a recording of a specific talk, contact David Hargreaves of Auckland Recording Studios at [email protected]. The next Annual Scientific Meeting will be held in New Plymouth from the 7th to the 10th of April, 2016. The theme is “Surfing the Pain Wave” with the sub theme of resilience.

Aside from the meeting news, in this Autumn issue we have articles from two New Zealanders in two quite different fields (that wide-ranging research that I enjoy seeing!). We feature an article by Dr Bronwyn Kivell from Victoria University of Wellington, A New Era for Developing Improved Opioid Drugs to Treat Pain. Bronwyn is conducting research on a new mu-opioid compound that is showing promise as an analgesic. Bronwyn outlines the history of the discovery of biased agonism, which allows for identification of drugs in the lab that may have reduced side effects, and introduces us to her current work at Victoria University of Wellington.

Dr Simon van Rysewyk, a Kiwi based in Taiwan, has contributed another article (see the 2014 Spring issue for Simon’s first article). This time in Assessing and Modelling Clinical Reality in Pain Therapeutic Studies, Simon descibes a theoretical framework for assessing the clinical applicability of research, recently developed by the Respiratory Effectiveness Group. Simon suggests applying this framework to assess the potential real world use of pain research.

Hello New Zealand Pain Society Members,

I’m filling in for our current Editor, Associate Professor Gwyn Lewis, for the 2015 Autumn and Winter issues of Ngau Mamae. I am a PhD candidate at Victoria University of Wellington, almost two years into my thesis examining the modulating effect of pain on cognition. I started on the Ngau Mamae team as a Sub-editor in January last year. It has been a great experience so far seeing the wide range of work that happens in the pain field in New Zealand and I am grateful for the opportunity to be your Editor for two issues.


Last but definitely not least, we feature a profile of one of our members, Jaap Rigtering. Jaap is a newer Occupational Therapist at The Auckland Regional Pain Service, and he describes an interesting journey getting to New Zealand and into pain management.

If you have a topic you’re passionate about, research, or news you would like to share with the membership in the upcoming Winter issue, please contact me on [email protected] or Joni Hollows at [email protected]. Thank you to those who have already contributed, or indicated their interest in contributing to the Winter issue.

I am off to Italy in June to attend a summer research school on the topic of functional and structural plasticity in chronic pain. I look forward to sharing my experiences with you in the Winter issue.

Enjoy reading this issue of Ngau Mamae.

The comments in this Editorial do not necessarily reflect those of the New Zealand Pain Society or its Executive, nor my university, Victoria University of Wellington.

D.L. Menzies provided the cover image for this issue of Ngau Mamae.

The Dreams All Sank AwayMy pain was most of all that of a broken heart. After carrying hardship and hope through my life – hope my true but secret friend – instead of blossoming I got cancer. Hope walked out the door ... like a husband ... and I was left all loss. The Mandalas were done in bed, one each night freehand. A circle, unplanned play of colour and geometry to act as meditation, distraction, something to call my own - and to remind me that though surgery had reshaped my body and my biography – I still had an inner harmony and geometry.


President’s CornerDr Brigitte GertoberensImmediate Past President, NZPS

Dear Members of the New Zealand Pain Society,

During this year’s Annual Scientific Meeting at the Langham Hotel in Auckland, my time as President of the NZPS came to an end, and at the AGM I handed over to Dr Frances James, the new President.

I would like to thank you all for giving me the opportunity to have a leading role within the Society and continue working on our strategic plan. It was a pleasure to work with a very dedicated Council and I am looking forward to another year of working closely with the team as Immediate Past President.

I enjoyed all the networking opportunities during international meetings, especially during IASP World Congresses, getting invited to Chapter President’s lunch meetings and IASP President’s reception for speakers and Chapter Presidents.

I also would like to say a big “thank you” to our Secretary, Joni Hollows, who is doing an amazing job!

For those who did not have the chance to come and join us for the Conference and AGM, you will find a summary of our activities in the 2015 President’s Report.

With warm regards,

Dr Brigitte Gertoberens

Dr Frances JamesPresident, NZPS

I hope you all enjoyed the conference! I found myself reflecting on the theme “Pain through the Ages” in the context of our NZ Pain Society, our history and the people who have walked this path before us.

As I begin my term as President of the NZPS, I want to thank Dr Brigitte Gertoberens for her gracious contributions as President. Brigitte has actively promoted wider education on pain and one indication of this is that this year NZPS members will be providing lectures at both the North and South Island General Practitioner’s conferences.

I thought the presentation of Lifetime Membership Awards to Drs’ Bob Large, and Barrie Tait, and Professor Bob Boas, fitted well with the conference theme and it made me aware of how quickly common knowledge can be forgotten.

I would like to see the history of the NZ Pain Society gathered and recorded. Obviously there are facts and figures which tell our story, however it is the people who make our Society and I would like to invite members to write about their experiences and memories of NZPS. What was your most memorable conference moment? Which keynote speakers inspired? If your memories are recent, don’t hesitate to send them in. One day there will be people asking about our experiences today.

I hope you will consider sending your thoughts, memories, songs and photos through to Joni at [email protected] and we will begin the process of documenting our history together.

Dr Frances James


President’s ReportDr Brigitte GertoberensImmediate Past President, NZPS NZPS AGM, 28th March 2015, Langham Hotel, Auckland

In 2014 we were able to make some progress in various areas:AdvocacyPaediatric Pain ServicesSince the Faculty of Pain Medicine (FPM) has a national Committee in NZ, there has been close collaboration between the FPM and the NZPS. The FPM approached the Ministry of Health applying for funding pain services for children and adolescents with chronic pain.

ACC Pain Management Services Re-design ProjectACC started intense communication with clinicians involved in the care of people with chronic pain and various organisations including the NZPS. The meet-ings and workshops aimed at identifying obstacles in delivering appropriate pain services to ACC clients and look at ways to get patients into the right services at the right time.Issues identified thus far: Availability and accessibility of services, especially in rural areas; flexibility in terms of the package of care delivered to the individual; transparency; integration of care and appropriate communication between all parties involved.

Networking Close communication with the NZPS, the FPM and the APS has been maintained. Regular teleconferences and face to face meetings have been held.

The NZPS has been approached by the American Psychological Association offering participation in a database “PsycEXTRA”. This database serves as a finding aid and archive for locating the “gray literature” of the behavioural and social sciences. Gray literature encompasses materials that are not published in traditional outlets such as books or journals. Potential material from the NZPS includes conference programmes, abstracts or presentations. Participation in PsycEXTRA is at no cost to the NZPS.

EducationPrimary Care/GPs/NursesA one hour session addressing chronic pain has been introduced to the GP’s annual conferences. This will hopefully be the start of a regular series of lectures

addressing chronic pain. A team from Auckland will organise the presentation in Rotorua and a team from Christchurch will take care of the Christchurch meeting.

We have also been asked to offer a session for Practice Nurses. Kate McCallum will contact colleagues and ask who could organise these sessions.

PublicIn collaboration with the Neurological Found- ation there have been some publications around chronic pain.

A team of members is involved in providing information for Healthpoint to be published on their website.

Education for members of the NZPSWe have been able to make financial contributions to members applying to participate in conferences including costs for travel, accomm-odation and registration fees. Please refer to our website for further details and closing dates for application rounds.

The NZPS has also supported members with research projects

ResearchThis year we will award a NZ researcher with the Broadfoot Prize. The prize money of $2000 will be given to the author for the best paper submitted. The papers were reviewed by two Australian scientists to guarantee a robust, fair and transparent process.

