Scientific Programme

AIM

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

MORNING SESSIONS

 

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

 

AFTERNOON SESSIONS

 

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

MORNING SESSIONS

 

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

 

AFTERNOON SESSIONS

14:00 –  16:30                    The clinical examination of the chronic neuropathic pain patient                             PER HANSSON

                                             in practice                                        

                                             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

MORNING SESSIONS

             

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

                                             Pain, immunity,depression                                                                                                                     

 

13:00 – 14:00                      Lunch   

 

AFTERNOON SESSIONS

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

MORNING SESSIONS

 

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                                                           

                                             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.

 

13:00                                   End of the Course

 

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