The 7th International Congress on Neuropathic Pain (NeuPSIG 2019) PRF Correspondents Blog
Posted May 10, 2019 | Correspondents' Programs News
Seven early-career pain researchers took part in the PRF Correspondents program during the 7th International Congress on Neuropathic Pain (NeuPSIG 2019), which took place May 9-11, 2019, in London, UK. This unique science communications training program provides participants with knowledge and skills needed to communicate science effectively to a wide range of pain researchers and to patients and the broader public. The Correspondents conducted interviews with plenary speakers, wrote summaries of scientific sessions—and provided live blogging, too! Take a look at their blog posts below.
Day 3: Saturday, May 11, 2019
Leaving NeuPSIG Feeling Reinvigorated
Mentally Stretched, Intellectually Stimulated, and Lots of Stairs
An Inspiring Workshop on the Spinal Cord Circuitry of Neuropathic Pain
Lots of Posters, Many Questions, and a Great Finale
Some Reflections on Science Communication
Leaving NeuPSIG Feeling Reinvigorated
The final day of NeuPSIG started early, but thankfully my head wasn’t too sore after the trainee reception the night before, as Prof. Makoto Tsuda’s plenary lecture was not to be missed! Using a channelrhodopsin targeted to low threshold mechanoreceptors, Prof. Tsuda’s group has been able to optically stimulate Aβ fibers and specifically analyze their function in mechanical allodynia after peripheral nerve injury. They have used this approach combined with chemogenetic modulation of inhibitory interneurons to delineate the changes in spinal circuitry permitting Aβ fiber stimulation of lamina I projection neurons. This work has revealed important details regarding the sufficiency of Aβ fiber activity to produce nocifensive behaviors after nerve injury.
In terms of content, I found the meeting very interesting and learned a lot. My PhD work has mostly related to traumatic nerve injury and its preclinical models, so the focus on diabetic and chemotherapy-induced peripheral neuropathy was a welcome change and highlighted two important clinical challenges. The quality of science was outstanding, not only from the topical workshops but also from the 300 posters presented by predominantly early-career scientists.
I’ve met some lovely people and had a number of impassioned discussions over the last few days. The PRF Correspondents program has been a really worthwhile experience, not only for the opportunity to meet some of the key movers and shakers in the pain field, but also because writing this blog has kept me the most consistently engaged that I’ve ever been at a conference. I would find myself paying extra close attention throughout the day for soundbites that might liven up a post. We’re presented with so much data at these meetings that it can be hard to digest or remember it all―the blog has been a great opportunity to review my notes, reflect on the implications of what’s been discussed, and clarify my own thoughts. It’s been fun to write freely and, in particular, to meet my fellow PRF Correspondents―a great group of enthusiastic young scientists. I will return to work reinvigorated and ready to implement some of the ideas that have been inspired in me this week at NeuPSIG.
Liam Peck, MB-PhD student, University of Oxford, UK.
Mentally Stretched, Intellectually Stimulated, and Lots of Stairs
NeuPSIG has officially ended, and I certainly feel like I’ve been mentally stretched, intellectually stimulated, and walked up and down a lot of stairs. But even though it was the last day, this did not mean that anything slowed down at all. One of my highlights today was Makota Tsuda’s talk on optogenetics. This has been an emerging method in the literature, with the ability to target specific types of nerve fibers―something that von Frey cannot do, as Makuto showed at the beginning of his lecture. He also made the point that if morphine can return rodent paw withdrawal thresholds back to baseline in chronic pain models, but is not an effective treatment for chronic pain in humans, why are we still using von Frey to assess reduction of pain? This was an argument that von Frey is not necessarily a good measure of allodynia in neuropathic pain. Makuto offered evidence that optogenetics can selectively target Aβ fibers, which may provide a better way to understand and assess chronic pain in the future.