Some weeks ago we received a donation of $40000 on behalf of Mrs Cynthia Mary Miller who passed away. With her donation the NZPS was able to establish the “Cynthia Mary Miller Research Fund” to support research into mechanisms and treatment of chronic pain. This fund, in conjunction with the Broadfoot Trust award, makes funds available to members of the NZPS involved in research projects.

We encourage members to apply for financial support for their research projects.

Finally, I will now hand over to Dr Fran James, incoming President.

Dr Brigitte Gertoberens Immediate Past President, NZPS


Member Profile

Growing up I remember distinctively being interested in EVERYTHING, yet finding it hard to focus on anything. As a dyslexic I struggled with school; reading and writing did not come naturally to me, but with persistent support from my family I completed high school in 2000. Initially I wanted to become an architect or do nursing, but applied for Occupational Therapy instead and never looked back after that. Finding practical solutions to problems was something I was good at. Focusing on a client’s desire to do more, despite limitations, felt like the most natural approach to me.

Occupational Therapy is a four year degree in The Netherlands and in my final year I first came to work with clients who were limited by pain. At the time I was doing a six month internship at ‘Medisch Centrum Leeuwarden’, a hospital in The Netherlands with a specialist out-patient clinic for people with upper limb problems, back problems or widespread limitations after injury. Many patients seemed to be dealing with persistent pain and I felt both completely lost and completely fascinated by the complexity of their issues. I suddenly found myself spending most of my free time reading and trying to learn more about pain and how the brain worked. With my minimal experience I started with what OTs know best; daily life activities. Working with people with severe ‘dystrophies’ (not

Jaap RigteringOccupational Therapist - NZROT, Bachelor of Health Science, University of Heerlen, Netherlands, 2005

Occupational Therapist at The Auckland Regional Pain Service, Greenlane Clinical Centre, Auckland DHB

called Complex Regional Pain Syndrome at the time), I admired their willpower to try and get more out of life despite their limitations. I felt inspired by how much more they seemed to achieve when focusing on tasks that were meaningful to them.

I was one of 180 OTs to graduate in 2005. At the time there were only five jobs advertised for new grads nationwide, so I decided to go traveling instead. Seven months later, having ticked off several countries on my wish list, I arrived in New Zealand to visit family. Although a foreign country, on the other side of the world, I somehow felt as if I had arrived home. I met a Kiwi girl (now my wife) and a few months later the decision was made to move to New Zealand permanently.

My first OT job in New Zealand was in Older Peoples Health (OPH) rehabilitation at North Shore Hospital. I then moved into OPH rehabilitation at Auckland City Hospital with a focus on stroke/neuro, upper limb recovery and pain prevention. After that I moved into paediatrics and worked at Starship Children’s Hospital for several years. Here I reconnected with my interest in pain, spending two days a week working together with Dr Ross Drake (Paediatrician, Pain Medicine Specialist) and his team helping kids deal with persistent pain.

For this piece in Ngau Mamae I thought it would be good to start at the very beginning… It was a cold winter night in 1981 and in a small Dutch village, called Son & Breugel, I was born. Ok, maybe a little bit too far back, however I did ask my sister to describe me as a child in a few words and she replied “outgoing, energetic, caring, always talking, and hyperactive”.


Share your knowledgeThe Health Navigator, Everybody and Liveto100.co.nz websites are currently in the process of merging, to create a state of the art national website dedicated to the provision of trusted health information and self-help resources for all New Zealanders. In preparation for this merger, the NZPS is working with the team from Health Navigator to review their existing pain resources and develop new ones, as appropriate.

We are currently looking for people to review the following pages on the Health Navigator site:

• Painful periods

• Back pain

• Pain relief medications

• Spinal pain

We are also interested in generating other pages for specific forms of pain, such as neck pain or fibromyalgia, and would welcome assistance with this. If you are keen to be involved, please contact Cat Swift at [email protected].

When a role at The Auckland Regional Pain Service (TARPS) came up I jumped at the opportunity to specialize further in this area. Changing from Paediatric’s to Adults has been interesting. My directive approach to rehab seemed less suitable to adults and for obvious reasons, engaging my patients by “bribing” them with 10 minutes of playing with Lego didn’t seem to work so well either. I spent time exploring adult learning styles and group facilitation skills, and have adjusted to a patient-directed self-management approach. From time to time though, I find that paediatric approaches do seem to come in handy with some of my more challenging adult patients; although I talk about ‘reward and motivation’ rather than ‘bribery’.

My main responsibility (and favourite part of my job) at TARPS is facilitating the occupational therapy component of the three week Pain Management Programme (PMP). I absolutely love working with groups and although my main brief is ‘to set goals with the group members’, I strongly believe that setting goals without knowing the deeper reasons

of why we want to work on these goals in the first place is, well, pointless. And so I start the process by exploring the group members “occupational identity”. This includes looking at intrinsic motivation, values and core beliefs in order to set realistic goals that help work towards improved confidence and ability to engage in more meaningful activities with their families and within their communities.

Other responsibilities include new patient comprehensive pain assessments and one-on-one pain management programmes along similar concepts to the three week PMP. Although I am the only Occupational Therapist in this multidisciplinary team I feel blessed by the support I receive from my colleagues at TARPS.

Outside of work I like to go to the beach with my wife, hanging out with my “little brother” (a 14 year old boy who I mentor through Big Brother Big Sister Auckland), travel home to see my family, have dinners with friends, go to the gym, play Ultimate Frisbee, cook, bake and more importantly eat good food.


“Pain Through the Ages”

Associate Professor Gwyn LewisHealth and Rehabilitation Research Institute, Auckland University of Technology

With some extra sponsorship this year, the organising committee managed to secure a range of quality international speakers, including Professor Chris Eccleston (UK), Professor Stein Husebo (Norway), Professor Bettina Husebo (Norway), Professor Allan Basbaum (USA), Dr Suellen Walker (UK), and Professor Andrew Somogyi (Australia). With all of the international speakers providing at least two talks each, the delegates certainly got their money’s worth.

The theme of “Pain Through the Ages” was maintained throughout the conference and provided for an informative meeting for clinicians working in a range of areas. As well as the international guest speakers, there were also a number of excellent local speakers that covered topics such as sleep, work, breathing,

40th Annual Scientific Meeting of the New Zealand Pain Society Auckland, March 25–29, 2015, Conference Reports

The NZPS had its Annual Scientific Meeting in Auckland over March 26–29, which was preceded by the Pain in Childhood Special Interest Group Symposium on March 25. Both meetings were extremely well attended and attracted a range of delegates from around the country and overseas. In fact, there was almost standing room only for the first couple of sessions of the Fundamentals Day, and even the last day was well attended. I suspect some of the attraction may well have been related to the delicious food the Langham Hotel provided as well as the excellence of the conference itself.

Packed room for Malcolm Johnson’s presentation.

teamwork, depression, engagement, palliative care, motor control, cultural perspectives, and the challenges of working in rural settings. With two free paper sessions and posters as well it shows the breadth of excellent clinical and research experience that we are gaining in the pain field.

A further highlight of the conference was the presentation of the Life Membership awards to Professor Bob Boas, Dr Bob Large, and Dr Barrie Tait. It was a lovely occasion that enabled NZPS members to hear a few stories about the establishment and the early days of the Society.

As a neurophysiologist, I was naturally captivated by the talks from Dr Suellen Walker and Professor Allan Basbaum on neurophysiology of pain across the

President, Dr Fran James, with NZPS members Karma Galyer and Pryha Beharry at the welcome function.


