1 / 47

Incontro Nazionale Neurofisiologia: Nuove Strategie

“ Controversie sulla diagnosi e terapia del dolore neuropatico ”. Incontro Nazionale Neurofisiologia: Nuove Strategie. Palermo, 29-30 novembre 2012. G. Sandrini. Dipartimento di Neurologia e Neuroriabilitazione Fondazione "Istituto Neurologico Nazionale C. Mondino" – IRCCS

homer
Download Presentation

Incontro Nazionale Neurofisiologia: Nuove Strategie

An Image/Link below is provided (as is) to download presentation Download Policy: Content on the Website is provided to you AS IS for your information and personal use and may not be sold / licensed / shared on other websites without getting consent from its author. Content is provided to you AS IS for your information and personal use only. Download presentation by click this link. While downloading, if for some reason you are not able to download a presentation, the publisher may have deleted the file from their server. During download, if you can't get a presentation, the file might be deleted by the publisher.

E N D

Presentation Transcript

  1. “Controversie sulla diagnosi e terapia del dolore neuropatico” Incontro Nazionale Neurofisiologia: Nuove Strategie Palermo, 29-30 novembre 2012 G. Sandrini Dipartimento di Neurologia e Neuroriabilitazione Fondazione "Istituto Neurologico Nazionale C. Mondino" – IRCCS Università di Pavia, Pavia

  2. Gli strumenti di screening (DN4, etc.) devono essere applicati nella diagnosi del dolore neuropatico?SI: Attal vs NO: Sandrini “BASTIAN CONTRARIO” “Never say yes” CRITICISM “That’s fine, but...”

  3. VISUAL vs VERBAL vs NUMERICAL SCALES:ARE THEY EQUIVALENT? A Williamson, B Hoggart Journal of Clinical Nursing 2005, 14:798-804 (1)

  4. VISUAL vs VERBAL vs NUMERICAL SCALES:ARE THEY EQUIVALENT? VAS most difficult –VRS less sensitive Journal of Clinical Nursing 2005, 14:798-804 (2)

  5. NEUROPATHIC NOCICEPTIVE PAIN:DIFFICULT TO DISTINGUISH? L Padua et al. Neurol Sci 2009, 30:99-106

  6. DIMENSIONS OF PAIN EXPERIENCE AND LANGUAGE OF PAIN:CAN WE QUANTIFY ALL THE ASPECTS? Pain “As-if” J Katz et al. SurgClin North Am. 1999, 79 (2): 231-52 ( 1)

  7. DIMENSIONS OF PAIN EXPERIENCE AND LANGUAGE OF PAIN:CAN WE QUANTIFY ALL THE ASPECTS? Pain is not an unidimensional experience SurgClin North Am. 1999, 79 (2): 231-52 (2)

  8. DIMENSIONS OF PAIN EXPERIENCE AND LANGUAGE OF PAIN:CAN WE QUANTIFY ALL THE ASPECTS? Pain as personal,subjective experience SurgClin North Am. 1999, 79 (2): 231-52 (3)

  9. DIMENSIONS OF PAIN EXPERIENCE AND LANGUAGE OF PAIN:CAN WE QUANTIFY ALL THE ASPECTS? Aeterogeneity of pain conditions and factors examined SurgClin North Am. 1999, 79 (2): 231-52 (4)

  10. DIMENSIONS OF PAIN EXPERIENCE AND LANGUAGE OF PAIN:CAN WE QUANTIFY ALL THE ASPECTS? Sensitivity of MPQ related to intensity of pain SurgClin North Am. 1999, 79 (2): 231-52 (5)

  11. DIMENSIONS OF PAIN EXPERIENCE AND LANGUAGE OF PAIN:CAN WE QUANTIFY ALL THE ASPECTS? Anxiety and psychological disturbance influence on MPQ SurgClin North Am. 1999, 79 (2): 231-52 (6)

  12. DIMENSIONS OF PAIN EXPERIENCE AND LANGUAGE OF PAIN:CAN WE QUANTIFY ALL THE ASPECTS? Behavioral Approaches better in children and adults with decreased ability to comunicate SurgClin North Am. 1999, 79 (2): 231-52 (7)

  13. DIMENSIONS OF PAIN EXPERIENCE AND LANGUAGE OF PAIN:CAN WE QUANTIFY ALL THE ASPECTS? Habituation phenomena SurgClin North Am. 1999, 79 (2): 231-52 (8)

  14. VISUAL vs VERBAL vs NUMERICAL SCALES:ARE THEY EQUIVALENT? Different compliance MJ Hjermstad et al. JPainSymptomManage 2011, 41 (6): 1073-93 (1)

  15. VISUAL vs VERBAL vs NUMERICAL SCALES:ARE THEY EQUIVALENT? Differences in patients preferences JPainSymptomManage 2011, 41 (6): 1073-93 (2)

  16. VISUAL vs VERBAL vs NUMERICAL SCALES:ARE THEY EQUIVALENT? No agreement about the recommendations JPainSymptomManage 2011, 41 (6): 1073-93 (3)

  17. THE PHARMACOLOGICAL TREATMENT: THE NP SCALES COVER ALL THE ASPECTS OF THE CLINICAL RESPONSE? N Attal et al. European Journal of Neurology 2010, 17: 1113-1123

  18. THE NOCICEPTIVE PAIN: ARE THE SAME SCALES USEFUL OR NOT? A poorly investigated issue GA Hawker et al. Arthritis Care Res 2011, 63 Suppl 11:240-52

  19. THE NOCICEPTIVE PAIN: ARE THE SAME SCALES USEFUL OR NOT? MPQ is useful to discriminate different type of pain,but….. Arthritis Care Res 2011, 63 Suppl 11:240-52

