Letter from the chair … 1-2 NeuPSIG Subcomittee updates… 3-4 Upcoming Meetings… 4-5 NeupSIG Committees… 2 NeuPSIG Member Publications…5 News from around the Globe – page 6

NEUROPATHIC PAIN www.neupsig.org NEWSLETTER of the IASP Special Interest Group on Neuropathic Pain

Issue 12 January 2009

Chair: Rolf-Detlef Treede, MD, Chair of Neurophysiology, CBTM Medical Faculty Mannheim University of Heidelberg D-68167 Mannheim, Germany

Vice Chair: Maija Haanpaa, MD Pain Clinic, Rehabilitation ORTON, Tenholantie 10, 00280 Helsinki, Finland maija.haanpaa@orton.fi

Past Chair: Robert H. Dworkin, PhD Department of Anesthesiology University of Rochester Medical Center 601 Elmwood Avenue, Box 604 Rochester, NY 14642 USA

Secretary: Andrew Rice, MD Dept of Anaesthetics, Pain Medicine & Intensive Care Imperial College London SW10 9NH, UK a.rice@imperial.ac.uk

Treasurer: Jonathan O. Dostrovsky, PhD Dept of Physiology University of Toronto Toronto ON M5S 1A8, Canada j.dostrovsky@utoronto.ca

Newsletter Editor: Srinivasa N. Raja, MD Dept of Anesthesiology & Critical Care Medicine Johns Hopkins University Baltimore, MD 21287, USA Sraja2@jhmi.edu

IASP Council Liaison: Troels S. Jensen, MD, PhD Dept of Neurology Aarhus University Hospital 8000 Aarhus Denmark

Timely topics in pain research and treatment may on occasion be mentioned in the newsletter, but the information provided and opinions expressed have not involved any verification of the findings, con-clusions, and opinions by the International Associa-tion for the Study of Pain (IASP)® or the SIG on Neuropathic Pain. Thus, the opinions expressed in this newsletter do not necessarily reflect those of the Association, the SIG, or the Officers and Councilors of either IASP or the SIG on Neuropathic Pain. No responsibility is assumed by the Association or the SIG for any injury and/or damage to persons or property as a matter of products liability, negli-gence, or otherwise, or from any use or operation of any methods, products, instructions, or ideas con-tained in the material herein. Because of the rapid advances of medical science, the publisher recom-mends independent verification of diagnoses and drug dosage.

Contents:

The Chair’s Column Dear friends and colleagues, It is a pleasure and an honor for me to greet you, the NeuPSIG membership, on the front page of this newsletter for the first time as the new Chair. Since the last edition, when our past Chair Bob Dworkin gave a brief account of where we stand, NeuPSIG has held a very successful satellite meeting in London to the 12th World Congress on Pain and had its General Meeting in Glasgow on August 20, 2008, where we elected a new executive committee and approved a change in bylaws.

The satellite meeting in London (August 13-15, 2008) drew an atten-dance of over 400 delegates. More than half of them went on to the World Congress in Glasgow, showing that this type of satellite meeting has a positive cooperative effect with its main meeting. I am happy that NeuPSIG has now established a second format for meetings (as a me-dium-size satellite to IASP meetings) in addition to our own international congresses. In London, we had a sizable attendance by about 70 train-ees, 12 of whom were supported by bursaries. The 40 posters were on display throughout the entire meeting in the refreshments area and re-ceived a lot of feedback as well as three poster awards. Trainees appre-ciated the occasion to talk to well-known experts in a non-intimidating atmosphere. We tried a new format of oral sessions, with short presenta-tions by trainees only and two oral presentation awards. Contrary to my personal expectations, this format worked extremely well. In former times, brief oral presentations were a waste of time, because the feed-back in the discussion was typically useless (either the discussant gave a short talk himself or asked questions revealing that he had not paid attention during the presentation). In London, because of the small size of the meeting, the plenary nature of the two sessions, and a number of senior researchers in the audience asking excellent questions, discus-sion ran at its best and served to elaborate the wider implications of the results presented for the mechanisms of neuropathic pain and its treat-ment in general.