Catherine SwiftRegistered Occupational Therapist, PhD student, Auckland University of Technology

lifespan, while Professor Andrew Somogyi’s talks on genetics and pain medicine dosing were also incredibly informative. There is always something about hearing words directly from the experts themselves that makes conferences so appealing. I don’t think that anyone will forget the powerful and emotive talks delivered by Professor Stein Husebo on palliative care and communication. As one of my colleagues said, “I want Stein to be my physician when I am dying”. I also thoroughly enjoyed the talks by Dr Tony Fernando on pain and sleep and the engaging presentation by Dr Nani Aiono Le-Tagaloa on Samoan cultural perspectives.

All in all, in was a fantastic conference that kept the audience engaged across the whole 5 days. Hopefully, 2016 in New Plymouth will be just as successful.

Professor Christoper Eccleston with Hazel Godfrey in front of Hazel’s poster.

Confession time: often during any conference that I attend there are a few sessions where I find myself nodding off, but not at this years NZPS Meeting. The ANZ Pain in Childhood Special Interest Group Symposium was well underway when I arrived at the conference venue, The Langham Hotel. Clearly well attended, the hum of people catching up with old friends, making new acquaintances and discussing pain related issues over afternoon tea created a contagious buzz that continued throughout the whole Meeting.

Thursday, “Fundamentals Day”, began by examining the issue of pain from a range of perspectives, including: biology, dementia, sleep, depression and breathing. One of the key messages that I felt came across from these sessions, was a reminder about the importance of a comprehensive assessment. The day then finished with a couple of sessions looking at the dynamics around teamwork and patient engagement.

Friday was broken into several different themes. While I enjoyed all of the presentations, it was the session immediately before lunch, “The Pain of Life”, delivered by Professor Stein Husebø that left me (and I’m sure many others), reflecting on the content for many hours. Professor Husebø structured his presentation around a number of case studies, but instead of providing the traditional clinical account, he focused on each person’s story. This presentation was delivered with an honesty and respect that allowed me to join in each person’s journey with pain. The opportunity to share in each person’s joys and sadnesses was humbling and I felt privileged to have attended this session.

Saturday and Sunday were an opportunity to acknowledge and celebrate the past, present and future. As a relative newbie to the NZPS, it was wonderful to learn about the Society’s beginnings and to hear about the new areas in pain research that are taking place internationally and within New Zealand - watch this space for exciting future developments in the world of pain.

Overall, I thought that this conference not only maintained its promise of addressing pain through the ages but it skilfully combined the scientific, practical and human sides of pain. I can’t wait for the next one in 2016.

AcknowledgementI wish to thank the NZPS for sponsoring me to attend the 2015 Meeting and for the opportunity to write this piece for Ngau Mamae.

Julia Barton and Fran Storr and the welcome function.


Immediate-Past President, Dr Brigitte Gertoberens, with Professor Allan Basbaum.

The NZPS Council. Front row (L-R): Dr Nani Aiono-Le Tagaloa (Council), Dr Frances (Fran) James (President), Aislinn Carr (Council), Luciana Blaga (Council), Dr Gwyn Lewis (Ngau Mamae Editor-in-Chief & Council), Jenny Sandom (Council). Back row (L-R): Dr Jim Olsen (Council), Dr Brigitte Gertoberens (Immediate Past President).


Cynthia Mary Miller BequestIn February 2015 we were delighted to receive a bequest from the estate of Cynthia Mary Miller for the very generous sum of $40,000. The letter from the lawyer states that it was Cynthia Mary Miller’s wish that this money would be used to promote research into the study and treatment of pain in New Zealand.We have placed this money into a high interest account. We invite researchers to submit applications at the bi-annual grant application round (1 June and 1 December). Applicants need to complete the standard grant application form (includes length of Pain Society membership) and attach a research proposal including indication of ethics application status if this has progressed. Proposals will be reviewed by the NZ Pain Society Council. Criteria will include benefit to New Zealand and quality and relevance of the research design. Applicants may be offered partial or full funding.

We wish to honour this generous gift by enabling quality New Zealand based pain research.

For further information please see the website (www.nzps.org.nz) and go to “Membership Resources”.


Life Membership Awards 2015Dr Brigitte Gertoberens

This year we are celebrating our 40th anniversary. In 1975 the founding members of the NZPS started to have official meetings and gradually formed a Society which now has 463 members.

I was delighted to have the opportunity to award the three founding members, Professor Bob Boas, Dr Bob Large and Dr Barrie Tait with Life Membership. Bob Large and Barrie Tait are also former Presidents of the NZPS.

A little “talk show” on stage gave the audience the opportunity to listen to these three most honourable members telling us the story of the early days of the NZPS. This short glimpse into the history of the NZPS demonstrated the dedication, enthusiasm and vision Bob Boas, Bob Large and Barrie Tait had.

In 1968, Dr Jack Watt, head of the Anaesthetic Department at Auckland City Hospital and Chair of ANZCA at that time, asked Bob Boas to spend some time with Professor John Bonica, working at the pain clinic in Seattle, U.S. On return to New Zealand, Bob Boas started recruiting a multidisciplinary team, asking Bob Large, who was a consultant psychiatrist at Auckland Hospital at that time, and Barrie Tait, Rheumatologist, to run pain clinics with him. It was lovely to hear how much they enjoyed the debates,

discussing their different perspectives, respecting different points of view and finding some consensus to form a treatment plan.

Initially, health professionals from New Zealand and Australia who had a special interest in pain, came together founding the “Australasian Pain Society”. Bob Boas who had strong connection to Professor Bonica, and Barrie Tait, represented New Zealand at an international symposium on pain in Washington in 1973 when IASP (International Association for the Study of Pain) was only a concept. The first IASP World Congress on Pain was held in Florence, Italy in 1975.

Some years later, New Zealand decided to become independent. This was the birth of the New Zealand Pain Society in 1975. Dr Michael Roberts, head of the Anaesthetic Department in Otago was the first President. Soon the NZPS became a Chapter of IASP.

Bob Boas and Bob Large continued working in Auckland, and Barrie Tait moved on to Christchurch and became the founder of the Burwood Hospital Pain Clinic. Thank you so much, Bob Boas, Bob Large and Barrie Tait for putting the seeds into the ground, nourishing and letting the tree grow which now forms a home for all members of the NZPS.

Dr Bob Large, Dr Brigitte Gertoberens, Professor Bob Boas and Dr Barrie Tait.

Professor Bob Boas with his lifetime membership award, and Dr Barrie Tait.


Broadfoot Trust Prize 2015Associate Professor Gwyn Lewis

The Broadfoot Trust was established by the Broadfoot family to support pain research and education in New Zealand. More specifically, it was detailed that the Trust should be used for “promotion and encouragement of education and training in the field of pain, to encourage research into pain mechanisms and pain syndromes, and to facilitate the dissemination of new information.” In light of this, the NZPS Council recently established the Broadfoot Trust Prize to acknowledge outstanding research in the pain field conducted by a NZPS member.

Applicants for the award had to be NZPS members and to have published a peer-reviewed paper in the last 12 months. Applications were judged based on the paper’s contribution to the pain community, clinical impact, and the science advancement. The winner of the Broadfoot Trust Prize received $2,000 and will present their paper at the next Annual Scientific Meeting of the NZPS. The applications for the 2015 award are highlighted below. The quality of the applications was excellent and shows some of the fantastic research that is currently being undertaken by NZPS members and their collaborators.

Broadfoot Trust Prize winner:Debbie Bean

Relationships between psychological factors, pain, and disability in complex regional pain syndrome and low back pain. Clinical Journal of Pain 30(8): 647-653.The paper compares the relationships between psychological factors and outcomes (pain and disability) in people with complex regional pain syndrome (CRPS) and low back pain. It aimed to address the paucity of research on interrelationships between psychological factors and pain in CRPS. The importance of such relationships has been firmly established in people with low back pain, and so it was hypothesised that if similar relationships existed in CRPS, this would be meaningful. Eighty eight people with CRPS and 88 people with low back pain completed measures of pain, disability, depression, anxiety, and fear of movement and reinjury. It was found that psychological factors were associated with pain and disability in both groups, and that several of these relationships were stronger in CRPS.

