Starts:

Wednesday, September 21st
10:45am-12:15pm EDT

Category:

Topical Workshop

Tracks:

Assessment | Diagnosis & Measurement of Pain

Room

714 A

Nociplastic Pain – What Clinicians need to Understand: Recent Insights, Presentation of new Clinical Criteria and Future Development.

The term nociplastic pain is a mechanistic descriptor adapted by IASP, alongside with nociceptive and neuropathic pain. Per definition, individuals suffering from nociplastic pain have altered nociception, i.e., pain hypersensitivity. However, as hypersensitivity is also seen in nociceptive and neuropathic pain conditions, and since patients often have combinations of several pain mechanisms, clinical criteria are needed. The criteria and the grading system for nociplastic pain affecting the musculoskeletal system, developed by the IASP Terminology Task Force will be presented. Principles of the classification algorythm, including hypersensitivity phenomena and co-morbidities will be discussed. The audience will be provided with state-of-the art, clinical algorythms to examine hypersentitivity and strategies how to interpret findings in mechanistic terms to distinguish between different pain types. The clinical relevance of co-morbidities forming part of the grading system of nociplastic pain will be discussed in the context of their mechanistic relationships to pain. Finally, recent findings increasing our understanding of altered nociception in nociplastic pain conditions will be presented, including potential autoantibody mediated mechamisms and vulnerability markers. The need to develop new strategies for phenotyping and stratification of the heterogenous group of patients suffering from nociplastic pain will be discussed in a broader context.

Presentations

Time
10:45am EDT12:15pm EDT

Clinical Criteria and Grading of Nociplastic Pain, Where Do We Stand?

Tracks: Assessment, Diagnosis & Measurement Of Pain
Categories: Topical Workshop
Presented By: Eva Kosek

Prof Kosek will first present the rational for developing the new nociplastic pain criteria and grading system and highlight the work done by the IASP Terminology Task Force, which she chairs. The principles of the classification algorithm will be presented, including hypersensitivity phenomena and co-morbidities. The clinical usefulness of the criteria will be demonstrated by carefully guiding the audience through the algorithm using relevant patient examples, with special emphasis on patients simultaneously presenting with several pain types that need to be distinguished in order to provide correct treatment. She will discuss the strengths and pitfalls in the grading system of nociplastic pain and provide guidance how this should be handled in clinical and research settings. In order to illustrate how the term nociplastic pain fits in and harmonizes with the ICD-11 concept of pain as a disease (primary pain) and pain as a symptom (secondary pain) the term will be discussed in relation to the recent developments in the understanding of mechanisms potentially underlying the altered nociception that defines nociplastic pain, eg. autoantibody mediated changes in neuronal excitability, neuroinflammation, glia cell activation and derangements in cerebral pain processing.

10:45am EDT12:15pm EDT

How Do We Examine and Interpret Pain Hypersensitivity Phenomena in the Context of Nociplastic Pain?

Tracks: Assessment, Diagnosis & Measurement Of Pain
Categories: Topical Workshop
Presented By: Prof. Ralf Baron


Prof. Baron will specifically focus on the hypersensitivity phenomena, the presence of which is mandatory for the classification of nociplastic pain. Based on his seminal work within the neuropathic pain field, he will present state-of-the art clinical algorithms to be used to screen and test for static and dynamic mechanical allodynia as well as heat/cold allodynia in a clinical setting. He will present practical strategies to optimize the validity and reliability of these bed-side examinations and discuss how the findings should be interpreted in mechanistic terms and used to distinguish between patients with different pain types. Although, currently quantitative sensory testing (QST) is not included in the nociplastic pain classification criteria, as QST equipment is expensive and thus often not available in clinical settings, is is still recognized that QST may have the potential to improve the grading of nociplastic pain. Prof. Baron will discuss the pros and cons with current QST protocols in the perspective of nociplastic pain and discuss future developments of QST to improve grading of nociplastic pain. Finally, the need to develop new strategies for phenotyping and stratification of the heterogenous group of patients suffering from nociplastic pain will be discussed in a broader context.

10:45am EDT12:15pm EDT

Presenters

Eva Kosek

Full Professor
Karolinska Institutet, Stockholm, Sweden and Uppsala Univeristy, Uppsala, Sweden

Prof. Ralf Baron

Head of Division of Neurological Pain Research and Therapy
University Medical Center Schleswig-Holstein, Campus Kiel

Dr. Daniel J Clauw

Professor
Department of Anesthesiology - CPFRC