  20. ASSESSING NP IN CLINICAL TRIALS:THE SCALES ARE ENOUGH? The role of Quantitative Sensory Testing N Attal et al. What is the relevance of symptom oriented classifications of NP? European Journal of Pain 2011, 15: 441-443 (1)

  21. ASSESSING NP IN CLINICAL TRIALS:THE SCALES ARE ENOUGH? Different drugs and different effects Assessing symptoms and signs in clinical trials of NP European Journal of Pain 2011, 15: 441-443 (2)

  22. ASSESSING NP IN CLINICAL TRIALS:THE SCALES ARE ENOUGH? QST is fundamental in therapeutical trial Recommendations on sensory profiling to increase therapeutic prediction European Journal of Pain 2011, 15: 441-443 (3)

  23. DIAGNOSIS AND ASSESSMENT OF NP:THE MAIN QUESTIONS D Bouhassira, N Attal Importance of the language of neuropathic pain: the advent and rise of screening tools Pain 2011, 152:74-83 (1)

  24. Description and discriminant properties of the screening tools DIAGNOSIS AND ASSESSMENT OF NP:THE MAIN QUESTIONS Pain 2011, 152:74-83 (2)

  25. DIAGNOSIS AND ASSESSMENT OF NP:THE MAIN QUESTIONS Conditions of use and limitations of the screening tools Pain 2011, 152:74-83 (3)

  26. DIAGNOSIS AND ASSESSMENT OF NP:THE MAIN QUESTIONS The challenge of neuropathic pain measurement: what could be the role of the symptom-based questionnaires? The Neuropathic pain Scale Pain 2011, 152:74-83 (4)

  27. DIAGNOSIS AND ASSESSMENT OF NP:THE MAIN QUESTIONS Other questionnaires Pain 2011, 152:74-83 (5)

  28. DIAGNOSIS AND ASSESSMENT OF NP:THE MAIN QUESTIONS Are neuropathic pain symptoms or dimensions related to the etiology? Pain 2011, 152:74-83 (6)

  29. DIAGNOSIS AND ASSESSMENT OF NP:THE MAIN QUESTIONS Do pain symptoms tell us something about the pathophysiological mechanisms? Pain 2011, 152:74-83 (7)

  30. NP ASSESSMENT QUESTIONNAIRE: A ROLE IN THE GUIDELINES? G Cruccu et al. Screening and assessment tools European Journal of Neurology 2010, 17:1010-1018

  31. DN4 QUESTIONNAIRE: AETIOLOGY IS RELEVANT? N Attal et al. JPain 2011, 12 (10):1080-1087 (1)

  32. DN4 QUESTIONNAIRE: AETIOLOGY IS RELEVANT? JPain 2011, 12 (10):1080-1087 (2)

  33. SCREENING TOOLS IN NP: ARE THERE LIMITATIONS IN CLINICAL PRACTICE AND RESEARCH? Role of screening tools in clinical practice and research Bridging the gap between definition and diagnosis Pain 2007, 127:199-203

  34. NP: THE GUIDELINES ARE APPLIED IN CLINICAL PRACTICE? G Cruccu, N Attal Pain 2012, 153:740-741

  35. NPS: ARE ABLE TO IDENTIFY THE SUBGROUPS? SG Bradley Neurology 1997, 48:332-338

  36. CONCLUSIONS NP scales have limits, but… We can improve their usefulness by: • Evaluating all the clinical aspects in the patient • Using instrumental tests • Using other scales exploring other parameters (i.e. QL, etc) • Using both verbal and numerical rating scales • Considering possible coexistence of nociceptive pain • Exploring aetiology • Identifying subgroups

  37. DIMENSIONS OF PAIN EXPERIENCE AND LANGUAGE OF PAIN:CAN WE QUANTIFY ALL THE ASPECTS? (7) Surg Clin North Am. 1999, 79 (2): 231-52

  38. VISUAL vs VERBAL vs NUMERICAL SCALES:ARE THEY EQUIVALENT? (2) J Pain Symptom Manage 2011, 41 (6): 1073-93

  39. VISUAL vs VERBAL vs NUMERICAL SCALES:ARE THEY EQUIVALENT? (3) J Pain Symptom Manage 2011, 41 (6): 1073-93

  40. VISUAL vs VERBAL vs NUMERICAL SCALES:ARE THEY EQUIVALENT? (6) Conclusions J Pain Symptom Manage 2011, 41 (6): 1073-93

  41. THE NOCICEPTIVE PAIN: ARE THE SAME SCALES USEFUL OR NOT? (2) Arthritis Care Res 2011, 63 Suppl 11:240-52

  42. THE NOCICEPTIVE PAIN: ARE THE SAME SCALES USEFUL OR NOT? (4) Arthritis Care Res 2011, 63 Suppl 11:240-52

  43. THE NOCICEPTIVE PAIN: ARE THE SAME SCALES USEFUL OR NOT? (5) Arthritis Care Res 2011, 63 Suppl 11:240-52

  44. THE NOCICEPTIVE PAIN: ARE THE SAME SCALES USEFUL OR NOT? (6) Arthritis Care Res 2011, 63 Suppl 11:240-52

  45. MI Bennett et al. SCREENING TOOLS IN NP: ARE THERE LIMITATIONS IN CLINICAL PRACTICE AND RESEARCH? (1) Limitations Independent validation Pain 2007, 127:199-203

  46. NPSI: FROM EXPERIMENTAL TO CLINICAL PAIN D Bouhassira Pain 2004, 108:248-257

More Related