At present, there is little research to guide psychological treatments for CRPS patients, and this paper demonstrated the importance of depression, fear-avoidance, and anxiety in CRPS. The findings of this study have also helped inform the design of a larger prospective study assessing predictors of outcome in CRPS. The paper was published as the leading paper in the August issue of the Clinical Journal of Pain, an international journal that is especially popular amongst those working in clinical settings.

Other applications were:Catherine Swift

A new perspective on family involvement in chronic pain management programmes. Musculoskeletal Care 12: 47-55.The aim of this study was to investigate how those with pain, and their significant others, perceive the involvement of significant others in a multidisciplinary chronic pain management programme.

Broadfoot Trust Prize winner, Debbie Bean, with NZPS President, Dr Fran James


Theory would suggest that including family in a programme will improve the outcomes achieved, but this has not been conclusively demonstrated by studies comparing the effectiveness of programmes with and without family participation. In fact, some studies have even suggested that family involvement may place those with pain or their significant others at risk of harm or disadvantage. The study involved semi-structured telephone interviews with eight people who had attended a Family Day as part of a three-week multidisciplinary chronic pain management programme.

The study makes an important contribution to the pain literature by asking families for their views on involvement in a chronic pain management programme; to our knowledge this is the first time that such an approach has been taken. The findings support the participation of significant others in programmes as a means of ensuring that all family members have a shared understanding about pain and its management, and so that significant others have the opportunity to access their own support.

A particularly valuable finding was the detail provided by participants about the areas in which families need to be supported to develop a shared understanding about pain and its management. For pain management clinicians, this insight suggests that programme outcomes will be most effective when the intervention includes: the involvement of family in the delivery of education about the neurophysiology of pain, the facilitation of family discussions about the signs that identify a loved one to be in pain, and strategies to manage when these signs are observed.

The article was published in Musculoskeletal Care, an international journal for clinicians and health providers that promotes high quality care for people with musculoskeletal conditions.

Debbie Bean

The outcome of complex regional pain syndrome type I: A systematic review. Journal of Pain 15(7): 677-690.The purpose of this systematic review was to examine the course and outcomes of CRPS type 1. The review included 18 studies, with almost 4000 participants.

It was found that amongst those with early CRPS, rates of recovery are high, but there was significant variability in outcomes for those not making an early recovery.

Most studies showed that motor symptoms, such as stiffness and weakness, were the most likely to persist, whereas sudomotor and vasomotor symptoms were the most likely to improve. Overall, the review suggested that some CRPS patients make a good early recovery whereas others develop lasting pain and disability. However, as yet, little is known about the prognostic factors that might differentiate between these groups. It was found that the research quality was low and it was suggested that future research should examine the factors associated with recovery and identify those at risk of poor outcomes.

The paper was published in the Journal of Pain, one of the leading international pain journals. The paper was selected by the Editor-in-Chief as the Journal Club Focus Article, and was showcased on the Journal of Pain website for the month.

Nicola Swain

A comparison of therapist-present or therapist-free delivery of very brief mind-fulness and hypnosis for acute experimental pain. New Zealand Journal of Psychology 43(3).The study was a laboratory-based acute pain experiment that compared the effectiveness of seeing a therapist on DVD or face-to-face, delivering either hypnosis or mindfulness therapy. Pain tolerance times and other results supported the use of psychological therapies on DVD as well as face-to-face. The interventions of both hypnosis and mindfulness were effective for acute pain management. These interventions were given in a very brief format, and their effectiveness should give confidence to the pain community that these types of treatment are worthwhile. There are many helpful treatments for pain available but funding and time are always an issue. The findings reported in this paper showing the effectiveness of a DVD and support the use of other modalities to deliver such treatments. For example, psychologists can use the internet to deliver relaxation, mindfulness or hypnosis therapies.

The research team has gone on to develop internet-based psychological interventions for chronic pain. We are also trialing a remote therapist virtual environment for psychological treatment. The paper was published in NZ Journal of Psychology and brings the topic of pain to the journal and its readership.


A New Era for Developing Improved Opioid Drugs to Treat PainBronwyn Kivell, PhDSenior Lecturer, Neurobiology, School of Biological Sciences, Centre for Biodiscovery, Victoria University of Wellington.

e: [email protected]

Abstract Chronic pain is poorly managed with current mu opioid medications such as morphine and its derivatives, although they remain the main treatment option for chronic cancer pain and moderate to severe acute pain. The use of mu opioids is plagued with side effects, they become ineffective with long-term use and have high abuse potential. There is a recent pharmacological discovery, ‘biased agonism’, in which a compound binds to a receptor to elicit unique regulation of cellular signalling pathways. With ‘biased agonism’ it is now possible to utilise high-throughput screens to identify mu opioids that preferentially activate signalling pathways associated with analgesic effects and not pathways associated with side effects. These exciting new developments coming from basic science are likely to lead to the identification of new and improved pharmacotherapies for treating pain.

IntroductionOpiates have been used for over a thousand years to treat pain and mu opioid drugs remain the ‘gold standard’, treatment for severe pain. However, their use is not without serious flaws. Respiratory depression, sedation, nausea and constipation are side effects of mu opioids that significantly impact the quality of life of pain suffers. In addition, abuse of highly addictive opiates remains a serious social and economic problem worldwide; with abuse of prescription opioids increasing (SAMHSA, 2011). The New Zealand National Alcohol and Drug Use Survey reported that 3.6% of New Zealand

adults use prescribed opioids recreationally (Ministry of Health, 2010). Furthermore, repeated use of mu opioids causes tolerance, whereby escalating doses are required to maintain analgesic effects. This seriously limits their effectiveness in the management of chronic pain.

Mu opioids are the main-line treatment for chronic cancer pain, however, their use in treating other types of chronic non-malignant pain is less established. Some studies report effectiveness in certain cases of chronic pain, while others report no effect (Rosenblum, Marsch, Joseph, & Portenoy, 2008). In addition to analgesic effects, increased pain or hyperalgesia following chronic use of mu opioids has also been well documented (Angst & Clark, 2006). This further complicates their clinical use and highlights the need for the development of more effective analgesics that have reduced abuse potential and fewer side effects.

Biased opioidsBoth the beneficial effects and side effects of mu opioid drugs have been shown to result from direct activation of mu opioid receptors and not the result of off target effects. Until recently, this finding restricted the development of new opioid medications. Advances over the last decade in how G-protein coupled receptors signal (a class that includes the opioid receptors) have changed the way pharmacologists and chemists approach the development of new opioid drugs. Previously, it was believed that drugs such as mu opioids bind to their receptors with varying affinities but regulate the same set of cellular signalling


proteins in an on/off fashion. We now know that each compound that binds to the receptor may do so in a unique way that enables differential regulation of each signalling pathway. This concept is called ‘biased agonism’ or ‘functional selectivity’ and has changed how drugs that target G-protein coupled receptors can be developed therapeutically. Since around 50% of current pharmacotherapies target the family of G-protein coupled receptors, this finding has had a significant impact on therapeutic drug development and has been the focus of many recent high impact reviews (Kenakin & Christopoulos, 2013; Luttrell, 2014; Shonberg et al., 2014).

