Speakers can check in at the lounge, submit their final slides, and prepare for presentations throughout NeuPSIG 2023. 

Early Career delegates are invited to stop by and network with colleagues.

One histological hallmark of neuropathies is loss of intraepidermal nerve fibers, as shown by skin punch biopsy from the distal and proximal leg. While the procedure is fast and simple, even small but missteps may lead to clinically relevant misinterpretations. Following standardised guidelines for processing and analysing skin samples should be mandatory to ensure accurate data. Even so, the literature is filled with heterogeneous and erroneous methodology, making comparison between studies difficult and, in worst cases, leading to inaccurate findings. Advance in methodology has carried skin biopsies far beyond the mere determination of nerve fiber density. It is, for example, possible to distinguish between somatosensory and autonomic nerve fibres, assess sweat gland innervation, quantify morphological abnormalities of the nerve fibers such as axonal swellings, and identify nerve fiber subtypes. Skin punch biopsy also allows the investigation of other cells such as keratinocytes, Langerhans cells, inflammatory cells, glia cells and many more.

This interactive workshop will teach the audience how to accurately obtain, process, and analyse skin punch biopsies for clinical and research purposes using short presentations, live demonstrations, pre-recorded videos, and on-stage microscopy.

Attendance at this workshop requires registration.  Fee:  $99 USD

Patients with cancer are nowadays better treated than before. However, cancer survivors often suffer from neurological complications after exposure to anticancer therapy. Chemotherapy-induced peripheral neurotoxicity (CIPN) with sensory loss and neuropathic pain in the extremities is most encountered. In this workshop the three speakers will cover new advances in the pathophysiology of CIPN and transfer preclinical pathways in the clinic. Dr. Dougherty will explore excitability of primary sensory neurons and the contribution of voltage gated channels to the pathophysiology of allodynia in taxane-, platin- and bortezomib-related CIPN. Different channels govern the development and maintenance of CIPN – some of which could be targeted by existing drugs or useful for development. Dr. Rittner will focus on non-neuronal cells controlling bortezomib-induced polyneuropathy. Nerve barriers and their preservation with growth factors are important axonal protectors. Preventing their damage e.g., by enforcing neuronal barriers could help to shield the nerve. Dr. Alberti will address the clinical phenotype of CIPN and two types of oxaliplatin-induced neurotoxicity, early (i.e., hyperexcitability) and delayed (chronic neuropathy). She will especially enlighten the challenges of translating diseases into preclinical models applying translational outcome measures as the basis for phase I clinical trials. Finally, all speakers will discuss the next steps to implement their findings into the clinic.  

It is well established that neuropathic pain is associated with maladaptive changes in neural tissue and circuitry. Current advances in adaptive neurotechnologies have enabled critical insights into understanding and treating neuropathic pain. These novel technologies have gained recent popularity for elucidating mechanisms of neuropathology and providing a means to modulate aberrant neural activity patterns. By extracting distinct electrophysiological patterns related directly to pain perception, it is possible to develop safe and novel approaches to treating a wide range of neuropathic pain symptoms. This session will focus on novel ways to leverage physiological markers of pain perception to improve the current repertoire of pain therapies. We will describe new electrophysiological patterns associated with pain relief, nociceptive processing, and post-operative pain severity. We will then describe how these mechanisms can be harnessed to create new devices and treatments for neuropathic pain.

This workshop will give an overview of recent developments in pre-clinical models of nerve injury and neuropathic pain. We will highlight the latest mechanistic findings obtained with cutting-edge technologies, improved animal models and interdisciplinary know-how. Specifically, we show evidence from 2-photon imaging that abnormal re-innervation patterns could contribute to the emergence of neuropathic pain. We will present findings on innate and adaptive immune cell dysregulation locally, within nerves, some of which persists over very long periods of time. And finally, we will present a novel translational model for pain after nerve crush. 

By the end, attendees will have gained an idea of what we have learned in the past few years about persistent local inflammation and neuron dysfunction in animal models of neuropathic pain. 

Cristina Peterson will illustrate the therapeutic potential of combination pharmacotherapy by highlighting – with recent examples – additive and synergistic analgesic interactions using preclinical investigative techniques. The rationale for picking certain targets for combinations will be presented, as will issues of adverse drug interactions. 

 

Ian Gilron will provide a recently updated evidence-based review of combination pharmacotherapy for neuropathic pain in order to highlight critical issues surrounding optimal combinations and necessary improvements for future combination trials. Key issues relating to combination therapy will be discussed, including 1) safety, 2) simultaneous versus sequential “add-on” therapy, and 3) optimal use of fixed-dose combinations. 

 

Flemming Bach will discuss combination pharmacotherapy in the context of real-world neuropathic pain. This will include a review of safe and effective evidence-based pain management practices by discussing known adverse drug interactions. The challenges and limitations of combination therapy with currently available drugs will also be presented. In particular, consideration of the narrow therapeutic window due to cognitive side effects represents an obstacle and calls for consideration of alternative combination approaches. 

