Primers to specific pain conditions

  • Hani Hattar

    Senior consultant in Pain Management, Pain Unit, VSpeästerviks Hospital, Sweden
  • Frank Huygen

    Anaesthesiologist, University Hospital, Erasmus Medical Centre, Professor in Anaesthesiology, Erasmus University Rotterdam, The Netherlands
  • Nina Bohm Starke

    Associate Professor and Senior Consultant, Department of Obstetrics, Gynecology, Danderyd Hospital Karolinska Institutet, Stockholm, Sweden
  • David Walsh

    Director, Pain Centre Versus Arthritis, Professor of Rheumatology, University of Nottingham, United Kingdom

Chair: Hani Hattar, Sweden
Frank Huygen, Netherlands
CRPS is a collection of locally appearing painful conditions following a trauma which chiefly occur distally and exceed in intensity and duration the expected clinical course of the original trauma. CRPS is a clinical diagnosis based on criteria (Harden Bruehl / Budapest / New IASP Criteria). CRPS1 is without demonstrable nerve lesion, CRPS 2 with nerve lesion. Mechanisms playing a role in the pathophysiology of CRPS can be classified as afferent (e.g. inflammation), efferent (e.g. central sensitization) and central (e.g. cortical reorganization). Several mechanisms are playing a role at the same time. After a while, inflammation disappears in a part of the patients, what remains is damage. Based on this course different phenotypes can be distinguished, namely patients with a fulminant picture, patients with mainly sensory, vasomotor and motor disturbances. When assessing the patient, it is important, in addition to establishing the diagnosis, to consider the comprehensive differential diagnosis and the individual phenotype. Therapy has to be personalized based on
these phenotypes 1.
Nina Bohm-Starke, Sweden
The objective of the presentation is to give a clinical overview of vulvodynia, explaining the clinical features and management. Future challenges of vulvodynia will also be discussed.

Vulvodynia affects 8-10% of women, but the condition is underreported and there is limited epidemiologic data from many countries. The most common subtype of vulvodynia is the “localized provoked vulvodynia or provoked vestibulodynia (PVD)” with severe pain at contact of the mucosa around the vaginal opening. Women with PVD suffer from superficial dyspareunia and are usually unable to have intercourse, resulting in large impact of quality of life.

The etiology is largely unknown with a complex interplay of peripheral and central pain mechanisms, pelvic floor muscle dysfunction as well as cognitive–affective, behavioural and interpersonal factors associated to the onset and maintenance of the pain.

There is low scientific evidence on treatment modalities, but a multi-modal approach is recommended focusing on pain management, physiotherapy to restore the function of the pelvic floor muscles and psychosocial interventions.

Future challenges are the need to increase the education and awareness of vulvodynia for both the general population and for health providers, improve the organization of health care systems in order to increase the availability for vulvodynia patients to receive adequate care and there is also the need for more research funding with special aim to improve studies on etiology and treatment.
Pain in hereditary connective tissue disorders
Hani Hattar, Sweden
David Walsh, United Kingdom
Osteoarthritis is the most prevalent form of arthritis, ever increasing in an ageing population. Osteoarthritis pain has diverse mechanisms and characteristics. Peripheral factors trigger weight-bearing pain, while central mechanisms determine prognosis. Specific tools have been developed to measure the pain of osteoarthritis, but measurement is only one component of assessment. 2019 guidelines from Osteoarthritis Research Society International (OARSI) reinforce the need for a tiered approach to osteoarthritis pain management, both multimodal and personalised.

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