For mu opioid receptors there are two main signalling pathways; G-protein mediated signalling pathways and beta-arrestin pathways. High-throughput screening assays to detect signalling via G-proteins, beta-arrestin and other downstream pathways are now readily available. Each of these signalling pathways is also linked to preclinical behavioural effects. The desirable analgesic effects of mu opioids are mostly linked to modulation of G-protein signalling; whereas, tolerance

has been associated with the activation of beta-arrestin signalling pathways. Therefore, design of mu opioid drugs that have reduced ability to recruit beta-arrestin are likely to have greater analgesic effects and reduced tolerance (Urban et al., 2007). In fact, one such compound, herkinorin, has recently been identified in preclinical studies.

Herkinorin is the first mu opioid developed from the unique structural scaffold of a compound called Salvinorin A, isolated from the plant Salvia divinorum. Similar to morphine, herkinorin is a potent and selective mu opioid agonist with the ability to attenuate inflammatory pain in mice. However, compared to morphine, herkinorin, also showed reduced analgesic tolerance to repeated use (Lamb, Tidgewell, Simpson, Bohn, & Prisinzano, 2012). Studies investigating biased signalling by this ligand showed G-protein signalling with significantly reduced beta-arrestin recruitment and mu opioid receptor internalisation (Tidgewell et al., 2008). This newly identified biased mu opioid shows improvements over morphine but it remains to be determined if this compound has abuse potential.

Figure. 1 – In a formalin footpad model of inflammatory pain (red), mice administered an analogue of Herkinorin (10 mg/kg) (IP), show rapid long lasting decreased pain responses (blue) compared to Herkinorin (10 mg/kg/IP) (green). Vehicle control (no formalin) shows no pain behaviours (Black).


Our research group at Victoria University of Wellington is working on a closely related, herkinorin-like, mu opioid compound also modified from the structure of Salvinorin A. This compound shows even greater analgesic effects compared to herkinorin (Fig 1). Ongoing research is needed to identify whether other behavioural effects such as abuse potential, sedation and tolerance are present. Also, cellular signalling pathways are yet to be screened to determine signalling bias.

Kappa opioid analgesicsDrugs activating the mu opioid receptor are not the only opioids that have analgesic effects. Drugs activating the closely related kappa opioid receptor also have the ability to attenuate pain without abuse potential. However, other side effects such as unpleasant feelings (dysphoria) have limited their use clinically, although the kappa opioid agonist nalfurafine is used in Japan to treat itch (Ueno, Mori, & Yanagita, 2013). Many of the side effects of drugs targeting the kappa opioid receptor are caused by the activation of receptors in the central nervous system (CNS). This has led medicinal chemists to modify kappa opioid drugs so that they do not readily cross the blood-brain barrier, with the understanding that these drugs will have the ability to attenuate peripheral pain without CNS mediated side effects. Based on this logic, several peripherally restricted kappa opioid drugs have been developed and tested preclinically in models of inflammatory, abdominal and neuropathic pain. For a review of kappa opioids and pain see Kivell and Prisinzano (2010).

Kappa opioids are believed to exert their analgesic effects via kappa opioid receptors located in peripheral. So may be a useful tool to treat the pain and discomfort associated with gastrointestinal disorders. Another kappa opioid analgesic called CR665 has been shown to have selective effects on visceral pain in human multi-tissue, multi model, pain tests (Arendt-Nielsen et al., 2009) and is expected to be safer and better tolerated than classical mu opioid agonists (Riviere, 2004). Oxycodone and morphine have also been compared in multi model pain tests, (Ross & Smith, 1997). In addition, opioids have demonstrated anti-inflammatory effects which contribute to their

ability to modulate pain and may be effective in the treatment of arthritis and joint pain (Tsukahara-Ohsumi et al., 2011).

SummaryThe discovery of biased signalling at mu opioid receptors is only beginning to be explored. Full investigations into the better tolerated mu opioid drugs that are currently available are likely to identify biased signalling to some degree and guide further compound development and refinement. The real excitement for this discovery, however, is the ability to screen new chemical sources for biased mu opioids and screen existing chemical libraries for biased signalling effects. This greater understanding of basic science on how opioids signal has the potential to identify and develop mu opioids that are safer, more effective, treatments for pain.

References Angst, M. S., & Clark, J. D. (2006). Opioid-induced

hyperalgesia: a qualitative systematic review.

Anesthesiology, 104(3), 570-587.

Arendt-Nielsen, L., Olesen, A. E., Staahl, C., Menzaghi,

F., Kell, S., Wong, G. Y., & Drewes, A. M. (2009). Analgesic

efficacy of peripheral kappa-opioid receptor agonist

CR665 compared to oxycodone in a multi-modal, multi-

tissue experimental human pain model: selective effect on

visceral pain. Anesthesiology, 111(3), 616-624. doi: 10.1097/

ALN.0b013e3181af6356

Camilleri, M. (2008). Novel pharmacology: asimadoline,

a kappa-opioid agonist, and visceral sensation.

Neurogastroenterol Motil, 20(9), 971-979. doi:

10.1111/j.1365-2982.2008.01183.x

Kenakin, T., & Christopoulos, A. (2013). Signalling bias

in new drug discovery: detection, quantification and

therapeutic impact. Nat Rev Drug Discov, 12(3), 205-216.

doi: 10.1038/nrd3954

Kivell, B., & Prisinzano, T. E. (2010). Kappa opioids and the

modulation of pain. Psychopharmacology (Berl), 210(2),

109-119. doi: 10.1007/s00213-010-1819-6

Lamb, K., Tidgewell, K., Simpson, D. S., Bohn, L. M., &

Prisinzano, T. E. (2012). Antinociceptive effects of herkinorin,

a MOP receptor agonist derived from salvinorin A in the

formalin test in rats: new concepts in mu opioid receptor


pharmacology: from a symposium on new concepts in mu

opioid pharmacology. Drug Alcohol Depend, 121(3), 181-

188. doi: 10.1016/j.drugalcdep.2011.10.026

Luttrell, L. M. (2014). Minireview: More than just a hammer:

ligand “bias” and pharmaceutical discovery. Mol Endocrinol,

28(3), 281-294. doi: 10.1210/me.2013-1314

Ministry of Health, New Zealand (2010) Drug use in New

Zealand: key results of the 2007/2008 National Alcohol and

Drug Use Survey. Wellington. Ministry of Health

Riviere, P. J. (2004). Peripheral kappa-opioid agonists

for visceral pain. Br J Pharmacol, 141(8), 1331-1334. doi:

10.1038/sj.bjp.0705763

Rosenblum, A., Marsch, L. A., Joseph, H., & Portenoy, R.

K. (2008). Opioids and the treatment of chronic pain:

controversies, current status, and future directions. Exp Clin

Psychopharmacol, 16(5), 405-416. doi: 10.1037/a0013628

Ross, F. B., & Smith, M. T. (1997). The intrinsic antinociceptive

effects of oxycodone appear to be kappa-opioid receptor

mediated. Pain, 73(2), 151-157.

SAMHSA. (2011). Results from the 2010 National Survey

on Drug Use and Health: Summary of National Findings.

NSDUH Series H-41. Rockville, MD: HHS Publication No.

(SMA), 11- 4658.

