MECHANISMS AND MANAGEMENT OF PAIN 2009 (DENT654)
Course Directors:
Dr. Ji Zhang; ji.zhang@mcgill.ca; 514-398-7203 x00036
Dr. Petra Schweinhardt; petra.schweinhardt@mcgill.ca; 514-398-1271
Dr. Laura Stone; laura.s.stone@mcgill.ca; 514-398-7203 x00039
Date(s): Wednesdays, 2:30-5:30 pm (Jan. 07, 14, 28; Feb. 04, 11, 18; Mar. 04, 11, 18, 25; Apr. 01, 08)
Thursday, January 22, 2:00-7:30 pm
Location(s): Room 3001 Genome Building; Room D14-102 Montreal General Hospital; McGill
Residence Hall, 3625 Avenue Du Parc.
Course Format: Lectures, McGill Pain Day, Pain rounds, Patient presentations, Student presentations,
Paper discussions
Evaluation:
1) Oral presentation (Jan 28, Based on McGill Pain Day): 20%
2) Written Assignment - Grant Proposal (Letter of Intent Due Jan 28; Proposal Due March 18): 40%
3) Paper Discussions (Jan 28, Mar 11, Apr 1): 20% as presenter, 5% per additional discussion (x2).
4) Attendance & Participation: 10%
Date
Location
Period 1 (2:30-4:00)
Chair(s)
Jan 7
Genome
3001
Introduction to course (L Stone)
Lecture: Grant Writing (L Stone)
LS
MGH
14-102
McGill
Res Hall
Genome
3001
MGH
14-102
MGH
14-102
MGH
14-102
Lecture: Central Pain Mechanisms
in the brain (C Bushnell)
LS
Jan 14
Jan 22
Jan 28
Feb 4
Feb 11
Feb 18
Feb 25
Mar 4
Mar 11
Mar 18
Mar 25
Apr 1
Apr 8
N/A
Genome
3001
Genome
3001
MGH
14-102
MGH
14-102
Genome
3001
Genome
3001
Period 2 (4:00-5:30)
Lecture: Introduction to Pain
Processing – periphery and spinal
cord (G Bennett)
Pain Rounds: Placebos in Clinical
Practice (Amir Raz)
McGill Pain Day; Thursday Jan 22; 2:00 – 7:30 PM
Student Presentations: What I
learned on Pain Day
Lecture: Peripheral Pain
Mechanisms (J Zhang)
Lecture: Pharmacological Pain
Management (M Ware)
Lecture: Visceral Pain (F Cervero)
JZ
LS
Paper Discussion
*Letter of Intent Due
JZ
Pain Rounds: Case Presentation
PS
JZ
Pain Rounds: Sleep and Pain
Interactions (G Lavigne)
Frontiers in Pain Research Seminar:
Dr. J. Eisenach
Reading Week (no class)
Lecture: Pain pharmacology (L
Stone)
LS
Lecture: Psychosocial pain
management (A Gamsa)
Lecture: Fibromyalgia (S Marchand)
PS
LS
Paper Discussion
Lecture: Neuropathic pain (Y Shir)
PS
Frontiers in Pain Research Seminar:
Dr. Ulrich Zeilhofer
*Grants Due
Lecture: Arthritis (Fitzcharles)
PS
Pain Rounds: Case Presentation
Lecture: Genetic Pain (J Mogil)
JZ
PS
Paper Discussion
Lecture: Consequences of living
with chronic pain (P Schweinhardt)
JZ
PS
Student presentations: Grant
Proposals
Course wrap-up
THE FOLLOWING ARTICLES SHOULD BE READ PRIOR TO EACH CLASS:
Jan 7
DeLeo JA. Basic science of pain. J Bone Joint Surg Am 2006;88 Suppl 2:58-62.
Jan 14
Bushnell CM, Apkarian, AV Representation of pain in the brain, Chapter 6, Wall and Melzack's
Textbook of Pain, 5th Edition, Edited by Stephen McMahon, PhD & Martin Koltzenburg, MD FRCP.
Jan 28
PAPER FOR DISCUSSION: Djouhri L, Koutsikou S, Fang X, McMullan S, Lawson SN. Spontaneous pain,
both neuropathic and inflammatory, is related to frequency of spontaneous firing in intact C-fiber
nociceptors. J Neurosci 2006;26(4):1281-1292.
