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Milano Convention Centre | August 27-31, 2012
IASP is sponsoring a series of half-day Refresher Courses on Monday, August 27, 2012. The registration fee includes the course, syllabus, and a coffee break. Refresher Course attendees must register for the Congress (either one-day or full registration) and pay a separate registration fee for each Refresher Course attended.
Note: Titles, faculty, and scheduled times are subject to change.
Morning Refresher Courses (08:30 - 12:00)
An Update on the Neurobiology of Acute and Persistent Pain (RC 01)
Michael Salter, Frank Porreca
Major advances have been made recently in understanding the pathobiology of acute and persistent pain at the molecular, cellular and neural systems levels. Thus, chronic pain may be conceptualized not as a symptom of disease but rather a disease unto itself. In this refresher course we will synthesize these recent advances and provide a unifying framework for understanding how fundamental cellular and subcellular processes that produce pathological pain neuroplasticity transform nociceptive neural networks in the spinal cord and brain. We will elucidate peripheral and spinal cord mechanisms of pain neuroplasticity through illuminating neuron-neuron synaptic plasticity and the emergent role of neuron-glia signaling, particularly in neuropathic pain. We will discuss the roles of plasticity and signaling in brain nociceptive networks in pain hypersensitivity. Finally we will describe the critical role of descending inhibitory and facilitatory modulation in gating persistent pain. Overall, we will discuss the pathological alterations in the peripheral nervous and central nervous systems that underlie and amplify chronic pain.
Chronic Musculoskeletal Pain Update: From Basic Science to Management (RC 02)
Daniel Clauw, Thomas Graven-Nielsen, Kim Bennell
This workshop is designed to give clinicians and researchers an overview of the underlying mechanisms operative in chronic musculoskeletal pain, as well as the most effective management strategies. A special emphasis will be placed on treating musculoskeletal pain based on a better understanding of the underlying mechanisms that are causing the pain in each individual, rather than the "disease" that is causing the pain. The reason for this is that recent research has clearly shown that conditions such as osteoarthritis, rheumatoid arthritis, and chronic low back pain, that had heretofore been thought to be predominantly "peripheral" pain states due to ungoing nociceptive input, are now being recognized as having a strong component of "centralization" of pain in subsets of individuals with these entities.
Headache Update - Diagnosis and Therapy (RC 03)
Peter Goadsby, Rigmor Jensen, Zaza Katsarava
The workshop will update attendees on the latest approaches to the diagnosis and management of the common primary headache disorders: migraine, tension-type headache and the trigeminal autonomic cephalalgias.
Pain Psychology for Non-Psychologists (RC 04)
Johan Vlaeyen, Lance McCracken, Amanda Williams
This refresher course is for non-psychologists working in the pain field who wish to become familiar with the application of psychological science to the assessment and treatment of acute and chronic pain. We also welcome psychologists who have recently begun to work in pain management, or to experienced psychologists who wish to refresh their knowledge of psychological principles and methods applicable to the assessment and treatment of acute and chronic pain. Our goals are to provide a review of the theoretical basis of psychological assessment and treatment methods, to summarize and update current empirical evidence supporting the efficacy of psychological interventions for chronic pain, and to illustrate major psychological assessment and treatment methods currently used in various pain management settings. Throughout the presentation, we will use specific clinical examples, modeling strategies, and interactive dialogue with participants to enhance learning. In this course three areas will be highlighted: (1) Multi-method assessment of pain and pain disability by Amanda Williams. (2) Psychosocial approaches to pain management, including mindfulness and acceptance and commitment therapy approaches by Lance McCracken. (3) The role of pain beliefs, pain-related fear and exposure based treatments by Johan Vlaeyen.
Clinical Pharmacology: Evidence-Based Guidelines and Defining the Proper Outcome (RC 05)
Ian Gilron, Eija Kalso, Stephan Schug
This workshop will provide a clinically oriented review of the pharmacology of NSAIDs, opioids, antidepressants and anticonvulsants for the treatment of pain.
