AFSA 2000

New Directions In Fibromyalgia Research And Treatments

August 4-6, 2000

Learn about cutting-edge research on fibromyalgia syndrome (FMS), find out which treatments work best, and hear about the most promising areas of research for the future. The conference schedule, with 14 experts from around the world, also allows time for attendees and their families to enjoy a vacation getaway at one of the top resorts in the United States!

Hosted by AFSA

6380 E Tanque Verde Rd., Ste D, Tucson, AZ 85715

(888) 508-5524

Fax: (520) 290-5550

Faculty

Robert Bennett, M.D.

Chairman, Arthritis & Rheumatic Diseases Division, Oregon Health Sciences University, Portland

Laurence Bradley, Ph.D.

Professor of Medicine, Brain Imagery & FMS Research Coordinator, University of Alabama at Birmingham

Sharon Clark, RN, Ph.D.

Professor, Oregon Health Sciences University, and President of Oregon Fibromyalgia Foundation, Portland

Steve Fanto, M.D.

Physiatrist & Pain Specialist, Phoenix, AZ

Nathaniel Katz, M.D.

Director of Pain Treatment Trials Center, Brigham & Women's Hospital, Boston, MA

Charles Lapp, M.D.

Internist & Pediatrician, Director of Hunter-Hopkins Center, Charlotte, NC

Alice Larson, Ph.D.

Neuroscientist & Professor of Veterinary Medicine University of Minnesota, St. Paul

William Maixner, D.D.S., Ph.D.

Neuropharmacologist, Professor of Endodontic Medicine, University of North Carolina, Chapell Hill

Serge Marchand, Ph.D.

Neuroscientist & Pain Researcher, University of Quebec, Canada

Bruce Maurer, Ph.D.

Center for Scentific Review, SEP Chief for CFS/FMS, National Institutes of Health, Bethesda, MD

Harvey Moldofsky, M.D.

Director of the Centre for the Chronobiology of Sleep, University of Toronto, Ontario, Canada

Robert Olin, M.D., Ph.D.

FMS/CFS Researcher, Karolinska Institute, Stockholm, Sweden

Roland Staud, M.D.

Rheumatologist & Professor of Medicine,University of Florida, Gainesville, FL

Dennis Turk, Ph.D.

Director of Multi-Disciplinary Pain Center, University of Washington, Seattle

Objective

Review existing findings in fibromyalgia syndrome (FMS), as well as the overlaps with chronic fatigue syndrome (CFS); discuss treatment options; and develop a set of promising research opportunities that will be most likely to improve the quality of life for FMS/CFS patients.

General Information

Registration fee of $425 ($200 for students, fellows, and interns) includes:

Syllabus, reception, two breakfasts, one lunch, three breaks, and a certificate of attendance. Three half-day sessions allow you to enjoy your stay as you learn. Bring your family along!

NOTE: Students, fellows, and interns must specify school plus professor's name and phone number for $200 rate.

Hotel rooms are subject to availability after July 7.

Hotel Information

Rated as one of the top 25 conference sites in the United States, The Westin La Paloma is situated in the lush, high Sonoran desert in the Tucson foothills. Recreational amenities include a 27-hole Jack Nicklaus Signature golf course, 12 tennis courts (4 clay), indoor raquetball, a fitness center and spa, three swimming pools, 177-foot waterslide, swim-up bar, children's lounge, exceptional dining, and breathtaking views. Additional hotel info is online at: www.westin.com. Call 1-800-WESTIN-1 and specify AFSA 2000 for conference rates. Call (520) 742-6000 to schedule special services (tee times, court times, etc.).

Online Air Fare

If you have internet access, three excellent sites to obtain low airline fares are: www.expedia.com, www.priceline.com, and www.travelocity.com.

Ground Transportation

Tucson International Airport has most of the major car rental companies on site (Alamo, Avis, Budget, Dollar, Hertz, National, and Thrifty).

If you don't want to rent a car, Arizona Stagecoach has shuttle service to La Paloma. Contact them at: (520) 889-1000 or online at: www.arizonastagecoach.com. You may prefer to take a cab for roughly $34 one way. Unlike the shuttle, a taxi will take you directly to La Paloma.

