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NeuP SIG Neuropathic Pain Congress 2015 in Nice

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  • NeuP SIG Neuropathic Pain Congress 2015 in Nice

    It looks interesting, some of the conferences will talk about hot topics where many questions are left un answered.

    Nice 2015 Internationnal Neuropathic Pain Congress

    I would really like to go but it's an expensive trip from Canada...
    Anybody here that plans on going so we could share a room?
    I'm still in a pre contemplative phase but I'm all ears for suggestions!
    Frédéric Wellens, pht
    «We often refuse to accept an idea merely because the tone of voice in which it has been expressed is unsympathetic to us.»
    «
    Those who cannot understand how to put their thoughts on ice should not enter into the heat of debate.
    »
    Friedrich Nietzsche
    www.physioaxis.ca
    chroniquesdedouleur blog

  • #2
    No one?
    Frédéric Wellens, pht
    «We often refuse to accept an idea merely because the tone of voice in which it has been expressed is unsympathetic to us.»
    «
    Those who cannot understand how to put their thoughts on ice should not enter into the heat of debate.
    »
    Friedrich Nietzsche
    www.physioaxis.ca
    chroniquesdedouleur blog

    Comment


    • #3
      Perhaps me since i'm native from Nice?
      Simplicity is the ultimate sophistication. L VINCI
      We are to admit no more causes of natural things than such as are both true and sufficient to explain their appearances. I NEWTON

      Everything should be made as simple as possible, but not a bit simpler.
      If you can't explain it simply, you don't understand it well enough. Albert Einstein
      bernard

      Comment


      • #4
        Bernard,

        Cela fait trois semaines que je fais le tour de mes contacts ici et ailleurs et pour l'instant personne n'y va. Alors, je vais peut-être me rabattre sur Palm Springs où a lieu au même moment le congrès de l'American Pain Society. Mais, les conférences sont un peu moins intéressantes.
        Frédéric Wellens, pht
        «We often refuse to accept an idea merely because the tone of voice in which it has been expressed is unsympathetic to us.»
        «
        Those who cannot understand how to put their thoughts on ice should not enter into the heat of debate.
        »
        Friedrich Nietzsche
        www.physioaxis.ca
        chroniquesdedouleur blog

        Comment


        • #5
          Frédéric,

          J'ai une soeur qui habite Nice. Elle connait pas mal de monde. Je vais aussi parler à Marc.
          Simplicity is the ultimate sophistication. L VINCI
          We are to admit no more causes of natural things than such as are both true and sufficient to explain their appearances. I NEWTON

          Everything should be made as simple as possible, but not a bit simpler.
          If you can't explain it simply, you don't understand it well enough. Albert Einstein
          bernard

          Comment


          • #6
            Flight and hotel are booked
            Congress registration confirmed

            I am going!

            Anyone wants to join me?

            Frédéric Wellens, pht
            «We often refuse to accept an idea merely because the tone of voice in which it has been expressed is unsympathetic to us.»
            «
            Those who cannot understand how to put their thoughts on ice should not enter into the heat of debate.
            »
            Friedrich Nietzsche
            www.physioaxis.ca
            chroniquesdedouleur blog

            Comment


            • #7
              D-day!

              I'm about to board my plane from Montréal to Amsterdam and then to Nice to finally take part to this, hopefully, very interesting congress.

              I'll try to chime in with some valuable info if time permits.
              Attached Files
              Frédéric Wellens, pht
              «We often refuse to accept an idea merely because the tone of voice in which it has been expressed is unsympathetic to us.»
              «
              Those who cannot understand how to put their thoughts on ice should not enter into the heat of debate.
              »
              Friedrich Nietzsche
              www.physioaxis.ca
              chroniquesdedouleur blog

              Comment


              • #8
                Allright. It's already over!

                My first impression where that I didn't quite fit in there. Lots of researchers and not many clinicians. Well, there were some clinicians too but we were a smaller group than researchers. And there were not many physios. The conferences were very diverse, ranging form fondamental science to clinical work with some interesting debates thrown in there.

                About the debates. Two were interesting. One on fibromyalgia and the other on persistant neuropathic pain. I'll be more specific in latter posts. I already blogged about it in french on my blog here.

                One thing that can only become really obvious after such a congress is that pain is overwhelmingly complex. Which brings us to the elephant in the room in physiotherapy. We keep trying we can tackle such a complex phenomenon with our really simplified and erroneous biomedical/mechanical model of care. Form channelopathies to complex brain neuroplasticity with an new twist in glial cells with gender specific components, Pain keeps the plot intringing and never stops to mindboggle us. Leaving us seemingly clueless on what to do about it.

                I certainly did not get any closer to a truly efficaceous way of treating my complex patients. But, I am more confident than ever that many are missing the big picture in our field.
                Frédéric Wellens, pht
                «We often refuse to accept an idea merely because the tone of voice in which it has been expressed is unsympathetic to us.»
                «
                Those who cannot understand how to put their thoughts on ice should not enter into the heat of debate.
                »
                Friedrich Nietzsche
                www.physioaxis.ca
                chroniquesdedouleur blog

                Comment


                • #9
                  Peripheral vs central dominance in persistant pain

                  One of the core topic that was discussed and debated in the congress were the seemingly opposing views on what drives persistant neuropathic pain.

