Dr. Paulina Scheuren is a postdoctoral fellow at the Spinal Cord Injury Center, Balgrist University Hospital in Zurich, University of Zurich in Switzerland. She recently obtained a PhD in Health Sciences and Technology/Neuroscience at the Swiss Federal Institute of Technology (ETH Zurich). Her research focuses on establishing sensitive readouts of somatosensory dysfunction related to the development of neuropathic pain by employing a multimodal phenotyping approach (i.e., multi-modal neurophysiology, quantitative sensory testing, pain-autonomic interaction).

Dr. Elon Eisenberg graduated from Sackler School of Medicine, Tel-Aviv University, completed a residency in Neurology, at Rambam Health Care Campus, Haifa Israel, and a Neurology-Pain Fellowship at Massachusetts General Hospital, Harvard Medical School in Boston.

Dr. Eisenberg is Director of the Multidisciplinary Pain Relief Unit at Rambam, and is also a senior lecturer at the Faculty of Medicine of the Technion-Israel Institute of Technology. His main areas of research include mechanisms and treatment of neuropathic pain including CRPS, cancer pain and opioids. Dr. Eisenberg has published over one-hundred and twenty articles, book chapters, and abstracts on various areas of pain.

Serge Perrot is Rheumatologist and Pain Specialist

He is currently Professor of Clinical Pharmacology at Paris University, and head of the Pain Clinic at Cochin University Hospital, in Paris.

He is the member of the INSERM Research Unit 987.

He is the past-president of the French Pain Society (SFETD) and member of the Council of the IASP

The main topics of his research are pain in musculoskeletal disorders: low back pain, osteoarthritis, fibromyalgia and inflammatory rheumatisms and also pharmacology of analgesics. His publications include more than 250 papers in international journals, and several books on pain and pharmacology of analgesics.

Complex Regional Pain Syndrome (CRPS) starts with an inciting event. Within some few days after a limb trauma, patients develop a characteristic combination of visible inflammatory signs and pain which is not related to the initial trauma anymore. It is intriguing that women in their middle ages are mainly at risk for CRPS. Not only pain but also autoimmune disorders are highly prevalent in this population. Histologic investigations have shown that in the acute phase of CRPS when inflammatory signs are prevalent, mast cells and keratinocytes proliferate in the affected skin, they become activated and produce a plenty of inflammatory cytokines as surrogates of innate immune system activation. In parallel, IgM autoantibodies, directed against different intracellular proteins (e.g. keratin, actin, enolase, histone), emerge and sensitize for pain in the skin (IgM from acute CRPS) and particularly the spinal cord (IgM from acute and chronic CRPS). This sensitization requires complement C5a activation and probably induces the release of hyperalgesic substances like cytokines. In case of chronic CRPS when pain prevails although there is a reduction of the local inflammatory signs, autoantibodies of IgG classes activate dorsal horn glia cells which again release hyperalgesic cytokines. Other investigations proved autoantibodies directed against autonomic receptors and endothelial cells in CRPS. This whole series of experiments proves that the adaptive immune system significantly contributes to pain and suffering in CRPS. Although it is unlikely that one mechanism explains CRPS comprehensively, the knowledge about autoimmunity after a trauma opens new possibilities for a targeted pain treatment in CRPS.

Current Research Projects

Scientific Honors

• Scholarship prize for pain research DGSS 2009: „Numbness in clinical and experimental pain – a cross-sectional study exploring the mechanisms of reduced tactile function“, Geber, Magerl, Fondel, Fechir, Rolke, Vogt, Treede, Birklein
• Scholarship prize for pain research DGSS 2004: „Cortical reorganization during recovery from complex regional pain syndrome“, Maihöfner, Handwerker, Neundörfer, Birklein
• Kornmüller-Prize 1998 DGKN: „Sympathetic vasoconstrictor reflex pattern in patients with complex regional pain syndrome“, Birklein et al.
• Sertürner-Prize 2000: „Left vagus nerve stimulation reduces experimentally induced pain“, Kirchner, Birklein et al.

Committees and Boards

• Vice-president of the German Interdisciplinary Associate of Pain Therapy (DIVS)
• Continuing Education Commission DGKN,  „Autonomes Nervensystem“
• Field Editor: „European Journal of Pain“
• Editorial Board: „Neurology
• Editorial Board: „Pain Medicine”
• Editorial Board: „The Open Neurology Journal”

Neuropathic pain in children can be severe and persistent. Recognition based on clinical history and sensory descriptors is feasible in older children and adolescents; modified neuropathy scales have identified chemotherapy-induced symptoms and signs; and neuropathic screening tool scores are increasingly reported and require ongoing validation.¹ Common causes differ from adults, and diseases that are rare but present in childhood² and have specific management implications need to be considered. Using quantitative sensory testing, we have identified distinct sensory profiles in adolescents (10-18 years) with peripheral neuropathic pain³ that parallel those reported in adults (ie. thermal hyperalgesia, mechanical hyperalgesia, sensory loss). Pharmacotherapy is largely extrapolated from adult data as evidence from paediatric populations is limited, and the significant impact of neuropathic pain on physical and emotional function and quality of life highlight the need for multidisciplinary management.

