EFIC's School for: Neurological Diagnosis in Chronic Pain "Clinical and instrumental processes"

26-30 October, 2009

"Salvatore Maugeri" Foundation
Scientific Institute for Research and Care
Montescano (PV) - Italy
Dept. of Clinical Neurophysiology & Pain Rehabilitation Unit


The outpatient
In outpatient practice it is important to make a first essential screening (neuropathic, nociceptive, mixed pain). The aim of this section is to give a quick reference flow chart for clinicians mainly working in outpatient clinics.

  1. The first interview(video recording, documentation on paper/PC)
    1. The clinical examination (first level)
    2. Minimum instrument set needed (hammer, tuning fork, Von Frey hairs, heat and cold, dermographic pencil)
    3. How to make easy and fast recordings of the clinical picture (scales & questionnaires, their short forms, etc.)
  2. The psychological profile
  3. The second interview and how to take recordings 
    Diagnostic procedures in an outpatient setting: what to ask for and how to interpret it.
    1. Standard and routine neurophysiology
    2. Routine radiology and neuroradiology
    3. Laboratory (blood samples for inflammatory markers, etc.)
    4. Quantitative sensory testing
    5. Minimally invasive tests (superficial nerve blockade, trigger points, etc.)
  4. How to obtain information on the pathophysiology of pain through the use of drugs
    1. Pharmacological tests (lidocaine test, etc.)
    2. Ca/Na/K blockers
    3. Non-steroidal anti-inflammatory drugs and COX2-selective inhibitors
    4. Inhibitors of the serotonin and noradrenaline reuptake
    5. Opiates
  5. The functional assessment
    1. Quality of life
    2. Motor impairment
    3. ICF classification

Pain Tournament or Europe against Pain – The First Challenge
A tournament will be organized between participants to verify the level of knowledge acquired after this session. The tournament consists of simulated cases within a range of pain topics from those most frequently seen in the outpatient setting. The aim is to make this an educational exercise while introducing the fun of a competition. The winner will be the participant who obtains the diagnosis in the shortest possible time with the most limited and best use of the laboratory results. 
The inpatient or the highly complex patient 
A patient is referred to a pain clinic mainly for further investigations, confirmation of the diagnostic hypothesis or to start a given treatment. In this setting the clinical and diagnostic tools should be used to define the type of pain precisely and determine the possible sites of action of the therapeutic options.

  1. The interview in a pain unit setting
  2. Critical revision of the patient's history
  3. The multidisciplinary approach
  4. How to use consultants from different specialities
  5. The clinical examination (second level)
    1. Mechanical static, dynamic, deep somatic
    2. Mechanical pinprick
    3. Thermal (heat & cold)
  6. Diagnostic procedures in an inpatient setting
    1. Quantitative sensory testing (thermal; vibratory)
    2. Neurovegetative tests (non-invasive)
    3. Sudomotor studies (SSR; QSART Quantitative sudomotor axon reflex test)
    4. Vasomotor studies (photoplethysmography; laser Doppler)
    5. Skin temperature (thermography)
    6. R-R variability (Valsalva manoeuvre, tilt test)
  7. Questionnaires and diaries (complex pain questionnaires; ADL questionnaires; specific, disease-oriented questionnaires)
  8. Special neurophysiology testing (clinical indications and limitations)
    1. Microneurography
    2. Evoked potentials (LASER, dermatomeric, SSEP)
    3. Reflex responses (blink, RaIII)
    4. Brain mapping
  9. Special neuroradiology
    1. PET
    2. SPECT
    3. Other functional neuroimaging
  10. Biopsies (skin, nerves, muscle)
  11. Psychological profile
  12. Laboratory (immunohistochemistry)
  13. Invasive diagnostic procedures
    1. Peripheral nerve blockade
    2. Electrostimulation (SCS, PNS, etc.)
    3. Bier's blockade with different compounds
    4. Systemic lidocaine test
    5. Pharmacological tests

Learning questionnaires 
In this setting, the clinical and diagnostic tools learned during the School will be discussed and compared, with teachers, in relation to real clinical cases.
Pain Tournament or Europe against Pain – The Final Challenge.
The "losers" of the First Challenge will have a second chance to tackle more complex and challenging cases of chronic pain. As for the First Challenge, the tournament will consist of simulated cases within a range of highly complex pain topics. The aim is to make this an educational exercise but with the fun of a competition.

General information

School, organisation and tools

  1. 15 students (maximum)
  2. 32 hours of lessons divided into:
    1. Lectures
    2. Simulations
    3. Role playing
    4. Hands-on workshops
    5. E-learning
    6. Brain storming and interactive sessions
    7. The Challenge: Europe Against Pain

The lessons will start on Monday morning at 8.00 a.m. and end on Friday at noon.

The School will take place at Montescano Rehabilitation Centre, "Salvatore Maugeri" Foundation, an Institute for Research and Care (IRCCS) (for more details go to: www.fsm.it, then click on "Gli Istituti della Fondazione in Italia" and click again on "Istituto Scientifico di Riabilitazione di Montescano" on the map). Montescano Rehabilitation Centre has about 300 beds for intensive rehabilitation (neurological, orthopaedic, cardiological and respiratory rehabilitation). It also has a Dept of Clinical Neurophysiology & Pain Rehabilitation Unit, and a Unit for Robotics and Virtual Reality Augmentation.

Montescano (Italy) is located 60 km from Milan and 30 Km from Pavia and Piacenza, in the hills of the Oltrepo Pavese. The area, surrounded by vineyards, is very charming (for more details go to: www.oltrepopavese.pv.it –in Italian).

AccommodationMonteScano Hotel, a very comfortable three-star hotel right next to the Rehabilitation Centre (to see the location go to: www.locandamontescano.com).

Length of stay: 4 ½ days (suggested Monday to Friday)

How to reach Montescano:
By plane: the venue is approximately 90 min travelling time from Milano-Malpensa and Milano-Linate airports. Transfers can be organized. 
By car: Montescano is located on the Torino-Piacenza-Brescia motorway (exit: Stradella)
By train: the nearest train station is Stradella

Social activities
Wine & Food tasting in renowned wineries
Pain & Pleasure Club®: Gospel & Soul evening

Important notes 
English is the official language of the School. No translation will be provided.
EACCME European (CME) as well as national educational (ECM) credits will be requested.