International Association for the Study of Pain®    IASP Press®

                                                                     Editor: Maria Adele Giamberardino

                       2002 · softbound · 471 pages · ISBN 0-931092-44-2.    Price: US$35.00

THIS BOOK IS SOLD OUT AND NO LONGER AVAILABLE FROM IASP

 

Table of Contents (click or see below)            Order Form                         IASP

Table of Contents (click on topic below or scroll down to see more details):
Mechanisms of Acute and Persistent Pain
Pain in Cancer Patients
Musculoskeletal and Rheumatic Pain
Clinical, Scientific, and Therapeutic Advancements in Headache
Clinical Trials of Pain Treatments
Neuropathic Pain
Pain and Physical Therapy
Interventional Therapies for Pain Management
Neurobiology of Chronic Pain: Molecular and Cellular Biology
Back Pain
Psychological Assessment and Treatment of the Pain Patient
Pain in Children
Postoperative Pain
Pharmacology of Pain
Orofacial Pain
Visceral Pain

 

R01 BASIC SCIENCE UPDATE: MECHANISMS OF ACUTE AND PERSISTENT PAIN

Allan I. Basbaum, PhD, Dept. of Anatomy, W.M. Keck Foundation Center for Integrative Neuroscience, University of California, San Francisco, California, USA
M. Catherine Bushnell,
PhD,
Harold Griffith Professor, Dept. of Anesthesiology, Faculty of Medicine, McGill University, Montreal, Quebec, Canada

The introduction to this course will discuss the problems and puzzles of pain and pain versus nociception - pain as a complex experience. It will go on to discuss: (a) peripheral mechanisms of pain including general properties of primary nociceptive afferents (types, responses to noxious stimuli and injury, transducers, and neurogenic inflammation and peripheral sensitization) and recent developments related to these properties and mechanisms and their clinical implications (injury-induced changes in nociceptor phenotype, contribution of sympathetics, relevance to pathophysiology of neuropathic pain, and chemical mediators); (b) spinal nociceptive mechanisms and their clinical implications, including transmission of nociceptive input to supraspinal centers (primary afferent projections to spinal cord, spinal dorsal horn transmission mechanisms, ascending pathways, thalamic pain mechanisms, and role of cortical structures in pain processing; (c) central sensitization mechanisms including central neuroplasticity and central sensitization (NMDA receptor-mediated changes; second messenger systems, LTP, sprouting and anatomical reorganization, and loss of GABAergic tone); and (d) modulation, including descending pain modulatory systems, modulation of pain by psychological states and environmental factors, and the influence of genetics, gender, and age on pain.

At the conclusion of this session, participants will have gained an understanding of: (1) general properties of and recent developments in the understanding the peripheral mechanisms of pain; (2) spinal nociceptive mechanisms and their clinical implications; (3) central sensitization mechanisms and central neuroplasticity; and (4) modulation of pain by descending systems and psychological states and environmental factors, as well as the influence of genetics, gender and age

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R02 PAIN IN CANCER PATIENTS

Marie T. Fallon, MD, FRCP, MRCGP, Senior Lecturer in Palliative Medicine, Edinburgh Oncology Center, University of Edinburgh, Edinburgh, UK
Eduardo Bruera
, MD, Professor of Palliative Care, MD Anderson Cancer Center, University of Texas, Houston, Texas, USA
Russell K. Portenoy, MD, Director of Pain and Palliative Care Program, Beth Israel Hospital, New York, New York, USA

Several country-wide surveys have reported comparable epidemiological data, suggesting consistent prevalence rates of 30-40% of patients in active therapy reporting pain and 70-90% of patients with advanced cancer reporting pain. Adequate assessment is the first critical step to define a treatment strategy for the patient with pain. Clearly the most appropriate diagnostic and therapeutic approaches to define the cause of the pain and to direct its treatment, must be used. Unfortunately lack of knowledge about pain assessment methodology is one of the common barriers associated with inadequate cancer pain treatment. Diagnosis of pain due to the common and less common pathological processes will be discussed alongside the most useful assessment strategies. In addition to problems with adequate cancer pain assessment, cancer pain once diagnosed, is often treated inadequately due to a lack of application of basic knowledge as outlined in the World Health Organization cancer pain program. In addition, there is a lack of more sophisticated knowledge about managing more complex cancer pain syndromes. The session will review the common approaches to cancer pain management, including the levels of evidence for each of the mentioned strategies and will progress to deal with more complicated strategies including complex drug regimens, anesthetic block techniques and surgical interventions for difficult cancer pain syndromes.