The feedback I received from trainees, in London and during the IASP trainee reception in Glasgow, was overwhelmingly positive. NeuPSIG plans to incorporate this session format into future meetings, including assigning designated discussants to these sessions. The Scientific Pro-gram Chair for London, Andrew Rice, deserves great applause for his excellent work.

I also think this experience bodes well for the next World Congresses on Pain in Montreal (2010) and Yokohama (2012). In Canada as well as in Japan, there are many excellent trainees locally, and I have started to explore with colleagues in those two countries ways to export the format of the London Satellite to the IASP congresses.

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Results of the IASP elections were announced well before the Glasgow Congress. NeuPSIG congratulates its mem-bers Cynthia Goh and Carlos Maurício de Castro Costa for being elected to the IASP Council.

At the NeuPSIG general meeting in Glasgow, the NeuP-SIG bylaws were changed by unanimous vote, thus keep-ing us in synchrony with the new pace of IASP con-gresses every two years. For the next two years I will have the pleasure of working with our Past Chair, Bob Dworkin, and the newly elected officers, Maija Haanpää (Vice Chair), Andrew Rice (Secretary), and Jonathan Dos-trovsky (Treasurer). The founding father of NeuPSIG, Ed Charlton, became an honorary member.

The new management committee is still in the process of being completed but already had its first retreat on No-vember 6, 2008, in Bermuda. In addition to reviewing plans for the upcoming NeuPSIG meetings, the commit-tee drafted a list of tasks for the next two years, including putting multilingual educational material on our website and identifying ways of implementing neuropathic pain assessment and treatment in limited resources environ ments. To persue these tasks, the following ad hoc sub-committees were formed, each of them spearheaded by a management committee member: Education (Srinivasa Raja), Research (Rolf-Detlef Treede), Assessment (Maija Haanpää), Treatment (Bob Dworkin and Nadine Attal), Bursaries (Geoff Gourlay and Ralf Baron), and Develop-ing Countries (David Simpson). We plan to report on the activities of these subcommittees in future newsletters. With best wishes for the year 2009, Rolf-Detlef Treede Here are several photographs from the NeuPSIG Satellite on Neuropathic Pain, which was held in London August 13-15 in association with the 12th World Congress on Pain. There were 429 registrants from 46 countries, of whom 88 were students or trainees. A total of five £200 prizes were donated by Schering Plough and awarded to trainees for outstanding free presentations: • Oral presentations: Eske Aasvang, Denmark; Irina

Kirillova, Germany • Poster presentations: Henriette Klit, Denmark; Hugo

Leite-Almeida, Portugal; Joanna Mika, Poland

NeuPSIG Executive Committee 2008-10

The nomination of the following members to the executive committee for the next two-year term was approved by the membership: Chair: Rolf-Detlef Treede Vice Chair: Maija Haanpaa Past Chair: Robert Dworkin Secretary: Andrew Rice Treasurer: Jonathan Dostrovsky

NeuPSIG Management Committee

The Executive Committee Chair: Rolf-Detlef Treede (Germany) Vice Chair: Maija Haanpaa (Finland) Past Chair: Robert Dworkin (USA) Secretary: Andrew Rice (UK) Treasurer: Jonathan Dostrovsky (Canada) Committee Members (Appointed) Nadine Attal (France) Allan Basbaum (USA) Sara Bistre (Mexico) Ralf Baron (Germany) Srinivasa Raja (USA) David Simpson (USA) Co-opted members (non-voting) Troels S. Jensen, IASP Liaison (Denmark) Geoff Gourlay, NeuPSIG Bali 2009 liaison (Australia) Chris Wells, NeuPSIG Athens 2010 Scientific Program Committee Chair (UK)

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The NeuPSIG management committee at Be rmuda. From left to right: Raja, Attal, Dworkin, Gourlay, Baron, Haanpaa, Treede, Simpson, Rice, Wells, Dostrovsky

Management Committee Meetings: The management committee met on November 6, 2008, at the Fairmont Southampton Hotel, Southampton, Ber-muda, in conjunction with the 10th International Confer-ence on the Mechanisms and Treatment of Neuropathic Pain. The next meeting of the committee will be held in Bali on April 19, 2009. NeupSIG and IASP combine to sponsor the Association of Southeast Asian Pain Societies (ASEAPS) meeting to be held April 17-20, 2009, in Bali. Saturday, April 18, will be devoted to aspects of the diag-nosis and treatment of neuropathic pain.

