Powered by:

The search engine that plants trees

Guesteditors: (From right to left) Bernadette Nedelec, Danielle Shashoua, Chantale Poulin, Ana De Oliveira,

Valérie Calva, Marie-Andrée Couture, Léo LaSalle

42 Nedelec et al. Guesteditorial Clinical Application of Somatosensory Rehabilitation and Research: Applying the Scholarship of Practice Model

50 Somatosensory Rehabilitation Centre’s Statistics 1st of July 2004 - 26th of April 2019

51 New sections in our blog: No Comment

52 Rajkumar J. S., Spiche C.J., Sharan D. Original Article Co-existence of Neuropathic Pain and Myofascial Pain: a Key Point to Consider

56 Dupeux A. Fait Clinique Original Syndrome Douloureux Régional Complexe de Budapest et méthode de rééducation sensitive des douleurs neuropathiques : une approche pour faciliter la reprise professionnelle.

64 Dufort M. & Spicher C. Ombre et Pénombre Porter le regard vers une singulière altérité de l’autre

65 Atmosphère douloureuse « À la lisière de la mutilation »

66 Aphorism - Leitmotiv - Aforismo “To create is letting arrive and simply embrace what is.”

68 Spicher et al. Continuous Education – Formation continue

Official e-Journal of the Somatosensory Rehabilitation of Pain Network

www.neuropain.ch #eNewsSomatosens

Peer-reviewed open-access journal

e-News Somatosens Rehab 2019, 16(2)

#eNewsSomatosens

#NeuroPainRehab 60th #eNewsSomatosens 2019 16(2)

42

Bernadette Nedelec, BSc OT(c), PhDa, b, c, Valerie Calva, BSc OT,

CSTP®b, Marie-Andrée Couture, BSc OT, MRéadb, Chantale

Poulin, BSc OTb, Danielle Shashoua, BSc PTb, Annick Chouinard,

BSc PTb, Ana de Oliveira, BScc, Léo LaSalle, MDb

a School of Physical and Occupational Therapy, McGill University b Hôpital de réadaptation Villa Medica c Centre de recherche, Centre hospitalier de l’Université de Montréal

(CRCHUM)

Montreal, Quebec, Canada.

Address correspondence author : Prof Bernadette Nedelec, PhD, McGill University, Faculty of Medicine, School of Physical and Occupational Therapy,3654 Promenade Sir William Osler, Montreal, Quebec, Canada, H3G 1Y5. e-mail: bernadette.nedelec@mcgill.ca

When new or emerging practices become available, there is a need to generate

knowledge and evidence to support these novel approaches. Partnerships between

clinical or community partners and academic programs have formally developed

in occupational therapy (OT) and have been referred to as the Scholarship of

Practice Model1,2 or Practice-scholar Programs3. Although these models may take

GUESTEDITORIAL

Clinical Application of Somatosensory Rehabilitation and Research: Applying the Scholarship of Practice Model

To medical doctors To neuroscientists To patients To therapists

#NeuroPainRehab 60th #eNewsSomatosens 2019 16(2)

43

on many different forms, they all value linking the production of theoretical and

empirical knowledge to clinically relevant issues in practice. This requires

meaningful partnerships between researchers and clinicians. Our publication on

somatosensory rehabilitation4 is a concrete example of these partnerships, which

we will briefly describe in this editorial.

When challenges arise in practice, which are not adequately addressed by existing

evidence, clinically applicable knowledge will potentially arise out of the efforts

to address these issues or solve problems in a particular context or with a

particular patient population. The novel assessment tools or interventions that

develop, therefore, are more likely to be clinically and ecologically relevant,

promoting their rapid integration into practice. Somatosensory rehabilitation

(SSR) had been described for a number of different conditions, but at the time of

