Plenary Abstracts

We have an increasingly robust armoury as to how to stratify neuropathic pain patients according to symptoms, sensory testing and more advanced techniques such as neurophysiology, genetics and functional imaging. These are now being applied at scale both in large collaborative research consortia and in some cases within national health services. In parallel to these technological advances harmonised data collection and storage is enabling advanced multi-modal data analysis and correlation with long term health outcomes. The application of these techniques is helping us to: identify conditions which were not previously understood to have a neuropathic component, identify those individuals at highest risk of neuropathic pain and stratify patients living with neuropathic pain in a clinically meaningful way. I will discuss how these approaches are enhancing our understanding of neuropathic pain with the ultimate goal of not only developing novel treatment strategies but also better targeting of existing treatments to those most likely to respond.


David Bennett
We have an increasingly robust armoury as to how to stratify neuropathic pain patients according to symptoms, sensory testing and more advanced techniques such as neurophysiology, genetics and functional imaging. These are now being applied at scale both in large collaborative research consortia and in some cases within national health services. In parallel to these technological advances harmonised data collection and storage is enabling advanced multi-modal data analysis and correlation with long term health outcomes. The application of these techniques is helping us to: identify conditions which were not previously understood to have a neuropathic component, identify those individuals at highest risk of neuropathic pain and stratify patients living with neuropathic pain in a clinically meaningful way. I will discuss how these approaches are enhancing our understanding of neuropathic pain with the ultimate goal of not only developing novel treatment strategies but also better targeting of existing treatments to those most likely to respond.
Learning objectives: At the end of this lecture I hope that participants will understand: • The diagnostic approach to neuropathic pain ranging from screening tools to advanced technologies. • How some of the newer techniques such as sensory profiling and genomics may help us stratify neuropathic pain patients. • New approaches to treatment of neuropathic pain both in terms of efforts to develop novel treatments but also better targeting of the existing treatments through patient stratification.

© 2021 The Author(s). Published with license by Taylor & Francis Group, LLC.
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Sarah Ross
The dorsal horn of the spinal cord is the first node at which sensory input is integrated within neural networks. However, our understanding of how these neural networks transform information remains limited. Here, we use a combination of genetic manipulation and 2P Ca2+ imaging to gain insight into this circuitry. In the first study, we examine the neural basis of morphine-induced itch. We find that spinal dynorphin (Pdyn) neurons are both necessary and sufficient for morphine-induced itch in mice. Moreover, agonism of the kappa-opioid receptor alleviated morphine-induced itch in mice and nonhuman primates. Thus, our findings reveal that spinal morphine causes itch through a mechanism of disinhibition. In the second study, we examine the neural basis of capsaicin-induced allodynia at a population level. We find that intradermal capsaicin triggers activity in a subset of excitatory neurons in the dorsal horn that persists for approximately five minutes. Thereafter, a larger population of neurons show emergent activity in response to low threshold input, consistent with the perceptual experience of allydynia. Finally, we use an approach called Cell-type Identification by Ca2+-coupled Activity though Drug Activation (CICADA) classify excitatory cell types in order to analyze which populations of excitatory neurons are involved in which aspects of spinal processing. Finally, we speculate about the channels through which noxious and pruritic information are conveyed to the brain.
Learning Objectives: Understand how spinal morphine causes itch and why kappa opioid receptor agonists reverse this side-effect. Visualize the neural manifestation of allodynia and understand which spinal populations are involved.
Consider (reconsider?) how noxious information is conveyed to the brain

Sean Mackey MD, PhD
The United States National Academy of Medicine (NAM) called for the development of national patient registries and Learning Healthcare Systems (LHS). This call has been echoed by other countries. I will describe the rationale and the power of patient registries and LHSs. As envisioned, LHS leverages an integrated digital infrastructure to provide data-based and coordinated care that is available just-in-time to the clinician and that is centered on the patient. Additionally, there is increasing interest in the use of real world data/real world evidence (RWD/RWE) to represent a much broader and more diverse patient experience compared to the traditional RCTs. Further, expansion of RWD/ RWE allows for very large sample sizes that promote the detection of infrequent events, treatment-treatment interactions, and better account for heterogeneity of treatment effects. LHSs are critical to advancing RWD/ RWE to inform patient care and to advanced more generalizable knowledge.
In this session, I will survey the field of LHS platforms, and illustrate its power using the Collaborative Health Outcome Information Registry (CHOIR) as a use case. CHOIR is an open source and free platform created at Stanford, available to academic institutions. Key topics include 1) clinical decision support features of CHOIR, 2) obtaining research-grade clinical data as a part of routine clinical care, 3) using LHS for clinical trials and rapid piloting of clinical interventions, 4) realtime aggregation and summarization of LHS data to provide on-going decision support in the perioperative and outpatient environments, and 5) research efforts and publications made possible by large-scale LHS platforms like CHOIR Learning Objectives: Identify defining features of patient registries and learning healthcare systems (LHS), and recognize the roles LHS platforms play in acute and chronic pain management.
Evaluate the impact of LHS platforms on patient care and research activities.
Delineate the aspects of registries and LHS and appreciate the data and process utility of them, both as a tangible IT infrastructure and as a profound cultural change in care delivery. Describe features of model open source LHS platforms and how to implement them in their home institution.
Describe results from both a chronic and perioperative registry identifying factors of high risk and good pain care