At the conclusion of this session, participants will have gained an understanding of: (1) the assessment of cancer pain and the diagnosis of common and less common cancer pain syndromes; (2) the management of cancer pain with levels of evidence for each strategy including an understanding of the place of alternative opioids and the use of adjuvant analgesics; and (3) an understanding of the management of cancer pain which does not respond to the strategies which are successful in the majority of patients. This will include more complicated pharmacological management, anaesthetic block techniques and surgical intervention.     Back to the top

R03 MUSCULOSKELETAL AND RHEUMATIC PAIN

Bruce L. Kidd, MD, Reader in Rheumatology, University of London, Bone & Joint Research Unit, Queen Mary’s School of Medicine, London, UK
Robert M. Bennett
, MD, FRCP, Chair, Arthritis/Rheumatic Diseases, Dept. of Medicine, Oregon Health Sciences University, Portland, USA
Michael Doherty
, MA, MD, FRCP,
Professor of Rheumatology, Nottingham City Hospital, Nottingham, UK

Musculoskeletal symptoms are ubiquitous and have costs both to the individual and to society. Paradoxically, disease or damage within the musculoskeletal system may remain asymptomatic in some individuals, whereas others experience symptoms in the absence of identifiable pathology. This diversity and the emergence of novel mechanism-specific drugs lends urgency to a reappraisal of techniques for diagnosis and management of patients with rheumatic disease. This course will characterize musculoskeletal symptoms and signs and includes discussions relevant to rheumatoid arthritis, osteoarthritis and fibromyalgia. Factors contributing to the development of symptoms in these conditions and strategies for delivery of optimal therapy will be explored.

At the conclusion of this session, participants will have gained an understanding of : (1) pathways underlying the development of mechanical hypersensitivity; (2) techniques for assessing musculoskeletal symptoms and signs; (3) the value of mechanism-based approaches to diagnosis; and (4) the efficacy of pharmacological and other therapies for alleviation of musculoskeletal pain. 
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R04 CLINICAL, SCIENTIFIC AND THERAPEUTIC ADVANCEMENTS IN HEADACHE

Jes Olesen, MD, Professor and Chairman, Dept. of Neurology, University of Copenhagen, Glostrup Hospital, Glostrup, Denmark
Peter J. Goadsby
, MD, PhD, FRACP, The National Hospital for Neurology and Neurosurgery, London, UK
Rami Burstein
, PhD, Dept. of Anesthesia and Critical Care, Beth Israel Deaconess Medical Center, Harvard University, Boston, Massachusetts, USA
Carl G. H. Dahlof
, MD, PhD,
Gothenburg Migraine Clinic, Gothenburg, Sweden

The classification of headache is based on multiple clinical symptoms, associated neurological disorders, and precipitating factors. Because headache attacks can be precipitated by a wide variety of internal and external factors that seem to vary through complex interactions with the physiological milieu and individual genetic predisposition, it is generally believed that multiple factors and different pathophysiologies produce the different headaches. Current studies on the initiation and pathophysiologies of the different headaches focus on two principal directions: (a) peripheral and central organization, physiological characterization and molecular properties governing the activation of sensory pain fibers that innervate cranial and pericranial pain-sensitive organs such as muscles, blood vessels, meninges, and sinuses; and (b) abnormal activity of cortical and hypothalamic neurons that regulate autonomic flow and brainstem descending pathways that facilitate or inhibit processing of pain signals by spinal cord neurons. The concept that activation of ascending trigeminovascular pain pathways could be achieved by both, signals that arise in peripheral pain fibers and enhanced or reduced signals from endogenous modulatory systems provide new targets for future headache therapies.