Neuropathic Pain Update: From Basic Mechanisms to Clinical Management (RC 06)
Rolf-Detlef Treede, David Bennett, Nadine Attal
Neuropathic pain has evolved from chronic intractable pain to a manageable clinical condition. Guidelines on its assessment and treatment have been developed by several institutions including the European Federation of Neurological Societies (EFNS) and the Neuropathic Pain Special Interest Group of IASP (NeuPSIG). Nevertheless, neuropathic pain remains puzzling for a number of reasons. For patients, it is puzzling why pain is perceived in a part of the body that appears to be perfectly healthy. For the treating physician and nurse, it is puzzling why only a minority of patients with the same diagnosis develop neuropathic pain and why the response to therapy is so variable. For basic scientists, the sheer magnitude of the signal pathways activated by damage to the peripheral or central parts of the somatosensory nervous system is staggering. This refresher course aims to provide the participants with insights into how to address all of these puzzles, although we are still far from solving them. We will start with a brief description of the conceptual basis of neuropathic pain, followed by an update on current animal models and their readouts. This section will lead into a brief summary of the peripheral and central mechanisms of neuropathic pain. We will then outline techniques for the assessment of patients with neuropathic pain that are intended to establish a diagnosis and to provide the basis for mechanism-based pain therapy. The section on treatment of neuropathic pain will begin with evidence-based treatment regimens, mostly for peripheral neuropathic pain due to diabetes or herpes zoster (shingles), followed by a discussion of how to treat some other common conditions. Some upcoming treatment options will also be explained, but it should be noted that they are not yet fully validated. Case reports illustrate some practical clinical problems that are commonly encountered.
Interventional Therapies for Chronic Pain: Indications and Efficacy (RC 07)
Maarten van Kleef, Richard Rauck, Richard North
This refresher course will focus on the intervention options for the treatment of chronic pain and cancer pain. Prof dr M. van Kleef will focus on spinal pain. Spinal pain is divided in cervical, thoracic and lumbar pain and differs between facet pain and radicular pain. Recommendations formulated are based on the available evidence until now. Dr Rauck will present interventional therapies in cancer pain. After the presentation, the participant should have a better understanding of the indications for interventional procedures in patients with cancer pain. The presentation will review the literature on efficacy and outcomes of different procedures and update new evolving technology and procedures in this area. The goal of reducing opioid burden, where possible, will be presented and discussed. Dr. North will present the evidence of spinal cord stimulation and will discuss the Evidence Based Medicine paradigm, present and review clinical research evidence on Spinal Cord Stimulation.
Rational Opioid Therapy for Cancer and Non-Cancer Pain (RC 08)
Jane Ballantyne, Seddon Savage, Mary Lynn McPherson
The focus of this Refresher Course will be the role of opioids in cancer and non-cancer pain in the light of new evidence about opioid limitations and safety. The aim of the session will be to outline new knowledge and add some perspective regarding opioid dosing, safety and likely outcomes. Mary Lynn McPherson will open the course with a discussion on the role of opioids in the management of advanced cancer pain. She will present evidence regarding the role and efficacy of opioids in this patient population, as well as pharmacokinetic and pharmacodynamic differences between opioids, and patient and opioid-related variables that influence opioid selection. Jane Ballantyne will discuss the application of palliative care principles to the management of chronic pain as they were applied when opioids were first extended to patients with chronic non-cancer pain, and as they might be applied now that we have a better understanding of opioid long-term efficacy and safety. Seddon Savage will consider the indications for opioid therapy in the context of multidimensional options for chronic pain management. She will present emerging understanding of risk factors for opioid misuse and medical factors that may result in adverse outcomes. She will discuss considerations in the selection of medications, dose and scheduling including the use of long and short acting medications.