The conference officially finished with a debate as to whether quantitative sensory testing or the more newly established brain imaging is better in predicting chronic pain. Despite talk of "the gloves coming off" and both debaters presenting excellent points to support their preferred method, Karen Davis and Rolf-Detlef Treede acknowledged that QST and brain imaging each have a pivotal part to play in predicting chronic pain. This was an apt end to a conference that often focused on how many different types of experimental approaches can ultimately come together to help solve the issues that we at NeuPSIG are concerned with: understanding the mechanisms, preventing the occurrence, and improving the treatment of chronic pain. I’ve really enjoyed the feeling of researchers and clinicians from a wide variety of institutions, countries, and research areas coming together to discuss and work toward these common goals.
I’ve loved every minute of NeuPSIG and have learnt so much; I very much look forward to coming back to this conference and hopefully many others. I would also like to thank Neil Andrews for facilitating the PRF Correspondents program and the other Correspondents for being some friendly faces in the busy conference setting. The Correspondents program has been an invaluable experience and definitely helped me get the most out of the conference. I look forward to working on my interview with Nadine Attal and my article on one of the sessions, to be published on the Pain Research Forum very soon …
Laura Pusey, third-year undergraduate student, BSc medical sciences (neuroscience) with professional training year, University of Exeter.
An Inspiring Workshop on the Spinal Cord Circuitry of Neuropathic Pain
Today was the final day of NeuPSIG 2019, and it was one where I presented my research on "Windup pain inhibition with CT fiber stimulation in humans." I also went to the most fascinating workshop of the conference. It covered spinal cord circuitry and neuropathic pain. Sarah Ross, Rebecca Seal, and David Hughes, all of whom I have admired during my research career, presented their stories, with all three deriving conclusions from transgenic animal models of pain. Sarah spoke about windup due to temporal summation―right up my alley. Becky spoke about VGLUT3+ transgenic mice and labeling C-LTMRs, which are the animal equivalent of the CT fibers I am studying in humans. Meanwhile, David started with a humorous analogy, likening his work to a bride on her wedding day. Like a bride, his work had something old, something new, something borrowed (the funding), and something blue (his immune histology figures). The research they presented was both elegant and inspiring. Becky also talked about how she is taking her work into the macaque monkey population, and I was immediately blown away, hoping to become involved in this project myself.
Until the next conference…
Sumaiya Shaikh, postdoctoral fellow, Linköping University Hospital, Sweden.
There is a lot of discussion about the survival of academic societies, particularly as there are fewer early-career researchers joining. Scientific societies have been established for centuries, with the eldest being the Royal Society, set up in 1660 to “promote science and its benefits, recognize excellence, support outstanding science, and provide scientific advice for policy, foster international and global co-operation, education and public engagement.” In more recent years there has been widespread criticism of academic conferences. They have been described as not useful, poor value for the money, and failing to deliver their hoped-for benefits such as building new collaborations, presenting advances, developing new research ideas, and the ability to come together to inform policy. Disappointingly, the high cost of attending a conference often precludes early-career researchers (ECRs) from attending, though I was pleased to learn that IASP does offer grants for ECRs to attend. ECRs, aka the workhorses, are the future, so there is much to be gained from their inclusion.
Despite the proliferation of web-based communication, I believe we should still place value on attending meetings, in part because of the informal opportunities to interact with other scientists. Conferences provide the opportunity to:
- present new work to colleagues and receive feedback―a more informal peer review process;
- clarify, share and refine our work;
- have an experience that is essential to learning; and
- share new research tools and techniques.
At NeuPSIG 2019, being a PRF Correspondent was my highlight. Knowing that each day I would write a blog changed my approach; I engaged more diligently and deeply with areas of research that are different from my own. In addition, I got to experience the challenge of distilling my thoughts from the jam-packed days into a short blog, which helped me hone my science communication skills. I loved the trainee drinks and meeting other ECRs to discuss aspects of our research and general academic life! The benefit of being a "small" SIG was that it did not take long to feel that you were really getting to know people.