Feb 4:
Woolf CJ, Ma Q. Nociceptors--noxious stimulus detectors. Neuron 2007;55(3):353-364.
Feb 11:
Katona I, Freund TF. Endocannabinoid signaling as a synaptic circuit breaker in neurological disease.
Nature medicine 2008;14(9):923-930.
Feb 18:
Cervero F, Laird JM. Visceral pain. Lancet 1999;353(9170):2145-2148
Cervero F, Laird JM. Understanding the signaling and transmission of visceral nociceptive events. J.
Neurobiology 2004;61(1):45-54.
March 4:
Rosenblum A, Marsch MA, Joseph H, Portenoy RK Opioids and the Treatment of Chronic Pain:
Controversies, Current Status, and Future Directions Exper Clin Psychopharmacol 2008; 16(5):405–
416
Eccleston, C. Role of psychology in pain management, British J. of Anaethesia, 2001;87:144-152.
March 11:
Marchand S. The physiology of pain mechanisms: from the periphery to the brain. Rheumatic diseases
clinics of North America 2008;34(2):285-309.
PAPER FOR DISCUSSION: Gilron I, Bailey JM, Tu D, Holden RR, Weaver DF, Houlden RL. Morphine,
gabapentin, or their combination for neuropathic pain. N Engl J Med 2005;352(13):1324-1334.
March 18:
Gilron I, Watson CP, Cahill CM, Moulin DE. Neuropathic pain: a practical guide for the clinician. Cmaj
2006;175(3):265-275.
March 25:
Fitzcharles MA, Shir Y. New concepts in rheumatic pain. Rheumatic diseases clinics of North America
2008;34(2):267-283.
April 1:
Lacroix-Fralish ML, Mogil JS. Progress in Genetic Studies of Pain and Analgesia. Annual review of
pharmacology and toxicology 2008.
PAPER FOR DISCUSSION: Cox JJ, Reimann F, Nicholas, AK et al., An SCN9A channelopathy causes
congenital inability to experience pain. Nature 2006:444:894-898.
April 8
TBA
ASSIGNMENTS AND GRADING:
Oral Presentation (20%): Each student will prepare a 3-5 minute presentation (+ 3 min for questions)
on a poster from McGill Pain Day. Students should briefly outline the study, including methods and
results, and explain why they found it interesting or important. Exceeding the time limit will result in a
reduced grade. Visual aids will not be permitted. Students cannot present their own work.
Paper Discussions (30%): There will be a total of three 1.5 hr class periods set aside for paper
discussions. Each paper will be presented by a team of 3-4 students. Teams will work together to
create a clear, seamless overview and analysis of the assigned article including background, methods,
results, discussion and interpretation. Presentations should not exceed 30 minutes. All students not
presenting must come prepared to act as reviewers. One non-presenting student will be selected at
random to be the “primary” reviewer and will be expected to ask the presenters at least 3 challenging
questions. Two “secondary” reviewers will then be selected to each ask two additional questions. The
remaining students will then each ask at least one additional question. Presenting students will be
graded on both the presentation and their responses to the reviewers (20%). Non-presenting students
will be judged by the insight and critical thinking displayed during the discussion (10% total; 5% per
discussion). The presenting teams will be decided by random draw on the first day of class.
Grant Assignment (40%): Each student will prepare a mock grant application. Each proposal will be
graded independently by 2 course directors according to the attached criteria. Students are encouraged
to discuss their proposal ideas with the course directors. Preliminary data can be taken from one’s own
work, from the literature or fictional. However, all source(s) must be clearly indicated in the
proposal.
The topic is to be determined by the student according to the following limitations:
1. The topic must be submitted for approval by the course directors as a Letter-of-Intent.
2. The topic cannot overlap with an individual’s thesis project. It can, however, be related to
your research. For example, you can propose the logical next steps to their current study or
design a clinical study based on an ongoing molecular project.
The Guidelines for the Letter-of-Intent are as follows:
1. One page maximum (minimum 2 cm margins, font of 11 (Arial) or 12 (Times New Roman),
six lines per inch, no condensed type or spacing).
