Physicians from many different specialities are increasingly involved in Pain Medicine.
The EFIC Bergamo Neuropathic Pain School will assist pain clinicians to refine their clinical neurological diagnostic and assessment approach to identify neuropathic pain and to improve their ability to interpret clinical, instrumental and laboratory finding and to estabilish the most appropriate treatment.
MONDAY, 10th October
08:00 – 08:30 Welcome Message from EFIC® President CHRIS WELLS
08:30 – 09:15 Opening Lecture: Definition and mechanisms of pain. ANTHONY DICKENSON
Translation of symptoms into pain mechanisms
The lecture will cover mechanisms of pain in the context translation to patients.
Transduction, Transmission: Perception. Modulation. Nociception and pain.
Pain without nociception and nociception without pain. Nociceptive and neuropatic pain
09:15 – 09:45 Pain generators in the nervous system: a neuroanatomy refresh ROBERTO CASALE
“Where” a neurological lesion or disease might express itself with neuropathic pain (peripheral or central).
09:45 – 10:45 Neurological lesion or disease DIDIER BOUHASSIRA
How a neurological lesion or disease express themself in term of positive and/or negative
sensory simptoms with other (motor , vegetative) symptoms and how to identify neuropathic
pain as a player in those conditions.
10:45 – 11:15 Coffee Break
11.15 – 13.00 Pain questionnaires, diaries and pain mapping. DIDIER BOUHASSIRA
A critical reappraisal of their usefulness and limits with special regards on:
Neuropathic pain questionnaires (LANSS; BPI, NPQ, DN4 etc ;)
Quality of life, ADL. (Importance of)
13:00 - 14:00 Lunch break
14:30 – 16:00 Assesment of patients with barriers to communication. ANTONIO DETANTI
Infants, children, patients with cultural, educational or language barreers to communicate,
adults with cognitive problems, intubated or in minimally conscious state pose a difficult task.
As a consequence there are no shared guidelines that can help the clinician in assessing and treating pain.
Afternoon Clinical Practical training ANTONIO DETANTI
Under the guidance of experts participants will have the opportunity to participate in assessing pain in minimally conscious state patients.
16:00 – 16:30 Coffee Break
16.30 –18.30 Objective pain diagnostics: theory and practice – Part 1 LUIS GARCIA-LARREA
(with the help of Drs N. TAJOCCHI, A. FURNARI, V. ROMEO & A. LAMANNA)
Routine neurophysiology (Clinical indications and limitations)
EMG, ENG, Reflex responses (blink, RaIII)
PEPs, CHEPS etc
Quantitative Sensory Testing (termal, vibratiory)
examination in normal subjects
Participants will carry out exercises applying QST on themselves.
TUESDAY, 11th October
08:00 – 08:45 Objective pain diagnostics: theory and practice – Part 2 MARIA NOLANO
The skin biopsy: the intraepidermal nerve fiber density (IENFD)
08:45 – 09:30 The imaging of Pain CARLO PORRO
09:30 – 10:15 Autonomic nervous system testing VALERIA TUGNOLI
10:15 – 10:45 Coffee Break
10:45 – 11:30 How to interpret inflammatory flags in the differential diagnosis PIERCARLO SARZI-PUTTINI
between nociceptive and neuropathic pain
Clinical red flags
Laboratory red flags (blood samples for inflammatory markers, etc.)
11.30 – 13:00 The clinical examination of the chronic neuropathic pain patient PER HANSSON
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
- QST interpretation in pain medicine
- Pressing issues
13:00 - 14:00 Lunch break
14:00 – 16:30 The clinical examination of the chronic neuropathic pain patient PER HANSSON
Under the guidance of an expert clinician, participants will have the opportunity to participate
to an outpatient consultation of the most common pain syndromes in neurology painful
diabetic polyneuropathy, postherpetic neuralgia, limb nerve entrapment neuropathies (including complicated low back pain).
16:15 – 16:45 Coffee Break
16:30 – 18:00 The QST examination in patients PER HANSSON
(with the help of Alessandro LAMANNA for the technical part)
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 including QST testing.
WEDNESDAY, 12th October
08:00 – 08:45 Guidelines on the pharmacological treatment of neuropathic pain:
which one and what revision.
08:45 – 09:45 Part-I
Drug classification and terminology from a pain medicine perspective PAOLA SACERDOTE
Drugs acting on transduction: nociceptor activation and peripheral sensitization
Drugs acting on transmission (from periphery to spinal cord; central sensitisation)
09:45 – 10:30 Topical treatments ROBERTO CASALE
Ketamine, baclofen, Lidocaine, capsaicine, benzodiazepine
10:30 – 11:00 Coffee Break
11:00 – 13:00 Part II RICCARDO TORTA
Drug classification and terminology from a pain medicine perspective.
Drugs acting on modulation (descending pathways)
Drugs acting on perception
13:00 – 14:00 Lunch
14.00 – 15:30 Drugs acting on modulatory non nociceptive system ROBERTO CASALE
Mastcells; scavenger, etc.
Aperitif session ROBERTO CASALE
Wine tasting and the psychophysical approach to pain perception.
Is pain a “simple experience”?
Attendants will describe sensations evoked by different stimulations (including wine tasting)
to understand how sometimes can be difficult to describe them.
THURSDAY, 13th October
08:30 – 10:00 Nociceptive neuropatic or mixed in cancer MAGDI HANNA
and non-cancer pain patients: a reappraisal of unclear concepts.
Why and how can cancer pain differ from nociceptive or neuropatic pain.
10:00 – 10:30 Coffee Break
10:30 – 12: 00 Critical Appraisal of Surrogate Human Pain Models: MAGDI HANNA
can they used for translational research
This lecture will cover all available human pain models from Electrical , chemical to cold etc
12:00 – 13.00 Take home messages FACULTY
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.
13:00 End of the Course