NeuPSIG Subcommittee Updates:

Assessment The committee, chaired by Maija Haanpaa, is finalizing a manuscript on the assessment of neuropathic pain by primary care providers (title: “Assessment of Neuropathic Pain in Primary Care”). Treatment The two most recent meetings of the committee were to develop evidence-based recommendations for invasive interventions for neuropathic pain and evidence-based recommendations for the non-pharmacologic, non-invasive management of neuropathic pain. A draft manu-script on invasive interventions that summarizes the sys-tematic reviews that provided the background for and pre-sents the evidence-based consensus recommendations developed at the first of these meetings has been pre-pared and is now being circulated among the authors. Work on a second manuscript on non-pharmacologic, non-invasive management that summarizes the system-atic reviews that provided the background for and pre-sents the evidence-based consensus recommendations developed at the second of these meetings is also ongo-ing but not as far along as the manuscript from the first meeting.

Research The committee, chaired by Rolf-Detlef Treede, is involved in preparing a two-day consensus meeting on human sur-rogate models of neuropathic pain.

Education The Education Committee is exploring several avenues to enhance the educational mission of the SIG. These include: 1) a list of "distance" mentors on the website with

each mentor's name and contact information being accompanied by a brief description of his or her areas of expertise for mentoring; 2) a NeuPSIG "speakers bureau" consisting of individuals who would be trained and pro-vided with a comprehensive slide set that could then be used as a basis for giving talks in developing countries with NeuPSIG paying all the expenses; 3) translations of key NeuPSIG guidelines articles on diagnosis, assess-ment, and treatment that would then be available on the web; 4) video presentations on the website on challenging and controversial topics or plenary lectures from NeuPSIG sponsored meetings. The Committee invites suggestions on other educational tools that would be helpful to the membership. Please send your suggestions to Srinivasa Raja by email (sraja2@jhmi.edu)

NeuPSIG Bursary Program Over the last three years, NeuPSIG has instituted a most generous bursary program to allow PhD students and early postdoctoral fellows to attend the various con-gresses and scientific meetings that NeuPSIG organizes. At the very least, this means that successful bursary ap-plicants can attend our scientific meetings at no cost once they get to the destination of the conference, i.e., we pro-vide complimentary registration and accommodation. For Berlin in 2007, we also provided significant contributions toward the airfares and, in some cases, provided funds to cover entire travel costs. This bursary program is in addi-tion to a very favorable registration fee for all students to attend our congresses, which barely covers our costs on a per-registrant basis. The NeuPSIG Management Com-mittee, together with our Education Subcommittee, con-siders such initiatives vital to support young researchers embarking on a career in pain. This financial support is a tangible expression of the importance we place on educa-tional initiatives. The funding for these initiatives is built into the local budget for each meeting, which means that the extent of the financial support we can provide varies for each meeting and is dependent on the ultimate size of the meeting in terms of registration numbers and industry support. The Management Committee derives much satis-faction in the success of this program, and we hope that all NeuPSIG members also feel the same way.

For the recent meeting we held in London as a satellite to the World Congress on Pain in Glasgow, we supported 10 individuals from a wide geographical area to attend this scientific meeting:

Jessica Alexander, USA Curtis Oware Asante, UK Adriano Franciosi, Brazil Jacqueline Hochman, Canada Thomas Klein, Germany Henriette Klit, Denmark Ricardo Kusuda, Brazil Hugo Leite-Almeida, Portugal Xue Jun Liu, Canada, Satyanarayana Padi, India

These individuals were either well advanced in their PhD programs or early postdoctoral fellows—precisely the type of researchers that this initiative aims to help.

