Applied Psychophysiology and its interventional techniques such as biofeedback are increasingly being shown to be valuable tools in the diagnosis and treatment of numerous pain problems.  Psychophysiological recording techniques are an important tool in clinician’s diagnostic armamentariums because they can easily and reliably differentiate between pain problems with similar symptoms – such TMD and TMJ - and to objectively demonstrate abnormal patterns of function which do not show on standard medical tests of structure – such as vaginal pain from pelvic muscle disregulation and non-cardiac chest pain caused by incorrect breathing patterns. Psychophysiological assessments have become ever more closely aligned with interventions such as biofeedback which have been shown to be highly efficacious for migraine and tension headache, irritable bowel syndrome, phantom limb pain, non-cardiac chest pain, and many others.

Applied psychophysiology techniques are designed first to objectively identify abnormal  patterns of physiological functioning and then to help patients rectify these patterns. Behavioral techniques such as biofeedback are used to train patients to correct patterns and responses causing pain so pain is neither generated nor maintained. Because many pain problems, such as tension headaches, non-cardiac chest pain, and irritable bowel syndrome, are caused by disorders of function rather than structure, standard medical tests rarely show any problems while psychophysiological assessments of incorrect levels and patterns of function show them clearly and consistently. Use of these diagnostic techniques and interventions permits clinicians to make far more accurate assessments of their pain patients and increase the level of success with many pain disorders than is possible with other techniques.

This workshop provides an introductory demonstration of how psychophysiological assessments and interventions are performed when working with patients whose primary complaint is pain. The presentation will begin with the use of pain diagrams and other assessment tools to guide the initial interview. It proceeds to show typical psychophysiological recording techniques used to assess common pain problems such as low back pain, jaw area pain, non-cardiac chest pain, and phantom limb pain.

Slides and real time recordings of normal and abnormal patterns of physiological function including muscle tension, temperature, and respiration will be shown. The typical approach to eliciting changes in physiological functioning by replicating work and stressful situations will be demonstrated. Biofeedback techniques for training patients to recognize and correct abnormal patterns of muscle tension and other parameters will be demonstrated using standard psychophysiological recording devices.

Clinical Implications of Opioid Receptor Regulation

Morphine and related opioid drugs very effectively relieve many (but not all) kinds of pain but they often lose their efficacy after prolonged treatment (tolerance).  We have established that loss of opioid receptor function is associated with tolerance but this precedes receptor trafficking mechanisms thought previously by other researchers to be pivotal for tolerance.  Long-term medication with opioids also produces physical dependence (and addiction in some people), which contributes to tolerance and causes a painful and dysphoric withdrawal syndrome upon cessation of treatment.  We know this is due to mechanisms in some nerve cells that attempt to balance their electrical and biochemical activity in the face of continuous inhibition by opioids.  We have now identified one of the key molecular targets in this process, the GAT-1 GABA transporter. In future, new drugs that target this molecule may in lessen opioid tolerance, alleviate withdrawal, or even assist with recovery from opioid addiction.

Conotoxins as Therapeutics for Persistent Pain

New therapeutics to treat persistent pain states are likely to emerge from deeper understanding of signalling molecules that are specifc to pain pathways and pathological changes in signalling. Novel marine snail toxins (conopeptides) are powerful tools to identify key signaling molecules in pain pathways in normal and injured tissue.  Thousands of different conopeptides have evolved in these predatory snails so that their venom very rapidly inactivates the nerves of their prey.  The potential utility of conopeptides in pain (one is already in clinical use) stems from their high potency to very specifically block individual types of excitability molecules on nerve cells, some of which give rise to pain states.  Our group was recently the first to identify the preclinical therapeutic potential of blockers of subtypes of sodium channels that are encoded only by pain sensing nerves entering the spinal cord and thereby treat pain resulting nerve injury.  Investigation of the mechanisms of action of novel TTX-resistant sodium channel blockers, subtype selective calcium channel blockers, subtype selective nicotinic channel blockers and acid sensing ion channel blockers in primary afferent and spinal neurons, and are examining their efficacy in neuropathic pain models will be discussed.

Carol is a women’s health physiotherapist who will be presenting a pelvic floor muscle training session for nurses on the current regimes. This will include muscle control, bladder retraining and sexual responsiveness

Carols Tonic session is a lively presentation of her Abdominal, Butt and core workout – as easy as ABC.
ora3 has the perfect tonic to boost vitality and enhance your health.

