Conversation With David Williams, PhD, President of the American Pain Society
Q: What do you see as your biggest challenge taking on the role of American Pain Society (APS) president?
Dr. Williams: Well, whether it’s a challenge or an opportunity, I think that at no other time in history has there been so much attention publicly being paid to pain and its management. Whether the attention is coming from the National Pain Strategy, or the attention is associated with opiates and addiction, no one can say pain is not in the forefront of folks’ minds right now. That’s an opportunity for APS given that our members provide the science that supports solutions for better pain care.
If there is a challenge associated with the high profile of pain these days, it is being able to move fast enough so as to fill our clinicians’ toolboxes with an array of multidisciplinary treatments that are effective for different forms of pain.
Q: How is the APS going to be working to help implement the National Pain Strategy?
Dr. Williams: One of the first things we’re doing is putting some money behind the National Pain Strategy. We have partnered with Pfizer to initiate a grant program (a $2 million grant from Pfizer).
The potential topics of the grant application are broad given that there are many different types of science that might support better pain care. The stipulation to the applicants is that each proposal must indicate what aspect of the National Pain Strategy is being addressed by the science being proposed.
Q: So the APS grants could be awarded to study any facet of pain, whether it be psychosocial or medical management or interventional?
Dr. Williams: Right. It could have a psychosocial component, it could be implementation of multidisciplinary treatment, and it could be educational—just so long as it is a hypothesis-based study that is relevant to the National Pain Strategy.
Q: Once these funds are awarded, what happens with the information; how long will it take from funding to final analysis?
Dr. Williams: These will be relatively brief studies, so we’re looking at a span of about 12 to 18 months. The studies can stand on their own, or may serve as precursor studies for larger multisite trials sometime in the future. The information from these studies will be peer-reviewed and then presented or disseminated at a future APS meeting and hopefully published in a peer-reviewed journal such as the Journal of Pain.
Q: You mentioned opiates and addiction. Is there one way to treat opioid addiction among chronic pain patients? Is there consensus on that?
Dr. Williams: I’m not an addiction specialist, but when pain is involved, it is important to make sure that the approach to pain treatment is best matched to the type of pain being experienced by the individual. Not all pain is responsive to opiates. When addiction is a comorbid condition along with pain, then both the pain and the opiate addiction need to be appropriately treated. These are two separate clinical problems.
Q: Does your group work with the other investigative groups from neurology, rheumatology, and gastroenterology? Is there cross-pollination of ideas?
Dr. Williams: APS is a multidisciplinary organization of clinicians and scientists. Many of our members belong both to APS and to their own professional organizations and present at both meetings so that there is cross-pollination of ideas across disciplines, if you will.
Historically, pain was studied in silos where you had rheumatologic pain, dental pain, cancer pain, etc. Where I think APS is a little different is that we study pain outside of the silos, which allows us to see commonalities as well as differences in the underlying pain mechanisms that occur in various regions of the body. When investigators from other specialties attend our meetings we often hear enthusiasm around opportunities to use new methods and to collaborate with people in other fields.
Q: This happened the other day [during the APS meeting]. The speaker on osteoarthritis was talking about pain, and she said, “You know, instead of giving them more of this [agent], then you might want to ask them how they’re sleeping. And if they’re having trouble sleeping, then maybe [they] should be referred to somebody to address [their] sleep issues.”
Dr. Williams: Right. As we learn more about how pain in general is processed, we are finding that many systems within the body can play a role in making it worse or better. It is becoming more important to understand the underlying mechanism of different forms of pain than, say, which body region seems to hurt.
Q: I know you’ve been studying the psychosocial connection between chronic pain, fatigue, fibromyalgia, and such disorders for many years. Are you happy with the meeting this year? It seems there are a lot of posters speaking to those issues.
Dr. Williams: There are. The nice thing about APS is that it is multidisciplinary, and so there is a lot of cooperation and mutual respect for medical and psychosocial/behavioral approaches to the study of pain and its treatment. I think that’s one reason why a lot of people enjoy coming to this particular meeting, because there is the feeling that everyone brings something to the table of chronic pain and its management.