Shonberg, J., Lopez, L., Scammells, P. J., Christopoulos, A., Capuano, B., & Lane, J. R. (2014). Biased agonism at G protein-coupled receptors: the promise and the challenges--a medicinal chemistry perspective. Med Res Rev, 34(6), 1286-1330. doi: 10.1002/med.21318

Tidgewell, K., Groer, C. E., Harding, W. W., Lozama, A., Schmidt, M., Marquam, A., . . . Prisinzano, T. E. (2008). Herkinorin analogues with differential beta-arrestin-2 interactions. J Med Chem, 51(8), 2421-2431. doi: 10.1021/jm701162g

Tsukahara-Ohsumi, Y., Tsuji, F., Niwa, M., Hata, T., Narita, M., Suzuki, T., . . . Aono, H. (2011). The kappa opioid receptor agonist SA14867 has antinociceptive and weak sedative effects in models of acute and chronic pain. Eur J Pharmacol, 671(1-3), 53-60. doi: 10.1016/j.ejphar.2011.09.169

Ueno, Y., Mori, A., & Yanagita, T. (2013). One year long-term study on abuse liability of nalfurafine in hemodialysis patients. Int J Clin Pharmacol Ther, 51(11), 823-831. doi: 10.5414/CP201852

Urban, J. D., Clarke, W. P., von Zastrow, M., Nichols, D. E., Kobilka, B., Weinstein, H., . . . Mailman, R. B. (2007). Functional selectivity and classical concepts of quantitative pharmacology. J Pharmacol Exp Ther, 320(1), 1-13. doi:

10.1124/jpet.106.104463

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For further information: The International Association for the Study of Pain (IASP) www.iasp-pain.orgFaculty of Pain Medicine Australian and New Zealand College of Anaesthetists www.fpm.anzca.edu.auAustralian Pain Society www.apsoc.org.auNew Zealand Pain Society www.nzps.org.nzPainaustralia www.painaustralia.org.au


Assessing and Modelling Clinical Reality in Pain Therapeutic StudiesSimon van Rysewyk, PhD 1,2

1School of Humanities, Department of Philosophy, University of Tasmania, Private Bag 41, Hobart 7001, Australia; 2Research in Real-Life Pte Ltd, 16 Raffles Quay, #33-03 Hong Leong Building, Singapore 048581.

e: [email protected]

BioSimon is a Kiwi who currently lives in Taiwan with his wife and two kids. He received his PhD in Philosophy from the University of Tasmania in May 2013, and until August 2014, was a National Science Council Postdoctoral Fellow at the Graduate Institute of Medical Humanities, Taipei Medical University, in Taiwan. Simon is interested in real-life (pragmatic/naturalistic) research to study pain, especially pain meaningfulness. He combines research with a medical writing position at Research in Real Life, Ltd.

AbstractTherapeutic pain studies do not always clearly simulate clinical reality. This poses a barrier to understanding the nature of such research and how it should be subsequently applied to target populations in healthcare contexts. I propose that a theoretical framework developed by the Respiratory Effectiveness Group (REG) can be applied in the field of pain to understand and appraise clinical factors in therapeutic pain studies. The framework should be thoroughly tested to establish its usefulness in a chronic pain management context.

Keywordspain, randomised controlled trials, observational

studies, pragmatic research, Respiratory

Effectiveness Group (REG)

IntroductionClinical practice guidelines for the assessment and management of pain are heavily supported by evidence from randomised control trials (RCTs) (Manchikanti et al. 2008). RCTs are designed to assess whether an intervention is efficacious at the group level under optimal conditions (Campbell & Stanley, 1962). They are conducted in specialized settings, using precisely defined, homogenous patient populations. To optimize internal validity, RCTs typically exclude from recruitment criteria or data analyses external patient and clinical factors, as well as variations in clinical care and monitoring, that might confound trial outcomes. These factors can be socioeconomic, personal (e.g., medication attitudes, religious beliefs), lifestyle (e.g., current exercise frequency per week) or clinical (e.g., comorbities) in orientation. Pain RCTs have high internal validity (Manchikanti et al. 2008), meaning that causal relationships reported in these studies should be confidently taken as approximately true (Campbell & Stanely, 1962).

RCTs are limited by the extent to which efficacy can capture ‘real-life’ effectiveness in diverse chronic pain populations treated in community clinics. RCTs conducted in the field of pain, like RCTs conducted in all medical research fields, predominantly assess outcomes by assessing the same domains across all trial patients. A major limitation of this approach is that few chronic pain RCTs take an individualized approach


to describing the therapeutic outcomes that individual patients judge most meaningful (Williams et al. 2000; Chiesa & Serretti, 2011; Veehof et al. 2011; Bowering et al. 2013; Klatt et al. 2015). Pain is widely recognized by clinicians and researchers as a subjective experience, so perceived meaning is extremely important in the way that pain is felt (van Rysewyk, 2014). Few chronic pain RCTs have asked trial patients which changes in pain experience they judge as meaningful with regard to pain magnitude and health-related quality of life, or what changes they judge perceivable but not meaningful (Dworkin et al. 2008; Manchikanti et al. 2008; Manchikanti et al. 2009). Indeed, few chronic pain RCTs have asked clinicians, from a clinical perspective, for their thoughts on these questions. Whether meaningful changes occur in pain management is critical in pain therapy adherence and outcomes, as well as in assessing the benefits and costs of initiating certain therapies (Dworkin et al. 2008).

A growing number of pragmatic (‘real-life’) studies using observational methods now complement findings from traditional pain RCTs (Manchikanti et al. 2009). The main observational study methods include cohort, case-control and cross-sectional designs. Observational studies describe the effects of an intervention under the routine clinical circumstances in which it will be applied (effectiveness) in contrast to the ideal conditions that are optimized in RCTs (efficacy). These routine circumstances include clinically significant interactions between external factors—patient, lifestyle, behavioural, socioeconomic or clinical—and therapeutic outcomes in clinical pain populations (Manchikanti et al. 2009). Such interactions are excluded in traditional RCTs.

The growing number of observational pain studies is part of an emerging awareness of the relevance of integrating patient, clinician and researcher perspectives (e.g., meanings, preferences, expectations, attitudes) into therapeutic pain studies and clinical guidelines (Manchikanti et al. 2009). This development parallels the growth of pain patient centered programs, events and organizations, as well as patient advocacy groups that partner patients, clinicians and researchers together in order to co-prioritize research needs and achieve research goals (Sanofi Challenge: Opportunity to Advance Patient-Centered CFS Research, 2012; National Hospice and Palliative Care Organization: Patient

Outcomes and Measures (POM), 2015; Patient Advocate Foundation, 2015; Stanford University Health Care, Nursing: Patient Centered Care and Education, 2015).

However, as some researchers have observed (Roche et al. 2013), determining to what extent a therapeutic study is “real-life” is not necessarily clear. For example, in the field of chronic pain management, a traditional pain RCT might select a fairly wide and varied population, but involve comprehensive patient follow-up (e.g., Fairbank et al. 2005). In terms of the treated population in the community, this type of pain study is likely quite representative, but in relation to the complex interactions between patient and clinical factors, including variations in clinical management - “ecology of care” - it is not (Roche et al. 2013). Comprehensive patient follow-up in healthcare settings is not always available or adequate in quality (e.g., McCarberg, 2011). Alternately, a pragmatic pain study can assess therapeutic outcomes in a highly idealized population, but could involve an intervention that simulates clinical care in the community (e.g., Witt et al. 2006). This type of study illustrates strong ecology of care, but it is likely weaker in representing the true treated patient population (Roche et al. 2013). These considerations lead to a general problem in the classification and interpretation of current findings in therapeutic studies, a problem in pain clinical research too. Is there a general model that can integrate the evidence base in clinical research?

The Respiratory Effectiveness Group (REG) theoretical frameworkFounded in 2012, the Respiratory Effectiveness Group (REG) is a “not-for-profit, investigator-lead initiative” that aims to develop “a unified approach to real-life research to improve and set quality standards and to understanding the optimum role of real-life data in informing meaningful clinical practice guidelines, drug licensing and post-marketing surveillance processes and improved patient care in respiratory medicine” (Respiratory Effectiveness Group, 2013). Discussions in 2013 held by REG collaborators led to the creation of a novel theoretical framework that allows classification of different types of respiratory studies according to general design (American Thoracic Society 2013 Respiratory Effectiveness Group Collaborator Meeting, 2013; Roche et al. 2013). The aim of the framework is


to inform people involved in management, prevention and research at both the patient and societal (i.e. policy) level in the use, and quality assessment, of therapeutic research. The REG framework may also inform pain researchers and clinicians on how to assess and model clinical reality in pain therapeutic studies for the ultimate benefit of public health.