Reception - Thursday, August 3rd

Enjoy a pre-conference, adults only evening reception from 7:30 to 9:30 p.m. with hors d'oeuvres and a no-host bar. Mix and mingle outside the ballroom entrance and onto a lovely terrace overlooking the resort. A registration table will be available so that attendees may pick up materials prior to the conference.

(888) 508-5524 www.afsafund.org

7:00 am - Breakfast - Served buffet-style

SESSION 1 - Physiological Findings in FMS

8:15 am - The Central Sensitization Model as it Applies to FMS and CFS

Speaker: Robert Olin, M.D., Ph.D.

Professor Emeritus of Preventative Medicine, and FMS and CFS researcher at the Karolinska Institute in Stockholm, Sweden. Dr. Olin will present a central sensitization theory, how this model may relate to FMS and CFS as well as other neurosomatic disorders, how pain generators and other sensory signals in the nervous system may be feeding this chronic pain state to sustain it, and offer thought-provoking hypotheses on what cells or areas in the brain might be malfunctioning to cause FMS/CFS symptoms. Dr. Olin will also review many of the relevant physiological clinical findings in FMS/CFS, as well as address the issue of FMS and CFS overlap.

9:00 am - Inhibited Functional Brain Activity in FMS, CFS, Depression and Healthy Subjects

Speaker: Laurence Bradley, Ph.D.

Dr. Bradley is a professor of medicine at the University of Alabama at Birmingham (UAB). He has received funding from NIAMS to further his SPECT scan with MRI imaging studies in patients with FMS, CFS, and healthy control subjects. He is also the recipient of two AFSA grants: The Role of the Limbic Brain System in Abnormal Pain Perception in FMS and Pain Induced Changes in Basal Ganglia and Limbic System Function Among Patients with FMS, CFS, and Health Controls versus People with Major Depression (tag-on to NIH study). Dr. Bradley will review his published findings to date as well as the ongoing fMRI studies of Richard Gracely, Ph.D., at NIDR and Dan Clauw, M.D., at Georgetown University (Dr. Clauw previously received a grant award from AFSA to explore autonomic nervous system dysfunction in FMS/CFS patients).

9:30 am - Abnormal Pain Inhibition and Autonomic Dysfunction in FMS

Speaker: Serge Marchand, Ph.D.

Dr. Marchand is a neuroscientist at the University of Quebec and will offer a brief review of the ascending and descending pain pathways, autonomic nervous system dysfunction findings in FMS patients, as well as his current work implicating problems of abnormal pain inhibition (or abnormal DNIC - Diffuse Noxious Inhibitory Controls). Dr. Marchand has just been awarded an AFSA grant to investigate the role of Effexor-XR to alter the DNIC in FMS patients, in addition to using his DNIC testing to distinguish between FMS patients and those with low back pain, depression, and no medical problems (healthy controls).

10:00 am - Pain Amplification and Abnormal Windup in FMS

Speaker: Roland Staud, M.D.

Dr. Staud is a rheumatologist and professor of medicine at the University of Florida in Gainesville. His presentation will discuss the pain amplification systems and in particular the NMDA receptor. Dr. Staud has researched the role of abnormal windup in FMS patients, compared to healthy controls. He has also completed an AFSA-funded study to investigate the effects of exercise on windup, and is a recipient of an NIH grant to further explore windup and the pain amplification system in FMS with interventions including such agents as dextromethorphan.

10:30 am - Break - Coffee, tea, and rolls

11:00 am - Role of SP, NGF and Neuropeptides in FMS

Speaker: Alice Larson, Ph.D.

Dr. Larson is a neuroscientist and professor of veterinary medicine, PathoBiology Department, at the University of Minnesota in St. Paul. Her presentation will include an overview of SP and related neuropeptide findings in FMS patients, her recent work in mice that mimics the elevated SP levels in the spinal fluid of FMS patients, the importance of SP metabolites such as SP(1-7), and Dr. John Stewart's efforts at the University of Colorado (Denver) to clone the SP(1-7) peptide. The work of Dr. Patrick Mantyh of Molecular Neurobiology Labs in Minneapolis using the "Trojan Horse" concept to selectively destroy SP in the end-terminal cell fibers that release this pain transmitter, as well as other relevant studies, will be discussed. Dr. Larson and Dr. Stewart have both received grant awards from AFSA, and now Dr. Larson is expanding her studies with the aid of NINDS funding.

