Ellipse: NeuP



     NEWSLETTER of the IASP Special Interest Group on Neuropathic Pain


Issue 5                                                                                                                                                                                     December 2004



Turo J. Nurmikko, MD

Pain Research Institute

Clinical Sciences Building

University Hospital Aintree

Liverpool L9 7AL  UK


Vice Chair

Robert H. Dworkin, PhD

Department of Anesthesiology

University of Rochester Medical Center

601 Elmwood Avenue, Box 604

Rochester, NY 14642  USA



Christopher D. Wells, MB ChB, FFARCS

45a Rodney Street

Liverpool L1 9EW  UK


Secretary /Newsletter Editor

J. Edmond Charlton, MB BS, FRCA

1 The Wynding, Bamburgh

Northumberland NE69 7DB  UK



IASP Council Liaison Person

Troels S. Jensen, MD, PhD

Department of Neurology

Aarhus University Hospital

8000 Aarhus  Denmark


Timely topics in pain research and treatment have been selected for publication, but the information provided and opinions expressed have not involved any verification of the findings, conclusions and opinions by the International Association 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 Counsellors 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, negligence or otherwise, or from any use or operation of any methods, products, instructions or ideas contained in the material herein. Because of the rapid advances of medical science, the publisher recommends that independent verification of diagnoses and drug dosage should be made.





Plans for Satellite meeting before 11th World Congress on Pain


Plans are now finalised for the NeuPSIG Satellite meeting at Uluru (Ayers Rock). The venue is one of the finest in the world and the splendour and the incredible beauty of Uluru has been recognised as a World Heritage Site. However, the venue is secondary to the superb scientific program. Some of the best speakers available will discuss peripheral and central mechanisms, diagnostic methods, treatments for individual diseases and the use of specific treatments. The final sessions emphasise future developments and
cannabinoids, novel receptor agonists and strategies for prevention are all featured.


Expanding Vistas in Neuropathic Pain, August 17-20, 2005

Program and speakers:


Peripheral Mechanisms -

Role of inflammation - Claudia Sommer

Ion channels – Gary Strichartz

Peripheral Sensitization – Martin Schmeltz

Central Mechanisms -

            Central Sensitization – Jürgen Sandkühler

Glial Activation – Ru-Rong Ji

            Thalamic Mechanisms - Jonathon Dostrovsky

Diagnostic Methods –

            Clinical Testing (including QST) – Per Hansson

            Invasive and Non-invasive Neurophysiologic Testing
                 – Luis Garcia-Larrea

            Functional Brain Imaging – Karen Davis

Debate –

Can we translate mechanisms into treatment?
                 – Per Hansson, Ralf Baron    (Debate format)

Treatment of Specific Diseases -

            TGN - Turo Nurmikko

Spectrum of Nerve Injury – Thomas Toelle

            CRPS – Ralf Baron

            Spinal Cord Injury – Philip Siddall

Role of Specific Treatments -

            Anticonvulsants for 2005 and beyond - Misha Backonja

            Opioids for Neuropathic Pain – Christopher Wells

            Intraspinal Drug Therapies  – Allen Hord

What is in the future?

            Cannabinoids - Andrew Rice

            Novel Receptor Antagonists – Charles Bountra

            Strategies for Prevention – Robert Dworkin


A brochure outlining the details of the scientific program will be circulated to all SIG members in the very near future. In addition, there are details of opportunities to see the wonders of Uluru and the spectacular sister site at Katja Tjuta (The Olgas). The program includes ample opportunity to ask questions and there also the opportunity to socialise with both faculty and other colleagues whilst enjoying the breath-taking beauty on offer at Uluru. For information: http://dcconferences.com.au/npp2005

Opportunities for Trainees


NeuPSIG is offering three travel awards to the trainees submitting the best posters. These are for the sum of Au$2000. This will be sufficient to cover travel to Uluru, full registration and accommodation. Posters should be submitted by
February 14, 2005
and will be assessed rapidly by Dr Strichartz and the members of the NeuPSIG research committee to ensure that prize winners are informed in ample time to make appropriate travel arrangements. Trainees who wish to attend the meeting anyway will be able to take advantage of a

reduced registration fee.