Treating Pain in Children: Current Practice, Recent Advances, and Current Debates (RC 09)
Denise Harrison, Christiane Hermann, Maria Fitzgerald
The refresher course will commence with a summary of the biological basis of pain processing and how this knowledge can be used to provide a rational basis for pain management strategies. The focus will be upon recent advances in our understanding of the structural and functional development of neural pathways that mediate pain and pain plasticity in infants. The potential for such a scientific approach in identifying new directions for the improvement of pain measurement and pain relief in vulnerable infants and children will be explained. The second presentation will focus on the evidence from current systematic reviews of pain reduction strategies for infants and young children. This will include systematic reviews of topical and local anesthetics agents; sucrose and other sweet solutions; skin-to-skin care; breast feeding, and other physical and psychological strategies. Evidence, utilization of the evidence, and research gaps pertaining to each of the topics will be discussed. Current debates, challenges in clinical applications and future research directions will be explored. In the third presentation, the current status of behavioral and pharmacological interventions in the treatment of chronic pain in children and adolescents with a specific focus on what is known about their efficacy, effectiveness and efficiency will be summarized. Closely related to these issues, the participants will learn about how treatment outcome can be measured. Moreover, the role of the social context in chronic pain will be outlined and an overview of which interventions are available to address these social influences and how they work will be provided. For each of these aspects, open questions and further developments are addressed.
Afternoon Refresher Courses (13:00 - 16:30)
Cancer Pain Update: From Mechanisms to Treatment (RC 10)
Michael Bennett, Anthony Dickenson, Anne-Kari Knudsen
This course will cover up to date evidence on mechanisms, classification, and treatment of cancer pain.
The Basics of Neuroimaging and Brain Interference Techniques (RC 11)
Petra Schweinhardt, Giandomenico Iannetti, Felipe Fregni
In this session, commonly used brain imaging techniques will be discussed as well as the novel field of brain interference techniques. Brain imaging techniques covered include methods that measure cerebral activation, such as electoencephalography [EEG], magnetoencephalography [MEG] and functional magnetic resonance imaging (fMRI), as well as methods that assess structure and morphology, such as voxel-based morphometry (VBM) and cortical thickness analysis (CTA). Finally, we will discuss the use of brain interference techniques (transcranial magnetic stimulation (TMS) and transcranial direct current stimulation (tDCS )) as emerging treatment options for pain relief.
Fundamentals of Neuropathic Pain Assessment and Diagnosis (RC 12)
Maija Haanpää, Didier Bouhassira, Michael Rowbotham
In the opening of the session the chair, Maija Haanpää will briefly explain the current IASP definition of neuropathic pain. Then Didier Bouhassira will introduce the neuropathic pain screening tools and critically review their utility and limitations based on the published literature and ongoing research. The next speaker, Michael Rowbotham, will teach how to perform a clinical examination to a patient with possible neuropathic pain, stressing meticulous sensory examination. In addition, his presentation will cover neurological examination overall to recognize the disease causing neuropathic pain, and how to differentiate neuropathic pain from other types of pains. Finally Maija Haanpää will present, with the help of illustrative examples, the use of clinical neurophysiology, neuroimaging, biopsies and other laboratory examinations in confirming the neurological diagnosis and guiding treatment. After the three talks, questions and lively discussion are encouraged.
Update on the Management and Treatment of Complex Regional Pain Syndrome (RC 13)
Lorimer Moseley, Frank Huygen, Frank Birklein
This refresher will focus on the prediction, assessment, diagnosis and treatment of CRPS. Current concepts in the pathophysiology of CRPS will be presented and related to the clinical features of acute and chronic CRPS. Prof Birklein will focus on acute CRPS and the role of inflammation in the early stages of the disease. Pharmacological treatments will be discussed according to their proposed mechanism of action, the evidence concerning their indications, effects, side effects and risks, and optimal timing and dosage. Prof Huygen will provide a current overview of the evidence for and against a range of treatments for acute and chronic CRPS. Prof Moseley will focus on rehabilitation of chronic CRPS, with an emphasis on strategies that target cortical mechanisms, including assessment and progression. This refresher will of interest to clinicians who see patients with acute or chronic CRPS.
What Do We Know About Orofacial Pain? Mechanisms and Clinical Approach (RC 14)
Rafael Benoliel, Antoon de Laat, Eli Eliav
The session will begin with an overview of the major clinical families of chronic orofacial pain and diagnostic systems currently in use. The individual talks will examine the clinical, pathophysiological and therapeutic aspects of selected groups- the temporomandibular disorders, burning mouth, trigeminal neuralgia, traumatic neuropathy and neurovascular pain.
