11th International Symposium on Pediatric Pain
By Neil Schechter, MD
The 11th International Symposium on Pediatric Pain (ISPP) was held in early July in Kuala Lumpur, Malaysia. For those unfamiliar with it, the ISPP is sponsored by the Pain in Childhood Special Interest Group of the International Association for the Study of Pain and this year 447 participants from 43 countries attended the meeting.
Liesbert Goubert chaired the Scientific Committee and Mary Suma Cardosa and Sushila Sivasubramaniam were responsible for local arrangements. This was the first ISPP meeting in Asia and the hope was to draw local participants who would not typically be able to attend an international meeting. KL is an interesting and vibrant city with a deep cultural heritage some of which was evident in the drumming and dancing welcome.
It is, of course, impossible to report on the numerous lectures and workshops that occurred over the three days of the meeting, but abstracts of the meeting included the well deserved presentation of the Distinguished Career Award to Maria Fitzgerald from England and the Early Career Award to Laura Simons from Stanford. Maria reviewed the evolution of her work in understanding the developmental neurobiology of nociception. Her talk was sprinkled with personal anecdotes about the challenges of being a woman scientist and about some of the pioneers in the field of pain medicine. In particular, she spoke of her relationship with her perfectionist mentor, Patrick Wall, a founder of our field who when asked in his final interview if he had any life regrets offered, “my only regret has been the tedious dullness of the opposition.” Laura Simons described her work on fear of pain which offers new insights into pain amplification.
Mark Baccei presented the opening keynote address and spoke on pain circuitry in the spinal cord of neonates offering intriguing insights into the neurobiology of “spinal cord sensitization”, as well as the harm that may emerge from untreated pain in newborns.
Jeff Mogil presented both his animal studies and recent translational research focusing on understanding the genetically-based variation in responses to pain. Jeff described the complexities of extrapolating from other animals to humans, particularly on the difficulty of creating paradigms that mimic human psychosocial stresses. Interestingly, he identified many surprisingly unexpected similarities such as empathy among cage-mates (people and rodents!). This work opens the door for meaningful research in chronic pain disorders.
Rikard Wiksell presented his research on acceptanace and commitment therapy, which focuses on ways to diffuse negative thinking about pain and focus on values-based goals and function.
Another outstanding lecture was by Lorimer Moseley of the University of Adelaide who described his protectometer and the DiMs and SiMs (signs of Danger in Me and Safety in Me). Nociception is only one DiM, but there are many other SiMs that we need to highlight which can dampen pain responsiveness. Lorimer has a famous TED talk on chronic pain which describes his thinking and is very useful for both clinicians and families.
Other keynote speakers included Dilip Pawar of India, who described his personal journey improving post-operative pain in a low resource area; Gareth Jones from the UK, who offered a detailed review of the epidemiology of pain in childhood; and Gary Walco who spoke on the difficulty of performing clinical trials in children and the necessity of new paradigms to accomplish that task.
As with each of the previous ISPP meetings, there was a media festival where videos discussing various aspects of pain were shown. For those interested in viewing this creative outpouring, they are still available on the ISPP website.
For those interested, the next ISPP Symposium will take place in Basel, Switzerland, June 16-20, 2019. Preliminary information is available at www.ISPP2019.org.