It’s important that conferences are an environment where one can thrive and grow professionally, and as such I think it is paramount that we continue to challenge traditional ways of working to get the best out of everyone so that we as a community can progress more effectively and efficiently. The NeuPSIG program had a very traditional approach to conferences and relied heavily upon a one-way method of communication with limited audience participation.
How will conferences secure their place in the future? I think there is merit to incorporating the suggestions below.
- Be more innovative with the program design to allow greater participation, for instance, games such as The Publishing Trap. The Society for the Improvement of Psychological Sciences has some great ideas on their Open Science Framework (OSF) page, ranging from hack-a-thons, lightning talks, and workshops to "unconference" sessions.
- Be broader with the program to increase opportunity for multidisciplinary approaches and crossover. I think it is likely that most attendees went to the workshops that were closest to their area of research―great, but are we missing a trick by not learning from each other and continuing to work in isolation?
- Be broader with the speakers and not only rely on the “old and bold.” Create more opportunity for ECRs (the fresh talent) to shine on a larger platform―for example, a trainee plenary. The four ECRs who presented their posters were great and engaging speakers; why can’t we have more?
- Use technology to encourage further debate, and ensure that all questions and answers are heard. For example, during a plenary, attendees could use an online platform (e.g., Twitter) to share their questions for the speakers, and some of these could be addressed immediately during the Q&A and/or the debate could continue online.
- Have a stronger focus on open science themes and how we can incorporate them.
- Have more tangible outputs, such as a hack-a-thon to write a guidance note/opinion piece.
- Prizes and awards beyond only "best poster." These don’t have to be monetary but an opportunity to recognize exciting and/or innovative contributions.
- Look for ways to be open and accessible to all.
After a few intellectually stimulating and challenging days, I have gotten over the fact that this year’s NeuPSIG was in my hometown and that I did not get to bolt on a holiday. I leave NeuPSIG 2019 feeling that despite many challenges yet to overcome, and we are some way from providing patients with adequate pain management options, I am inspired and motivated. My message to other ECRs is to take advantage of every chance where you can discuss science with people. Do not act as an audience simply there to receive knowledge; talking with people offers more opportunities, and through establishing professional relationships we will cement our place as researchers.
Thanks to all the attendees, presenters, and IASP staff for making it a great experience! Looking forward to Madrid 2021!
Nadia Soliman, PhD candidate, Imperial College London, UK.
Lots of Posters, Many Questions, and a Great Finale
Hello from Day 3, the final day of NeuPSIG 2019. This has been such a fantastic event! To start our day, Dr. Makoto Tsuda gave an informative lecture on the investigation of neuropathic allodynia by using optogenetics in rats. This was followed by another great set of posters on many topics, including precision medicine, translation, new treatments, and genetics. There is so much to think about: 1) how to use aggregate data for individualized or precision medicine; 2) where the science is headed in terms of understanding how genetics contributes to risks/benefits of treatment; 3) what the best measure is of neuropathic pain—self-report questionnaires or objective measures. (If the latter, then which ones?)
Today I also had an opportunity to speak with a colleague from the UK about current research in the cannabis field―a conversation that then segued into a discussion of politics and societal norms in the UK versus the US, as well as differences in health payer systems in the two countries: Is healthcare a basic human right or a privilege? We did not have solutions, but we engaged in an earnest and interesting discussion.
This final day of NeuPSIG 2019 ended with a rousing friendly debate between Dr. Karen Davis and Dr. Rolf-Detlef Treede titled “QST versus imaging for the prediction of chronic pain.” The debate questioned the usefulness of QST in the clinical setting as well as the practicality of imaging in the clinical setting. If I were to judge the debate, I would call it a tie. Members of the audience engaged the speakers with questions at the end of the session, making this a great finale to the conference.
Brenda W Dyal, PhD, DNP, APRN, postdoctoral associate, University of Florida, US.
