This session provides an in-depth review of the presentation, classification and mechanisms of chronic widespread pain in fibromyalgia syndrome. Over the last decade, we have witnessed several scientific advances in our mechanistic understanding of fibromyalgia algogenesis, but the diagnostic criteria and management of fibromyalgia syndrome remain stagnant. What can the pain community comprising researchers and healthcare professionals do to progress effective pain management for fibromyalgia patients in a precision medicine approach? The talks in this session scope from clinical aspects related to characteristics of centralised pain, the relevance of the neuro-immune axis in disease pathogenesis, as well as omics platforms for profiling cellular substrates mediating pain in fibromyalgia.

Faculty:

• Daniel Clauw
• Luda Diatchenko

Artificial intelligence (AI) is often used to describe the automation of complex tasks that we would attribute intelligence to. Machine learning (ML) is commonly understood as a set of methods used to develop an AI. Both have seen a recent boom in usage, both in scientific and commercial fields.

For the scientific community, ML can solve bottle necks created by complex, multi-dimensional data generated, for example, by functional brain imaging or *omics approaches. ML can here identify patterns that could not have been found using traditional statistic approaches. However, ML comes with serious limitations that need to be kept in mind: their tendency to optimise solutions for the input data means it is of crucial importance to externally validate any findings before considering them more than a hypothesis. Their black-box nature implies that their decisions usually cannot be understood, which renders their use in medical decision making problematic and can lead to ethical issues. 

Here, we present an introduction for the curious to the field of ML/AI. We explain the principles as commonly used methods as well as recent methodological advancements before we discuss risks and what we see as future directions of the field. Finally, we show practical examples of pain research and neuroscience to illustrate the use and limitations of ML.

Faculty:

• Jan Vollert
• Allison Barry
• Tamas Spisak
• Beth Hogans
• Antje M. Barreveld

Structural and functional imaging and neurophysiological evidence point to a wide range of alterations taking place in the central nervous system (CNS) in a large range of chronic pains. Central changes seem to mediate the effects of chronic pain on mood, cognition, and sleep, and may play a role in its persistence. While central alterations have been reported in many pain conditions, central changes are particularly prominent when pain is caused by neurological diseases affecting the central nervous system, even when the somatosensory system is not primarily affected. Importantly, the presence of central abnormalities does not grant these pains are "neuropathic", in as much as central neuropathic pain needs evidence of lesion or disease of the central somatosensory transmission system, and specific pain characteristics in relation to the lesion location. Distinguishing which clinical, imaging, and neurophysiological findings are specific to central neuropathic pain and can differentiate it from (i) non-neuropathic pain due to CNS diseases, and (ii) other chronic "centralized" pains is key for a clear diagnosis and treatment. Three speakers provide fundamental and new evidence from the clinic, neurophysiology and imaging to allow attendees detangle central neuropathic pain from central abnormalities seen in chronic pain in general.

Faculty:

• Daniel Ciampi de Andrade
• Luis Daniel Ciampi de Andrade
• Ruth Defrin

This master class explores the molecular role of epigenetics and proteins in the development, maintenance, and increased susceptibility to chronic pain. 

Dr. Giordano will focus on the involvement of epigenetic changes in patients with musculoskeletal pain and the possibility to evaluate these changes in human pain models. During this session, Dr. Giordano will share research and evidence on how epigenetic mechanisms can influence pain pathways and responses and discuss the opportunity to discover targeted epigenetic interventions and their potential in managing and treating pain disorders.

Prof. Géranton 's session will guide us through trauma-induced epigenetic changes, focusing on the intricate molecular changes occurring following stress exposure, during the critical early years of life but also in adulthood. Attendees will gain insights into how these epigenetic modifications may influence susceptibility to pain chronicity. This knowledge opens new doors in understanding the long-term implications of stress exposure, particularly in early-life, on the susceptibility to chronic pain.

Prof. Ghafouri, as our final speaker, will provide an in-depth overview of the latest advancements in proteomics in the context of chronic pain research. Prof. Ghafouri's lecture will focus on the exciting potential of proteomic techniques to identify novel pain-related biomarkers, unravel intricate pain pathways, and uncover therapeutic targets for more effective pain management strategy.

Faculty:

• Lars Arendt-Nielsen
• Rocco Giordano
• Sandrine M. Geranton
• Bijar Ghafouri

Recently, there has been an upsurge of interest in how psychological principles and techniques can be integrated into the pain practice of health professionals of varied backgrounds (e.g. nurses, rehabilitation specialists, and palliative care providers).  Such psychologically-informed practice (PIP) strategies represent a promising approach to preventing and treating chronic pain.  This master class provides a state-of-the science review of the current status and future of psychologically-informed pain care.  

The presenters draw upon extensive clinical and research experience to illustrate the strengths and challenges of this approach.  The master class will be divided into three sections: 1) Dr. Keefe will highlight how advances in behavioral/psychological theories of pain are linked to the current continuum of intervention strategies (from brief to more intensive), 2) Dr. Nicholas will discuss key issues and challenges related to training health professionals in psychologically-informed practice (e.g. amount of training needed to master skills,  maintaining treatment fidelity, supervision, and professional boundaries), and 3) Dr. George will pinpoint future practice clinical and research directions (e.g. understanding/appraising the current state of the science, treatment timing and dosing, and tailoring treatment in pragmatic trials).  The session will end with a panel discussion led by questions and comments from audience members.  (199 words)

Faculty:

• Francis Keefe
• Steven George
• Michael Nicholas

In this Master Class, practical and interactive presentations will provide updated information on the clinical management of patients with orofacial pain. After a general introduction on orofacial pain classification, an interactive clinical examination of a patient with orofacial pain will be presented. Hands-on demonstration of neurophysiological testing of trigeminal system will be also offered, and case series of neuroimaging investigation in patients with orofacial pain will be discussed with the attendees. Then the attendees will be involved in a pros and cons session dedicated to pharmacological and surgical treatment of trigeminal neuralgia.