Full details on the NeuPSIG website on www.neupsig.org  or the conference website http://dcconferences.com.au/npp2005  


The programme is timed so that it is possible to view the majesty of Uluru as the sun rises and sets. Transportation to and from Uluru is part of the package being put together by DCConferences and delegates attending the Uluru meeting will be returned to Sydney in ample time for the Refresher Course at the start of the World Congress on Pain.


No one with an interest in neuropathic pain should miss this meeting. No one wishing to see one of the most spectacular sights in the world should miss it either. 


Business Meeting of NeuPSIG

 to be held during the
11th World Congress on Pain® (WCP)
at the Sydney Convention Center ,
Wednesday, August 24, 2004, 16:30-17:30


As required by our constitution and bylaws, the SIG will hold a General Meeting during the WCP. We have not been advised room number yet and this will be circulated to members with the statutory notice sent 60 days before the meeting. The items of business that need to be considered during this meeting will include the adoption of the constitution and bylaws of the SIG. A draft version of these was circulated with newsletter number 3 asking SIG membership for comments and alterations.  There have been a small number of minor modifications to that draft as a result and the final draft will be circulated to all members with the Agenda for the General Meeting and the Minutes of the last General Meeting held in San Diego in August, 2002.


Under the interim constitution, the Vice Chair of the SIG will assume the Chair in Sydney. In other words, Turo Nurmikko will stand down and Bob Dworkin will become Chair for the next three years. Nominations will be sought for the other three posts on the SIG Executive; those of Vice Chair (who will take over the Chair at the WCP in Glasgow 2008), Secretary and Treasurer.




The method of election is as follows: - Candidates for executive committee posts should be proposed and seconded in written or electronic format by members of IASP and the SIG in good standing. The nomination should be accompanied by the agreement of the candidate to take part in an election and to serve if elected. Nominations should be made to the Executive Committee twenty eight (28) days prior to the general meeting. Election of officers shall be by means of a ballot, with a simple majority vote of members attending the general meeting deciding the successful candidates.


The officers of the SIG (the Executive) are appointed by election at the General Meeting. Members of the Management Committee (the ones who do all the work) are appointed by the Executive shortly afterwards. This system enables the SIG to maintain a broad spread of membership covering different disciplines and geographical areas in keeping with the philosophy of our parent body the International Association for the Study of Pain.


Please discuss these elections with your friends and colleagues. The Executive will present a slate of individuals who are willing to stand. For example, Chris Wells has expressed a willingness to serve a further term as Treasurer and Rolf-Detlef Treede has stated that he is willing to be nominated for the post of Vice Chair. This is not an attempt to create a self-perpetuating gerontocracy (as, it is alleged,  may be the case with other SIGs), simply a method of ensuring that there are no embarrassing moments where we have to run around forcing ‘volunteers’ to stand for election. One thing you will all be relieved to know, is that I will be standing down as Secretary. If any member has questions or comments please contact me by email. edmond.charlton@btinternet.com , or by post;  I really enjoy the nostalgia of getting a letter...



The chair of the NeuPSIG website committee (Dr Jonathan Dostrovsky) has compiled a list of workshops and mini-symposia that feature neuropathic pain in some way. 


Titles approved are : - Mechanisms of pain induced by cancer and cancer treatment; Lamina I spinal cord neurons and the control of chronic pain states; Cold Hyperalgesia; MAP kinesis and pathological pain; Candidate gene studies in pain and headache; Spinal sensitization during peripheral nerve damage; Opioids for Chronic Non-cancer Pain: Bench to Bedside; Cannabinoids: Developing clinically useful analgesics; Injury-dependent plasticity at multiple levels of nociceptive transmission; Long-term potentiation: A central mechanism in plasticity of nociceptive transmission and pain perception; Methods to assess allodynia and hyperalgesia in clinical practice;

What should we measure in chronic low back pain patients; Pain in immuno - compromised patients; Mechanisms underlying pain and dysfunctional following whiplash injury: Implications for management; Descending control of pain during persistent peripheral damage: Is it inhibitory or facilitatory? Postherpetic neuralgia (PHN): a disease with many faces; 5 - HT1A receptors in chronic pain processing and control; Classification, diagnosis and outcome measures in patients with orofacial pain. Central pain .


19 workshops with subjects that cover every aspect of neuropathic pain, and all with excellent presenters who are bound to stimulate discussion and debate.


NeuP SIG Committees


·        Classification.