Some Reflections on Science Communication
The last day of NeuPSIG was spent at WCAPP, an IASP conference on the study of abdominal and pelvic pain, where I had the opportunity to present a poster on my work on pelvic and widespread pain in endometriosis. While at this conference, I had the chance to reflect on my time as a PRF Correspondent at NeuPSIG. Above all, I am so fortunate to have been a part of this program. Not only was it an incredible meeting and to be working alongside the other Correspondents, but this role taught me a lot about science communication.
Prior to NeuPSIG, I was a novice tweeter who liked to talk to people about my research, and science more generally, in person; now I’d like to think that I’ve advanced to the ranks of intermediate tweeter. I’ve also heard my voice on the podcasts that I’ve done―something that I was terrified of―and even in the midst of laughter and fumbles, I am now keen on developing my podcast skills to talk about endometriosis-associated pain in a way that can be easily understood by the non-endo fiends of the world. I’ve also blogged about my experience at NeuPSIG and about the highly controversial topic of cannabis as a potential treatment option for pain.
All in all, I couldn’t be more thrilled with my experience as a Correspondent. I learned a lot about neuropathic pain―something that I wasn’t quite sure I fully understood prior to the conference. I feel more confident as a (new) member of the pain field, and am so excited to continue my research career. Thank you, NeuPSIG, for opening my eyes to a new realm of research (I will now frantically be trying to read papers by the presenters), for confirming that science communication is a passion of mine worth pursuing, and for introducing me to so many outstanding researchers.
Danielle Perro, DPhil candidate, University of Oxford, UK.
The final day. The “rush” you get when you want the pride of having participated in pretty much all the congress activities, aiming to get to everything on time and feeling how exhausted you are—it’s kind of odd. Thankfully, I arrived right on time to hear Prof. Makoto Tsuda’s lecture. It’s amazing how new technology is allowing us to answer questions that previous studies would have just set aside; it gives you the feeling that, nowadays, nothing is impossible in pain research. Such feelings are increased when you have the chance to meet and chat with other attendees (I especially want to acknowledge Prof. Roberto Guiloff, who expresses his ideas in an amazingly clear way and enlightened me several times over the course of the conference).
In my experience, you try to find the answers in different ways: from the people that surround you, in nearby facilities, or just from the people that you know, and you get the feeling that there are walls you must try to break through; after so many experiments, you start to become weary. But at meetings like NeuPSIG, problems can be solved and there are no walls to break through―you just need the right ladder and then you reach for your answers. When meeting people, I always remember Isaac Newton’s words, “If I have seen further it is by standing on the shoulders of Giants.”
While in the UK for NeuPSIG, I’ve also been able to visit many inspirational places. Coming from Chile, I really want to mention some of the most amazing places I’ve visited and things I’ve seen.
In Cambridge, I visited The Eagle Bar, where Watson and Crick used to meet, and the place where the Cavendish Lab was, which is where J. J. Thompson discovered the electron. I also went to Trinity College and walked around the same gardens that Newton visited at some point. Later, in Oxford, I visited several colleges, as well as great places like the Turf Tavern, one of the oldest pubs in Oxford, where people like Stephen Hawking and Bill Clinton have been. Finally, in London, at the Science Museum, I saw some things I really didn’t expect: J. J. Thompson’s cathode ray tube―the one he used for the electron discovery―the first two patented transgenic mice, and a moon stone. A moon stone!
This fantastic trip really blew my mind, and I hope I have the chance to go to future NeuPSIG meetings and meet again with amazing friends and colleagues, in places as enlightening and inspiring as London has been. After all, coming to this meeting is not only a matter of science, but also cultural enrichment. That’s really what you take home in your backpack.
Soon I’ll be hopping on a plane back to my side of the world, with a strengthened sense of responsibility and hope for the future of pain research.
Luis Martin González-Gómez, PhD candidate, Pontificia Universidad Católica de Chile.