The REG framework proposes that all therapeutic studies can be classified and interpreted along two standardized dimensions: population and ecology of care (Roche et al. 2013). Studies are positioned relative to each other based on their specific study population and ecology of care characteristics. The population continuum consists of “narrow” or “broad” population series. At one extreme of the population continuum, the narrowest study population is characterised as highly-idealized in terms of selection and involves close patient monitoring. At the other extreme, the broadest target population is represented as having a “managed” condition with or without a confirmed diagnosis. Ecology of care focuses on clinical management and spans three different control options, as defined in Roche et al. (2013):

• Highly controlled: Defined as highly-idealized RCT efficacy and patient monitoring

• Pragmatically controlled: Defined as managed simulation of routine clinical practice in terms of monitoring intensity and therapies

• Observational: Defined as comprehensive simulation of routine clinical care in the community

The REG framework may be conceived as a figure with two axes (population [y-axis], ecology of care [x-axis]) that together bound a “real-life” space integrating all in vivo therapeutic studies (Roche et al. 2013). Where a therapeutic study fits along each of these two dimensions determines what type of study it is, how it relates to other studies positioned within the framework, and its fundamental relationship to clinical reality.

As stated above, a main ambition of the REG framework is to enable informed classification and quality appraisal of therapeutic research (Roche et al. 2013). The two dimensional assessment process requires that studies be suitably characterized in terms of patient populations and ecology of care, as defined in the framework, as well as in terms of high internal and external validity

(efficacy and effectiveness). This arrangement in two dimensional space allows relevant studies (to the population and treatment setting) to be identified easily. Findings from these relevant studies can then be used to make management plan decisions and assessments. I believe that the REG framework could usefully be applied to therapeutic study findings in the field of pain to assess their relevance for target pain populations in healthcare settings, and also to inform clinical treatment recommendations.

ConclusionTherapeutic pain studies do not always clearly model clinical reality. This poses a barrier to understanding the nature of such studies and how they relate to target pain populations and clinical settings. To help address this significant problem, I described a theoretical framework developed by the Respiratory Effectiveness Group (REG) for the use, and quality assessment, of therapeutic study findings and I suggested applying the framework to clinical pain research. The next step is to submit the framework to thorough testing in a chronic pain research context to determine the extent of its applicability.

ReferencesAmerican Thoracic Society 2013 Respiratory Effectiveness Group Collaborator Meeting. (2013). Retrieved April 12, 2015, from http://www.effectivenessevaluation.org/resources/presentations-events/reg-kick-off-meeting-ats/

Bowering KJ, O’Connell NE, Tabor A, Catley MJ, Leake HB, Moseley GL, Stanton TR. The effects of graded motor imagery and its components on chronic pain: a systematic review and meta-analysis. J Pain 2013; 14(1): 3–13.

Campbell DT, & Stanley J. Experimental and quasi-experimental designs for research. Boston, MA: Houghton Mifflin Company, 1962.

Chiesa A, & Serretti A. Mindfulness-based interventions for chronic pain: a systematic review of the evidence. J Altern Complem Med 2011; 17(1): 83–93.

Dworkin RH, Turk DC, Wyrwich KW, Beaton D, Cleeland CS, Farrar JT, Haythornthwaite JA, Jensen MP, Kerns RD, Ader DN, Brandenburg N, Burke LB, Cella D, Chandler J, Cowan P, Dimitrova R, Dionne R, Hertz S, Jadad AR, Katz NP, Kehlet H, Kramer LD, Manning DC, McCormick C, McDermott MP, McQuay HJ, Patel S, Porter L, Quessy S, Rappaport BA, Rauschkolb C, Revicki DA, Rothman M, Schmader


KE, Stacey BR, Stauffer JW, von Stein T, White RE, Witter J, Zavisic S. Interpreting the Clinical Importance of Treatment Outcomes in Chronic Pain Clinical Trials: IMMPACT Recommendations. J Pain 2008; 9(2): 105–121.

Fairbank J, Frost H, Wilson-MacDonald J, Yu LM, Barker K, Collins R. Randomised controlled trial to compare surgical stabilisation of the lumbar spine with an intensive rehabilitation programme for patients with chronic low back pain: the MRC spine stabilisation trial. BMJ 2005; 330(7502): 1233.

Klatt E, Zumbrunn T, Bandschapp O, Girard T, Ruppen, W. Intra-and postoperative intravenous ketamine does not prevent chronic pain: A systematic review and meta-analysis. Scand J Pain 2015; 7: 42–54.

Manchikanti L, Hirsch J, Smith HS. Evidence-Based Medicine, Systematic Reviews, and Guidelines in Interventional Pain Management: Part 2: Randomized Controlled Trials. Pain Physician 2008 11(6), 717–773.

Manchikanti L, Singh V, Smith HS, Hirsch JA. Evidence-Based Medicine, Systematic Reviews, and Guidelines in Interventional Pain Management: Part 4: Observational Studies. Pain Physician 2009; 12(1): 73–108.

McCarberg, B. Pain management in primary care. In: Fishman SM, Ballantyne JC, Rathmell, JP, editors. Bonica’s Management of Pain. (4th Edition). Philadelphia, USA: Lippincott, Williams and Wilkins, 2010. pp. 1537–1546.

National Hospice and Palliative Care Organization: Patient Outcomes and Measures (POM). (2015). Retrieved April 10, 2015, from http://www.nhpco.org/quality-performance-measures/patient-outcomes-and-measures-pom

Patient Advocate Foundation. (2015). Retrieved April 10, 2015, from http://www.patientadvocate.org/

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Roche N, Reddel H, Agusti A, Bateman ED, Krishnan JA, Martin R, Papi A, Postma D, Thomas M, Brusselle G, Israel E, Rand C, Chisholm A, Price D, on behalf of the Respiratory Effectiveness Group. Integrating real-life studies in the global therapeutic research framework. Lancet Respir Med 2013; 1: e29–e30.

Sanofi Challenge: Opportunity to Advance Patient-Centered CFS Research. (2012). Retrieved April 10, 2015, from http://solvecfs.org/sanofi-challenge-opportunity-to-advance-patient-centered-cfs-research/

Stanford University Health Care, Nursing: Patient Centered Care and Education. (2015). Retrieved April 10, 2015, from https://stanfordhealthcare.org/health-care-professionals/nursing/patient-care/pain-management.html

van Rysewyk S. Objective Knowledge of Subjective Pain? Towards a Subjective-Neuroscience of Pain. Ngau Mamae 2014; Spring: 10–20.

Veehof MM, Oskam MJ, Schreurs KM, Bohlmeijer ET. Acceptance-based interventions for the treatment of chronic pain: a systematic review and meta-analysis. Pain 2011; 152(3): 533–542.

Williams ACDC, Davies HTO, Chadury, Y. Simple pain rating scales hide complex idiosyncratic meanings. Pain 2000; 85(3): 457–463.

Witt CM, Jena S, Selim D, Brinkhaus B, Reinhold T, Wruck K, Liecker K, Linde B, Wegscheider K, Willich K, Stefan N. Pragmatic randomized trial evaluating the clinical and economic effectiveness of acupuncture for chronic low back pain. Am J Epidemiol 2006; 164(5): 487–496.