At the conclusion of this session, participants will have gained an understanding of: (1) key clinical symptoms used in the diagnosis and classification of the different headaches; (2) current knowledge on the pathophysiology of headache and migraine; and (3) future directions in headache therapy.                                                                                                                                      Back to the top

R05 CLINICAL TRIALS OF PAIN TREATMENTS

Mitchell Max, MD, Pain and Neurosensory Mechanisms Branch, National Institute of Dental and Craniofacial Research, National Institutes of Health, Bethesda, Maryland, USA (chair)
Audun Stubhaug
, MD, Department of Anesthesiology, University of Oslo, Oslo, Norway
Jaap Mandema
, PhD, Pharsight Corporation, Mountain View, California, USA
Scott Diehl
, PhD, Molecular Genetic Epidemiology Unit, DIR, National Institute of Dental and Craniofacial Research, National Institutes of Health, Bethesda, Maryland, USA
Michael P. Meredith
, PhD, Procter & Gamble Research Fellow, Biometrics & Statistical Sciences Dept., Procter & Gamble Pharmaceuticals, Mason, Ohio, USA
Bradley S. Galer
, MD,
Endo Pharmaceuticals, Chadds Ford, Pennsylvania, USA (discussant)

This course is intended for both beginning and experienced clinical researchers. Dr. Max's talk will acquaint the beginner with the fundamentals of designing clinical trials of pain treatments, including the concepts of assay sensitivity and positive controls, current issues about placebo treatments and responses, and the advantages and disadvantages of crossover designs. The subsequent topics - all different from this course's topics during previous IASP Congresses - will introduce the experienced clinical researcher to new tools that may be incorporated into analgesic clinical trials. Dr. Stubhaug will discuss quantitative sensory testing as a tool for defining the mechanism of analgesics. Dr. Mandema will present current pharmacokinetic and pharmacodynamic concepts that can increase the power of analgesic trials. Dr. Diehl will present the elements of pharmacogenomics as these methods might be applied to acute and chronic pain. Dr. Meredith will describe lessons learned from a decade of using new statistical methods for analyzing the onset of pain relief. Case studies will be presented for consideration by the audience. Any participant who wishes to submit an issue for consideration should send it to Dr. Max at mm77k@nih.gov by July 1, 2002.

At the conclusion of this session, participants will have gained an understanding of: (1) the fundamentals of designing clinical trials of pain treatments; and (2) new tools for analgesic clinical trials                                                                                     Back to the top

R06 NEUROPATHIC PAIN

Martin Koltzenburg, Dr Med, Institute of Child Health & Institute of Neurology and National Hospital for Neurology and Neurosurgery, University College London, London, UK
Stephen McMahon
, PhD, Centre for Neuroscience Research, King's College London, London, UK
Michael C. Rowbotham
, MD,
Pain Clinical Research Center, University of California, San Francisco, California, USA

In recent years there have been major developments in the assessment and management of neuropathic pain, in the understanding of basic neurobiological mechanisms causing these pains and in the critical appraisal of treatment options. Clinical investigations show that distinct symptoms can be related to distinct neurobiological changes and this has led to the currently evolving concept of a mechanism-based classification of neuropathic pain that supplements the traditional etiology-based classification. Novel investigations like imaging of peripheral nerves using MRI or assessment of nociceptor function using skin biopsies have been useful to diagnosis. A wealth of animal models now permits detailed investigations of the morphological, cellular and molecular changes occurring in painful neuropathies and to correlate these changes with nociceptive behavior. Alterations in the supply of neurotrophic factors are likely to cause altered ion channel expression and change of neurotransmitter phenotype which will result in an abnormal transduction, transmission and modulation of nociceptive information in painful neuropathy. Advances in clinical trail design and evaluation of several anti-hyperalgesic drugs have demonstrated the usefulness of oral and topical treatment options that are significantly improving pain and quality of life in patients suffering from neuropathic pain.

At the conclusion of this session, participants will have gained an understanding of: (1) clinical presentation, differential diagnosis and assessment of neuropathic pain; (2) underlying neurobiological mechanisms in animal models of neuropathic pain and how these mechanisms are related to symptoms in patients and how they might be harnessed for the development of novel analgesic therapy; and (3) an evidence-based evaluation of current treatment options and the use of a rational treatment algorithm using oral or topical medications.                                                                                                        Back to the top

R07 PAIN AND PHYSICAL THERAPY: MECHANISMS, MOVEMENT MEASUREMENT AND MANAGEMENT

Maureen J. Simmonds, PT, PhD, Associate Professor, School of Physical Therapy, Texas Woman's University, Houston, Texas, USA
Kathleen A. Sluka
, PT, PhD, Graduate Program in Physical Therapy and Rehabilitation Sciences, University of Iowa, Iowa City, Iowa, USA
Jennifer Klaber Moffett
, MCSP, MSc, PhD,
Deputy Director, Institute of Rehabilitation, University of Hull, Hull, UK