our publication4, no peer-reviewed evidence existed for the use of SSR with burn

survivors. The School of Physical and Occupational Therapy at McGill University

supports the development of meaningful partnerships between our educators,

researchers, the students, clinicians, decision-makers and health service

consumers. These partnerships have many attributes and benefits, one being that

researchers from the School are commonly embedded within clinical sites. This

close proximity supports the development of dynamic, synergistic interactions

that are mutually beneficial. After the occupational therapists at Villa Medica

Rehabilitation Hospital (VC, MAC) received training from Claude J Spicher in

the use of the SSR approach (2009 – 2012)5, they believed this approach would

potentially be advantageous for burn survivors suffering from neuropathic

pain. Although some modifications were required to the SSR approach, to

optimally address the unique characteristics of these complex burn injuries, the

SSR approach did appear to reduce burn survivors’ pain and increase their ability

to engage in functional activities. Since a long-standing partnership existed

#NeuroPainRehab 60th #eNewsSomatosens 2019 16(2)

44

between the clinicians, and an occupational therapist and researcher (BN) from

McGill University, whose research lab is embedded within Villa Medica

Rehabilitation Hospital, it was a natural extension of ongoing discussions about

evidence-based practice and research, to collaboratively develop a case-series

describing the outcomes associated with the application of the SSR approach with

burn survivors.

Successful introduction of a novel practice, such as the SSR approach, into the

clinical milieu creates a moral obligation to objectively summarize and publish

the outcomes so that the foundation for more advanced empirical investigations

can be built. However, this can produce an almost insurmountable challenge for

busy clinicians who are not traditionally allocated time for scholarly activities.

The collaborative clinician-researcher relationship that exists at Villa Medica,

took advantage of the clinical data documenting the superior outcomes, and the

researcher’s training, experience, and dedicated time for scholarly activities, to

produce a retrospective case series. One of the important lessons learned through

this experience from the clinicians’ perspective, is the need to generate systematic,

structured evaluation and treatment documentation to facilitate retrospective

analyses of this nature. Also, for those clinicians intimidated by the prospect of

becoming involved in research, this experience reinforced how similar the

thinking and processes of research are to clinical practice. Portney and Watkins6

described five steps of the research process : 1) identify the research question,

2) design the study, 3) conduct the study, 4) data analysis, and 5) communicate

findings. As a clinician, you have a patient with a clinical problem that you discuss

with them and evaluate. Based upon your assessment results, knowledge of the

literature, personal judgment, clinical experience and expertise, you generate a list

of alternative solutions or hypotheses (identify the research question) and then, in

conjunction with your patient, you design a treatment plan (design the study). This

treatment plan is carried out (conduct the study). You then re-evaluate your client

#NeuroPainRehab 60th #eNewsSomatosens 2019 16(2)

45

and based upon your interpretation of the assessment results, you determine if you

have reached your goals (data analysis). You then complete your documentation

(communicate findings). Therefore, if you take a very systematic approach to your

clinical practice and documentation, some of your clinical data can readily be

applied to answer research questions that have not already been reported in the

literature. Thus, a novel case study can be the springboard that catapults the

patients, clinicians and researchers toward innovative solutions.

The production of this case series now provides the evidence-building stepping-

stone for further exploration. In fact, our collaborative team developed a

randomized controlled trial protocol as the next step towards the production of

higher-level evidence for the SSR approach with burn survivors. However,

interestingly, since that time we have not had an adequate number of burn

survivors who developed chronic neuropathic pain to recruit into this trial. Exactly

why, is not clear, but it may be an increased awareness of the entire clinical team

working with this population that sensory re-education is warranted when a burn

survivor presents with hypoesthesia and/or active avoidance of prolonged or

intentional stimulation of sites where neuropathic-type sensations are

experienced. This early interruption of the cycle of pain production may reduce

or eliminate the central nervous system’s learned response that interprets all

mechanical stimulation as noxious, as is the case with mechanical allodynia. We

believe that it is critically important that the entire team is well-versed in SSR to

ensure consistency. However, whether specific practices can prevent the

development of chronic neuropathic pain and mechanical allodynia, requires

further investigation.