11:30 am - Sleep, Immune and Endocrine Factors in FMS/CFS

Speaker: Harvey Moldofsky, M.D.

Renown pioneer researcher in the FMS and CFS field, and Director of the Centre for the Chronobiology of Sleep at the University of Toronto. Dr. Moldofsky has received grants from NIH and the Canadian government, in addition to a small grant award from AFSA. He will discuss abnormalities in sleep, immune system substances, growth hormone, cortisol, and other dysregulated hormonal findings. The relationship between the sleep-wake cycle disruption in patients and its possible correlation with circadian rhythm abnormalities of the immune and endocrine systems will also be addressed.

12:20 pm - Breakout Groups. To discuss the significance of the following:

1 - Brain Imaging Findings (Moderator: Dr. Bradley)

2 - Neuropeptide Abnormalities (Moderator: Dr. Larson)

3 - Pain Inhibitory and Pain Amplification Systems (Moderators: Drs. Marchand and Staud)

4 - Circadian Rhythm Abnormalities (Moderator: Dr. Moldofsky)

1:15 pm - Session 1 Adjourns for the Day

Attendees may enjoy the afternoon at the resort and, if they choose, they may return to the ballroom entrance area at 6:30 p.m. for a Mexican-style Dinner Buffet with no host-bar and music entertainment. Individual tickets must be purchased and family members are welcome to attend.

11:00 am - Lunch - Served sit-down, pre-arranged table style.

AFSA and The Patient's Perspective on Research Needs (20 minutes)

Speaker: Kristin Thorson, AFSA's president and founder

SESSION 2 - Pain Assessments and Pharmacologic Interventions

12:00 pm - Alterations in Pain Regulatory Systems - Implications for FMS and Other Related Disorders; Suggestions for Therapeutic Interventions

Speaker: William Maixner, DDS, Ph.D.

Dr. Maixner is professor of endodontic medicine and a neuropharmacologist at the University of North Carolina in Chapel Hill. He is well-known for his TMD research and publications on the relationship between gender and experimental pain measures. He is currently looking into the role of sodium channel blockers for pain relief. In addition, he recently received a grant from the NIDR to investigate the role of cytokines and chronically-induced stress in FMS patients. Treatments relevant to FMS and related pain disorders will be addressed in the context of using various experimental pain measures to assess the efficacy of therapeutic interventions.

12:50 pm - Tender Points, Patient Selection and Subgroupings

Speaker: Dennis Turk, Ph.D.

Dr. Turk is a pain researcher at the University of Washington, Department of Anesthesiology, in Seattle. He has published studies that emphasize the importance of patient selection and subgrouping, and is the author of "The Tender Point Survey Manual" that provides a useful method of better categorizing the pain severity in FMS patients beyond just counting up a patient's ACR criteria tender points. Dr. Turk recently received a large NIH grant to further explore ways to subgroup FMS patients in an effort to better predict their treatment outcome to various therapies at his multi-disciplinary pain center.

1:30 pm - Opioids and Anticonvulsants for Chronic Pain

Speaker: Nathaniel Katz, M.D.

Dr. Katz is director of the Pain Treatment Trials Center at Brigham and Women's Hospital in Boston, MA. He will discuss myths about opioid addiction, the APS and the FSMB guidelines for chronic opioid use, and the addition of NMDA antagonists (e.g., Morphidex) and calcium channel blockers to synergize the effects of opioids. Also, the theory behind the use of anticonvulsants, such as gabapentinoids, for chronic pain will be addressed.

2:15 pm - Break - Coffee, tea, sodas and cookies

2:40 pm - Past and Current Therapies Tested; Impact of Exercise

Speaker: Sharon Clark, RN, Ph.D.

Dr. Clark is a professor at the Oregon Health Sciences University in Portland and President of the Oregon Fibromyalgia Foundation, an organization involved in research and education on FMS. She will provide a review of published and ongoing therapeutic trials and the effects of exercise in FMS. As an expert in the field of exercise, Dr. Clark will discuss the phenomenon of delayed-onset muscle soreness (DOMS) and how DOMS might tie into Dr. Staud's findings of increased windup with exercise (presented in Session 1). Dr. Clark was involved in the Ultram trial in FMS patients and is currently studying the impact of adding dextromethorphan (an NMDA receptor antagonist) to Ultram to further reduce the pain of FMS. Dr. Clark, along with her colleague Dr. Bennett, are AFSA grant recipients.