For many years, much of physical therapy theory and practice was based on tradition, testimonials and "pseudoscience." In recent years results from basic and clinical studies utilizing an expanded (bio-psycho-social) model have provided a clearer and more complete understanding of the extent of the problem of pain and movement dysfunction and on the efficacy and effectiveness of specific physical therapies. The neurobiological mechanisms of transcutaneous electrical nerve stimulation (TENS) have been deciphered and the most appropriate parameters identified. Both high and low frequency TENS work through activation of opioid receptors (delta and mu, respectively) located in the spinal cord and the brainstem. Human studies in movement assessment tools have been systematically evaluated and the two dimensional nature (speed/coordination and endurance/strength) established. The time and energy burden of movement difficulties in patients with back pain, cancer and HIV/AIDS has been quantified. The inefficiency of movement helps explain the contradictory literature on de-conditioning in patients with pain. Research is also emerging to highlight the importance of psychological factors (cognitions and emotions) on movement difficulties indicative of the need for an expanded approach to clinical practice. It is now clear that patients with mechanical back pain need to be encouraged to return to normal physical activities as soon as possible but there is some uncertainty as to how this is best achieved. Currently a large national multi-center clinical trial in the UK is testing the clinical effectiveness and cost effectiveness of spinal manipulation, exercise and appropriate advice to stay active for back pain.

At the conclusion of this session, participants will have gained an understanding of: (1) neurobiological mechanisms underlying specific physical therapies; (2) the impact of pain, and systemic disease on movement and function; (3) the impact of psychosocial factors on movement dysfunction and disability; and (4) current evidence on efficacy and effectiveness of specific and combination management regimens for individuals with back pain.                                                                                                                  Back to the top

R08 RATIONAL USE OF INTERVENTIONAL THERAPIES FOR PAIN MANAGEMENT

Douglas Justins, MB BS, FRCA, Consultant in Pain Management and Anaesthesia, Pain Management Centre, St. Thomas Hospital, London, UK
Richard B. North
, MD, Professor of Neurosurgery, Anesthesiology and Critical Care Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
Allan R. Molloy
, MB BS, FRCA,
Director, Chronic and Cancer Pain Programme, University of Sydney, Pain Management and Research Centre, Royal North Shore Hospital, Sydney, New South Wales, Australia

Interventional therapies are widely used in the management of acute, chronic and cancer pain. There are issues surrounding the evidence of effectiveness, appropriateness and cost/benefit ratio of these therapies for some patients with chronic pain where a single modality treatment may fail to address a complex chronic pain problem. This course will examine: (1) indications, clinical use and complications of therapeutic neural blockade including epidural injections and autonomic nerve blocks plus neurolytic blocks for cancer pain. (2) neurosurgical approaches to pain management including stimulation-induced analgesia (peripheral nerve stimulation, spinal cord stimulation, deep brain stimulation and motor cortex stimulation). There will be discussion of the neurophysiological basis as well as the clinical application of these techniques. (3) the use of implanted drug delivery systems including spinal and paravertebral techniques. There will be discussion of the neuropharmacological basis and the clinical application of these techniques. Throughout the course emphasis will be given to appraising evidence of effectiveness and of the ways of integrating interventional therapies into comprehensive pain management approaches.

At the conclusion of this session, participants will have gained an understanding of: (1) indications, clinical use, and complications of therapeutic neural blockade; (2) neurosurgical approaches to pain management; (3) use of implanted drug delivery systems; and (4) integration of these therapies into comprehensive pain management approaches.                                                 Back to the top

R09 UNDERSTANDING THE NEUROBIOLOGY OF CHRONIC PAIN: MOLECULAR AND CELLULAR BIOLOGY

Stephen P. Hunt, PhD, Professor, Dept. of Anatomy, University College London, London, UK
Patrick W. Mantyh
, PhD, Professor, NeuroSystems Lab, University of Minnesota, Minneapolis, Minnesota, USA
Cheryl L. Stucky
, PhD,
Assistant Professor, Dept. of Cell Biology, Neurobiology & Anatomy, Medical College of Wisconsin, Milwaukee, Wisconsin, USA

Pain is necessary for survival, but persistent chronic pain can lead to depression, increased anxiety and a reduction in the quality of life. In recent years there has been a revolution in our understanding of the cellular and molecular events that are involved in the generation and maintenance of chronic pain. This new information is changing not only how we view chronic pain but also the way chronic pain is managed. The course will enable the pain clinician to understand these new ideas and also how they may lead to novel therapeutic approaches to the treatment of chronic pain.

