Professor Rainer Freynhagen is a specialist in anaesthesiology, intensive care, pain management, palliative care and sports medicine. He studied medicine in Germany, Switzerland and Great Britain and completed his studies 1992 at the Heinrich-Heine-University in Düsseldorf. After obtaining the status as Diplomate by the European Academy of Anaesthesiology and Intensive Care (DEAA) in 1999, he additionally completed a study in Health Management in Cologne in the following years.

For more than 10 years Professor Freynhagen led the Division of Pain Management and Palliative Medicine, Department of Anaesthesiology at the University Hospital Düsseldorf. In 2007 he was jointly awarded the Prize for Pain Research from the German Society for the Study of Pain (DGSS). Since April 2009 he is the elected head of the Department of Anaesthesiology, Critical Care Medicine, Pain Therapy & Palliative Care at the Benedictus Hospital Tutzing, Germany, an Academic Teaching Hospital of the Technical University Munich, which is at the same time one of the largest and renowned Pain Centres in Europe (Pain Centre Lake Starnberg). He holds his professorship, research and teaching assignment at the medical faculty of the Technische Universität München.

Professor Freynhagen is an elected member of the European Society of Anaesthesiology, member of the International Association for the Study of Pain and many other national and international scientific associations. He is specialized in the diagnosis and treatment of neuropathic pain, back pain and the fibromyalgia syndrome. His main research interests focus on pharmacologic mechanisms, treatment, epidemiology and phenotyping of neuropathic pain. He and his co-workers developed painDETECT, a worldwide used screening tool to discriminate between neuropathic and non-neuropathic pain.

Rainer Freynhagen serves as scientific grant reviewer for the Ministry of Health in several countries and an authorized expert for the German Federal Government. He has published numerous research articles, book chapters and reviews in different prestigious international top journals in the field of pain medicine, Anaesthesiology and palliative care and he has delivered globally several hundred invited scientific lectures.

Rolf-Detlef Treede, Dr. Med., (Germany), Past President IASP

IASP Activities

IASP Member Since 1982
Councilor; Section Editor of PAIN; Chair of Committee on Committees, Audit Committee, Classification on Pain Diseases Task Force; Member of numerous committees

Professional Background

Prof. Dr. Treede’s research addresses peripheral transduction, cortical processing, pain memory and neuropathic pain. His laboratory employs a broad range of techniques in cell cultures, animals and humans. They are members of national and international research consortia, and have contributed to the development of clinical laboratory tests such as Quantitative Sensory Testing. As former NeuPSIG chair, Prof. Dr. Treede was involved in international guidelines on assessment and treatment of neuropathic pain. As former president of the German pain society DGSS, he contributed to the introduction of a chronic pain code into the German ICD-10 and to mandatory teaching of pain medicine in medical schools.

Chronic neuropathic pain is often difficult to treat and research into risk factors and prevention is important. In recent years, there have been a focus on mechanisms and risk factors for the “transition of acute to chronic pain”. Acute pain is most often a transient nociceptive pain and it has been proposed that there may be a shift from a “physiological” to a “pathological” pain, when pain become chronic. However, in neuropathic pain, the pain may be “pathological” from the beginning. There is limited research into acute neuropathic pain. Neuropathic pain may occur immediately after a disease or lesion of the somatosensory nervous system but the onset may be delayed. Prospective studies in neuropathic pain due to stroke, spinal cord injury, and surgery suggest that early sensory hypersensitivity and paresthesia or dysesthesia can precede the onset of an ongoing chronic neuropathic pain. We need better tools to identify neuropathic pain early in order to understand the mechanisms underlying the onset and resolution or persistence of acute neuropathic pain.

Prof. Nanna Brix Finnerup is director of the Danish Pain Research Center, Department of Clinical Medicine, Aarhus University, Denmark. She graduated from the Medical School at Aarhus University 1993, and after internship worked at the department of Neurology and Clinical Neurophysiology at the University of Copenhagen.

Prof. Finnerup is currently chair of NeuPSIG, the neuropathic pain Special Interest Group of the International Association for the Study of Pain (IASP), and is past president of the Scandinavian Association for the Study of pain (SASP). She is section editor of the journal PAIN, and editorial board member of Scandinavian Journal of Pain and Pain Management.

Prof. Finnerup has authored more than 150 refereed publications. Her main research interest is the pathophysiology and therapy of neuropathic pain. Current research areas include painful chemotherapy-induced and diabetic polyneuropathy, postsurgical neuropathic pain, spinal cord injury pain, pain biomarkers, thermal sensory integration, neurophysiological assessment of pain mechanisms, neuropharmacology, clinical trials, and systematic reviews.

Since 2014 Prof. Rolke is Chair and Director of the Department of Palliative Medicine, RWTH Aachen University. Before he was the Assistant Medical Director of the Department of Palliative Medicine (Director Prof. Lukas Radbruch) at the University Hospital of Bonn. He worked before as a neurologist (senior physician) in the Department of Neurology, University of Mainz, Germany. For some years, he also joined the pain research group of Prof. Rolf-Detlef Treede (Neurophysiology of pain, former IASP president).

Specifically, his research interests include the pathophysiology and therapy of neuropathic cancer pain. He was involved in the development of the protocol for the implementation of quantitative sensory testing in the context of the German Research Network on Neuropathic Pain (DFNS). He managed nationwide training sessions in this methodology for the measurement of pain sensitivity. Within the neuro-scientific focus and palliative medicine approach of the University Clinics of Mainz, Bonn and Aachen, he conducted studies in the area of “back pain”, “neuropathic pain” and “cancer pain”. Prof. Rolke is first author of several internationally acclaimed studies in high level journals. In 2007, he won the 1st prize for clinical pain research of the German Pain Association, the most prestigious German pain prize. Prof. Rolke was member of the Research Committee and is editor of a patient´s guide of this society. He gave numerous lectures in the aforementioned Universities and organised several national and international congress workshops (IASP Cancer Pain SIG, NeuPSIG, EFIC, EAPC).