Persistent Postoperative Pain: Pathogenic Mechanisms and Preventive Strategies (RC 15)
Henrik Kehlet, Robert Edwards, Asokumar Buvanendran
To provide an overview of pre-, intra- and postoperative risk factors for developing persistent postsurgical pain and to outline strategies for prevention and therapy.
Pain Genes: A Course for Non-Geneticists (RC 16)
Marshall Devor, Luda Diatchenko, Michel Ferrari
The course, which is geared to non-geneticists, will provide a general introduction to pain genetics including reasons why everyone involved in Pain Science and Medicine would benefit from a basic familiarity with the subject. We will begin by explaining basic concepts such as the difference between a gene and its protein product, gene expression and regulation, genes affecting disease susceptibility vs. genes affecting pain susceptibility, mutations vs. polymorphisms, types of inheritance (monogenic and polygenic), multi-factorial/ complex genetics in relation to diseases, interactions of genes and environment and differences between the pursuit of candidate genes vs. the unbiased search for gene linkage and association. We will then proceed to a more specific discussion of monogenic influences on pain and headache syndromes. This will include presentation of some key mutations that result in painful and pain-free neuropathies and headache syndromes (including migraine), and analysis of transgenic mouse models of these mutations. Finally, we will consider multifactorial complex pain conditions and genetic approaches to analyzing them and deriving from them novel information about pain mechanisms.
Pathophysiology, Diagnosis, and Treatment of Persistent Abdominopelvic Pain (RC 17)
Fred Howard, Karen Berkley, Emeran Mayer
This workshop will present our current understanding of visceral neurobiology, with focus on the gastrointestinal tract and the reproductive tract, and the mechanisms involved in persistent or chronic abdominopelvic pain. Both central and peripheral nervous system mechanisms in persistent abdominopelvic pain will be discussed. This understanding of neurobiology will be integrated in a translational manner to try to explain current and possible future approaches to diagnosis and treatment of chronic abdominopelvic pain.
Low Back Pain: Basic Mechanisms, Treatment, and Management (RC 18)
Steven Linton, Chris Maher, Jan van Zundert
Low back pain is a leading reason for seeking health care and yet there is considerable variation in how the problem is dealt with in the clinic. This course will provide an updated overview of the problem, the mechanisms driving it, and guidance on assessment and treatment. Indeed, low back pain is a multidimensional problem that has physiological as well as psychological and social aspects. It is also associated with dysfunction and high costs for the individual and society. Unfortunately, the pain sometimes develops into a recurrent or persistent problem associated with great suffering and disability. In order to deal with low back pain, a good assessment is necessary. Further, the assessment should provide guidance for making appropriate treatment choices. We will provide guidance in conducting assessments that are also helpful for developing a treatment plan and introduce the idea of attending to risk factors during patient evaluation. Based on the assessment and whether the pain is acute or recurrent, we will explore treatment options for dealing with the pain and maintaining function. An emphasis will be made on treatments that are most applicable for the acute stage versus the recurrent stage. We will also deal with psychological methods that may enhance the selection of treatment and aid in maintaining function. The evidence concerning various treatment options will be highlighted and the choices available illuminated. Finally, methods to manage patients on a long-term basis will be discussed as an alternative for patients with recurrent or persistent low back pain.
Emergent Integrative Therapies for Chronic Pain (RC 19)
Vitaly Napadow, Ted Kaptchuk, Karen Sherman
Integrative, or Complementary and Alternative Medicine, therapies have enjoyed growing popularity for patients suffering from chronic pain. There is also a growing body of research evidence exploring both the efficacy and potential mechanisms of action underlying various therapies described as integrative medicine. Many integrative therapies that have demonstrated the most promise for alleviating chronic pain take advantage of endogenous analgesic mechanisms. Interestingly, recent studies have begun to unravel different endogenous analgesic mechanisms underlying so-called placebo effects, which may have interesting overlap with some integrative therapies. This refresher course will review the research base for integrative therapies including (1) manual therapies such as massage and joint manipulation, (2) yoga, and (3) acupuncture. The course will also focus on inter-relationships between the placebo effect and integrative therapies, and how placebos can be harnessed to augment many conventional analgesic therapies and to help alleviate pain.