Message from EFIC and opening lecture

• EFIC initiatives 

 

The outpatient

In outpatient practice it is important to make a first essential screening (neuropathic, nociceptive, mixed pain). The aim of this section is to give a quick reference flow chart for clinicians mainly working in outpatient clinics.  

 

The interview: empathy for the devil? 

• how to improve the patient/doctor relationship

• what the patient tries to tell us about her/his pain

• is empathic approach needed  

 

The ABC of the clinical examination of the somatic sensory system

Minimum instrument set needed and how to use it (hammer, tuning fork, Von Frey hairs, heat and cold, dermographic pencil)

• Mechanical static, dynamic, deep somatic

• Mechanical pinprick

• Thermal (heat & cold)

 

The associated motor impairment

• Voluntary, autonomic

• Peripheral, central

 

Afternoon Practical training

Participants will carry out exercises applying what they have learned in the morning lessons through workshops composed of small groups, interactive sessions, role playing and multimedia simulations, including how to map a painful area.

 

Questionnaires, diaries and pain mapping   

How to make easy and fast recordings of clinical picture (analogic, semantic, numerical)

• Complex pain questionnaires and specific, disease-oriented questionnaires

• Quality of life, ADL; Motor impairment

 

The instrumental examination of the somatic sensory system: QST

• Quantitative Sensory Testing (Mandatory for all the attendants)

 

The instrumental examination of the somatic sensory system: neurophysiology

(Optional. Groups will be organised according with attendants requests)

 

Routine neurophysiology testing (clinical indications and limitations)

• EMG ENG

• Reflex responses (blink, RaIII)

 

Special neurophysiology testing (clinical indications and limitations)

• Microneurography

• Evoked potentials (LASER, dermatomeric, SSEP)

• Brain mapping

 

Is pain a “simple experience”: Psychophysical approach to pain perceptions 

 

The clinical examination in minimally conscious state patients

The presence of pain in minimally conscious state  patients (MCS), how to assess and treat it is still a matter of uncertainty.

As a consequence there are no guidelines that can help the clinician in assessing and treating pain in MCS. This seminal lecture will  give a minimal clinical core set to evaluate pain in these patients.  

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The clinical examination of the chronic neuropathic pain patient

This pivotal tutorial will examine diagnostic approaches to most common pain syndromes in neurology i.e.: painful diabetic polyneuropathy, post herpetic neuralgia, entrapment neuropathies (including complicated low back pain).

• Data from clinical evidence and case scenarios are presented and discussed in relation with guidelines on Neuropathic pain (IASP NeupSig EFNS etc)

• Diagnostic work-up of neuropathic pain flow chart

• Data from clinical evidence and case scenarios are presented and discussed in relation with guidelines on Neuropathic pain (IASP NeupSig EFNS etc)

• Diagnostic work-up of neuropathic pain flow chart

• Symptoms and questionnaires utility for NeP identification

• QST  interpretation in pain medicine

• Pressing issues

 

The clinical examination of the chronic neuropathic pain patient in practice

Under the guidance of an expert clinician, participants will carry out exercises applying what they have learned in the morning lessons through workshops composed of small groups, role playing and multimedia simulations.

 

Afternoon Practical training

Participants will also have the opportunity to participate to an outpatient consultation and QST testing in some of the most common pain syndromes in neurology painful diabetic polyneuropathy, postherpetic neuralgia, limb nerve entrapment neuropathies (including complicated low back pain).  

 

How to interpret inflammatory flags in the differential diagnosis between nociceptive and neuropathic pain 

• Clinical red flags

• Laboratory red flags (blood samples for inflammatory markers, etc.)

 

Translation of symptoms into pain mechanisms: a dictionary

The lecture will cover the peripheral, spinal and supraspinal mechanisms of pain as evidenced from preclinical studies but in the context translation to patients. Allodynia, hyperalgesia, ongoing pain will be covered.

• Neuropathic, inflammatory and visceral pain mechanisms

• Peripheral sensitization, central sensitization – what these may mean in terms of signs and symptoms

• Can the actions of drugs aid us in terms of understanding pain mechanisms?

 

Minimally invasive procedures for Peripheral Neuropathic Pain: what to ask for  and how to interpret it 
Diagnostic peripheral nerve and central neuraxial blockade 

• Electrostimulation (SCS, PNS, etc.)

• Bier’s blockade with different compounds

• Systemic lidocaine test

• Pharmacological tests

 

Food for Pain

 

Neuropathic or Nociceptive. Rephrasing unclear concepts, uneasy questions in cancer pain

 

 

The inpatient: difficult diagnosis and difficult patients

A patient is referred to a pain clinic mainly for further investigations, confirmation of the diagnostic hypothesis or to start a given treatment. Quite often they can be defined as “difficult patients”. In this setting the clinical and diagnostic tools should be used to define the type of pain precisely and determine the possible sites of action of the therapeutic options.

• The multidisciplinary approach and the critical revision of the highly complex patient’s history

• Chronic pain and the psychological profile of the difficult patient

• The neuro-psycho-social model 

 

Cold Cases 

Under the guidance of an expert clinician, a tournament will be organized between participants to verify the level of knowledge acquired. The tournament consists of simulated “cold” cases within a range of pain topics from those most frequently seen in the outpatient setting.

The aim is to make this an educational exercise on how to reach the most appropriate diagnostic hypothesis while introducing the fun of a sort of competition.

 

Learning questionnaires

In this setting, the clinical and diagnostic tools learned during the School will be discussed and compared, with teachers, in relation to real clinical cases.