Prof. Rolke is member of the IASP, EAPC, German Palliative Care Association and German Pain Association. He served as an Associate Editor of PAIN and the European Journal of Pain, and is reviewer for many other journals such as e.g. Palliativmedizin, PAIN, European Journal of Pain, Journal of Pain, Schmerz, Neurology, Movement Disorder.

Prof. Rolke is married and has three children.

Pharmacotherapy, including non-opioid and opioid analgesics, is an important cornerstone in the multimodal management of chronic pain. Opioids are recommended for the treatment of moderate to severe cancer pain in all recent guidelines. However, the use of opioids in the management of non-cancer-related pain, including neuropathic pain, is the topic of much debate and many national and international bodies have published updated guidelines and recommendations.

Recently, the European Pain Federation EFIC formulated clinical practice recommendations.

The key clinical practice recommendations suggest: (a) first optimizing established non-pharmacological treatments and non-opioid analgesics and (b) considering opioid treatment if established non-pharmacological treatments or non-opioid analgeics are not effective and/or not tolerated and/or contraindicated. It should be stressed that the value of opioid therapy must be confirmed for each patient through differential diagnosis, and by weighing up the risk of comorbidities and the potential for opioid‐related adverse effects and substance abuse. Based on at least one RCT, opioids achieve improvements of pain and function compared to placebo at the cost of a lower tolerability in some neuropathic pain syndromes such as painful non-diabetic polyneuropathy, phantom limb pain, radicular pain and central neuropathic pain after spinal cord injury. For all other neuropathic pain syndromes, the clinical practice statement states that it can be considered based on expert consensus. Importantly, opioid treatment should be tapered and stopped if the individual therapeutic goals are no longer achieved, or insufficiently treatable or intolerable adverse events occur, or the individual therapeutic goals are achieved by other medical, physiotherapeutic, physical or psychotherapeutic measures, and finally if people prescribed with opioids diverse and /or use the prescribed opi­oid in an abusive manner despite complementary treatment from a dependence specialist.

In conclusion, opioids can be a ‘go’ in well selected patients with non-cancer neuropathic pain as part of a comprehensive, multimodal, multidisciplinary approach to treatment.

Key reference

Häuser W, Morlion B, Vowles KE et al. Eur J Pain. 2021 May;25(5):949-968.

Prof. Bart Morlion, MD, PhD, DEAA, EDPM, University Leuven, Belgium

Bart Morlion trained as an anesthesiologist but has worked full-time in pain medicine for many years. He is Director of the Leuven Centre for Algology and Pain Management at the University Hospitals of Leuven, Belgium, and Clinical Professor at the University of Leuven, teaching pain management, pharmacology, and evidence-based medicine. Professor Morlion’s professional interests include all aspects of multimodal chronic pain management, cancer-pain management, pharmacotherapy of pain, and quality management. He was President of the European Pain Federation EFIC till 2020 , is recently past president, and was president of the Belgian Pain Society (2006–2012). He is Program Director of the Belgian Interuniversity Postgraduate Studies in Algology and an active member of international scientific society committees. He has authored numerous publications on pain management and is Deputy Editor of the European Journal of Pain.

Prof. Nanna Brix Finnerup is director of the Danish Pain Research Center, Department of Clinical Medicine, Aarhus University, Denmark. She graduated from the Medical School at Aarhus University 1993, and after internship worked at the department of Neurology and Clinical Neurophysiology at the University of Copenhagen.

Prof. Finnerup is currently chair of NeuPSIG, the neuropathic pain Special Interest Group of the International Association for the Study of Pain (IASP), and is past president of the Scandinavian Association for the Study of pain (SASP). She is section editor of the journal PAIN, and editorial board member of Scandinavian Journal of Pain and Pain Management.

Prof. Finnerup has authored more than 150 refereed publications. Her main research interest is the pathophysiology and therapy of neuropathic pain. Current research areas include painful chemotherapy-induced and diabetic polyneuropathy, postsurgical neuropathic pain, spinal cord injury pain, pain biomarkers, thermal sensory integration, neurophysiological assessment of pain mechanisms, neuropharmacology, clinical trials, and systematic reviews.

Lydia Coxon is a post-doc researcher in the Pain in Women and the EndoCaRe research groups at the University of Oxford. She is currently working on the Translational Research in Pelvic Pain study investigating Chronic Pelvic Pain in women using a variety of methods including questionnaires and physiological testing. Her previous work has investigated a neuropathic component to endometriosis-associated pain.

Professor Huang is a behavioral neuroscientist (also referred to as a biopsychologist). His research interests are central post-stroke pain. Future studies will examine how the spinothalamocortical pathway and its specific neurons and molecular factors (e.g., BDNF and TrKb receptors and neuroinflammatory responses) regulate pain and its comorbid symptoms, which include major depression, anxiety disorders, and memory deficits. Recently, his research has primarily focused on drug addiction. In this area, his work examines the reward comparison hypothesis for morphine, amphetamine, and alcohol. His studies have produced a substantial amount of conflicting data that challenges the reward comparison hypothesis. He has introduced the paradoxical effect hypothesis of abused drugs to explain the reward and aversion effects of abused drugs as a controlling factor in drug addiction behaviors. His third investigation involves PTSD, a critical mental illness. He is analyzing the brain's neural mechanisms for PTSD in an animal model. How the medial prefrontal cortex (mPFC) and amygdala are involved in PTSD symptoms and how the serotonin-specific reuptake inhibitor fluoxetine reduces PTSD symptoms in the brain are also being examined.