The presence of researchers within the clinical setting has benefits that extend far

beyond this one example. One of the goals of McGill University’s OT and PT

Programs is to create scholarly practitioners, that is, therapists who provide

#NeuroPainRehab 60th #eNewsSomatosens 2019 16(2)

46

theory-driven and evidence-based services. However, knowledge and confidence

gaps have been identified as major barriers to evidence-based practice7 and these

gaps are not readily addressed by classroom learning, rather require more

experiential learning. Having a researcher embedded in the clinical milieu may

facilitate the provision of evidence-based services by stimulating high-level,

theory-driven discussion and reflective practice that is contextually informed by

the patients, the practice culture and the system. These discussions include

clinicians, researchers, students, patients and administrators, and are supported by

regular formal or informal meetings and open communication, which is made far

more fluid when the researcher is embedded within the clinical milieu. This

personal relationship may be particularly transformative for the patients who

commonly feel disenfranchised and alienated from the research process. The

continuous evaluation of evidence-based practice by clinicians, as it applies to

burn survivor rehabilitation or other areas of practice, is predicated on their

capacity to actively engage in the knowledge translation process8,9. The close

proximity of researchers to clinicians provides a framework to nurture the

knowledge translation capacity amongst clinicians and researchers, by bringing

people together to co-create knowledge and tools that are rigorous and applicable

to their clinical communities. It is not simply the close proximity that provides the

rich relationship building opportunities, rather a plethora of multi-level, diverse

interactions. In collaboration with the OT and PT programs at McGill University,

clinicians from both the private and public sector can choose to be involve in

clinician-driven Master’s Professional Entry Level research, apply for knowledge

translation grants, apply for nil salary faculty lecturer appointments that

provides access to online library resources as well as other benefits participate in

clinical trials, and en-gage in student teaching and supervision opportunities.

Direct involvement of clinicians in research projects can also progressively evolve

and take on multiple forms, such as recruitment of participants for researcher led

projects, providing an active treatment role in clinical trials, generating research

#NeuroPainRehab 60th #eNewsSomatosens 2019 16(2)

47

questions that are modified by the researcher for student projects, or becoming the

project leader on a funded study. From the researcher’s perspective, their research

program benefits from their informed awareness of the clinical milieu’s strengths,

opportunities, and distinct attributes. Being embedded within their clinical reality

ensures that all stakeholders can confirm that the research questions are pertinent

and it enables the integration of patients, and their personal experiential

knowledge, into all stages of the research process so their needs, preferences and

priorities are addressed.

Thus, collaborative clinician-research partnerships directly benefit the patients by

embedding scholarly activities in practice, whereby practice informs research and

research informs practice. These activities ultimately produce knowledge and

outcomes that are significant and relevant, which subsequently reduces the

predicted time lag10 for knowledge transfer into practice. The resources, strengths,

and attributes that each partner contributes, allows for learning, knowledge, and

products to be created, that neither party could have generated without the other.

In order to advance the science of SSR, and all rehabilitation approaches, we

would suggest that these partnerships be encouraged and concretely supported, so

that the evidence to support clinical practice can be optimized.

References

1. Braveman BH, Helfrich CA, Fisher GS. Developing and maintaining community

partnerships within "a scholarship of practice". Occupational therapy in health care.

2002;15(1-2):109-125.

2. Hammel J, Magasi S, Mirza MP, et al. A Scholarship of Practice Revisited: Creating

Community-Engaged Occupational Therapy Practitioners, Educators, and Scholars.

Occupational therapy in health care. 2015;29(4):352-369.

3. Crist P, Munoz JP, Witchger Hansen AM, Benson J, Provident I. The practice-scholar

program: an academic-practice partnership to promote the scholarship of "best practices".

Occupational therapy in health care. 2005;19(1-2):71-93.

#NeuroPainRehab 60th #eNewsSomatosens 2019 16(2)

48

4. Nedelec B, Calva V, Chouinard A, et al. Somatosensory Rehabilitation for Neuropathic

Pain in Burn Survivors: A Case Series. Journal of burn care & research : official

publication of the American Burn Association. 2016;37(1):e37-46.

5. Spicher CJ. Handbook for Somatosensory Rehabilitation. Montpellier, France: Sauramps

Médical 2006.

6. Portney LG, Watkins MP. Foundations of Clinical Research: Applications to Practice. 3rd

ed. Upper Saddle River, New Jersey: Pearson Education, Inc.; 2009.