At the conclusion of this session, participants will have gained an understanding of: (1) molecules that directly stimulate primary afferent nociceptive neurons; (2) plasticity of neurons involved in pain processing; (3) cells and molecules involved in relaying nociceptive information to the brain; (4) mechanisms and site of action of pharmacological and non-pharmacological treatments for chronic pain; and (5) how disturbances of pain transmission can result in chronic pain and, in turn, lead to changes in those parts of the brain implicated in anxiety and depression.                                                                                                                                Back to the top

R10 BACK PAIN

Gordon Waddell, DSc, MD, Dept. of Orthopaedic Surgery, The Glasgow Nuffield Hospital, Glasgow, UK
Maurits W. van Tulder
, PhD, EMGO-Institute and Dept. of Clinical Epidemiology, Vrije University Medical Centre, Amsterdam, The Netherlands
Steven J. Linton
, PhD,
Program for Behavioural Medicine, Dept. of Occupational and Environmental Medicine, Orebro Medical Centre Hospital, Orebro, Sweden

In recent years there have been major developments in the understanding and management of non-specific low back pain. A great deal of new scientific evidence is now available. This has produced a radical shift from the traditional strategy of rest to a more positive strategy of encouraging and supporting patients with back pain to stay active and get on with their life, which requires carefully tailored information and advice. There is increasing focus on interventions at the sub-acute stage, aimed at the secondary prevention of chronic pain and disability. These new strategies are embodied in international clinical guidelines which now give generally consistent messages about management at the acute and sub-acute stages. There is currently an increasing evidence base on occupational health management with new occupational health guidelines and recognition of the need for all clinicians to be aware of occupational health issues. This course will review these areas and allow ample time for comments and discussion.

At the conclusion of this session, participants will have gained an understanding of: (1) current scientific evidence base on effective treatments for back pain; (2) current international clinical guidelines for back pain; (3) occupational health management of back pain; (4) information and advice to patients; and (5) secondary prevention and rehabilitation strategies for back pain.             Back to the top

R11 PSYCHOLOGICAL ASSESSMENT AND TREATMENT OF THE PAIN PATIENT

Chris J. Main, PhD, Professor, Dept. of Behavioural Medicine, Hope Hospital, Salford, UK
Francis J. Keefe
, PhD, Professor, Duke Pain and Palliative Care Center, Durham, North Carolina, USA
Gary B. Rollman
, PhD, Dept. of Psychology, University of Western Ontario,
London, Ontario, Canada

The primary focus of the course will be on patients with clinically significant pain, but the course will also address the issue of secondary prevention. A critical evaluation of experimental and clinical approaches to pain assessment will lead to consideration of the nature of pain-associated dysfunction, as viewed from a biopsychosocial perspective. The relative importance of different sorts of psychological factors will be set within a cultural and social framework, with a focus on the influence of culture, age, gender and ethnicity on perception of pain, healthcare consulting, selection for treatment and response to treatment. Particular features of the course will include the role of the patient’s spouse, family and caregiver; assessment of pain behavior with the role of significant others and the utility of spouse-assisted and caregiver-assisted approaches to biopsychosocial intervention. The nature and efficacy of cognitive-behavioral interventions for patients with established pain problems will be appraised. A further focus on factors influencing doctor/therapist communication will lead to consideration of the clinical interview as a tool for clinical decision making, with a focus on the assessment of patient priorities, identification of therapeutic targets and appraisal of obstacles to recovery. Evaluation of change and assessment of outcome will be addressed from both a clinical and an occupational perspective, and consideration will be given to the influences of economic, occupational and family factors on response to treatment. The course will conclude with the presentation of several exciting new initiatives in secondary prevention from both an individual and a "systems" perspective.