Rolf-Detlef Treede reports that the Classification subcommittee met during the Neuropathic Pain Congress in Madrid to discuss the development of a definition of diagnostic criteria for Neuropathic Pain. This meeting was chaired by Troels S. Jensen, and was attended by J Campbell, G Cruccu, J Dostrovsky, J Griffin, P Hansson, M Koltzenburg, T Nurmikko, J Serra (Secretary) and R-D Treede acting as vice chair. The group discussed a rephrasing of the current IASP definition of Neuropathic Pain, the introduction of a grading system (definite, probable, possible), and the redefinition of some of the basic pain terms. Once an agreement on this taxonomy has been reached within NeuPSIG, the resulting document will be submitted to the IASP task force on taxonomy (chair: John Loeser).


These are the first proposals : -


New draft definition for neuropathic pain:


Pain arising as a direct consequence of diseases affecting the somatosensory system.


New draft grading system for neuropathic pain


This is still under development. As a starting point, the definitions by Rasmussen et al. (Pain 110 (2004) 461-469) are proposed:


Definite Neuropathic Pain:

Pain in neuroanatomically defined area plus at least two of the following:

        decreased sensibility in painful area

        disease causing nerve lesion

        confirmed by neurophysiology, surgery, neuroimaging


Work is continuing about the lower two levels of evidence for the presence of Neuropathic Pain (probable, possible) in a given patient: these conditions have to be graded in two further steps.


Urgent request

The task force invites comments by NeuPSIG members about advantages and disadvantages of the proposed definitions to be sent to Troels S. Jensen: or Jordi Serra: jserra@meditex.es .



Membership of this committee is being finalized It is recognized that assessment guidelines are available, but not all are suitable for use by all disciplines and the committee is anxious to produce recommendations that will benefit all members. A review of existing guidelines will be carried out as a prelude to a meeting to be held early next year. A full report will be given to members at the General Meeting in Sydney by the Chair, Turo Nurmikko.




·        Treatment

Under Bob Dworkin’s dynamic leadership, this committee has undertaken the enormous task of reviewing all properly constructed and peer-reviewed work on treatment and will also include articles in press. The intention is to collect these into a pack that would be circulated and reviewed by the subcommittee. Thereafter, available treatments would be graded into first and second line therapy. The initial focus is to be on pharmacotherapy, but other forms of therapy will be considered in due course. A meeting of the full committee to be held on 2nd April, 2005, and this too, will report to the General Meeting.


·        Research.

Dr Gary Strichartz, the chair of the NeuPSIG research committee, is anxious to assess interest in a proposed multicenter trial of the use of IV Lidocaine to treat neuropathic pain of different etiologies and with differing dosing regimens. In the first instance, it would be helpful if members of the SIG could email Gary if they wish to be kept informed about this initiative:  gstrichz@zeus.bwh.harvard.edu. If there is sufficient interest, those replying will be contacted with a date, time and venue of an informal meeting to be held in Sydney during the WCP.  Those unable to attend will be informed of the outcome and conclusions of the meeting at a later date.


·        Website

Dr Jonathan Dostrovsky has agreed to become chair of this sub-committee to ensure that the content reflects the views and interests of the membership. Many suggestions have been received about improving the content and many more will always be welcome. Among the suggestions received are that abstracts of previous meetings should be left on the website for a finite period after the meeting. The website committee and the secretary are anxious to receive details of meetings with some content on any aspect of neuropathic pain.


Your views are sought about the electronic distribution of this newsletter. In addition, we ask whether an email list of SIG members could be maintained for the purpose of circulating members rapidly with issues such as the proposed changes to definitions and the new grading system.


In view of the urgency of the request for comments by NeuPSIG members about advantages and disadvantages of the proposed definitions, the committee would be grateful if you could email your comments without delay to:

edmond.charlton@btinternet.com  . In addition, it is proposed that a ‘one-off’ email circulation take place of members who list their email addresses with the IASP secretariat. They would be offered the chance to receive further newsletters and communications from the SIG by this method. Adopting this method of communication would save on postage and administration costs and would undoubtedly be quicker in getting information to the membership. It could also be used to highlight changes or recently added material on the website. Let us know what you think about this matter too and we will be guided by your views.