7. Thomas A, Law M. Research utilization and evidence-based practice in occupational

therapy: a scoping study. The American journal of occupational therapy : official

publication of the American Occupational Therapy Association. 2013;67(4):e55-65.

8. Cramm H, White C, Krupa T. From periphery to player: strategically positioning

occupational therapy within the knowledge translation landscape. The American journal of

occupational therapy : official publication of the American Occupational Therapy

Association. 2013;67(1):119-125.

9. Bennett S, Whitehead M, Eames S, Fleming J, Low S, Caldwell E. Building capacity for

knowledge translation in occupational therapy : learning through participatory action

research. BMC medical education. 2016;16(1):257.

10. Morris ZS, Wooding S, Grant J. The answer is 17 years, what is the question: understanding

time lags in translational research. Journal of the Royal Society of Medicine.

2011;104(12):510-520.

#NeuroPainRehab 60th #eNewsSomatosens 2019 16(2)

49

Congratulations to:

• Bernadette Nedelec1 and her team of Villa Medica, were elected to the

prestigious Occupational Therapy Research Academy of the American

Occupational Therapy Foundation (AOTF), which is a philanthropic,

scientific and educational organization that aims to support occupational

therapy research and raise public awareness of the important relationship

between daily activities and health.

• The AOTF Academy of Research in Occupational Therapy were

established in 1983. It recognizes individuals who have made exemplary

and distinguished contributions toward the science of occupational therapy.

Prof Nedelec and her team is thus part of an elite group of scientists and

researchers who have received the most prestigious honor from the AOTF.

1 Prof Nedelec, PhD, BScOT(C), is an Associate Professor and the former Director of the Occupational Therapy Program, School of Physical and Occupational Therapy at McGill University, Montreal, Quebec, Canada.

ON A WEBSITE Academy of Research in Occupational Therapy 2018

To medical doctors To neuroscientists To patients To therapists

#NeuroPainRehab 60th #eNewsSomatosens 2019 16(2)

50

Spicher, C.J.2

The 3066 patients included in this research were refered to the Somatosensory Rehabilitation Centre3. They were recruited prospectively and consecutively. Thus, the topographic study could be carried out on 2853 aesthesiographies : maps of cutaneous hypoaesthesia. In order to study a group that is as homogeneous as possible, we restricted this topographical research to patients whose skin was accessible : they did not show hypersensitivity to touch.

Aβ axonal lesions n Inclusion criteria Positive diagnosis 4766 Exclusion criteria Positive allodynography 1913 Total Positive aesthesiography 2853

Table I: Inclusion criteria for topographic study of Aβ axonal lesions in 3066 patients.

The distribution of these lesions (N = 3066 patients) is as follows :

Cutaneous department Number of Aβ axonal lesion

Trigeminal 89 Occipital 61 Cervical 40

Brachial 644 Thoracic 140

Lumbo-abdominal 93 Lumbo-femoral 126 Femoral 321

Ischiatic 1211 Sacral 128

Total 2853

Table II: Distribution of the 2853 Aβ axonal lesions according to their cutaneous department.

2 Swiss Certified HT, Platform of Translational Neurosciences Department of Neurosciences and Movement Sciences Faculty of Sciences & Medicine University of Freiburg. 3 Somatosensory Rehabilitation Centre ; Clinique Générale ; Freiburg (Switzerland).

Somatosensory Rehabilitation Centre’s Statistics1st of July 2004 - 26th of April 2019

To MD To neuroscientists To patients To therapist

#NeuroPainRehab 60th #eNewsSomatosens 2019 16(2)

51

No Comment New section in our blog

All the No Comments are now listed in our new section. You can choose the

language or the neuropathic condition (stage of Aβ axonal lesions) that you are

interested in.

Classifications: 4 languages & 5 neuropathic conditions

Stage I

Stage II

Stage III

Stage IV

Stage V

.

