- Email: [email protected]
41 MULTIDIMENSIONAL PSYCHOLOGICAL AND NEUROSCIENTIFIC PREDICTION OF POST-OPERATIVE PAIN
10
TOPICAL SEMINAR SUMMARIES / European Journal of Pain Supplements 5 (2011) 5–14
Clinical findings are important for an optimal pharmacological management, where opioid analgesics are of utmost importance in pure cancer pain, but will need additional co-strategies including e.g. antidepressants and anticonvulsants in the case of a neuropathic pain component. Disclosure: None declared
39 ON THEIR WAY FROM BASIC SCIENCES TO BEDSIDE: NOVEL ELECTROPHYSIOLOGICAL DIAGNOSTIC TOOLS AND PROCEDURES IN PAIN AND PAIN RESEARCH L. Hu1 , W. Greffrath2 *, A. Mouraux3 , S. Hatem4 . 1 Key Laboratory of Cognition and Personality (Ministry of Education) and School of Psychology, Southwest University, Chongqing, China; 2 Department of Neurophysiology, Centre for Biomedicine and Medical Technology Mannheim (CBTM), Universitaetsmedizin Mannheim, Medical Faculty Mannheim, Heidelberg University, Mannheim, Germany; 3 Laboratoire d’algologie, Universit´e catholique de Louvain, 4 Clinic of Physical and Rehabilitation Medicine, CHU Brugmann (Site Horta), Brussels, Belgium This topical seminar aims to focus on novel methods and tools developed in basic research for the study of pain. To gain fundamental insights into cortical mechanisms underlying nociception and pain, new approaches are needed to identify brain responses more specifically related to nociceptive and nonnociceptive processing. The speakers will shed light on whether and how those new features may be used in clinical routine to improve detailed diagnostics of pain and pain syndromes. In particular, the talks will focus on recent approaches and advantages to stimulate clinically-meaningful populations of nociceptors selectively and thereby evoke specific event-related potentials (ERPs). Contact thermal stimulation for the induction of cold-evoked potentials will be introduced and their advantages and disadvantages discussed in comparison with heat-evoked ones. Recent advances using intra-epidermal electrical stimulation for activation of Ad- and C-fiber skin nociceptors, feedbackcontrolled infrared laser – as well as mechanical stimulation will be presented and their clinical potentials discussed. Furthermore, novel stimulation paradigms that may further improve diagnostics in pain patients will be introduced and nociceptive steady-state evoked potentials that specifically tag nociceptive cortical activity. Novel EEG analysis techniques that have been already or are likely to have clinical relevance in future will be presented including wavelet filters for enhancement of ERPs, time-frequency analysis and approaches to exploit the information contained in trial-to-trial variability. Finally, automated single trial analysis of event-related potentials and their major asset for clinical studies will be described and compared with visual approaches for analysis of nociceptive and non-nociceptive somatosensory ERPs in patients. Disclosure: None declared
40 THE SCIENCE OF EARLY INTERVENTION FOR DISABLING PAIN K.E. Vowles1,2 *, C.J. Main2 , J. Hill2 , A. Meulders3 . 1 IMPACT Pain Service, Haywood Hospital, Burslem, 2 Centre for Primary Care Sciences, Keele University, Keele, UK; 3 Department of Psychology, University of Leuven, Leuven, Belgium Psychosocial factors are established predictors of longer term functioning in acute and chronic pain. There have been multiple calls for improvements in our ability to identify individuals at risk, as well as our ability to provide efficacious treatment. Over the past several years, multiple studies have attempted to achieve these goals. This seminar will provide an overview of the latest academic and clinical efforts in this area. Dr. Jonathan Hill will review the findings of a large study aimed at identifying risk status within a large sample of over 800 low back pain patients and assigning them to appropriate treatment based on risk status.
