#EFIC2023 GP Sessions

This workshop aims to provide the most recent evidence-based information on diagnosing and curing patients with neuropathic pain.

The first presentation will deal with the recent guidelines on neuropathic pain diagnosis issued by a joint EAN-EFIC-NeuPSIG task force. More specifically, Andrea Truini will present details on the diagnostic accuracy of the different tools commonly used for diagnosing neuropathic pain, namely screening questionnaires, quantitative sensory testing, neurophysiology and skin biopsy.

In the second presentation Xavier Moisset will discuss the currently available evidence on the safety and efficacy of the commonly used drugs for treating neuropathic pain; he will also open the discussion on the current controversies about the misuse of gabapentinoids. He will then provide suggestions for an evidence-based therapeutic algorithm for patients with neuropathic pain.

In her presentation, Nathalie André-Obadia will show the currently used non-invasive brain neurostimulation techniques for treating neuropathic pain, i.e. repetitive transcranial magnetic stimulation (rTMS) and transcranial direct current stimulation (tDCS). She will present the mechanisms underlying their efficacy and will detail the current evidence supporting their use in patients with neuropathic pain.

We aim to present established and novel methods to generate evoked potentials recorded by EEGs.

These procedures, some of them only recently developed, enable the detailed revealing of components of the somatosensory system. Providing objective results, they are especially advantageous over previously established methods such as Quantitative Sensory Testing. Several stimuli are applied to the skin, which is then processed centrally. This processing manifests as potentials in the simultaneously-recorded EEG. Thus, latencies and amplitudes can be measured and assigned to the respective fiber classes. This enables a dedicated assessment of the somatosensory system. Thus, pathologies can be uncovered – objectively.

In this workshop, cold, contact-heat, laser and PinPrick stimuli are presented to facilitate a broad overview of the field of evoked potentials. The clinical relevance of these methods is discussed and explained in more detail using exemplary cases. Next to appealing cases, the speakers will engage participants in discussions on how to prevent pitfalls both in assessing and interpreting evoked potentials. Participants will have the chance to apply stimuli independently and will be made familiar with EEG evaluation. They will also have the opportunity to perceive the various stimuli themselves. The relevance for clinical and scientific use will be discussed.

The perception of pain highly depends on the spatial and temporal aspects of pain modulation. These aspects are most likely altered during pathological states such as chronic pain, causing disrupted integration of nociceptive input. However, it remains unclear how pain is shaped by dynamic changes within the nociceptive system in terms of its temporal and spatial domains. Recent findings from basic research in humans have shed light on how nociceptive input is filtered (peripherally and centrally) and integrated. Accordingly, our labs showed, for instance, that spatial summation of pain (SSP) is non-linear and temporal contrast enhancement very often completely abolishes pain perception (as seen in offset analgesia). Furthermore, temporal and spatial aspects of pain modulation are also highly dependent on cognitive processes such as learning and expectations. Studies from our labs indicate that the delivery of different temporal suggestions can modulate when placebo analgesia and nocebo hyperalgesia set in, giving novel insights into the temporal modulation of pain at a high-cognitive level. In this workshop, recent findings related to the spatial and temporal aspects of pain modulation will be presented with a particular focus on SSP, offset analgesia and the temporal modulation of placebo analgesia and nocebo hyperalgesia.

INTEGRATE-Pain was created by the NIH in the U.S. and IMI-PainCare in Europe to foster cooperation in the field of pain research, with the goal of improving research and treatment for all pain conditions and increasing comparability and generalizability across pain conditions. INTEGRATE-Pain has been focused on developing overarching core outcome sets (COS) for pain categories which span the spectrum of pain from acute to chronic pain. Our team conducted a systematic literature review (SLR) to identify and bring together initiatives that had previously developed disease or condition-specific COS for pain. We invited researchers from the COS initiatives and persons with lived experience (PWLE) to provide feedback at a virtual meeting and then participate in a Delphi to create COS for acute pain, the transition from acute to chronic pain, recurrent/episodic pain, and chronic pain. The online Delphi reached a consensus on the most critical domains for the COS. The goal of this workshop is to present the SLR, Delphi process (including engagement of researchers and PWLE), Delphi/COS results, and perspectives of PWLE. We will also discuss challenges and implications associated with the adoption of these overarching COS for the field of pain.