#NeuroPainRehab 60th #eNewsSomatosens 2019 16(2)

52

Joshua Samuel Rajkumar4, Claude J Spicher5, Deepak Sharan6

Introduction Myofascial Pain Syndrome (MPS) is a type of regional Soft Tissue Pain syndrome (STP) with the presence of Trigger Points (TrPs) giving rise to local or referred pain limited over a specific region or quadrant of the body. Myofascial pain may arise independent of other pain generators (primary myofascial pain) or can often coexist with or is secondary to other acute and chronic painful musculoskeletal conditions. One of the commonest co-existing condition with MPS is Neuropathic Pain (NP), which is an acute or chronic pain syndrome in which the mechanism that sustains the pain is inferred to involve aberrant somatosensory processing in the peripheral nervous system or central nervous system. In neuropathic myofascial pain, structural factors exist as well, such as muscle shortening, degraded and weakened collagen, and trophic changes that contribute to the pain.1

Somatosensory System The somatosensory system allows for the perception of touch, pressure, pain, temperature, position, movement and vibration. Lesions or diseases of the somatosensory nervous system can lead to altered and disordered transmission of sensory signals into the spinal cord and the brain. Patients typically experience a distinct set of symptoms, such as burning and electrical-like sensations, and pain resulting from non-painful stimulations (such as light touching). The symptoms persist and have a tendency to become chronic and respond less to pain medications. Sleep disturbances, anxiety and depression are frequent and severe in patients with neuropathic pain, and quality of life is more impaired in patients with chronic neuropathic pain.

4 Address correspondence author: Consultant Physiotherapist, CSTP® and Manager – Research & Development, RECOUP Neuromusculoskeletal Rehabilitation Centre, Bengaluru 560108, KA, India. e-mail: joshphysiotherapist@yahoo.com joshua.physio@hotmail.com5 Scientific collaborator, Platform of Translational Neurosciences, Department ofNeurosciences and Movement Sciences, Faculty of Sciences & Medicine, University ofFreiburg & Somatosensory Rehabilitation Centre ; Clinique Générale ; Freiburg (Switzerland).6 Orthopaedic Surgeon, CSTP® and Medical Director, RECOUP NeuromusculoskeletalRehabilitation Centre, Bengaluru, India.

Original Article Co-existence of Neuropathic Pain and Myofascial Pain:

a Key Point to Consider To MD To neuroscientists To patients To therapist

#NeuroPainRehab 60th #eNewsSomatosens 2019 16(2)

53

Patho-Physiology Neuropathic pain is customarily perceived as beginning with peripheral sensitization. In peripheral sensitization, increased transduction sensitivity of nociceptors is associated with alteration of ionic conductances in the peripheral terminal. Sensitization can occur following tissue inflammation or damage to a peripheral nerve. Inflammatory cells also produce growth factors and cytokines that contribute to the increased sensitivity of nociceptors.2

“Denervation Supersensitivity” is a phenomenon that follows Cannon and Rosenblueth's Law of Denervation, which states that "When a unit is destroyed in a series of efferent neurons, an increased irritability to chemical agents develops in the isolated structure or structures, the effect being maximal in the part directly denervated." Any circumstance that prevents the flow of motor impulses for a period of time can rob the effector organ of its excitatory input and cause disuse supersensitivity in that organ (including skeletal muscle, smooth muscle, spinal neurons, sympathetic ganglia, adrenal glands, sweat glands, and brain cells).3

Alteration of the electrical properties of sensory nerves leads to imbalances between central excitatory and inhibitory signalling so that inhibitory interneurons and descending control systems are impaired. In turn, transmission of sensory signals and disinhibition or facilitation mechanisms are altered at the level of the spinal cord dorsal horn neurons. At the periphery, spinal cord and brain, a gain of excitation and facilitation and a loss of inhibition are apparent. These changes shift the sensory pathways to a state of hyper-excitability.4

Diagnosis & Screening Diagnosis of Neuropathic pain is always a challenging process which can be classified under three categories as : Possible Neuropathic Pain, Probable Neuropathic Pain and Definitive Neuropathic Pain on the presence of the following three criteria : Criteria 1 : History of Neurological Lesion Criteria 2 : Clinical examination of somatosensory signs – Quantitative Sensory Testing (QST) Criteria 3 : Objective Diagnostic tests – Neurophysiological tests At least 2 out of 3 above criteria is required to carry forward with the treatment specific for Neuropathic Pain.5

