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Incontro Nazionale Neurofisiologia: Nuove Strategie

Incontro Nazionale Neurofisiologia: Nuove Strategie “Controversie sulla diagnosi e terapia del dolore neuropatico” Palermo, 29-30 novembre 2012.

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Incontro Nazionale Neurofisiologia: Nuove Strategie

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  1. Incontro Nazionale Neurofisiologia: Nuove Strategie “Controversie sulla diagnosi e terapia del dolore neuropatico” Palermo, 29-30 novembre 2012 May QST offer useful infos for the diagnosis of neuropathic pain? Yes  David YarnitskyNo  Valeria TugnoliDiscussants: Marcello Romano, Stefano Tamburin,

  2. Conclusions Stefano Tamburin Palermo, 29-30 novembre 2012

  3. QST for NP diagnosis: pros QST may document loss-of-fx changes in small fibers and central pain pathways (EDX may not)

  4. QST for NP diagnosis: pros QST maydocumentloss-of-fxchanges in smallfibers and central pain pathways (EDX maynot) QST may help toapply the NeuPSIGalgorithmfor the diagnosisof NP (EDX may help too)

  5. QST for NP diagnosis: pros QST maydocumentloss-of-fxchanges in smallfibers and central pain pathways (EDX maynot) QST may help toapply the NeuPSIGalgorithmfor the diagnosisof NP (EDX may help too) QST may separate NP fromnociceptive pain (?)

  6. 10 pts with chronic musculoskeletal pain (non NP)

  7. QST for NP diagnosis: pros QST maydocumentloss-of-fxchanges in smallfibers and central pain pathways (EDX maynot) QST may help toapply the NeuPSIGalgorithmfor the diagnosisof NP (EDX may help too) QST may separate NP fromnociceptive pain (?) QST mayfollowpts up (naturalhistory, treatment)

  8. QST for NP diagnosis: pros QST maydocumentloss-of-fxchanges in smallfibers and central pain pathways (EDX maynot) QST may help toapply the NeuPSIGalgorithmfor the diagnosisof NP (EDX may help too) QST may separate NP fromnociceptive pain (?) QST mayfollowpts up (naturalhistory, treatment) QST mayexploregain-of-fxchanges (EDX doesnot)

  9. QST for NP diagnosis: pros QST maydocumentloss-of-fxchanges in smallfibers and central pain pathways (EDX maynot) QST may help toapply the NeuPSIGalgorithmfor the diagnosisof NP (EDX may help too) QST may separate NP fromnociceptive pain (?) QST mayfollowpts up (naturalhistory, treatment) QST mayexploregain-of-fxchanges (EDX doesnot) QST maypredictdevelopmentof NP in pts at risk

  10. QST for NP diagnosis: pros QST maydocumentloss-of-fxchanges in smallfibers and central pain pathways (EDX maynot) QST may help toapply the NeuPSIGalgorithmfor the diagnosisof NP (EDX may help too) QST may separate NP fromnociceptive pain (?) QST mayfollowpts up (naturalhistory, treatment) QST mayexploregain-of-fxchanges (EDX doesnot) QST maypredictdevelopmentof NP in pts at risk QST maypredictresponseto NP drugs

  11. QST for NP diagnosis: cons No standardized and widely accepted QST protocol and normal range of values

  12. Palermo, 29-30 novembre 2012

  13. QST for NP diagnosis: cons No standardized and widelyaccepted QST protocol and normal range ofvalues Test-retest and interobserverreproducibility are unclear

  14. QST for NP diagnosis: cons No standardized and widelyaccepted QST protocol and normal range ofvalues Test-retest and interobserverreproducibility are unclear QST cannotdefine the anatomicallevelofchanges (EDX and EPs can)

  15. QST for NP diagnosis: cons No standardized and widelyaccepted QST protocol and normal range ofvalues Test-retest and interobserverreproducibility are unclear QST cannotdefine the anatomicallevelofchanges (EDX and EPs can) QST is a subjectivemeasure (aswellas pain, VAS and NRS)

  16. QST for NP diagnosis: cons No standardized and widelyaccepted QST protocol and normal range ofvalues Test-retest and interobserverreproducibility are unclear QST cannotdefine the anatomicallevelofchanges (EDX and EPs can) QST is a subjectivemeasure (aswellas pain, VAS and NRS) QST cannotdifferentiaterealfromsimulated and psychogenicchanges (medico-legalissues)

  17. QST for NP diagnosis: cons No standardized and widelyaccepted QST protocol and normal range ofvalues Test-retest and interobserverreproducibility are unclear QST cannotdefine the anatomicallevelofchanges (EDX and EPs can) QST is a subjectivemeasure (aswellas pain, VAS and NRS) QST cannotdifferentiaterealfromsimulated and psychogenicchanges (medico-legalissues) QST istimeconsuming, expensive, needs a long training and isavailableonly in specializedcenters

  18. Principal limitations of methods for studying small fiber function

  19. QST for NP diagnosis: cons No standardized and widelyaccepted QST protocol and normal range ofvalues Test-retest and interobserverreproducibility are unclear QST cannotdefine the anatomicallevelofchanges (EDX and EPs can) QST is a subjectivemeasure (aswellas pain, VAS and NRS) QST cannotdifferentiaterealfromsimulated and psychogenicchanges (medico-legalissues) QST istimeconsuming, expensive, needs a long training and isavailableonly in specializedcenters QST cannotsubstitutebedsideevaluation (aswellas EDX)

  20. Palermo, 29-30 novembre 2012

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