Starts:

Thursday, September 22nd
10:45am-12:15pm EDT

Category:

Topical Workshop | Virtual Program

Tracks:

Specific Pain Conditions/Pain in Specific Populations

Room

718 A

Phenotyping Pain Mechanisms in Low Back Pain: Modulatory Factors and Clinical Utility

Treatment success for back pain patients without curable pathophysiological or pathoanatomical cause, is limited by imprecise mechanistic assessment in clinical practice. Research in recent years has substantially refined and validated mechanistic pain assessment of individual patients. In this workshop, state of the art assessment of pro-nociceptive mechanisms such as widespread hyperalgesia and facilitated temporal summation of pain in people with recurrent or chronic back pain will be presented. Moreover, novel data on impaired anti-nociceptive mechanisms in back pain, and how they may be modulated by attentional and affective factors will be discussed. Mechanistic and clinical pain phenotypes will be mapped to treatment and outcomes in low back pain. Evidence on how mechanistic pain measures may contribute to personalized care, patient stratification, and outcome measurement will be critically discussed. The IASP defines three major pain mechanisms that underlie the persistence of pain – nociceptive, nociplastic and neuropathic. The findings from 2 recent systematic reviews and a Delphi expert consensus project provide guidance regarding features that are agreed to have potential to aid the discrimination between these mechanism groups, which is likely to aid clinical decision making.

This Session is Available in Virtual Congress

Presentations

Time
10:45am EDT12:15pm EDT

Can Nociceptive, Neuropathic or Nociplastic Phenotypes be Identified in Musculoskeletal Pain?

Tracks: Specific Pain Conditions/Pain In Specific Populations
Categories: Topical Workshop, Virtual Program

Summary of 2 systematic reviews and Delphi expert consensus project that identified the key features that are agreed to characterize the different underlying pain mechanisms and the clinical tools and measures that could aid discrimination between them. There are critical issues to consider for implementation of this into clinical practice. First, there is overlap between mechanisms and many, if not most, individuals will present with a combination of mechanisms involved. Second, the assumption is that identification of mechanism underlying pain will aid selection of matched treatments. This requires substantial evaluation.

10:45am EDT12:15pm EDT

Mapping Mechanistic and Clinical Pain Phenotypes to Treatment and Outcomes in LBP

Tracks: Specific Pain Conditions/Pain In Specific Populations
Categories: Topical Workshop, Virtual Program
Presented By: Prof. David Walsh

Data will be presented on the measurement properties and statistical relationships between psychophysical measures in people with chronic low back pain, compared with other indices of peripheral and central sensitization, and with other chronic musculoskeletal pain conditions. Attention will focus on Pressure Pain detection Thresholds at various anatomical sites, Temporal Summation and Conditioned Pain Modulation, each using mechanical stimuli. Associations of psychophysical measures with patient characteristics and with other indices of sensitization, and their ability to predict prognosis and a breadth of patient-centred treatment outcomes will be discussed, including pain and self-management. Balance will be explored between repeatability, precision, validity, feasibility and acceptability to patients, researchers and clinicians. The value of psychophysical measures for defining phenotypic groups and informing individual patient care will be compared. Psychophysical measurement describes consequences of diverse and heterogenous mechanistic pathways, which may constitute stable phenotypic traits, or vary over time. Each may act in isolation, or together they may change as a concordant nociplastic state.

10:45am EDT12:15pm EDT

Pro-nociceptive and Anti-nociceptive Mechanisms in Spinal Pain

Tracks: Specific Pain Conditions/Pain In Specific Populations
Categories: Topical Workshop, Virtual Program
Presented By: Dr. Megan McPhee

This presentation will focus on factors that may influence pain modulatory mechanisms. Here, the focus will be on how pain modulatory mechanisms present in people with spinal pain, how they may change over time in relation to the experience of experimental and clinical back pain episodes, and how they may be modified by attentional manipulation, affective manipulation, lifestyle factors and clinical features. The presentation will include an overview of the state of the literature on pain modulation in people with spinal pain, as well as data from a series of experimental and clinical studies in people across a spectrum of low back pain presentations, to illustrate how pain modulatory mechanisms are impacted by clinical spinal pain presence and manipulation of attentional and affective demands.

Presenters

Dr. Megan McPhee

Post-doctoral Researcher
Center for Neuroplasticity and Pain (CNAP), Aalborg University

Prof. Thomas Graven-Nielsen

Professor and Director
Center for Neuroplasticity and Pain (CNAP), Aalborg University

Professor Paul W. Hodges

NHMRC Leadership Fellow
The University of Queensland, NHMRC Centre of Clinical Research Excellence in Spinal Pain, Injury and Health, the School of Health and Rehabilitation Sciences, Brisbane, Australia

Prof. David Walsh

Co-Director Pain Centre Veersus Arthritis
The University of Nottingham