2. At the top of the page, indicate your name, student ID# and the project title
3. Brief introduction to the research question
4. The Hypothesis
5. Brief description of how you will test the hypothesis
6. Statement of relevance
The Guidelines for the Mock Grant Application are as follows:
1. 12 page maximum (not including figures or references; minimum 2 cm margins, font of 11
(Arial) or 12 (Times New Roman), double-spaced, no condensed type or spacing).
2. At the top of each page, indicate your name, student ID# and the project title
3. At the bottom of each page clearly indicate the page number
4. The proposed studies should be reasonably completed within three years
5. The recommended sections and lengths are as follows:
i. Lay Abstract (0.5 pages)
ii. Summary of Research Proposal, including Hypothesis and Specific Aims (1-1.5
pages)
iii. Background (2-4 pages)
iv. Research Plan (5-8 pages)
v. Timeline (1/3 page)
vi. Significance (1 page)
vii. References (1 page)
viii. Preliminary Results & Supporting Data (No limit)
Attendance & Participation (10%): Students are expected to read the assigned reviews before the
lecture and be prepared to ask questions and contribute to group discussions. This portion of the grade
will be the average of the three course directors’ subjective assessment of each student’s preparation
and level of engagement.
Policy on Absences: Students may miss one class with either prior permission or proof of medical
need. Additional absences will require remedial assignments on a per case basis.
Academic Integrity: Students should be aware that McGill University values academic integrity.
Therefore all students must understand the meaning and consequences of cheating, plagiarism and
other academic offences under the Code of Student Conduct and Disciplinary Procedures. Students
who have any doubt as to what might be considered "plagiarism" in preparing an essay or term paper
should consult the instructor of the course to obtain appropriate guidelines. Moreover, the Code of
Student Conduct and Disciplinary Procedures includes sections on plagiarism and cheating (see
http://www.mcgill.ca/integrity/ for more information).
Criteria For Preparation and Grading of Mock Grant Proposal: The overall grade is the sum of the
marks earned for each category. In each category partial mark can be given. For example, a hypothesis
that is better then average but not quite excellent can be given a mark of 12/15.
Criteria
Hypothesis
Experimental
Design
Background
&
Significance
Style
Excellent
Good
Satisfactory
Unacceptable
Original,
unambiguous
hypothesis.
Original
hypothesis,
somewhat broad.
Interesting
hypothesis, but has
been tested before
in limited number of
studies.
5
Suggested
experiments may
provide relevant
information,
important controls
are missing,
alternative
outcomes are not
discussed
Hypothesis is
obscure, or the
answer represents
general knowledge.
15
10
Logical
Logical
experiments are
experiments are
suggested,
suggested;
alternative
however, some
outcomes are
controls are
considered/
missing, or some
discussed and
alternative
appropriate
outcomes are not
controls are
discussed
suggested
60
50
Introduction
Introduction
demonstrates
demonstrates good
excellent
knowledge of the
knowledge of the
field, the student is
field, the student is
able to place his
able to place his
study within
study within
broader content,
broader content,
referencing is
referencing is
accurate. Studies
accurate. Studies
are somewhat
are highly
significant.
significant.
15
10
All structural
All structural
elements are
elements are
present; text within present but not all
the sections is
are identified; Text
logically divided
is logical, good
into paragraphs,
flow of ideas,
Good flow of ideas.
occasional
All formatting
repetitions. All
requirements are
formatting
respected
requirements are
respected
10
7
40
Introduction
demonstrates
some knowledge of
the field, the
student attempts to
place his study
within broader
content,
referencing is
accurate. Studies
are of questionable
significance.
5
Structural elements
are present but
poorly identified,
the text is hard to
follow. All
formatting
requirements are
respected
4
0
Suggested
experiments will not
address the
question, controls
are not included,
suggested
methodology will
not provide
evidence for the
hypothesis
0
Introduction
demonstrates
limited knowledge
of the field, the
student is not able
to place his study
within broader
content, referencing
is inaccurate.
Studies are not
significant.
0
Major structural
element is missing
(such as
Introduction), the
text is hard to
follow. Formatting
requirements are
not respected
0