Starts:

Monday, September 19th
1:00pm-4:30pm EDT

Category:

Refresher Course

Tracks:

Chronic pain: Other

Room

601 A

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Neuropathic Pain Assessment in Real Life: From the Bedside to the Lab

This refresher course is intended to provide clinicians and basic scientists interested in practical aspects of neuropathic pain diagnosis with a critical, real-life and evidence-based approach to the challenges in diagnosing and interpreting confirmatory tests for neuropathic pain. Emphasis will be given to practical history taking and physical examination of patients with didactic films, showing manoeuvres and signs that carry high diagnostic value in the differentiation of neuropathic pain from other chronic pain syndromes. Then, neurophysiological tests frequently ordered for these patients such as nerve conduction tests and laser evoked potentials will be explained, their main indications and short-comings will be discussed and real-life examples will be presented. Then practical aspects of skin biopsy will be discussed such as the proper region to perform them, how are result of intra-epidermal nerve fibre density interpreted and contextualized in a patient-centered perspective. At the end, an overview of how data from the clinical encounter, from neurophysiology tests and from nerve fibre counting can help detect potential responders to specific treatment choices based on the current scientific knowledge and recommendations.

Presentations

Time
1:00pm EDT–4:30pm EDT

A Look at Skin Nerves: When Shall I Order Skin Biopsies and How do they Help to Diagnose Pain?

Tracks: Chronic Pain: Other
Categories: Refresher Course
Presented By: Professor Andrea Truini

In this presentation we will highlight the main clinical issues related to skin biopsy. In particular we will discuss when skin biopsy is indicated in patients with pain, and show the basic methodological aspects of this technique, including practical issues regarding how the skin biopsy is performed, and the different immunostaining techniques for skin nerves. In this presentation we will also show recent studies and metanalysis dealing with the diagnostic yield of skin biopsy and provide a critical discussion about the diagnostic accuracy of skin biopsy in patients with small-fibre neuropathy. We will also present the current controversy on the role of small-fibre pathology as assessed with skin biopsy in patients with nociplastic pain; in particular we will show how specific skin biopsy variables might help in distinguishing small-fibre pathology and small-fibre neuropathy.

1:00pm EDT–4:30pm EDT

From Lesion to Pain: Pain and Nociception Neurophysiology in a Nutshell

Tracks: Chronic Pain: Other
Categories: Refresher Course
Presented By: Professor Luis Garcia-Larrea

In presentation n° 2 Luis Garcia-Larrea will give a general view of neurophysiology tests commonly used in the diagnostic workout of neuropathic pain such as nerve conduction tests, small-fiber / spinothalamic related evoked potentials, and vegetative reactions. He will follow a practical approach to show what these tests can detect and what they cannot, when they should be used and when they can be omitted, and in particular, which is the profile of patients who will benefit from these confirmatory tests.

Key Insight: Neurophysiological techniques are widely accessible, rapid, inexpensive, and often provide the critical link between probable and definite neuropathic pain. But they are not always necessary, and should be used with discernment. They should always follow a good clinical exam (cf presentation 1) rather than precede it. A thorough understanding of the type of information that can be gathered from such exams, and of the patients who may benefit from them is the gateway to their useful utilization

1:00pm EDT–4:30pm EDT

Physical Examination of the Patient with Neuropathic Pain: Pearls and Pitfalls

Tracks: Chronic Pain: Other
Categories: Refresher Course
Presented By: Professor Daniel C De Andrade

This refresher course is intended to provide clinicians and basic scientists interested in practical aspects of neuropathic pain diagnosis with a critical, real-life and evidence-based approach to the challenges in diagnosing and interpreting confirmatory tests for neuropathic pain. Emphasis will be given to practical history taking and physical examination of patients with didactic films, showing manoeuvres and signs that carry high diagnostic value in the differentiation of neuropathic pain from other chronic pain syndromes. Then, neurophysiological tests frequently ordered for these patients such as nerve conduction tests and laser evoked potentials will be explained, their main indications and short-comings will be discussed and real-life examples will be presented. Then practical aspects of skin biopsy will be discussed such as the proper region to perform them, how are result of intra-epidermal nerve fibre density interpreted and contextualized in a patient-centered perspective. At the end, an overview of how data from the clinical encounter, from neurophysiology tests and from nerve fibre counting can help detect potential responders to specific treatment choices based on the current scientific knowledge and recommendations.

Presenters

Professor Andrea Truini

Professor of Neurology
University Sapienza

Professor Daniel C De Andrade

Professor
Faculty of Medicine, Aalborg University

Professor Luis Garcia-Larrea

Director of Research
Inserm, Head of Central Integration of Pain lab at the Lyon Centre for Neuroscience