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The Management Committee will again consider imple-menting a bursary program for the 3rd International Con-gress on Neuropathic Pain that will be held in Athens, Greece, on May 27-30, 2010. Developing World

A new committee was formed to deal with developing world issues that will be chaired by Dr. David M. Simpson and will also include Drs. Andrew Rice, Srinivasa Raja, and Nadine Attal. This committee will require not only neuropathic pain expertise, but also expertise in develop-ing world health care. Other members will be approached about joining the committee. The planned tasks for the committee include: 1) modify SIG assessment and treat-ment guidelines into a format appropriate to the develop-ing world; 2) act as a two-way conduit for the SIG for is-sues relating to the developing world; and 3) consider future venues where a management committee meeting might be held in conjunction with a local IASP chapter or local federation.

JOB ADS If you would like to advertise any jobs related to neu-ropathic pain in the NeuPSIG newsletter and website, please send details electronically to the Secretary, Andrew Rice. The Center for Biomedicine and Medical Technology Mann-heim (CBTM) of the University of Heidelberg is seeking a

Head of CNS neurophysiology laboratory

The Neurophysiology division of the newly established Cen-ter for Biomedicine and Medical Technology Mannheim (CBTM) is focused on the study of nociception and pain. In addition to the four operating laboratories (molecular biology,

dorsal root ganglion electrophysiology and imaging, human psychophysics, human EEG and neuroimaging), we are funded to establish a laboratory for the study of spinal-cord and brain slices (patch clamp, Ca-imaging, multi-electrode array). This new laboratory shall complement the existing peripheral neurophysiology laboratory in our translational approach to study mechanisms of nociception and pain memory in humans and animals. We closely cooperate with the department of Anesthesiology and the Central Institutes for Mental Health in Mannheim and with several other labora-tories in the Heidelberg-Mannheim region. Our work is funded by DFG, BMBF, EU and NIH.

Major tasks of the laboratory head are: set up a new labora-tory with electrophysiology and live cell imaging, establish animal models of spinal and cortical nociceptive processing, and contribute to our local and international collaborations. Salary is according to the German Tarifvertrag-Länder up to level E15.

Profile of the candidate: PhD or MD-PhD degree in life sciences; excellent knowledge and experience in either in vivo or slice electrophysiology of the mammalian spinal cord or brain; excellent managerial and administrative skills; interest in the mechanisms of no-ciception and pain memory.

Applicants should submit a letter of interest, curriculum vitae, and the addresses of three senior scientists who are able to supply a reference statement to:

Prof. Dr. med. Rolf-Detlef Treede Chair of Neurophysiology, CBTM, Medical Faculty Mannheim University of Heidelberg, Ludolf-Krehl-Str. 13-17 D-68167 Mannheim, Germany Tel: +49-621-3839926 Fax: +49-621-383-9921 Email: rita.weber@medma.uni-heidelberg.de http://www.ma.uni-heidelberg.de/inst/cbtm/nphys/

News Items

Current SIG information

As of January 16, 2009, the NeuPSIG has 1,050 mem-bers in 66 countries representing 49 specialties.

MARK YOUR CALENDAR!

Association of Southeast Asian Pain Societies (ASEAPS) Meeting

April 17 -20, Bali, Indonesia

12th International Meeting on Mechanisms and Treatment of Neuropathic Pain

November 19-21, 2009, San Francisco, USA

Third International Neuropathic Pain

Congress

May 27-30, 2010, Athens, Greece

ASEAPS (Association of Southeast Asian Pain So-cieties), NeuPSIG, and IASP combine to sponsor a pain meeting in Bali, Indonesia, on April 17-20, 20 09.

NeuPSIG is delighted to be associated with ASEAPS, which is an association of five National Pain Chapters in Southeast Asia (Indonesia, Thailand, Singapore, Malay-sia, and the Philippines) to sponsor a meeting from Fri-day, April 17, to Monday, April 20, 2009, in Bali.

