Pain, Affect, and Opioids Workshop Nov 9 at UBC Robson Square Theater

Program (Also on the Web: http://faculty.arts.ubc.ca/maydede/Program.html)
9:30–9:45 Coffee and Welcome (Murat Aydede & Ken Craig)
9:45–10:45 ADAM SHRIVER: "The Moral Dimension of Pain"
10:45–11:00 Coffee Break
11:00–12:15 GREG CORDER: “Deciphering the neural codes of nociception: How basic neuroscience is reshaping physicalist theories of pain”
12:15–1:15 Lunch Break
1:15–2:30 MARK SULLIVAN: "Pain and Opioids: Damage and Danger, Mechanism and Meaning"
2:30–2:45 Coffee Break
2:45–4:00 HOWARD FIELDS: "Opioids at the Nexus of Pain and Pleasure"
4:00–5:00 Discussion Panel with audience and participants

ADAM SHRIVER: "The Moral Dimension of Pain"

Abstract. In rare cases, patients will report feeling pains but not finding them unpleasant. How should we think of such cases? And what is the underlying neuroscience story? In this introductory presentation, I discuss the so-called affective/motivational dimension of pain and its relevance for ethical theory, applied ethics, and the opioid crisis. Sorting out the precise neurophysiological details will be extremely important for a number of ongoing philosophical debates.

GREG CORDER: “Deciphering the neural codes of nociception: How basic neuroscience is reshaping physicalist theories of pain”

Abstract. Pain is an unpleasant experience that commands attention and the engagement of motivational protective behaviors to limit exposure to noxious stimuli. Acute painful experiences are constructed from neural information relating not only sensory, but also emotional, interoceptive, inferential, and cognitive data, which coalesce into a unified conscious perception of pain. In contrast, chronic pain is not merely a persistent sensory disorder, but a neurological disease of affective dysfunction that serves no survival function. As such, chronic pain negatively impacts the mental state, professional goals, and personal relationships of hundreds of millions of people. However, it is unclear how the nociceptive systems in the brain undergo pathological maladaptations to enable the transition to a chronic pain state. In this talk, we will cover contemporary basic neuroscience findings that are beginning to decipher the nociceptive neural code, how these codes causally shape the emergence of pain affect and behavior selection, and how these miscoding within the brain’s affective circuitries facilitates chronic pain. Understanding the processes by which these different functional dimensions of pain perceptions are generated from distinct brain networks, in particular the negative affective or unpleasantness of pain, permits the generation of new dynamic frameworks for modeling the development of chronic pain and the discovery of more effective pain-management strategies.

MARK SULLIVAN: "Pain and Opioids: Damage and Danger, Mechanism and Meaning"

Abstract. Modern pain science challenges our traditional sensory-mechanical notions of pain. Pain has both sensory and motor aspects. If pain does not prompt protective behavior, it serves no function. As an interoceptive faculty, its sensory-discriminative function is subordinated to its affective-motivational function. Pain is caused by damage, but also by danger. Physical trauma is relevant, but so is psychological trauma, especially for chronic pain. Pain arises from disrupted tissues, but also disrupted relationships. Opioids relieve both forms of pain. While pain is naturally aversive and intrusive, its valence and salience are varied in order to protect the individual’s physical and social survival. Nociceptive activity from the periphery is continuously modulated by the endogenous opioid system to promote the overall safety of the organism. Exogenous opioids are seductive because they simulate physical and psychological safety. Pain’s mechanism is subordinated to its meaning because the mechanism must serve to enhance the survival of the species.

HOWARD FIELDS: “Opioids at the Nexus of Pain and Pleasure”