1. Walker SM. Neuropathic pain in children: Steps towards improved recognition and management. EBioMedicine 2020;62:103124.
2. Arthur L, Keen K, Verriotis M, Peters J, Kelly A, Howard RF, Dib-Hajj SD, Waxman SG, Walker SM. Pediatric Erythromelalgia and SCN9A Mutations: Systematic Review and Single-Center Case Series. J Pediatr 2019;206:217-24 e9.
3. Verriotis M, Peters J, Sorger C, Walker SM. Phenotyping peripheral neuropathic pain in male and female adolescents: pain descriptors, somatosensory profiles, conditioned pain modulation, and child-parent reported disability. Pain 2021;162(6):1732-48.

Dr Suellen Walker is a Reader and Honorary Consultant in Paediatric Anaesthesia and Pain Medicine and has worked at Great Ormond Street Hospital (GOSH) since 2002.

Dr Walker completed her training in both anaesthesia and pain medicine in Australia and held Consultant posts at Royal Children’s Hospital Melbourne and Children’s Hospital at Westmead.

She moved to London in 2001 to pursue further research related to pain and analgesia in early development. She has held a clinical academic post at UCL Institute of Child Health and GOSH since 2005.

Specialisms

Dr Walker spcialises in paediatric anaesthesia and acute and chronic pain management.

Qualifications

• 1993 FANZCA (Fellow of Australian and New Zealand College of Anaesthetists)
• 1999 FFPMANZCA (Foundation Diplomate, Faculty of Pain Medicine, ANZCA)
• 2010 Associate Fellow, Royal College of Anaesthetists
• 2005 PhD, University of Sydney
• 2001 MSc in Neuroscience with Distinction, University College London
• 1999 MMed in Pain Medicine, University of Sydney
• 1984 MBBS (Hons), University of Melbourne

Research Interests

Dr Walker is the Research Lead for Pain in the Respiratory, Critical Care and Anaesthesia section at the UCL Institute of Child Health. Her laboratory studies evaluate age-related changes in pain response, the long-term effects of early pain and injury, and the developmental pharmacodynamics of analgesic drugs. She collaborates with scientists at UCL, University of California San Diego and University of Toronto.

She also has a clinical Sensory Testing Laboratory (within the Lung Function Unit) at the Walrus Clinical Investigation Unit at GOSH, and is involved in multi-disciplinary studies with other pain clinicians and researchers at GOSH that evaluate acute and chronic pain in children.

Dr Walker is the Chair of the Scientific Committee of the Association of Paediatric Anaesthetists, Great Britain and Ireland (APAGBI), represents the APAGBI on the National Institute of Academic Anaesthesia Scientific Council, and is the Local Educational Supervisor for Advanced Pain Training at GOSH.

Consultant in anaesthesia and pain medicine at the James Cook University Hospital Middlesbrough and Clinical Professor of Anaesthesia and Pain Medicine at Exeter and Durham Universities. His interests include the use of neuromodulation for the treatment of neuropathic pain particularly Failed Back Surgery Syndrome, which has led him to an interest in medication management with particular reference to opioids. He published more than 60 articles on the subjects of pain relief and cost effectiveness of various pain procedures and is currently Chief Investigator of 8 research projects.

Pharmacological inhibition of neurotransmitter release and/or ectopic impulses by afferent nociceptor terminals in the periphery or dorsal spinal cord have long been regarded as key mechanisms mediating the effects of some treatments for chronic neuropathic pain.  However, there is increasing evidence that pathophysiological mechanisms at the DRG itself may underlie neuropathic pain, particularly in clinical neuro-inflammatory and immune conditions, thus providing a target for current and novel analgesic treatments.        

Data will be presented which show that in clinical painful neuro-inflammatory and immune conditions, such as Sjogren’s syndrome and voltage-gated potassium channel antibody disease, which are non-length dependent, the pathophysiological mechanism lies within the DRG and adjacent nerve roots; skin punch biopsies in such patients show increased regenerating nerve fibres marked by GAP-43, a pattern different from the length-dependent “dying-back” painful neuropathies, such as painful diabetic neuropathy.  

Marshall Devor has shown the potential role of ectopic electrogenesis in DRGs in models: subthreshold oscillations, enhanced in neuropathies, are sensitive to Na+ channel blockers and other membrane stabilizing drugs at lower concentrations than required to block impulse propagation along sensory axons.  He has proposed that systemically or locally administered drugs that suppress neuropathic ectopia at DRG within a therapeutic window may advance treatment, providing greater efficacy but reduced side-effects.  The efficacy and advantages of DRG neuromodulation has been shown by many groups. 

In summary, this talk will highlight DRG pharmacological pain targets, including satellite cells expressing NGF and other neurotrophic factors, and abnormal nerve sprouting.  The role and efficacy of local and systemic immune therapies such as IVIg will be discussed, with regard to both the effect on chronic neuropathic pain and disease-modification.

Praveen Anand is Professor of Clinical Neurology and Head, Centre for Clinical Translation, based at Hammersmith Hospital campus. His medical education was at the Universities of Oxford and Cambridge, and post-graduate training at the Hammersmith Hospital and the National Hospital for Neurology and Neurosurgery, Queen Square, London.  His research focuses on pathophysiological and molecular mechanisms in human sensory neuropathies and chronic pain syndromes. Collaborations with colleagues and pharmaceutical companies are directed to projects which bridge the gap between pre-clinical developments and their successful clinical applications.  The translational approach has guided the recent success of 4 novel drugs from the laboratory to Phase II trials for chronic neuropathic pain and itch.  He has over 200 peer-reviewed publications in journals including Nature, Nature Medicine, Nature Genetics, Science and The Lancet.

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.