‘Tonic’ provides a series of easy to follow exercises presented by three of ora3‘s professional instructors; a physiotherapist, a Pilates expert and a personal trainer. There are three levels of exercises from gentle through to advanced and Carol says, “I put the DVD together as a way of getting people more active. It’s easy for people to find an excuse not to go to the gym, but with ‘tonic’ you can do a fantastic workout at home and in your own time.”

As there is a close correlation between pain and depression, can helping to improve a person’s mood also ease the experience of pain?  Can a person be happy in pain and, if so, what does that improved affect do for a person’s quality of life?  And can hypnosis be used to help such improvements?  This workshop explores, in a practical, skills-based approach, how the growing science of positive psychology can be simply and effectively incorporated into therapy and hypnosis for enhancing happiness, relieving depression and facilitating pain management. 

 

In the workshop you will learn about:

• The science and practice of positive psychology.
• Making happiness and well-being legitimate goals of therapy.
• Facilitating the client's shift from problem to positive.
• Assessing the client for outcome.
• Using hypnosis, positively.
• Building helpful cognitive styles.
• Building skills in resilience.
• Avoiding the pitfalls that limit happiness.
• And employing these positive therapeutic approaches effectively, especially in the area of clinical hypnosis, depression and pain.

It will include illustrative case examples, demonstrations, and simple, pragmatic exercises to help you quickly apply these methods for enhancing therapy and therapeutic outcomes with your own clients.  

Currently Professor of Nursing in a clinical chair between Massey University and MidCentral Health, Palmerston North, New Zealand.

Holds clinical postgraduate qualifications in oncology and cardiovascular nursing and in counseling.  Holds a PhD from Massey University. Ongoing research interests continue into primary health services, development of the nurse practitioner role and patient safety.
Member of the Ministerial Task Force on Nursing and  past president and now executive director of the College of Nurses Aotearoa (NZ) for the last fifteen years.  Currently deputy chair of the Ministry task force on implementation of the primary health strategy and member of the Nurse Practitioner employment and development working party.

Awarded a Member of the New Zealand Order of Merit in the Queens Birthday Honours, 2000.

With the increasing use of complementary and alternative medicine, particularly for persistent conditions, there is increasing interest in the role that nutrition might have in pain relief. A number of research studies have suggested that nutrition and diet might play a role in the management of pain. This presentation will consider the mechanisms by which dietary constituents can act as anti-inflammatory and antioxidant agents.

Cellular damage due to cytokine-induced oxidative stress is one of the potential pathways whereby dietary components can influence pain. Of particular interest are studies investigating soybean and isoflavones. Dietary fats may also modulate pain possibly by abrogating cytokine production or by altering the ratio of long chain polyunsaturated fatty acids which affect the consequent production of inflammatory mediators. Sucrose has been used as an analgesic agent particularly for neonatal pain. Recent research suggests that anthocyanins from berry fruits are also worth further investigation. The presentation will also review the evidence that nutrition has a role in controlling pain from rheumatoid arthritis.

Internationally the assessment of pain in people with intellectual disability has been identified as an area fraught with difficulty leading to major health disparities. Working with people with intellectual disabilities, family/carers and health professionals, at MidCentral Health we have begun exploring the difficulties that lead to these health disparities. In my presentation I will begin by providing an overview of the difficulties that are frequently experienced by health professionals and then discuss the education, processes and systems that are currently being implemented here at MidCentral Health in an attempt to minimise these barriers.

"The process of Rehabilitation requires comprehensive goal-setting, and this is particularly important in patients with chronic pain.The WHO ICF Model (International Classification of Functioning, Disability and Health) provides a holistic conceptual framework which can support Rehabilitation professionals in this process, as well as providing a template for report writing.  Our multidisciplinary rehabilitation team provides Rehabilitation programmes for people with a wide range of disabilities and as part of this, we also offer individual functional restoration programmes for patients with chronic pain.Our team has used the WHO ICF model in our inpatient- as well as outpatient programmes for some 3 years now,and in this presentation I will present a brief overview of this model and some of our experiences with it."

In order for any animal to experience pain, it has to be sentient and ‘aware’. Recent evidence suggests that the fetus is maintained in a sleep-like unconscious state and that ‘awareness’ therefore only occurs after birth. However, the timing of the onset of ‘awareness’ after birth will depend on the maturation of underlying neurological processes and hence it is anticipated to vary depending on the species. Some aspects of neurological maturation can be assessed by investigating the functionality of the neural apparatus using developmental changes in the electroencephalographic (EEG) activity in species which are mature (e.g. sheep), moderately immature (e.g. rat) and extremely immature (e.g. wallaby) at birth. Pain-specific EEG responses of lightly anaesthetised young of these three species have been investigated and apparently depend on neurological maturity and, in lambs, on proximity to birth. The results of these studies have some novel implications for pain management, and hence maintenance of animal welfare standards, in the laboratory, especially in developmental research facilities, and when dealing with newborn livestock and companion animals. These insights might equally have implications for managing pain in prematurely born or full-term newborn infants.