At the conclusion of this session, participants will have gained an understanding of: (1) experimental and clinical approaches to pain assessment; (2) importance of different psychological factors in pain assessment; (3) the nature and efficacy of cognitive-behavioral interventions; (4) the role of the clinical interview in clinical decision making; (5) evaluation of change and assessment of outcome; and (6) new initiatives in secondary prevention in patients with clinically significant pain.                                                     Back to the top

R12 PAIN IN CHILDREN

Kenneth D. Craig, PhD, Professor of Psychology, Canadian Institutes of Health Senior Investigator, University of British Columbia, Vancouver, British Columbia, Canada
Bonnie J. Stevens
, RN, PhD, Signy Hildur Eaton Chair in Paediatric Nursing Research, Hospital for Sick Children, and Professor, Faculty of Nursing, University of Toronto, Toronto, Ontario, Canada
Charles B. Berde
, MD, PhD,
Pain Treatment Service, Children’s Hospital and Dept. of Anesthesia, Harvard University, Boston, Massachusetts, USA

Our understanding of pain in infants and children has developed substantially in recent years, as have assessment measures and approaches to pain control. Evidence-based advances have challenged many beliefs and practices, led to an appreciation of age-specificity and continuity of pain through childhood, generated physiologic, behavioral observation, and self-report assessment strategies tailored to the capabilities of the child, and led to innovative pharmacological, environmental, psychosocial, and other interventions appropriate to the needs of individual children.

At the conclusion of this session, participants will have gained an understanding of: (1) the most frequent forms of acute and chronic pain encountered across infancy and childhood, including consideration of immediate and long-term, adverse effects; (2) developmental changes, including the role of the family and other socialization influences in modulating pain; (3) the merits and limitations of physiologic, behavioral, self-report and composite pain assessment measures for infants and children; (4) current strategies and issues concerning symptom control and treatment guidelines; (5) the roles and relationships among nurses, physicians, and psychologists in the management of the infant/child in pain; and (6) organizational and logistic issues in multidisciplinary pediatric pain management programs.
                                                                                                                                                            
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R13 POSTOPERATIVE PAIN

Harald Breivik, MD, DMSc, FRCA, Professor and Chairman, Dept. of Anaesthesiology, University of Oslo, Oslo, Norway
J. Edmond Charlton
, MB BS, FRCA, Pain Management Services, Royal Victoria Infirmary, Newcastle upon Tyne, UK
Gena L. Lantry
, RN, BHSC,
Clinical Nurse Consultant , Hunter Integrated Pain Service, Newcastle, New South Wales, Australia

Major advances have been made in recent years in the understanding of postoperative pain, consequences of unrelieved activity-provoked postoperative pain for the outcome of surgery, short-term and long-term complications, patients well being and satisfaction with surgical care. Experiences with acute postoperative pain services show that a well organized team of dedicated nurse(s) and anesthesiologist(s) is required for success.

At the conclusion of this session, participants will have gained an understanding of: (1) the pathophysiology of acute postoperative pain and its immediate and long term consequences; (2) how to implement a postoperative pain relief program; and (3) the importance of an ongoing educational program for optimal use of low-tech as well as high-tech approaches, including well tailored epidural analgesia and various forms of patient controlled analgesia.                                                                                                         Back to the top

R14 PHARMACOLOGY OF PAIN – PRINCIPLES AND DRUG COMBINATIONS

Kay Brune, MD, Professor and Chairman, Dept. of Experimental and Clinical Pharmacology and Toxicology, Friedrich-Alexander University, Erlangen, Germany
Geoff Gourlay
, PhD, Chief Medical Scientist, Associate Professor, Pain Management Unit, Flinders Medical Centre, Bedford Park, South Australia, Australia
R. Andrew Moore
, FRSC, Pain Research, Churchill Hospital, Oxford, UK

The drug therapy of acute and chronic pain is subject to constant adaptation consequent to a better understanding of the underlying processes leading to the different forms of pain. In addition, the discovery of new analgesic compounds, new ways of administration and disease- specific combinations of drugs require changes of our treatment regimes. Recently, the classical aspirin-like drugs were supplemented by a new class, the so-called cyclooxygenase 2 selective inhibitors. On the other hand, classical opiates and opioids were rediscovered and their disadvantages in part compensated for by new administration techniques including, e.g., transdermal application. These innovations appear to allow for better (safer) treatment regimes. Finally, basic science and clinical experience suggest combining the different classes of analgesics with each other and with, e.g., additional neurotropic drugs to achieve superior effects, e.g., in neuropathic pain and regional pain syndromes.