The following website gives a comprehensive description of this important scientific meeting: http://www.aseaps2009.net/

This will be a four-day meeting with a day devoted to the diagnosis and treatment neuropathic pain on Saturday, April, 18. The NeuPSIG Management Committee has organized this Neuropathic Pain Day, and we are also contributing other presentations to the general program. Editor-in-Chief of PAIN, Allan Basbaum (Member to the NeuPSIG Management Committee); Prof. Tony Dicken-son; and IASP Past Presidents Troels S. Jensen and

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Michael Bond will also participate in this meeting. IASP will also have significant involvement in the Bali meeting by providing sponsorship for doctors and researchers from nearby countries that do not currently have national pain chapters to attend the Bali meeting. Anybody inter-ested in pain should consider attending the Bali meeting, as it provides a comprehensive program composed of local clinicians and researchers from the ASEAPS group together with a distinguished international faculty.

Third International Neuropathic Pain Congress Athens, Greece ~ May 27–30, 2010

Plans are well advanced for NeuPSIG's Third Interna-tional Congress on Neuropathic Pain. The excellent congress facility in the center of Athens has been booked. All of the plenary speakers have been contacted and have accepted, and a list of speakers is provided below. The sun has a 99% chance of shining for most of the week!

Stimulation of the central nervous system has been used for over 30 years for pain relief, but it is only recently that encouraging evidence-based papers have been pro-duced, confirming its efficacy. Recent guidelines from NICE, the rather difficult English Governmental body charged with ascertaining clinical excellence (or is it curbing expenditure?) have recently agreed that spinal cord stimulation is useful for failed back surgery syn-drome and for complex regional pain syndrome. Exciting developments occur with motor cortex stimulation. And so, our keynote theme for this conference is "stimu-lation of the central nervous system: mechanisms and management." We have two plenary speakers address-ing this on the first day, and a series of workshops linked into the subject.

We will also be taking a close look at the spinal cord, as well as genetics and epidemiology of neuropathic pain. The final plenaries on Sunday, May 30, promise to de-liver a barnstorming session on neuropathic pain medi-cation, warts and all, by two world authorities—Bob Dworkin and Andrew Moore. It also honors the work of Peter Nathan, a veteran in the field of neuropathic pain. We do hope all who are attending make this final ses-sion, as we are also giving out poster prizes and bur-saries on this occasion. Also, remember that flights back from Athens will be much cheaper on a Sunday, provid-ing a good excuse to stay over on Saturday night! Suggestions for workshops should be posted on the Ke-nes website (www.kenes.com/neuropathic) by the end of February. We can supply a small amount of support for those presenting. However, from past experience, we anticipate a vast number of submissions for workshops. Details regarding poster applications and bursaries will appear on the website later in 2009. Please register your interest with Kenes if you are interested in receiving de-tails.

We think this is going to be a tremendous meeting in a beautiful, vibrant city, and we advise anyone who is traveling to make sure they take some time, either be-fore or after the conference, to visit the Greek islands! Although there will be a lot of cutting edge science, the

program is also an extremely practical one, which will equip clinicians to return to their everyday work with enhanced knowledge and treatment strategies, to pro-vide better support for their patients. Scientists will have the opportunity to network with international colleagues looking at research into neuropathic pain and will also be able to exchange ideas with clinicians. Plenary Speakers Marshall Devor (Israel) Sulayman Dib-Hajj (USA) Robert Dworkin (USA) Luis Garcia Larrea (France) Stephen McMahon (UK) Andrew Moore (UK) Richard North (USA) Jurgen Sandkuhler (Germany) Geoffrey Schott (UK) Blair Smith (UK) Johann Vlayen (Belgium) Gunnar Wasner (Germany)