Future Meetings of NeuPSIG


Planning must continue for future SIG activity and the nature and format of future meetings were discussed at the recent Management Committee meeting. Next year’s Satellite meeting at Uluru is organised and it was agreed that the SIG will continue to co-sponsor the highly successful series of meetings on neuropathic pain held by the University of Rochester. Your view is sought about suitable topics and format for future meetings to be held in 2005/2006. One of the ideas expressed was that the SIG should address areas of controversy: for example, a meeting on animal clinical models for neuropathic pain. The Research Committee would very much like to hear from members with suggested titles, as well as favoured venues and preferences for the format of the proposed meeting. Contact Gary Strichartz with your ideas gstrichz@zeus.bwh.harvard.edu .


In 2007 it is proposed that the SIG organize a meeting with a similar format to the highly successful Madrid meeting reported by Rolf-Detlef Treede at the end of this newsletter. Another European venue has been suggested and Berlin is the favoured site. The following year (2008), a satellite symposium will be organized in conjunction with the WCP to be held in Glasgow.


Report on the International Congress on the Study of Neuropathic Pain in Madrid, Spain that was held May 13-16, 2004


NeuPSIG’s first major congress followed the format of the highly successful series of World Congresses on Pain ® organized by our parent body IASP®. It consisted of plenary sessions, topical workshops, industry-sponsored symposia, and poster presentations. The aim of this congress was to gather basic and clinical scientists and practicing clinicians from all disciplines engaged in the care for patients who suffer from neuropathic pain. The feedback we have received after the meeting shows that this congress was of equal interest to both practicing clinicians and basic scientists.


There were over 1000 participants and an exceptionally high attendance during plenary sessions, symposia and workshops, lively discussions during the poster sessions and a full exhibition hall throughout the conference. The SIG can be very proud of this meeting, which was the first of its kind in Europe and which we hope will establish a series of scientific conferences on neuropathic pain associated with NeuPSIG. Many of the registrants in Madrid were members of the SIG and we will be happy to hear further comments about this meeting or any suggestions for future meetings that you might have. In particular, we would be delighted to hear from you regarding the next Congress in 2007, which, as reported earlier in the newsletter, is tentatively planned for Berlin. (In response to the one major criticism we have received about Madrid – a venue nearer the major sights and amenities is being sought!)


SIG financial statement: 
At the end of the third quarter, 9/30/04, the SIG had a balance of US$ 34,139 in the account.

The bottom line is that meetings like this have huge benefits for the SIG; it enables us to continue to fulfill the aims and objectives of the SIG, and for those of you who want a reminder they are : -


The SIG will advance the understanding of mechanisms, assessment, prevention and treatment of neuropathic pain.

Aims and Objectives


Ÿ        Collaboration for basic and clinical research

Ÿ        The study of the underlying mechanisms of neuropathic pain

Ÿ        The exchange of information and experience about the assessment and treatment of neuropathic pain

Ÿ        The identification and implementation of programs to prevent the development of neuropathic pain

Ÿ        Furthering the educational objectives of the SIG via international meetings, an annual symposium, workshops at the IASP World Congress on Pain®, Congress satellite meetings, a newsletter and the IASP Web site.’




The Madrid meeting was organized by Rolf-Detlef Treede and Chris Wells with local support from Pedro F. Bejarano and his colleagues. Rolf-Detlef and Chris deserve a resounding vote of  thanks, not only for organizing a superb meeting of the highest quality, but also for ensuring that a modest surplus was achieved which will be used to fund other SIG activity as outlined above.


Your management committee have asked you to consider several areas and let us have your views. Specifically and urgently, we need to know your opinion about the proposed changes in the definition of neuropathic pain and the introduction of a grading system. We need to know about other topics - future SIG meetings, their content, the proposal for a multicenter research meeting and we be grateful if you could let us know about meetings with neuropathic pain content to be held by other groups so these can be listed on the website. Tell us if electronic communication is the way forward. There are advantages and disadvantages; what would you prefer?


Finally, make sure you book early for the Uluru meeting: http://dcconferences.com.au/npp2005  This is a chance-in-a-lifetime opportunity – don’t miss it! 



For any correspondence, suggestions and comments, please contact the NeuPSIG secretary, Dr. Ed Charlton at:  edmond.charlton@btinternet.com  


For other SIG information go to the NeuPSIG Web Site:   www.neupsig.org   


SIG members need to be members of IASP.  To join the SIG contact IASP at: members@iasp-pain.org  .