Day 2: Friday, May 10, 2019
On the Importance of Finding the Right Mentor
The Predictive Validity of Animal Models
A Disconnect Between Pain Conferences and Pain
On the Importance of Finding the Right Mentor
I started my uncaffeinated morning by interviewing the incredible Dr. Harriet Kemp. We had the chance to talk about many important things―we continued the conversation about cannabis use in pain management, specifically as it applies to her field of anesthesia; discussed gender equality in STEM (science, technology, engineering, and mathematics); and considered her experience with science communication as a PRF Correspondent at the North American Pain School. Our chats continued post-podcast as we talked about mentors and the importance of finding the right one for you.
Since starting my DPhil, I’ve come to learn that without mentors and support from those I admire, remaining motivated during the inevitable trials and tribulations associated with the DPhil would be far more challenging than it already is. When I asked Harriet about her experiences with mentors, she brought up a point that I think is important for all of us, particularly those of us early in our training or career: Mentors don’t have to be the obvious ones. Some of the best mentor-mentee relationships that Harriet has established have been with those outside of her lab and research field. In many cases, having someone in your corner like a former employer or someone you’ve met at a conference can be more beneficial to our growth as scientific researchers and, of course, as people. These individuals are able to act as a soundboard without interjecting their previous experiences as a template to navigate our own. Both Harriet and I agreed on the importance of finding a mentor with whom you get on personally and in many other ways; someone who can relate to your life experiences or general interest is what we should be striving for.
Yes, of course, we all want to be mentored by the big names in our respective fields, and I’m sure this isn’t unique to science. We want those who lead successful careers, and who appear to balance it all, to give us their secrets and guide us to similar successes.
At the end of the day, we need mentors who are candid with us about their experiences. In particular, this vulnerability is important to hear as early-career researchers. When leaders in the field, the ones who we aspire to be, fail to show their "human" side and discuss their lived realities and barriers they’ve encountered on their academic or clinical journey, it is detrimental in many ways. First, it makes their accolades seem unattainable. Additionally, if only the good and happy things are discussed, how can we come to terms with and openly discuss our own insecurities that we may be feeling? As we continue to grow our networks here at NeuPSIG and beyond, let’s try to keep these things in mind when seeking out those who will shape our training, impact the opportunities we engage with, and provide us with support during the highest of highs and lowest of lows on our career trajectories.
Danielle Perro, DPhil candidate, University of Oxford, UK.
One of the subthemes of this conference has been how to close the gap between preclinical success and effective treatments in humans―avoiding the “rodent trap” as Prof. Angelika Lampert refers to it. How many times have we seen that graph―you know the one―showing complete reversal of von Frey hypersensitivity from spared nerve injury?
Do our injury and neuropathy models suffer from confirmation bias, designed (consciously or not) such that we will see the greatest possible effect of our chosen interventions in rodents?
I was impressed with Rohini Kuner’s dedication to the reverse translational approach today. She discussed elegant work using locally and genetically targeted, bidirectional chemogenetic modulation of M1 motor cortex activity to mimic and interrogate the circuit mechanisms of transcranial direct current stimulation―shown to be analgesic in human neuropathic pain conditions. As well as producing bidirectional modulation of neuropathic pain using this system, projections of layer-specific motor cortex neurons were depicted beautifully. When I asked about a descending corticospinal tract recently shown to modulate spinal cord processing of tactile allodynia, her reply stated that she didn’t believe this tract had been defined in humans, so why pursue this when trying to recapitulate and understand human mechanisms? Fair point!