At the conclusion of this session, participants will have gained an understanding of: (1) the different classes of analgesic compounds and ongoing innovations; (2) the pros and cons of new administration techniques; and (3) the rational use of combinations of analgesics from different classes under clinical conditions.                                                                                                         Back to the top

R15 VISCERAL PAIN

Maria Adele Giamberardino, MD, Associate Professor of Internal Medicine, Director, Pathophysiology of Pain Laboratory, Dept. of Medicine and Science of Aging, "G. D’Annunzio" University of Chieti, Chieti, Italy
Fernando Cervero
, MD, PhD, DSc, Professor, Departamento de Fisiología, Universidad de Alcalá, Alcalá de Henares, Madrid, Spain
Emeran A. Mayer
, MD, Professor of Medicine, Biobehavioral Sciences & Physiology, UCLA Mind Body CRC & CURE Neuroenteric Disease Program, Division of Digestive Diseases, University of California, Los Angeles, California, USA

Pain originating from internal organs represents a prominent medical problem not only for its high incidence, but also because of its often recurrent or chronic nature. Despite this clinical impact, knowledge about mechanisms of visceral pain is relatively limited compared to somatic pain, which is reflected in a poorer therapeutic control. The aim of this course is to provide a comprehensive overview of the modalities of presentation of the symptom, its physiology and pathophysiology, and the diagnostic and therapeutic approach to some of the most frequent forms encountered in the clinical setting.

At the conclusion of this session, participants will have gained an understanding of: (1) the unique characteristics of visceral pain; (2) the physiological properties of visceral nociceptors and the process of their sensitization by inflammation; the biochemical identification of visceral afferent fibers; (3) the central mechanisms of visceral pain; the CNS pathways for the transmission of pain signals and the relevance of the basic mechanisms of visceral pain to clinical practice; (4) how to approach diagnosis and treatment of frequent painful syndromes of the urogenital district and gain an understanding of the unique features of phenomena of viscero-visceral hyperalgesia produced by the concomitance of algogenic conditions of both the urinary tract and female reproductive organs; and (5) clinically relevant syndromes of acute and chronic gastrointestinal (GI) pain, and classification of syndromes involving pain from the digestive system, impact of functional GI disorders on quality of life and healthcare costs, evolving pathophysiological models for functional GI disorders, diagnosis of most common syndromes and, lastly, their current and future therapies.                                                                  Back to the top

R16 OROFACIAL PAIN

Yair Sharav, DMD, MS, Professor of Oral Medicine, School of Dental Medicine, Hebrew University-Haddassah, Jerusalem, Israel
Peter Svensson
, DDS, PhD, Institute of Dentistry, Aarhus University, Aarhus, Denmark
Karen G. Raphael
, PhD, Associate Professor, Schools of Medicine & Dentistry of New Jersey, Newark, New Jersey, USA

Acute orofacial pain is mostly associated with an acute inflammatory process and usually originates from intraoral structures such as teeth and the periodontium. Chronic orofacial pain can be defined as musculoskeletal, vascular and neuropathic. This diagnostic classification is most useful for choosing the appropriate therapy. Psychological aspects of chronic orofacial pain may determine the course of disease and affect prognosis and treatment. Musculoskeletal pain originates from deep tissues like muscle, fascia, tendons, periosteum, ligaments, and articular surfaces. Epidemiological surveys and animal models paired with human models contribute to the understanding of the musculoskeletal pain problem. Neuropathic orofacial pain can be paroxysmal and most specific to the region, i.e., trigeminal neuralgia, or is associated with nerve injury and deafferentation. In the latter, neuropathic and vascular mechanisms may co-act to produce pain and autonomic phenomena, and may determine the type of medication used. Primary vascular-type orofacial pain is periodic, strong, pulsatile, unilateral, wakes the patient from sleep and is associated with autonomic signs. Psychological factors play a role in the onset and maintenance of chronic orofacial pain. These are unique to the face and differ in their role from other chronic pain conditions. Specific psychologically based treatments were developed for chronic orofacial pain.

At the conclusion of this session, participants will have gained an understanding of: (1) the classification of pain in the orofacial region; (2) the current understanding of the mechanisms of the different types of orofacial pain; and (3) the diagnostic and treatment approach to the most relevant forms of this pain.                                                                                                                        Back to the top

2002 · softbound · 471 pages · ISBN 0-931092-44-2.    Price: US$35.00

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This page was updated on July 8, 2003