• Group leader and participants

Chronic Pain

- Dr. Daniel Clauw• Associate Dean for Clinical and Translational

Research and Director, Chronic Pain and Fatigue Research Center, Univ. of Michigan

- Dr. William Maixner• Director, Center for Neurosensory Disorders,

Univ. of North Carolina at Chapel Hill

- Dr. Clifford Woolf• Director, Neural Plasticity Research Group and

Richard Kitz Chair of Anesthesia Research, Massachusetts General Hospital and Harvard Univ.

- Dr. Jim Witter • Program Director, Division of Skin and

Rheumatic Diseases, NIAMS

- Dr. Jonelle Drugan• Science Policy Analyst, Office of Science

Policy and Planning, NIAMS

- Dr. Cheryl Lapham • Program Director, Division of Skin and

Rheumatic Diseases, NIAMS

- Dr. Gayle Lester • Program Director, Division of

Musculoskeletal Diseases, NIAMS

- Dr. John Kusiak• Director, Molecular and Cellular

Neuroscience Program, National Institute of Dental and Craniofacial Research

2008 NIAMS Scientific Retreat

• Overarching question- How can the NIAMS contribute toward

understanding chronic pain and developing treatment options for patients who suffer from chronic musculoskeletal pain?

• Key Discussion Points- Types of pain- Neuroplasticity and pain- Heterogeneity of pain syndromes

Chronic Pain

2008 NIAMS Scientific Retreat

All Pain is not the Same

• Four types of pain - Nociceptive, protective pain—generated by the presence of

tissue-damaging stimuli and responds to NSAIDs and opioids- Neuropathic pain—caused by damage or entrapment of

peripheral nerves and responds to neuroactive compounds (such as tricyclic antidepressants) and traditional analgesics

- Inflammatory pain—caused by tissue injury- Dysfunctional, non-nociceptive (central) pain—occurs

without obvious signs of tissue damage

• Inflammatory pain and non-nociceptive pain are associated with - Allodynia—the perception of pain in response to a benign

stimulus- Hyperalgesia—heightened sensitivity to noxious stimuli

2008 NIAMS Scientific Retreat

Points of Consideration

• Interactions among the peripheral and central nervous systems and the inflammatory system- Patients with chronic pain conditions undergo neurobiological,

psychological, and cognitive and behavioral changes that dramatically affect symptoms and functioning

• Reversible and permanent biochemical and anatomic changes that cause or are caused by chronic pain - Mechanisms underlying allodynia and hyperalgesia- Transition from pain as a symptom of a disease to a chronic condition

that can be prevented, treated, or cured

• The heterogeneity of pain syndromes - Genetic risk factors- Mechanisms by which chronic pain develops- Variations in phenotypic manifestations 2008 NIAMS Scientific Retreat