Abstract. Tissue injury is signaled by nociception and experienced subjectively as pain. Consequently, animals act to avoid or terminate pain. Furthermore, their success in achieving this goal is enhanced by learning so that certain previously neutral sensory cues signal an increased probability or intensity of imminent pain. The biological significance of cues is that they are predictive, allowing individuals to anticipate harm and to initiate and shape appropriate actions in a timely fashion. Animals are often faced with pain-related decisions that are in conflict with concurrent motivations for other goals (e.g., to approach food or avoid it because of a nearby predator). When present, particularly when there is a concurrent conflicting motivation, nociceptive transmission both contributes to and is itself modulated in the course of a decision process. Through top-down modulatory circuits, pain can be either facilitated by the decision to avoid potential injury or inhibited via endogenous opioid release if the decision is to pursue a conflicting goal. This modulatory process occurs on multiple time scales and contributes to the variability in human subjective reports of pain. I propose that predictions are an inevitable component of pains. Understanding the neurobiology of predictions and their influence on pain transmission offers a path for improving pain treatment. Plant derived and synthetic opioids are highly effective analgesics that target both the pain transmission and the top down pain inhibitory circuit. Opioids are widely used for the treatment of acute severe to moderate pain. Acting directly on other circuits, opioids can suppress respiration, elicit positive motivational states and reinforce behaviors that are not beneficial to the individual. Thus, while endogenous opioids play a physiological role in motivation and decision making essential for human survival, exogenous opioids, acting in a non-physiological manner, can produce harm directly and by reinforcing dysfunctional behaviors.

DR. ADAM SHRIVER is a philosopher with a Ph.D. from the Philosophy-Neuroscience-Psychology program at Washington University in St. Louis. Prior to Oxford, he worked at the University of Pennsylvania and the University of British Columbia. Adam’s research examines the intersection of ethics and cognitive science and he has written multiple articles about human well-being and animal welfare. In particular, Adam’s research has examined the significance of the dissociation between the affective and sensory components of pain for philosophical theories of ethics and well-being. To this end, Adam has written about the relationship between pain and pleasure, the legal and ethical questions that arise from the search for a neural signature of pain in humans, and the capacity for suffering across different species. He also has research examining the ethics of using genetic modifications in livestock. Previously, Adam organized a workshop on neuroethics and animals, and he is currently co-editing a book on the topic.

DR. GREG CORDER (PhD) is an Assistant Professor of Psychiatry and Neuroscience at the University of Pennsylvania. His research aims to uncover how brain circuits transform emotionally inert nociceptive sensory information into an affective painful experience. Utilizing multidisciplinary approaches, including in vivo calcium imaging, neuroanatomical tracing, mouse genetics, optical neuromanipulation, and behavioral pharmacology, Dr. Corder’s lab is deconstructing the dynamic neural mechanisms of pain and pleasure experiences, and the molecular remodeling effects caused by endogenous and exogenous opioids within limbic and cortical brain circuits.

DR. MARK SULLIVAN (MD, PhD in Philosophy) is a psychiatrist at the University of Washington Medical Center for Pain Relief and Regional Heart Center. He is also a UW professor of Psychiatry and Behavioral Sciences, adjunct professor of Anesthesiology and Pain Medicine and adjunct professor of Bioethics and Humanities. He has served as attending physician at the UWMC Center for Pain Relief for 30 years and at the UWMC Regional Heart Center for 10 years. He has published over 250 peer-reviewed articles. Dr. Sullivan's latest book from Oxford University Press is titled The Patient as Agent of Health and Health Care.

DR. HOWARD FIELDS (MD, PhD) is Professor Emeritus of Neurology and Physiology at the University of California, San Francisco (UCSF). Dr. Fields founded the UCSF Pain Management Center and has made major contributions to the understanding and treatment of neuropathic pain, and to the understanding of mechanisms of pain modulation and placebo analgesia. Dr. Fields’ major interests are in nervous system mechanisms of pain and substance abuse with a focus on how endogenous opioids contribute to these mechanisms. His group was the first to demonstrate the clinical effectiveness of opioids for neuropathic pain and of topical lidocaine for post-herpetic neuralgia. In laboratory studies he discovered and elucidated a pain modulating neural circuit that is required for opioids to produce analgesia. He also discovered that placebo analgesia is blocked by an opioid antagonist. His recent work has centered on the problem of opioid reward, and he has begun to delineate the underlying molecular and cellular circuitry. His laboratory discovered nerve cells in the striatum that selectively encode the magnitude of a reward. They have also shown how the neurotransmitter dopamine contributes to motivation and reward-based choice. Professor Fields is a member of the US National Academy of Medicine and the American Academy of Arts and Sciences.