The EEG has long been known to reflect changes in cortical function by an alteration in the components of its frequency. Development of the Fast Fourier Transformation method has allowed statistical analysis of specific variables in the power spectra of EEGs. Changes in EEG power spectra have been shown to reflect alterations in the activity of the cerebral cortex associated with cognitive perception of pain. Combined with the use of a minimal anaesthesia model, EEG spectral analysis is a useful tool in the quantification of noxiousness of dehorning in cattle.

Modified Tai Chi, as a form of exercise, brings a growing awareness of the many benefits, which include improved balance, blood pressure regulation, posture control, coordination …...

The posture and coordination involved in tai chi enhances a healthy breathing pattern, improves joint alignment and range of movement, strengthens, enables controlled movement when living with chronic pain.

Basic forms of tai chi will be demonstrated with indications of individual modifications for “comfort and safety”. Opportunities for attendees to experience the movements are to be available."

Painless Studies of Pain Including Somatic and Visceral Pain Models
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This paper will explore new experimental methodologies which allow pain research to be undertaken without causing pain in experimental subjects. In particular, use of EEG responses in lightly anaesthetised animals will be discussed.

Human and Animal Pain: Novel Studies Informing Pain Management
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 This paper will review the development of the minimal anaesthesia model and its adaptation to different species of experimental animals.  Examples of its use in basic and applied animal welfare research will be covered.

Malcolm Johnson
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Professor David Mellor’s research and scholarly interests include: fetal and neonatal physiology, stress physiology, pain assessment and management, and bioethics as it applies to animal welfare. He has more than 365 publications in these areas, at least 200 of which are significant works of scholarship. During the last 5 years in particular he has sought to integrate his interests in fetal and neonatal physiology and pain research by exploring issues of prenatal ‘awareness’ and the potential, or otherwise, for pain perception in utero.

David Mellor is currently Professor of Applied Physiology and Bioethics, Professor of Animal Welfare Science and Director of the Animal Welfare Science and Bioethics Centre at Massey University in New Zealand, positions he has held since 1998. Previously at Massey, between 1988 and 1998, he was Professor and Head of the Department of Physiology and Anatomy in the Veterinary Science Faculty. Between 1969 and 1987 he was Head of the Physiology Department at the Moredun Research Institute in Edinburgh Scotland. He has a BSc(Hons) from New England University (1966) and a PhD from Edinburgh University (1969), and was made an Honorary Associate of the Royal College of Veterinary Surgeons (HonAssocRCVS – 2005).

Pelvic autonomic reflexes and pain states can be influenced by hormonal status and many pelvic pain conditions are more common in women than men (e.g. interstitial cystitis, an inflammatory condition of the bladder). The mechanisms underlying these effects are unknown, but to date most studies have focused on steroid hormone action on central nociceptive processing. This presentation will discuss our recent findings from patch clamp studies on isolated pelvic visceral nociceptor neurons where we have investigated the actions of estrogens on signalling activated by capsaicin, ATP and protons. We will also discuss these results in the context of the potential impact of estrogens on signalling between the urothelium and nociceptors.

A preliminary investigation was undertaken to assess the validity of the SF-36 health survey as an assessment tool for a multidisciplinary pain management programme. The admission and 6-month full-time scores were compared to changes in scores of the QE Health Scale and six minute walk.

Bronwyn Thompson originally trained as an occupational therapist, graduating from CIT in 1984.  She later completed her MSc in Psychology in 1999 at Canterbury University, and is currently enrolled as a part-time PhD student in the Department of Health Sciences at Canterbury University.

She has worked in pain management for 18 years, with a main focus on pain management at work.  Her work has ranged from interdisciplinary pain management programmes, private practice, case management both for private organizations, and ACC, primary prevention and secondary prevention, and since 2002, teaching postgraduate papers in pain and pain management at Otago University, and Otago Polytechnic.

Her main interest areas include the factors that complicate return to work, pain and anxiety, exposure therapy for pain-related anxiety and avoidance, importance and confidence in motivation for self management, and resilience. 

The effect of her occupational therapy training has never fully left Bronwyn’s aims in pain management.  Occupational therapy has always targeted function, or the ability to fulfil life roles despite limitations.  In the same way, Bronwyn’s aims for pain management are to help people reduce the functional impact of pain and improve their engagement in living life to the full.