Plenary Lecture

Plenary Lecture

Basic and Clinical Neurophysiology of Chronic Pain:
From Localised Symptoms to Generalised and Widespread Pain

Professor Cesar Fernandez de las Penas
Departamento de Fisioterapia
Facultad de Ciencias de la Salud
Universidad Rey Juan Carlos
Avenida de Atenas s/n,
28922 Alcorcon, Madrid, SPAIN

Educational objective:
The aim of the plenary session would be to integrate basic, experimental and clinical scientific studies related to chronic pain and how local pain symptoms can lead to spreading of pain, generalized pain, and central sensitization. The lecture will focus on clinical evidence related to headache, carpal tunnel syndrome, lateral epicondylalgia and fibromyalgia syndrome.

It has been reported that several local pain syndromes show both peripheral and central sensitization mechanisms. The existence of sensitization mechanisms in local pain syndromes suggests that prolonged peripheral noceceptive inputs driving to the central nervous system play a role in the initiation or maintenance of central sensitization mechanisms. This finding would explain the phenomenon seen by clinicians in which patients with local pain generally develop spreading of their symptoms with time. Some animal models where the phenomena of localized nociception cause the development of secondary, widespread hyperalgesia have been used. In addition, human experimental pain models are generally used as surrogate models simulating clinical conditions, particularly localised musculoskeletal pain conditions. Primary hyperalgesia in musculoskeletal tissues can be experimentally induced by infusion of different algogenic substances (nerve growth factor, or glutamate). Such experimental models can also be applied to patients with chronic musculoskeletal pain for mechanistic evaluation to investigate which aspects of the pain sensitisation process are modulated. Localised and experimentally induced muscle sensitisation can subsequently initiate central sensitisation which is manifested as sensitisation of adjacent structures and spread of pain. The temporal and spatial phenomena can be quantified. Finally, clinical evidence will concentrate on three local pain syndromes: chronic tension type headache (CTTH), lateral epicondylalgia (LE) and carpal tunnel syndrome (CTS) and how they can spread and cause generalized sensitization. Clinical evidence of central sensitization in these pain syndromes is the fact that both CTTH and LE have pressure pain hyperalgesia and larger referred pain areas elicited by active trigger points (TrPs). Further, CTTH is also characterized by the presence of multiple active TrPs in the same muscle (spatial summation) whereas unilateral LE is characterized by the presence of bilateral muscle TrPs. There is also clinical evidence of segmental and central sensitization mechanisms in other local pain syndromes, e.g. carpal tunnel syndrome, knee osteoarthritis, unilateral shoulder pain, myofascial temporomandibular disorders and low back pain. Finally, the presentation will also include the evidence for fibromialgia syndrome as pain condition representative of widespread pain sensitization and symptoms.

Brief Biography of the Speaker:
Cesar Fernandez-de-las-Penas is a Professor of Physical Therapy at Universidad Rey Juan Carlos, Madrid, Spain where he is the head division of a research group focused on clinical sciences related to pain. He has conducted his PhD in biomedical Sciences in the Center for Sensory Motor Interaction (SMI) in Aalborg University and a second PhD in Physical Therapy at the Universidad Rey Juan Carlos. His research activities are concentrated on biomedical sciences within neuroscience. The specific research areas have been on pain and assessment of pain in volunteers and chronic pain patients. The main focus is on human clinical chronic pain research. A substantial network of international collaborations with 5 different countries has been established with universities and hospitals. He has published around 100 publications and he is first author of approximately 85 of them. Most papers concentrate on clinical human pain research, drug screening and interaction between motor control and chronic pain. The most relevant topics of his research are focussed on neck pain, headache, carpal tunnel syndrome, lateral epicondylalgia and neuro-physiological effects of manual therapy. He has participated in 50 conferences with related published abstracts/ proceedings and he has given several lectures at Spanish and foreign universities and hospitals. He has given around 10 invited lectures at international meetings/workshops/seminars.

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