Message from Augusto Pagani

(Piacenza Medical Council President)

 

Message from Nevenka Krčevski Škvarč on behalf of EFIC

(Executive Board Member)

 

The Clinical approach

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:

• how to improve the patient/doctor relationship

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

 

The clinical examination of the  sensory system

Description of the minimum instrument set needed and how to use it (hammer, tuning fork, Von Frey hairs, heat and cold, dermographic pencil) in the evaluation of sensory signs and symptoms referred to the skin

• Mechanical static, dynamic, deep somatic

• Mechanical pinprick

• Thermal (heat & cold)

 

 

The associated motor impairment

• Voluntary, autonomic

• Peripheral, central

Pain questionnaires and diaries

What they can tell us and what they cannot

• Easy and fast recordings of the clinical picture (analogic, semantic, numerical etc)

• Complex pain questionnaires and specific, disease-oriented questionnaires

• Quality of life, ADL; Motor impairment

Cartography of pain

Where the signs and symptoms are perceived and found

Pain drawing and pain mapping.

 

 

Afternoon Practical training at Dept clinica Neuropysiology & Pain Rehabilitation unit, Montescano (PV)

• 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.

 

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

 

 

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

 

Polling Session

Use of diagnostic work-up algorithm for clinical diagnosis in chronic pain.

 

The clinical examination of muscle and visceral pain

Diagnosis and differential diagnosis of different forms of primary and secondary muscle pain, and of different visceral pain phenomena (true visceral pain, referred pain with and without hyperalgesia, visceral hyperalgesia, viscero-visceral hyperalgesia)

• Clinical procedures

• Instrumental procedures

 

Pain Tournament or Europe against Pain

The First Challenge

Cases reports from Valeria Tugnoli ,Renato Vellucci

Cold Cases: Under the guidance of expert clinicians, a tournament will be organized between participants to verify the level of knowledge acquired after this session. The tournament consists of simulated 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 while introducing the fun of a competition.

 

Pharmacological dissection of pain mechanisms for a mechanism-based clinical approach to chronic pain

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

• Neuropathic, inflammatory and visceral pain mechanisms

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

 

Pain in Neurology

This tutorial will examine diagnostic approaches and therapeutic options available to manage most common pain syndromes in neurology: painful diabetic polyneuropathy, postherpetic neuralgia, limb nerve entrapment neuropathies (including complicated low back pain). Data from clinical evidence and case scenarios are presented  presented to support IASP NeupSig guidelines on Neuropathic pain, and EFNS guidelines on the pharmacological treatment of neuropathic pain.

 

Minimally invasive procedures for Peripheral Neuropathic pain and how to interpret their failure

Diagnostic peripheral nerve and central neuraxial blockade

• Electrostimulation (SCS, PNS, etc.)

• Bier’s blockade with different compounds

• Systemic lidocaine test

• Pharmacological tests

 

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.

 

Pain Tournament or Europe against Pain

The Final Challenge

Cases reports from Valeria Tugnoli ,Renato Vellucci

Cold Cases: Under the guidance of expert clinicians the “losers” of the First Challenge will have a second chance to tackle more complex and challenging cases of chronic pain. As for the First Challenge, the tournament will consist of simulated cases within a range of highly complex pain topics. The aim is always to make this an educational exercise but with the excitement of a competition.

 

Narrative medicine  as a tool in the management of chronic pain person

• Introduction to narrative medicine: storytelling applied to health care.

• Narrative tools: parallel chart, patient’s diary, free and semi-structured stories.

• Storytelling and health care professionals in prevention of burn out:  writing as a pragmatic tool.

• Analysis of stories and texts (verbal and non verbal). 

 

A working group on how to collect the stories of the professionals (parallel chart) and of the patients

 

Neuropathic or Nociceptive

Rephrasing unclear concepts, uneasy questions from the Participants 

 

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.