Dr. Kevin Vowles will provide a detailed examination of those at high risk of long term disability, including methods of early detection using self-report measures so that appropriate treatment can be implemented. Dr. Ann Meulders will present experimental data supporting the involvement of learning mechanisms in the development of fear of movement-related pain, as well as the implications for optimizing treatment and interventions. Finally, as chair, Professor Chris Main will provide a critical appraisal of these data, synthesize them relative to the field as a whole, and comment on avenues of further study. Disclosure: None declared
41 MULTIDIMENSIONAL PSYCHOLOGICAL AND NEUROSCIENTIFIC PREDICTION OF POST-OPERATIVE PAIN S. Lautenbacher1 *, M. Peters2 , D. Yarnitsky3 . 1 Physiological Psychology, University of Bamberg, Bamberg, Germany; 2 Experimental Health Psychology, Maastricht University, Maastricht, The Netherlands; 3 Neurology, Rambam Health Care Campus, Haifa, Israel It is desirable to predict post-operative pain by a small set of easily accessible clinical data. However, such data have been shown to be far from allowing for best possible prediction. Other variables targeting both somatic and mental domains can still add substantially to prediction. The symposium will review the various dimensions, which have recently shown their predictive value in the psychological and neuroscientific domains. There are factors, which the patients can be aware of and self-report. Such factors like depression, hypervigilance, surgical fear and optimism have been proven to be first-class predictors of post-operative pain. There are other factors, which remain unconscious and require alternative methods of assessment. For example, attentional biases with overly focus on pain can behaviorally be tested and have shown predictive value. Pain itself activates a cascade of excitatory and inhibitory processes, the balance of which seems to differ between patients and can only be assessed by static and dynamic pain tests. A lack of pain inhibitory capacity can be psychophysically detected and has appeared to predict acute and chronic post-operative pain as well as response to pain therapy. This still growing list shows the huge range of critical factors in the psychological and neuroscientific domains. Complete lists of critical and mutually independent factors are needed not only for a better understanding of post-operative pain but for a rational of reducing the number of predictors to levels, which can be useful in clinical practice. Recommendations according to the state-of-the-art will be given. Disclosure: None declared
42 SPHINGOSINE 1-PHOSPHATE: REGULATOR OF INFLAMMATION AND PAIN G. Nicol1 , M. Langeslag2 , G. Geisslinger3 , D. Salvemini4 , M. Kress5 *. 1 Indiana University School of Medicine, Indianapolis, IN, USA; 2 Medical University Innsbruck, Innsbruck, Austria; 3 Frankfurt University, Frankfurt/Main, Germany; 4 Saint Louis University School of Medicine, St. Louis, MO, USA; 5 Medical University University, Innsbruck, Austria Bioactive sphingolipids are strongly associated with inflammation including chronic inflammatory diseases such as relapsing multiple sclerosis or rheumatoid arthritis. In particular, sphingosine-1phosphate (S1P) is locally increased in inflammation. It is generally accepted that S1P controls proliferation, differentiation and migration of macrophages or B lymphocytes, and the local immune response. Specific functions of S1P in the nervous system and in particular the pain pathway have been discovered only recently. Peripherally injected S1P induces spontaneous pain-like behaviour and thermal hypersensitivity in vivo. S1P enhances excitability of small diameter sensory neurons and induces nociceptor sensitisation via TRPV1 regulation in vitro. G-protein coupled S1P receptors (S1PRs) are expressed in nociceptors and
TOPICAL SEMINAR SUMMARIES / European Journal of Pain Supplements 5 (2011) 5–14
Clinical findings are important for an optimal pharmacological management, where opioid analgesics are of utmost importance in pure cancer pain, but will need additional co-strategies including e.g. antidepressants and anticonvulsants in the case of a neuropathic pain component. Disclosure: None declared
39 ON THEIR WAY FROM BASIC SCIENCES TO BEDSIDE: NOVEL ELECTROPHYSIOLOGICAL DIAGNOSTIC TOOLS AND PROCEDURES IN PAIN AND PAIN RESEARCH L. Hu1 , W. Greffrath2 *, A. Mouraux3 , S. Hatem4 . 1 Key Laboratory of Cognition and Personality (Ministry of Education) and School of Psychology, Southwest University, Chongqing, China; 2 Department of Neurophysiology, Centre for Biomedicine and Medical Technology Mannheim (CBTM), Universitaetsmedizin Mannheim, Medical Faculty Mannheim, Heidelberg University, Mannheim, Germany; 3 Laboratoire d’algologie, Universit´e catholique de Louvain, 4 Clinic of Physical and Rehabilitation Medicine, CHU Brugmann (Site Horta), Brussels, Belgium This topical seminar aims to focus on novel methods and tools developed in basic research for the study of pain. To gain fundamental insights into cortical mechanisms underlying nociception and pain, new approaches are needed to identify brain responses more specifically related to nociceptive and nonnociceptive processing. The speakers will shed light on whether and how those new features may be used in clinical routine to improve detailed diagnostics of pain and pain syndromes. In particular, the talks will focus on recent approaches and advantages to stimulate clinically-meaningful populations of nociceptors selectively and thereby evoke specific event-related potentials (ERPs). Contact thermal stimulation for the induction of cold-evoked potentials will be introduced and their advantages and disadvantages discussed in comparison with heat-evoked ones. Recent advances using intra-epidermal electrical stimulation for activation of Ad- and C-fiber skin nociceptors, feedbackcontrolled infrared laser – as well as mechanical stimulation will be presented and their clinical potentials discussed. Furthermore, novel stimulation paradigms that may further improve diagnostics in pain patients will be introduced and nociceptive steady-state evoked potentials that specifically tag nociceptive cortical activity. Novel EEG analysis techniques that have been already or are likely to have clinical relevance in future will be presented including wavelet filters for enhancement of ERPs, time-frequency analysis and approaches to exploit the information contained in trial-to-trial variability. Finally, automated single trial analysis of event-related potentials and their major asset for clinical studies will be described and compared with visual approaches for analysis of nociceptive and non-nociceptive somatosensory ERPs in patients. Disclosure: None declared
40 THE SCIENCE OF EARLY INTERVENTION FOR DISABLING PAIN K.E. Vowles1,2 *, C.J. Main2 , J. Hill2 , A. Meulders3 . 1 IMPACT Pain Service, Haywood Hospital, Burslem, 2 Centre for Primary Care Sciences, Keele University, Keele, UK; 3 Department of Psychology, University of Leuven, Leuven, Belgium Psychosocial factors are established predictors of longer term functioning in acute and chronic pain. There have been multiple calls for improvements in our ability to identify individuals at risk, as well as our ability to provide efficacious treatment. Over the past several years, multiple studies have attempted to achieve these goals. This seminar will provide an overview of the latest academic and clinical efforts in this area. Dr. Jonathan Hill will review the findings of a large study aimed at identifying risk status within a large sample of over 800 low back pain patients and assigning them to appropriate treatment based on risk status.