Quantitative Sensory Testing QST use standardized mechanical and thermal stimuli to test the afferent nociceptive and non-nociceptive systems in the periphery and the CNS. QST assess loss and gain of function of the entire different afferent neurofibre classes (Aα, Aβ, Aδ and C fibres). These thermal and mechanical tests include the determination of detection thresholds for cold, warm, paradoxical heat sensations and touch and vibration; determination of pain thresholds for cold and heat stimulations, pinprick and blunt pressure; and determination of allodynia and pain summation.6

Somatosensory Rehabilitation Network for Pain (SRNP) SRNP is a method to test and treat somatosensory disorders of neuropathic pain patients by Claude J Spicher. The aim of somatosensory rehabilitation is to increase the quality of touch or even normalize the sensation of touch in the case of neuropathic pain due to peripheral nerve

#NeuroPainRehab 60th #eNewsSomatosens 2019 16(2)

54

lesions. Neuropathic symptoms like burning, tingling, numbness and tugging are most often felt by the patient inside the hypoaesthetic territory as demarcated or mapped by an aesthesiography, which is the first phase in SRNP. Hence, when hypoesthesia decreases, neuropathic pain decreases. The assessment of partial tactile hypoaesthesia is done by aesthesiography which is based on the concept of the largest cutaneous distribution of the nerve branch where the symptoms are more likely to be felt. The second phase is the regular and rigorous assessment of the quality of hypoaesthesia in terms of somatosensory qualifiers, tingling sign, static two-point discrimination test and pressure perception threshold. But there would be sometimes a presence of allodynia, when the skin is hypersensitive to touch for which additional methods like allodynography and Rainbow pain scale are used for quantification. Finally, a diagnosis of the presence of neuropathic pain is labelled under any of the five stages of Aβ axonal lesions as follows7 : Stage I : Tactile hypoaesthesia ; Stage II : Simple mechanical allodynia ; Stage III : Intermittent neuralgia ; Stage IV : Persistent neuralgia ; Stage V : Complex Regional Pain Syndrome (CRPS).

Allodynia Vs Hypoaesthesia Allodynia is defined as pain due to a stimulus which does not normally provoke pain and Hypoaesthesia is considered as a reduced sensation of touch or sensation. This conflict between hypersensitivity and hypoaesthesia is commonly seen in the clinical setting in patients with neuropathic pain like complex regional pain syndrome. But in general, there would always be an hypoaesthetic area under the hypersensitive or allodynic area on the skin.8

Treatment Considerations The presence of allodynia, hinders other physical treatments. For the reason that, any contact on the hypersensitive territory, although it can be bearable in the moment, can induce several hours of a very painful post-effect or even several sleepless nights. This hypersensitivity to touch is induced by the peripheral nerve lesion of the large myelinated Aβ neurofibers. In other words, after a peripheral nerve lesion, aberrant sprouting occurs in the dorsal horn which can explain that a non-noxious stimulus is perceived as being noxious. This is one of the explanatory models of the different mechanisms of peripheral, subcortical and cortical sensitization. Somatosensory Rehabilitation of Neuropathic Pain can reverse these mechanisms of the somatosensory nervous system - even many years after the lesion.6

Treatment Protocol according to SRNP The treatment algorithm follows in two divisions based on the presence or absence of hypoaesthesia and allodynia. If only hypoaesthesia is present (absence of allodynia), then rehabilitation starts with the focus on re-education of hypo-sensitivity. On the other hand, in the presence of allodynia, rehabilitation first starts with distant vibrotactile counter-stimulation to reduce the hypersensitivity followed by re-education of the underlying hyposensitivity.6

#NeuroPainRehab 60th #eNewsSomatosens 2019 16(2)

