📢 Early bird deadline EXTENDED 16 January 2024 31 January 2024. Register now

ICC Sydney

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ISPRM Pain Sig Session: Physiatric Led Pain Management Including Nocicpetive, Neuropathic And Nociplastic Pain: From Mechanisms To Personalized Management

Session outline

Chronic pain affects more than 30% of people, globally. Biological, psychological and sociocultural factors dynamically interact, causing several negative effects in people living with chronic pain. It can be classified into nociceptive, neuropathic and nociplastic pain. Nociceptive pain is classically defined as “an unpleasant sensory and emotional experience associated with, or resembling that associated with, actual or potential tissue damage”. Neuropathic pain arises from a lesion or disease of the somatosensory nervous system, including central and peripheral neurons leading to altered transmission of sensory signals in the nervous system. Overall lifetime prevalence of neuropathic pain is estimated to be greater than 50%. Neuropathic pain is common in Physical and Rehabilitation Medicine daily practice and remains a challenge, both to diagnose and to treat. In fact, effective management of neuropathic pain remains an unmet clinical need, with less than 50% of patients achieving substantial pain relief with medications currently recommended.

Nociplastic pain is recently defined as pain that arises from altered nociception despite no clear evidence of actual or threatened tissue damage causing the activation of peripheral nociceptors or evidence for disease or lesion of the somatosensory system causing the pain. Prevalence is estimated to be between 5% and 15% of the general population. Nociplastic pain derives from augmented pain processing and altered pain modulation in the central nervous system and should be considered in any patient with chronic pain. It is a phenotypic expression of multifactorial processes originating from different inputs, both as a response to a peripheral nociceptive or neuropathic trigger and reduced pain inhibitory mechanisms. Main clinical features of nociplastic pain conditions include combined peripheral and central sensitization, spinal cord reorganization, hyper-responsiveness to painful and non-painful sensory stimuli, associated with fatigue, sleep and cognitive disturbances, hypersensitivity to environmental stimuli, anxiety and depression mood. It is relevant to recognize this type of pain, as it responds to different therapies than nociceptive pain with a decreased responsiveness to peripherally directed therapies such as anti-inflammatory drugs, opioids, surgeries and invasive procedures.

Differential diagnosis of nociceptive, neuropathic and nociplastic pain is, therefore key to proper management. Novel multimodal emerging pharmacological and non-pharmacological approaches targets the modulation of afferent input and descending pathways inhibition. Such interventions are based on specific conditions, patient comorbidities and best available scientific evidence. Multidisciplinary pharmacological, behavior, and neuromodulation approaches to achieve optimal outcomes. Phenotype-based stratification facilitates the provision of individualized therapeutic mechanism-based treatments. We present state-of-the-art clinical assessment, validity of diagnostic, screening tools and recommendations for the personalized interventions for managing common nociceptive, neuropathic and nociplastic pain conditions using PRM led pain management.

Learning outcomes

  • Participants will have a better understanding of the pathophysiological mechanisms involved in the ongoing pain processing, including peripheral nociceptor sensitization, spinal sensitization and supraspinal changes.
  • Learners will be acquainted with clinical updates on neuropathic pain management in patients with cerebral palsy, spinal cord injuries, amputees and cancer.  
  • Learners will be updated on assessment tools, including self-reported instruments, screening tools, bedside examination and confirmatory tests for the differential diagnosis of nociceptive, neuropathic and nociplastic pain.
  • Learners will be able to perform clinical diagnosis of neuropathic pain, be familiar with its grading system, and understand the rationale for the confirmatory tests of neuropathic pain in patients with spinal cord injuries
  • Learners will be able to understand the rationale for the phenotype-based stratification to facilitate the provision of individualized therapeutic mechanism-based treatments.

Target audience

  • Allied health
  • Medical practitioners
  • Students
  • Trainees
  • Nursing staff
  • General public