Faculty:

• Andrea Truini
• Rafael Benoliel
• Joanna Zakrzewska
• Jillie Abbott
• Mojgan Hodaie
• Giulia Di Stefano
• Raymond Sekula

This Master Class focuses on autonomic nervous system factors, potential molecular targets, and translational approaches to care for women with Interstitial Cystitis/Bladder Pain Syndrome (IC/BPS), a relatively common chronic primary pelvic pain condition. A functional abnormality of the autonomic nervous system associated chronically increased activity of the central stress (threat) response system has been found in both women and pet cats (a naturally occurring animal model of IC).

In rodents, mitochondrial damage and increased oxidative stress associated with genitourinary dysfunctions including IC have been found. This suggests the possibility of resolving these dysfunctions with a purine nucleoside phosphorylase inhibitor (PNPase). Preclinical studies have revealed that inhibiting PNPase exerts beneficial effects in the lower urinary tract, suggesting a potential therapeutic role in the treatment of IC and related disorders.

Current bladder-centric treatments for IC remain disappointing, whereas those based on psychosocial models show more promise. We tested the feasibility of a behavioral intervention in women living with IC, the Learning to THRIVE Program, which uses principles of adult learning and instructional design. This pilot study used a one-group pre-post design to assess the feasibility of program implementation, and of pain intensity, distress, and interference outcomes. 

Please see below the recommended pre-reading list for the course. 

• Dr. Levesque - Clinical Criteria of Central Sensitization in Chronic Pelvic and Perineal Pain (Convergences PP Criteria): Elaboration of a Clinical Evaluation Tool Based on Formal Expert Consensus.
• Dr. Chelimsky - Autonomic neurophysiologic implications of disorders comorbid with bladder pain syndrome vs myofascial pelvic pain
• Dr. Birder - Purine nucleoside phosphorylase inhibition is an effective approach for the treatment of chemical hemorrhagic cystitis.
• Dr. Buffington - Interstitial Cystitis - an Imbalance of Risk and Protective Factors?
• Dr. Santurri - Learning the neurobiology of pain: A scoping review of pain education from an instructional design perspective

Faculty:

• Thomas Chelimsky
• Lori Birder
• Laura Santurri

There is growing scientific and clinical recognition that mainstream psychological interventions for chronic pain (e.g., cognitive behavioral therapy), although more effective than usual care and associated with few negative effects, have relatively limited clinical benefits. Innovative psychological treatments based on emerging neuroscientific models of pain have been recently developed and tested, with encouraging results for the pain clinician searching for more powerful therapies. A common theme of these new therapies is that they view the brain as the driving organ of most chronic pain, with treatment focusing on reducing patients’ fear and avoidance or pain and movement as well as negative emotions and stressful or traumatic experiences. The three speakers here are the lead developers and clinical trialists of three of these newer approaches: Pain Reprocessing Therapy (Dr. Yoni Ashar), Emotional Awareness and Expression Therapy (Dr. Mark Lumley), and Hybrid Exposure Therapy (Dr. Katja Boersma). Each speaker presents the rationale for the given therapeutic approach and supporting data and will focus on teaching attendees how these therapies are conducted, using case presentations, demonstrations, or video materials. Presenters will also examine the opportunities and challenges in implementing these approaches.

Faculty:

• Yoni Ashar
• Mark Lumley
• Katja Boersma

While symptom relief is the goal of most current treatments for neuropathic pain, and their mechanisms related to pain pathophysiology, this Master Class will introduce and discuss the novel concept of disease-modification for neuropathic pain.  
As an introduction, the disease-modifying potential of neurotrophic factors (e.g. rhNGF, HGF gene therapy), and immune therapies (e.g. IVIg), will first be discussed in general.   

The main focus is on recently published clinical studies using the Capsaicin 8% patch treatment, which showed regeneration and restoration of small sensory nerve fibres in serial skin biopsies; importantly, the neuropathic pain relief correlated with structural and functional recovery of small sensory nerve fibres.  These observations and the underlying mechanisms are described in patients with painful diabetic peripheral neuropathy (PDPN), chemotherapy-induced peripheral neuropathy (CIPN), and Non-freezing cold-injury (NFCI, “Trench Foot”).  Further, there is increasing evidence from large clinical trials for progressively improved efficacy when the patch application is repeated 2- to 3-monthly, both in patients with painful Diabetic and non-diabetic peripheral neuropathy; moreover, some patients who did not show a response to initial treatment reported good pain relief after two or more repeated applications.   Hence, clinical and tissue evidence supports the concept of Capsaicin 8% patch as an example of a Disease Modifying treatment.

Faculty:

• Praveen Anand
• Uma Anand
• Ralf Baron
• Marieke Niesters
• Rainer Freynhagen