55

Conclusion Neuropathic pain is often found associated in patients with myofascial pain syndrome, hence an appropriate diagnosis and rehabilitation of the neuropathic pain plays a crucial role in expecting a complete recovery. Once the neuropathic pain symptoms reduces, especially allodynia, allows for addition of further rehabilitation techniques especially manual therapies like trigger point releases or fascial releases like myofascial release addressing the superficial fascia and fascial manipulation addressing the deeper fascia, to address the myofascial dysfunction followed by postural stabilization and awareness with appropriate training methods and finally planned progressive exercises are laid forth for aiding recovery and preventing recurrence. References 1. Nicol, A.L., Crooks, M., Hsu, E.S. & Ferrante, F.M. (2018).

https://www.researchgate.net/publication/324110851_Myofascial_Pain_Syndrome (05/23/2019)

2. Woolf C.J. & Thompson S. (1991). The induction and maintenance of central sensitization is dependent on N-methyl-D-aspartic acid receptor activation; implications for the treatment of post-injury pain hypersensitivity states. Pain, 1991:44:293-299.

3. Cannon, W.B. & Rosenblueth, A. (1949). The supersensitivity of denervated structures, a law of denervation. New York : MacMillan.

4. Woolf, C.J. & Doubell, T.P. (1994). The pathophysiology of chronic pain - increased sensitivity to low threshold AB-fiber inputs. Curr Opin Neurobiol, 4, 525-534.

5. Thomas, P.K. (1984). Symptomatology and differential diagnosis of peripheral neuropathy: clinical and differential diagnosis. In P.J. Dyck, P.K. Thomas, E.H. Lambert & R. Bunge (Eds.) Peripheral neuropathy (pp. 1169-1190). Philadelphia : Saunders.

6. Spicher, C., Quintal, I. & Vittaz, M. (2015). Rééducation sensitive des douleurs neuropathiques (3e édition) – Préface : S. Marchand. Montpellier, Paris : Sauramps Médical, 369 pages.

7. Greenspan, J.D. (2001). Quantitative assessment of neuropathic pain. Curr Pain Headache Reports, 5: 107-113.

8. Merskey, H. & Bogduk, N. (Eds.) (1994). Classification of Chronic Pain : Descriptions of Chronic Pain Syndroms and Definitions of Pain Terms, (2nd ed.). Seattle : IASP Task Force on Taxonomy.

#NeuroPainRehab 60th #eNewsSomatosens 2019 16(2)

56

Armelle DUPEUX, ergothérapeute DE, RSDC®7

RÉSUMÉ

Le Syndrome Douloureux Régional Complexe de Budapest (SDRC) se caractérise par une

sensation de « cuisson », associée à un dysfonctionnement vasomoteur, sudoral et

ultérieurement à des troubles trophiques, d’après les critères de Bruehl et Harden qui définissent

ainsi les « critères de Budapest » (Bruehl et al., 1999). La méthode de rééducation sensitive a

déjà montré son efficacité, notamment sur le membre supérieur, pour réduire les sensations et

dysfonctionnements induits par le SDRC (Packham & Spicher, 2018). En cherchant à diminuer

ces troubles, la méthode de rééducation sensitive des douleurs neuropathiques pourrait être

intéressante pour favoriser la reprise de l’activité professionnelle.

Mots clefs : Syndrome douloureux régional complexe, Douleur neuropathique, Rééducation

sensitive, Allodynie mécanique, Conséquences socio-professionnelles.

INTRODUCTION

Actuellement, le SDRC semble encore mal reconnu par le système de santé en France. En effet,

il n’existe pas de recommandations spécifiques données par la Haute Autorité de la Santé (HAS)

pour ce syndrome. A ce jour, elle l’associe aux prises en charge de la douleur chronique.

Le SDRC représente 8% des patients pris en charge dans les structures de lutte contre la

douleur en France (HAS, 2008). D’après une récente étude française, les personnes atteintes de

SDRC ont souvent des arrêts de travail de longue durée, avec une reprise incertaine de leur

activité professionnelle, liés à une douleur invalidante : « Les patients qui n’ont pas repris le

travail semblent avoir des douleurs plus importantes que les autres (p : 0,11). La douleur est

donc un facteur déterminant dans la reprise du travail. » (Makos, 2016) La rééducation sensitive

des douleurs neuropathiques est une méthode qui semble justement permettre de diminuer

7 Centre Hospitalier Rhumatologique d'Uriage - Médecine physique et de réadaptation. Rte d’Uriage 1750, 38410 Saint-Martin-d'Uriage, France. e-mail : ergotherapeutes@ch-uriage.fr

FAIT CLINIQUE ORIGINAL Syndrome Douloureux Régional Complexe de Budapest et

méthode de rééducation sensitive des douleurs neuropathiques : une approche pour faciliter la reprise professionnelle.

