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Neuropathic pain

Presented at: EFIC Virtual Pain Education Summit

Speakers

Thomas Tölle

Professor, Department of Neurology, Technische Universität München, Germany
BIOGRAPHY
Julia Forstenpointer

Germany
BIOGRAPHY
Solomon Tesfaye

Consultant Physician/Endocrinologist, Sheffield Teaching Hospitals, Honorary Professor of Diabetic Medicine, University of Sheffield, United Kingdom
BIOGRAPHY
Nanna Brix Finnerup

Professor And Head of the Danish Pain Research Center, Department of Clinical Medicine, Denmark
BIOGRAPHY

Abstract

Chair: Thomas Tölle, Germany

Assessment of neuropathic pain

Julia Forstenpointner, Germany

The grading system or diagnostic algorithm of neuropathic pain published by NeuPSIG of the IASP in an updated version in 2016 (Finnerup et al., 2016) is heavily relying on the definition of neuropathic pain published by the IASP in 2011 (Jensen et al., 2011). The definition states that neuropathic pain is “pain caused by a lesion or disease of the somatosensory nervous system”. The diagnostic algorithm is a grading system of the potential presence of neuropathic pain in the individual patient (Finnerup et al., 2016) and starts with a first step to seek for a history of relevant neurological lesion or disease.The other initial step is to try to relate the projected pain distribution, communicated in a pain drawing by the patient, to the suspected level of the lesion or disease of the somatosensory system. If matching, one has reached the first “possible” grade of certainty of the pain being neuropathic in nature. The search for somatosensory aberrations is the next examination step, and if present speaks in favor of a lesion or disease of the somatosensory channels, now arriving at the second grade, “probable”, of neuropathic pain presence. Finally, diagnostic tests confirming a lesion or disease of the somatosensory nervous system explaining the pain can be used, e.g., electroneurography, MRT or intraepidermal nerve fiber density count. If such findings are revealed the “definite” neuropathic pain grade level has been reached. Importantly, regardless of which of the two latter levels of certainty one finally arrives at one must always question the causality between the suspected or demonstrated lesion or disease of the somatosensory nervous system and the presumed neuropathic pain. This and other details related to the diagnostic work-up of neuropathic pain will be discussed during the presentation.

Phenotyping: Ready to implement in clinical practice?
Thomas Tölle, Germany

Update on the pharmacotherapy of neuropathic pain
Nanna Brix Finnerup, Denmark

In this presentation I will give a brief overview of the treatment options for neuropathic pain. The presentation will discuss general treatment strategies and clinical decision making. It will briefly discuss the pharmacological treatment, including the efficacy and side effects of tricyclic antidepressants, serotonin-noradrenaline reuptake inhibitors, gabapentin, pregabalin and topical agents and will briefly mention other pharmacological treatments. In addition non-pharmacological treatment options will be discussed.

Results of the OPTION DM trial
Solomon Tesfaye, United Kingdom

The main aims of this head-to head, double-blind, cross-over trial are to determine the most clinically beneficial, cost-effective and best tolerated. Treatment Pathway amongst: amitriptyline supplemented with pregabalin, duloxetine supplemented with pregabalin and pregabalin supplemented with amitriptyline, for patients with painful diabetic neuropathy (PDN). This multi-centre trial has been designed to have direct clinical applicability in the management of PDN following completion. The main results will, for the first time, be presented at the EFIC virtual meeting (6-8 November 2020).

Q&A

Neuropathic pain

Thomas Tölle

Julia Forstenpointer

Solomon Tesfaye

Nanna Brix Finnerup