Publications by NeuPSIG Members 2nd edition of Neuropathic Pain Editors J P Drummond and Jaime Olavo Marquez. The first publication on the subject, in Portuguese lan-guage. Clinical Pain Management, 2 nd Edition A comprehensive four-volume set for trainees and spe-cialists in pain medicine that includes volumes on acute pain, chronic pain, and cancer pain, and a separate "Practice and Procedures" volume. Many NeupSIG members have contributed to these volumes both as editors and authors. Publisher: Hodder Arnold www.clinicalpainmanagement.co.uk Guidelines sponsored or co-sponsored by NeuPSIG and related articles describing NeuPSIG guidelines: Dworkin RH, Johnson RW, Breuer J, Gnann JW, Levin MJ, Backonja M, Betts RF, Gershon AA, Haanpää ML, McKendrick MW, Nurmikko TJ, Oaklander AL, Oxman MN, Pavan-Langston D, Petersen KL, Rowbotham MC, Schmader KE, Stacey BR, Tyring SK, van Wijck AJM, Wallace MS, Wassilew SW, Whitley RJ. Recommenda-tions for the management of herpes zoster. Clinical In-fectious Diseases, 2007;44(suppl 1):S1-S26. Dworkin RH, O'Connor AB, Backonja M, Farrar JT, Jen-sen TS, Kalso EA, Loeser JD, Miaskowski C, Nurmikko TJ, Portenoy RK, Rice ASC, Stacey BR, Treede R-D, Turk DC, Wallace MS. Pharmacologic management of neuropathic pain: evidence-based recommendations. Pain, 2007;132:237-251. Treede R-D, Jensen TS, Campbell JN, et al. Neuro-pathic pain: redefinition and a grading system for clinical and research purposes. Neurology, 2008;70:1630-1635. Geber C, Baumgärtner U, Schwab R, Müller H, Stoeter P, Dieterich M, Sommer C, Birklein F, Treede RD. Re-vised definition of neuropathic pain and its grading sys-

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tem: an open case series illustrating their use. American Journal of Medicine, in press. Haanpää M, Backonja MM, Bennett M, Bouhassira D, Cruccu G, Hansson P, Jensen TS, Kauppila T, Rice ASC, Smith BH, Treede RD, Baron R. Assessment of neuropathic pain in primary care. American Journal of Medicine, in press. O'Connor AB, Dworkin RH. Treatment of neuropathic pain: an overview of recent guidelines. American Journal of Medicine, in press.

News from around the Globe

Certification for Quantitative Sensory Testing (QST ) introduced in Germany As of November 2008, hospitals or laboratories in Ger-many can be certified as having the infrastructure to per-form Quantitative Sensory Testing (QST) according to the profiles of the German Research Network on Neuro-pathic Pain (DFNS). The underlying criteria are based on the validated protocol of the DFNS.

QST is the standardized extension of the clinical-neurological sensory examination and allows the com-plete assessment of all sensory submodalities including the large (Aβ-) and small fibers (Aδ- and C-fibers). It de-tects not only hypophenomena but also hyperphe-nomena due to a disturbed pain processing in the pe-riphery, spinal cord, or brain. In this way, QST has gained an increasing importance for the understanding of pathological mechanisms involved in neuropathic pain and is recognized as a useful additional diagnostic tool.

Because quantitative sensory testing is based on a sub-jective psychophysical method and accordingly on pa-tients’ cooperation, standardized protocols and instruc-tions are of special importance to allow comparisons across laboratories as objectively as possible. Therefore, the German Pain Society (DGSS) and the DFNS have initiated a certification procedure for QST quality stan-dards through the agency Certkom (http://www.certkom.com/).

For the certification procedure, structural and procedural criteria as well as outcome parameters were established. Those criteria cover the evaluation of the QST laboratory including its operating times as well as required devices, of standardized protocols and standardized instructions, and finally of the clinical interpretation of the collected data. A score was established for these several struc-tural, procedural, and outcome criteria and used for the evaluation of the ability of certification. Of crucial signifi-cance is the inspected validity and reliability of the as-sessed parameters.

The DFNS working group and the DGSS are convinced that this certification is a step forward to guarantee a standardized quality of the diagnostic of neuropathic pain. By maintaining those high quality standards, the certification of QST is intended to contribute to a better understanding of the mechanisms of neuropathic pain syndromes. In addition to an improved patient care it can be of special importance for research and industry to perform QST based studies in qualified and certificated laboratories.

Please submit your contributions, ideas, and comments for the NeuP SIG Newsletter to the Newsletter Editor:

Srinivasa N. Raja, MD, Department of Anesthesiology and Critical Care Medicine, Johns Hopkins University, Baltimore, MD 21287 USA Email: sraja2@jhmi.edu