3:10 pm - The Clinical Experience

Speakers:

Robert Bennett, M.D. (20 minutes) - A rheumatologist's clinical experience on what therapies appear to work best. Dr. Bennett began publishing in the field of FMS almost two decades ago. He is chairman of the arthritis and rheumatic deseases division at Oregon Health Sciences University in Portland, is one of the most prominent researchers in the field of FMS, and oversees a highly acclaimed multi-disciplinary treatment center for people with FMS. Dr. Bennett is one of the co-investigators on a major grant involving CFS and is currently working on an AFSA-funded trial using NMDA receptor antagonist, dextromethorphan, in conjunction with Ultram to determine if pain can be further reduced.

Harvey Moldofsky, M.D. (20 minutes) - A sleep expert's experience in treating the sleep disruption and abnormal sleep/wake cycles in patients.

Steve Fanto, M.D. (20 minutes) - A pain specialist's perspective on what therapies work. Dr. Fanto is board certified in physiatry, and the American Academy of Pain Medicine. He spends most of his time treating FMS and complex regional pain patients at his four offices in the Phoenix, AZ area.

Charles Lapp, M.D. (20 minutes) - An internist's and pediatrician's perspective on what therapies work. Dr. Lapp is board certified in internal medicine and pediatrics. In the past, he has been involved in CFS research studies and currently serves on the Board of the American Association for CFS. He spends most of his time treating both FMS and CFS patients in Charlotte, NC. Dr. Lapp is both an AFSA Board member and Medical Advisory Committee member.

4:40 pm - Breakout Groups - To discuss the importance of:

1 - Clinical trial study design and assessment tools

(Moderators: Drs. Turk and Maixner, Marchand, and Staud)

2 - Sleep and neuroendocrine therapies

(Moderators: Drs. Moldofsky and Bennett)

3 - Pain relieving drugs that warrant studying

(Moderators: Drs. Fanto and Katz)

5:30 pm - Session 2 Adjourns for the Day

7:00 am - Breakfast - Served buffet-style

SESSION 3 - Summary of Findings in FMS and Research Recommendations

8:00 am - Physiology Overview and Attendee Q/A

Speaker: Laurence Bradley, Ph.D.

8:45 am - Therapy Overview and Attendee Q/A

Speaker: Robert Bennett, M.D.

9:30 am - Special Emphasis Panel at NIH for FMS Grants plus Attendee Q/A

Speaker: Bruce Maurer, Ph.D.

Dr. Maurer oversees the SEP for grant reviews pertaining to FMS and CFS. He will discuss how this panel works and how to submit a research proposal to the SEP. Because the goal of AFSA is to seed investigators in the field of FMS and CFS, it is essential that all AFSA-assisted researchers know what lies ahead at NIH.

10:15 am - Break - Coffee, Tea, and rolls

10:45 pm - Recommendations for AFSA-Funded Research

Presentations by:

Robert Olin, M.D., Ph.D. (30 minutes) - Physiology, basic mechanisms, genetics, and pharmacological interventions for relieving the primary symptoms

William Maixner, D.D.S., Ph.D. (30 minutes) - Gender considerations, useful pain measures, and biochemical assays

Dennis Turk, Ph.D. (30 minutes) - Patient selection, subgroups and tender point guidelines; recommended control populations

Nathaniel Katz, M.D. (30 minutes) - Promising drugsboth those available and those in the development stage

Charles Lapp, M.D. (30 minutes) - Special areas of research that cater to patient needs

1:15 pm - Conference Summary and Adjournment

Relax, Enjoy And Learn!

Fibromyalgia syndrome (FMS) and related central pain disorders are a challenge to both researchers and clinicians. The AFSA 2000 conference represents the first step in bringing together treating physicians with FMS esearchers in breakout discussions designed for plenty of interaction and learning. Our goal is to pique the interests of pain scientists so that they become more involved in investigating FMS, while equipping health care providers with the most effective tools for treating this chronic, painful condition.

All sessions are only half-days to ensure that attendees and their families will have ample time to enjoy the spectacular amenities of The Westin La Paloma resort. Space is limited, so make arrangements to attend now! See the handy conference checklist on the other side of this page for your planning convenience.