                  On the one hand, the central mechanisms with complex neuroplastic changes at many level of the neuraxis combining both lack of inhibition to overt excitation with all the BPS components and gene expression and so forth. But on the other end, the evidence for peripheral issues/anomalies in peripheral nerves and receptors that change the neuronal signaling of individual neurones, namely the C and a- delta nociceptive fibers. It is clear to me now that in many ongoing neuropathic pain there is proof of abnormal peripheral signaling from these nociceptors, including, but not limited to spontaneous signaling. The question that remains unanswered and debated over is whether the pain is present because of this abnormal signaling or rather more because of central mecanisms. The debate was framed as an either-or debate while, clearly, it's a lot more complicated obviously.

                  And in the camp defending the peripheral thesis, the central mecanisms where clearly aknowledge. In fact, one of the conclusion of its proponent was that despite what he taught was more of a peripheral issue, our best targets for treatment, at this moment, are central processes regardless. He didn't seem too confident a true treatment for the peripheral nerve anomalies would be found any time soon. The main argument for the peripheral side was that there exist many evidence for ongoing abnormal signaling in peripheral nerves and that pain is correlated at least with the presence of spontaneous activity on some types of EMG data. He wasn't too impressed with phantom limb pain as axones are still present to signal so that doesn't prove the central dominance of the problem to him (Jordi Serra). Lorimer didn't seem too convinced of his arguments btw...

                  Dr Tony Dickensen argued for the central hypothesis in a very convincing matter. (I am biased here!)

                  At the end of the conference, the audience was still divided 50-50 as to were the culprit was.
                  Frédéric Wellens, pht
                  «We often refuse to accept an idea merely because the tone of voice in which it has been expressed is unsympathetic to us.»
                  «
                  Those who cannot understand how to put their thoughts on ice should not enter into the heat of debate.
                  »
                  Friedrich Nietzsche
                  www.physioaxis.ca
                  chroniquesdedouleur blog

                  Comment


                  • #10
                    The debate was fierce too in fibromyalgia, the once queen of central pathology, now being increasingly associated with an ongoing peripheral new suspected culprit : small nerve polyneuropathy.

                    Many groups have found evidence of widespread small nerve pathology with as many as 80% of the patients involved in their trials. Skin biopsies and confocal microscopy showing decreased small nerve density and indicating some form of peripheral anomaly along with its signaling implication. There is still no formal proof it's the reason for the pain or how could that explain the other central symptoms beside pain but they find the findings interesting nonetheless.

                    One thing is for sure... Nothing is for sure
                    Frédéric Wellens, pht
                    «We often refuse to accept an idea merely because the tone of voice in which it has been expressed is unsympathetic to us.»
                    «
                    Those who cannot understand how to put their thoughts on ice should not enter into the heat of debate.
                    »
                    Friedrich Nietzsche
                    www.physioaxis.ca
                    chroniquesdedouleur blog

                    Comment


                    • #11
                      this article was mentionned in the debate

                      http://www.ncbi.nlm.nih.gov/pubmed/24018757
                      Frédéric Wellens, pht
                      «We often refuse to accept an idea merely because the tone of voice in which it has been expressed is unsympathetic to us.»
                      «
                      Those who cannot understand how to put their thoughts on ice should not enter into the heat of debate.
                      »
                      Friedrich Nietzsche
                      www.physioaxis.ca
                      chroniquesdedouleur blog

                      Comment


                      • #12
                        Up to 80% of the effect of medication in neuropathic pain could be the result of expectation/placebo responses.
                        Frédéric Wellens, pht
                        «We often refuse to accept an idea merely because the tone of voice in which it has been expressed is unsympathetic to us.»
                        «
                        Those who cannot understand how to put their thoughts on ice should not enter into the heat of debate.
                        »
                        Friedrich Nietzsche
                        www.physioaxis.ca
                        chroniquesdedouleur blog

                        Comment


                        • #13
                          And it would seem that you can't only substract the size of the placebo group from the treatment group to find out the true magnitude of the treatment. Crossover design and other more complex research design yield result suggesting that the actual specific effect of a treatment is magnified by the effect of the anticipation/priming. The true effect of the drug is better because of the anticipation and this adds up to the effect of anticipation alone or the effect of the drug alone. In other word :

                          Drug + Anticipation together is better than the effect of anticipation alone + the effect of the drug alone. Or sort of...

                          It's kind of a feedback loop of the non-specific effects within the specific effects!
                          Frédéric Wellens, pht
                          «We often refuse to accept an idea merely because the tone of voice in which it has been expressed is unsympathetic to us.»
                          «
                          Those who cannot understand how to put their thoughts on ice should not enter into the heat of debate.
                          »
                          Friedrich Nietzsche
                          www.physioaxis.ca
                          chroniquesdedouleur blog

                          Comment

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