Starts:

Tuesday, September 20th
4:30pm-6:00pm EDT

Category:

Topical Workshop | Virtual Program

Tracks:

Assessment | Diagnosis & Measurement of Pain

Room

718 A

A Translational Approach to Mechanistic-based Pain Medicine

The number-needed-to-treat (NNT) for most pharmaceutical therapies remains high. This could be explained by the non-selective manner with which chronic pain patients are prescribed analgesic regimens. Enrichment strategies for recruitment of patients in clinical trials might lower of NNT, but currently, this is rarely used in pain trials. Quantitative Sensory Testing (QST) is neurological examinations of somatosensory function and often uses a combination of pain thresholds, temporal summation of pain, and conditioned pain modulation. Increasing evidence suggests that QST profiles are associated with surgical, pharmacological, and non-surgical non-pharmacological treatment responses. A preclinical understanding of the underlying QST mechanisms, how these can be translated into human data, and how QST profiles are linked to treatment outcomes, might be able to decrease the NNT in clinical pain trials and ultimately improve the treatment options for chronic pain patients. This workshop will provide: 1) a preclinical view on central pain mechanisms, and how these are modulated (Kirsty Bannister, UK), 2) an in-depth translational discussion on QST data from rodents and humans (Esther Pogatzki-Zahn, Germany), and 3) the predictive value of QST for treatment outcomes and examples of how these profiles can be used to enrich clinical trials (Kristian Petersen, Denmark).

This Session is Available in Virtual Congress

Presentations

Time
4:30pm EDT6:00pm EDT

Parallel Studies in Mice and Men by Using QST and Non-evoked Pain Measures

Tracks: Assessment, Diagnosis & Measurement Of Pain
Categories: Topical Workshop, Virtual Program

Translation from preclinical rodent animal models to patients are hindered by several aspects including the use of non-relevant pain models and a mismatch between pain-related outcomes in preclinical and clinical studies, which will be discussed. First, relevant preclinical pain models (incisional, cancer – related and neuropathic pain model) will be discussed including advantages and disadvantages and ways to improve their translational value. Secondly, multidimensional behavioral outcome measures that objectively and reproducibly assess clinically relevant pain-related symptoms in rodent will be discussed. From a historical perspective, evoked pain-related behaviors are assessed by determining withdrawal reactions to externally applied mechanical and thermal stimuli to the hind paw of rodents. However, these assessments are not only prone to experimental bias; they also encompass mainly the somatosensory (spinal reflex) pathways and miss the complex cognitive and emotional as well as voluntary components of pain. In contrast, multidimensional behavioral outcome measures in preclinical settings presumably capturing clinically relevant symptoms might improve translation. This talk will present recent advantages in preclinical (rodent) pain assessment methods such as pain-related gait changes, non-evoked pain-related behavior assessments, and video-based methods for assessing pain-related outcomes. Finally, parallel laboratory results from preclinical and clinical studies will be presented.

4:30pm EDT6:00pm EDT

Pre-clinical Identification of Pain Mechanisms and the Likelihood of Clinical Translation for Analgesic Optimisation

Tracks: Assessment, Diagnosis & Measurement Of Pain
Categories: Topical Workshop, Virtual Program
Presented By: Dr. Ryan Patel

This presentation will outline the preclinical basis for measures of pain modulatory processes, and the likelihood of translational targets being identified. Specifically, understanding the functionality of spinal amplification and top-down modulatory controls in health is a crucial component of identifying novel pharmacotherapeutic targets in disease. Facilitatory and inhibitory spinal processes impact the way pain is perceived in humans and ensuring that their correlates can be measured in paradigms applied pre-clinically is crucial if clinical translation is to be realised. We will consider the validity of translational approaches to inform mechanistic-based pain medicine and the evidence supporting the use of equivalent paradigms in preclinical and clinical research. Finally, recent evidence suggests that the modulation of pain is led by discrete circuits encompassed by the descending pain modulatory system and distinguishing pathways based on their functionality will be discussed.

4:30pm EDT6:00pm EDT

The Predictive Value of Mechanistic Pain Profiling, and How This Can Enrich Clinical Pain Research

Tracks: Assessment, Diagnosis & Measurement Of Pain
Categories: Topical Workshop, Virtual Program

Patients with long-standing and severe chronic pain demonstrated lowered pain thresholds, facilitated temporal summation of pain, and impaired conditioned pain modulation when compared with pain-free subjects, and these assessments form the basis for a mechanistic pain profile. Recent evidence suggests that some patients are more pain sensitive than others and that pre-treatment pain sensitive pain mechanistic profiles are associated with poor pain-relieving response to standard pain treatment (e.g., surgery, NSAID treatment, and exercise therapy). Anti-depressants (such as serotonin-noradrenaline re-uptake inhibitors) might interact with the pain profiles, but the evidence is mixed. Emerging evidence suggests that mechanistic pain profiles can be modulated by cognitive factors, and that these are related to e.g., sleep deprivation.

This talk will provide an overview of mechanistic pain profiling of patients with chronic pain with a focus on osteoarthritis, and how these profiles are linked to treatment outcomes. This talk will discuss factors associated with the modulation of mechanistic pain profiles with focus on duloxetine and sleep deprivation, and how mechanistic pain profiles might enrich clinical trials in future.

Presenters

Dr. Ryan Patel

Research Associate
King's College London

Kristian Kjaer Petersen

Associate Professor
Aalborg University

Prof. Esther Pogatzki-Zahn

Full Professor
University Hospital Muenster