Dr. Kevin Vowles will provide a detailed examination of those at high risk of long term disability, including methods of early detection using self-report measures so that appropriate treatment can be implemented. Dr. Ann Meulders will present experimental data supporting the involvement of learning mechanisms in the development of fear of movement-related pain, as well as the implications for optimizing treatment and interventions. Finally, as chair, Professor Chris Main will provide a critical appraisal of these data, synthesize them relative to the field as a whole, and comment on avenues of further study. Disclosure: None declared
41 MULTIDIMENSIONAL PSYCHOLOGICAL AND NEUROSCIENTIFIC PREDICTION OF POST-OPERATIVE PAIN S. Lautenbacher1 *, M. Peters2 , D. Yarnitsky3 . 1 Physiological Psychology, University of Bamberg, Bamberg, Germany; 2 Experimental Health Psychology, Maastricht University, Maastricht, The Netherlands; 3 Neurology, Rambam Health Care Campus, Haifa, Israel It is desirable to predict post-operative pain by a small set of easily accessible clinical data. However, such data have been shown to be far from allowing for best possible prediction. Other variables targeting both somatic and mental domains can still add substantially to prediction. The symposium will review the various dimensions, which have recently shown their predictive value in the psychological and neuroscientific domains. There are factors, which the patients can be aware of and self-report. Such factors like depression, hypervigilance, surgical fear and optimism have been proven to be first-class predictors of post-operative pain. There are other factors, which remain unconscious and require alternative methods of assessment. For example, attentional biases with overly focus on pain can behaviorally be tested and have shown predictive value. Pain itself activates a cascade of excitatory and inhibitory processes, the balance of which seems to differ between patients and can only be assessed by static and dynamic pain tests. A lack of pain inhibitory capacity can be psychophysically detected and has appeared to predict acute and chronic post-operative pain as well as response to pain therapy. This still growing list shows the huge range of critical factors in the psychological and neuroscientific domains. Complete lists of critical and mutually independent factors are needed not only for a better understanding of post-operative pain but for a rational of reducing the number of predictors to levels, which can be useful in clinical practice. Recommendations according to the state-of-the-art will be given. Disclosure: None declared
42 SPHINGOSINE 1-PHOSPHATE: REGULATOR OF INFLAMMATION AND PAIN G. Nicol1 , M. Langeslag2 , G. Geisslinger3 , D. Salvemini4 , M. Kress5 *. 1 Indiana University School of Medicine, Indianapolis, IN, USA; 2 Medical University Innsbruck, Innsbruck, Austria; 3 Frankfurt University, Frankfurt/Main, Germany; 4 Saint Louis University School of Medicine, St. Louis, MO, USA; 5 Medical University University, Innsbruck, Austria Bioactive sphingolipids are strongly associated with inflammation including chronic inflammatory diseases such as relapsing multiple sclerosis or rheumatoid arthritis. In particular, sphingosine-1phosphate (S1P) is locally increased in inflammation. It is generally accepted that S1P controls proliferation, differentiation and migration of macrophages or B lymphocytes, and the local immune response. Specific functions of S1P in the nervous system and in particular the pain pathway have been discovered only recently. Peripherally injected S1P induces spontaneous pain-like behaviour and thermal hypersensitivity in vivo. S1P enhances excitability of small diameter sensory neurons and induces nociceptor sensitisation via TRPV1 regulation in vitro. G-protein coupled S1P receptors (S1PRs) are expressed in nociceptors and