This session will focus on cancer pain states across the cancer cycle from diagnosis, pre, post-surgical and chemotherapy states, and the encompassing management of pain. Cancer pain has been identified as having significant prevalence across the globe.

Educational Objectives

Upon completion of this sessions, attendees should be able to:

This session has  been independently planned and developed to be delivered by IASP/NeuPSIG.  Grunenthal has provided a donation for the independent development of this session.  

This workshop will provide new insights into the basic, translational, and clinical aspects of chemotherapy-induced peripheral neuropathy (CIPN) and explore translation and failures. Recognizing the importance of people living with CIPN, Fiona Talkington, BBC broadcaster, will co-chair the session and give the view of someone with lived experience.  Dr. Lesley Colvin will discuss the current clinical state of CIPN; the clinical and research challenges the field faces, and the emerging scientific opportunities to find effective therapeutics for CIPN. Second, Dr. Peter Grace will describe how histone deacetylase 6 (HDAC6) inhibitors have therapeutic potential to reverse cisplatin-induced neuropathic pain via enkephalin-delta opioid receptor signaling in peripheral sensory neurons in a rodent model. And third, co-chair Dr. Alfonso Romero-Sandoval will provide translational evidence on how an endoplasmic reticulum stress sensor (IRE1a/XBP1) in circulating immune cells, correlates with neuropathy severity in cancer patients with CIPN, as predicted by preclinical studies. 

In this TW DB will initially review the up-to-date evidence supporting the use of non-invasive motor cortex stimulation for neuropathic pain management. He will provide a critical appraisal of the rationale, utility and limitations of a treatment approach that is currently entering guidelines for pain management of refractory to pharmacological approaches. This presentation will be followed by Zheng Gan, who will review the known mechanistic framework for M1 stimulation for analgesic purposes. He will then present new groundbreaking data indicating that stimulation of different cortical layers of the precentral gyrus can lead to different outcomes in experimental animals. Based on a comprehensive use of viral tracing and mouse genetics, combined with chemo- and optogenetic approaches, he will show how steering of stimulation within M1 cortical layers can improve pain-related symptoms and improve outcomes. These presentations will be followed by DCA, who will present new strategies to personalize non-invasive neuromodulation such as the use of connectivity measurements by EEG coupled with TMS and the possibility to use the individual´s own brain oscillatory activity to guide stimulation, om another attempt to individualize and personalize analgesic approaches to neuropathic pain by non-invasive neuromodulation.

Dysregulation of pain-associated genes in sensory nerve system is considered to be a molecular basis of chronic neuropathic pain genesis. Non-coding RNAs including miRNAs and long non-coding RNAs govern gene expression. In this workshop, we will discuss the updated evidence that non-coding RNAs contribute to chronic neuropathic pain and are potential biomarkers and/or targets for this disorder. Dr. Malcangio will discuss how miRNAs regulate neuron-immune communication in the dorsal root ganglia (DRG) under neuropathic pain conditions. Dr. Sakai will present a potential of non-coding RNAs, especially lncRNAs, as therapeutic targets and biomarkers in neuropathic pain. Dr. Tao will discuss how a newly identified nerve injury-specific long lncRNA expressed in rodent and human DRG participates in neuropathic pain and provide novel evidence that it could be a potential target for this disorder.

Pain radiating from the spine into the leg is commonly referred to as ‘sciatica’. ‘Sciatica’ is associated with reduced quality of life, significant suffering and socio-economic burden. Two of the main challenges associated with a diagnosis of ‘sciatica’ relate to the inconsistent use of terminology for the diagnostic labels ‘sciatica’/radicular pain/painful radiculopathy, and the identification of neuropathic pain. These challenges hinder collective clinical and scientific understanding and clarity regarding these conditions, impact effective clinical communication and care planning, prevent clear interpretation of the scientific literature related to the condition, and ultimately may contribute to the limited efficacy and personalisation of care for people living with ‘sciatica’.

In this workshop, we will highlight these challenges from a clinical, research and lived experience perspective. We will summarise the outcome of a working group commissioned by the Neuropathic Pain Special Interest Group (NeuPSIG) of the International Association for the Study of Pain which includes recommendations on the terminology as well as an adaptation of the neuropathic pain grading system in the context of spine-related leg pain. These recommendations will facilitate common language in clinical practice and research and assist the initiation of more specific management for this patient population. 

Venue: Cafe IN, Avenida Brasilia 311, Lisbon 1300-598 Portugal

This event is by invitation only for trainee delegates and senior mentors to network informally. Attendees will enjoy beer, wine, non-alcoholic beverages, and passed canapes after some brief welcome remarks.