Similarly, the plenary lecture delivered by Steve Waxman was a fantastic example of the insights we can gain from reverse translating rare genetic pain disorders to in vitro models. Making iPSC-derived nociceptors from patients carrying fully penetrant Nav1.7 mutations causing inherited erythromelalgia (IEM), Prof. Waxman has been able to identify variants sensitive to an existing anti-convulsant drug, carbamazepine (CBZ), in a real step towards personalization of treatment for this excruciating condition. On the basis of three-dimensional structural analysis of the Nav1.7 channel, one more mutation (S241T) shared by a mother and son was identified that had potential to confer CBZ sensitivity. Characterization of iPSC-derived nociceptors from these patients indeed showed hyperexcitable properties including depolarized resting potential. Interestingly, the mother’s cells exhibited a less severe phenotype, indicating that something in her genetic background, presumably an ion channel, was providing some degree of pain resilience. Sure enough, whole exome screening found a gain-of-function in the potassium channel Kv7.2, a known contributor to resting membrane potential. Despite small sample sizes, these dramatic phenotypes can therefore help to identify bona fide resilience genes for further therapeutic targeting. Reverse translation promises to make our models much more relevant to what is seen in the clinic.
Are we even asking the right questions behaviorally?
Prof. Kuner also said to me yesterday that “we can’t study pain in isolation.” We must take into account the complex nature of pain. There is so much going on here―afferent sensation, central modulation, affect, cognition, learning and memory, motivation, stress―and so simple withdrawal reflexes can’t be held up as a gold standard. There has been a positive push in recent years towards more ethological outcome measures, advocated for by Andrew Rice among others, and its importance was demonstrated today by Ted Price in his exploration of MNK-eIF4E signaling, the effects of which are absent using reflex assays but are observed with conditioned place preference. Ultimately, we need to develop more holistic approaches to investigate the response of the whole nervous system to pain, and the good news is that we are moving steadily in that direction.
Liam Peck, MB-PhD student, University of Oxford, UK.
The Predictive Validity of Animal Models
The translatability of animal models and why success observed in animal models does not translate to patients in the clinic―I can only imagine that this is debated at every biomedical conference and NeuPSIG is no exception. Given the multifaceted complexity of pain and the lack of effective analgesics, this topic is perhaps discussed even more fervently in our field.
It is well documented that many of the drugs prescribed for the management of neuropathic pain were not rationally designed, such as tricyclic antidepressants and anti-epileptics. Dr. Nadine Attal’s plenary gave an extremely comprehensive insight into translational neuropathic pain research―from bench to bedside and/or bedside to bench?!?
Prof. Malcolm Macleod presented evidence from preclinical systematic reviews showing that studies that did not report conducting blinding, randomization or a sample size calculation resulted in an over-estimation of effect. Of concern (including ethical concern) is that many studies are at high risk of bias and therefore the results may not be reliable. In answer to calls to deprioritize the use of animals he also provided empirical evidence to show that the in-vitro situation is worse! Hence, there is a need to improve the rigor of all experiments!
Jan Vollert of the EQIPD consortium presented a handy guide to improve animal research, including just five steps:
1. Predefine whether your study is exploratory or confirmatory.
2. Predefine, document and standardize all methods and analyzes.
3. Predefine your statistical analysis plan―determine which tests are most appropriate for your data and ensure you conduct a sample size calculation.
4. Randomize and blind.
5. Document―“not all bias can be prevented but it can be uncovered: use full comprehensive documentation.”
Prof. Andrew Rice addressed the "reproducibility crisis" of animal studies. Proving the concept, a multicenter approach was able to provide high-quality evidence proving burrowing as a robust and reproducible tool to infer the global effect of pain on rodents. He also provided important information for the use and conduct of multicenter studies in the future. Although this approach requires greater project management and is more resource intensive, the quality and reliability of the results are likely to outweigh the additional cost.
The lunchtime session from Transpharmation, a contract research organization, acknowledged the problems of construct validity; of animal models not mimicking the human condition; of animals displaying sensory gain but not the more common sensory loss as experienced by patients, though this was not addressed in their characterization of a diabetic neuropathy model. They advocated use of more ethologically-relevant behavioral assessments and with that presented some interesting data on how, in a diabetic neuropathy model, an animal’s burrowing behavior is significant
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