ANAESTHESIAAnaesthetic Provisional FellowDr Wei Chung TongAuckland

Anaesthetist/Pain Medicine SpecialistDr Stephanie KeelWaikato

Clinical Pharmacist – PainMiss Leah HodgkinsonAuckland

Pain Fellow/AnaesthetistDr Yvonne MurrayWellington

GENERAL MEDICINEDoctor – GPDr David Boothman-BurrellMarlborough

General PractitionerDr Claire IshamBay Of Plenty

PhD Candidate-Discipline of General PracticeManasi GaikwadAustralia

GENERAL PRACTICEGP/Elder CareDr Jill RochaNorthland

HEALTH PSYCHOLOGY

MEDICINEMusculoskeletal PhysicianDr Charles NgAuckland

NURSINGPain Nurse SpecialistMrs Jorjina StewartAuckland

Registered Nurse, Paediatric Quality and Education CoordinatorSue CranstonEast Coast

Rehabilitation Advisor – ACCMs Brenda Kenworthy

PALLIATIVE CAREPaediatric Palliative Care SpecialistDr Emily ChangAuckland

PHARMACYClinical Pharmacist – PainMiss Leah HodgkinsonAuckland

PHYSIOTHERAPY PhysiotherapistLisa FordAuckland

PhysiotherapistPaul LagermanAuckland

Physiotherapy Student Mrs Poonam MehtaOtago

Director Bob SellersOtago

Physiotherapist Rachel OwenCanterbury

PSYCHOLOGY

Clinical PsychologistDr Karma GalyerWaikato

Clinical PsychologistDr Katharine BlackmanBay Of Plenty

Clinical Psychologist Linda ZampeseWellington

Clinical PsychologistPrya BeharryBay Of Plenty

Health PsychologistMs Anna O’SullivanAuckland

Psychologist Ms Katherine SreedharanAuckland

Psychologist Dr Peter GilmourNorthland

REHABILITATIONVocational RehabilitationGrant LangleyTaranaki

New Members 2015


PresidentDr Frances (Fran) JamesConsultant Clinical PsychologistCounties Manukau District Health BoardPrivate Bag 94052South Auckland Mail CentreAuckland 2240p: 021 241 4587 e: [email protected]

Immediate Past PresidentDr Brigitte GertoberensSpecialist Anaesthetist & Pain Medicine SpecialistThe Auckland Regional Pain ServicePrivate Bag 92 189Auckland Mail CentreAuckland 1142p: (09) 307 4949 ext: 27896e: [email protected]

TreasurerMs Jenny SandomClinical Nurse SpecialistPain Relief ServicesC/o Dept of AnaesthesiaDunedin HospitalPO Box 1921Dunedin 9054p: (03) 474 0999 ext: 8648e: [email protected]

SecretaryMrs Joni HollowsNew Zealand Pain Society IncPO Box 652Wellington 6140p: 027 734 4974e: [email protected]

Ngau Mamae Editor-in-Chief & CouncillorDr Gwyn LewisHealth & Rehabilitation Research InstituteAUT UniversityPrivate Bag 92006Auckland 1142p: (09) 921 9999 ext: 7621f: (09) 921 9620e: [email protected]

Councillor & Sub-editorDr Leinani Aiono-Le TagaloaSpecialist AnaesthetistThe Auckland Regional Pain ServicePrivate Bag 92 189Auckland Mail CentreAuckland 1142p: (09) 638 0370

CouncillorDr Jim OlsonSpecialist Anaesthetist & Pain Medicine SpecialistNorth Shore HospitalDepartment of Anaesthesia124 Shakespeare RdWestlake 0622Aucklandp: (09) 441 8991e: [email protected]

CouncillorLuciana BlagaOccupational TherapistDunedin HospitalPO Box 1921Dunedin 9054p: (03) 474 0999 ext: 8601e: [email protected]

CouncillorAislinn CarrClinical Nurse Specialist – Chronic PainCounties Maunkau District Health Board Private Bag 94052South Auckland Mail CentreAuckland 2240p: 021 706 511e: [email protected]

CouncillorErica GleesonClinical Nurse Specialist – Acute PainMidCentral Health50 Ruahine Street Private Bag 11036Palmerston North 4442p: (06) 356 9169e: [email protected]: [email protected]

Website TeamBronwyn ThompsonPain Management Clinician & Educatore: [email protected]

Louise SheppardPhysiotherapiste: [email protected]

Cat SwiftOccupational Therapiste: [email protected]

NZPS Council Members 2015

New Zealand Pain Society Inc. Registration Form for New Membership

Date

Name

Mailing Address

Alternative Address (not for publication)

Telephone (work)

Fax

Email

Present Clinical Title of Affiliation

Discipline

Institutions in which you work in the field of pain

Proportion of working week in the field of pain

Classification of practice setting Modality-oriented Clinic Multidisciplinary Pain Centre

Multidisciplinary Pain Clinic Solo

Pain Clinic Other

Patient Group Inpatient Private

Outpatient Public/Private

Public

Particular Interests

Other Affiliations •(list other major national or international scientific and health professional organisations to which you belong)

•

•

Course of Study(if you are a student)

Are you a member of the IASP no please send me membership details for IASP

yes

We intend distributing regularly to NZPS members only, an updated membership list. If there is any portion of the information on this page that you would prefer to be kept out of the membership list, please place an asterisk * beside it.

GST No: 49-718-500

Choose the correct tier based on your pre-tax (gross) income*

*Pre-Tax *Rate (Gross Income) (GST Inclusive)

Tier 1 less than $100,000 $75

Tier 2 greater than $100,000 i.e. 100k+ $150

Student (full time) $25

Retiree $25

Affiliate (*select tier 1 or 2 above)

Corporate Membership Please email Membership Secretary $5000

Optional (must be NZPS Member to join) Pain in Childhood Special Interest Group $30

Applicant’s Signature

Fees Payable: Membership Fees $

SIG Membership Fees $

Total Payable $

NOTE:

Modality-oriented Clinic • Provides specific type of treatment, eg. nerve blocks, TENS acupuncture, etc• May have one or more health care disciplines.• Does not provide an integrated, comprehensive approach.

Pain Clinic • Focuses on the diagnosis and management of patients with chronic pain, or may specialise in specific • diagonses of pain related to a specific region of the body.• Does not provide comprehensive assessment or treatment.• A single physician functioning within a complex healthcare institution which offers appropriate consultative and therapeutic services would qualify, but not an isolated solo practitioner.

Multidisciplinary Pain Clinic • Specialises in the multidisciplinary diagnosis and management of patients with chronic pain.• Staffed by physicians of different specialities and other healthcare providers.• May have facilities that are inpatient, outpatient or both.• Differs from a Multidisciplinary Pain Centre only because it does not include research and teaching.

Multidisciplinary Pain Centre • An organisation of healthcare professionals and basic scientists that includes research, teaching, and patient care in acute and chronic pain.• Typically a component of a medical school or a teaching hospital.• Clinical programmes supervised by an appropriately trained and licensed Director.• Staffed by a minimum of physcian, clinical psychologist or psychiatrist, occupational therapist, physiotherapist, and registered nurse.• Services provided must be integrated and based upon interdisciplinary assessment and management.• Offers both inpatient and outpatient programmes.

Payment Details: Post Cheque NZPS PO Box 652 Wellington New Zealand 6140

or

Internet Deposit Account Name: New Zealand Pain Society Inc. Account No#: 030618 0066677 00 Swift Code: WPACNZ2W (for overseas members payment)

Please complete this form and return to: Membership Secretary New Zealand Pain Society PO Box 652 Wellington New Zealand 6140

www.nzps.org.nz

ISSN 1175–821X