Aux médecins Aux scientifiques en neurosciences Aux patients Aux thérapeutes

#NeuroPainRehab 60th #eNewsSomatosens 2019 16(2)

57

rapidement la douleur dans le cas de SDRC, avec ou sans allodynie mécanique associée

(Spicher & Degrange, 2008 ; Vittaz et al., 2013 ; Packham et al., 2018). Ainsi, la rééducation

sensitive peut-elle participer à améliorer la réinsertion professionnelle des patients atteints de

SDRC ?

L’objectif de ce fait clinique est d’illustrer l’intérêt de cette méthode pour diminuer

efficacement la douleur, afin d’accélérer la reprise professionnelle.

PATIENTE ET MÉTHODE

Mr T. est âgé de 49 ans. Il exerce dans le secteur autoroutier AREA. Son travail possède

d’importantes exigences physiques. Le 1/03/17, il a été opéré afin de décomprimer une racine

du nerf sciatique (hernie discale en L4-L5). Il conserve des séquelles motrices et sensitives :

déficit à 2/5 des releveurs des orteils, allodynie sur le pied et la jambe gauche avec des douleurs

nocturnes. Devant la plainte du patient, les troubles sensitifs et l’intensité des douleurs, la

procédure diagnostique du SDRC selon Bruehl et Harden (1999) est réalisée. Elle révèle un

score de 9. Le diagnostic d'un SDRC d’après les critères de Budapest est positif. Il est donc

hospitalisé pour sa prise en charge. Celle-ci est pluri-disciplinaire, avec des séances de

rééducation sensitive une fois par semaine lors de son hospitalisation à temps complet (1 mois),

puis une fois par mois en hospitalisation à temps partiel (15 mois).

L’évaluation de l’Allodynie Mécanique Statique (AMS), débute par un entretien avec le patient

concernant ses douleurs, leurs localisations et la gêne occasionnée. Ensuite, une évaluation de

la douleur est réalisée avec le Questionnaire de la Douleur de St Antoine (QDSA). Enfin, à

l’aide de l’algorithme de gestion des douleurs neuropathiques, il est établi une stratégie

thérapeutique (Spicher et al., 2016) :

- Définition de l’invariant douloureux avec l’Echelle Visuelle Analogique (EVA).

- Réalisation d’une cartographie de la zone allodynique (allodynographie) par l’intermédiaire

de l’esthésiomètre de 15,0 grammes (monofilament de Semmmes-Weinstein).

- Réalisation du « 5e point » pour mesurer la sévérité de l’atteinte (INDIGO : 8,7g).

Ces bilans nous permettent de confirmer l’hypothèse neuroanatomique de la branche cutanée

lésée et de définir la condition neuropathique : SDRC du nerf péronier profond associé à une

discrète allodynie mécanique statique (stade V de lésions axonales). Des débordements extra–

territoriaux sont observés sur le territoire de provenance cutanée du nerf péronier superficiel et

celui du nerf cutané sural latéral.

Le traitement débute par la rééducation de l’AMS. Le patient doit éviter le plus possible de

#NeuroPainRehab 60th #eNewsSomatosens 2019 16(2)

58

toucher la zone qui se se situe entre le point le plus distal du territoire de provenance cutanée

de la branche lésée et le point le plus proximal non confortable à la contre-stimulation (Spicher,

et al., 2015). Il doit aussi limiter les mouvements des articulations douloureuses du pied gauche.

La technique de Contre-Stimulation Vibrotactile à Distance (CSVD) est enseignée et la zone à

contre-stimuler est déterminée, en se référant à l'Atlas des territoires cutanés (Spicher et al.,

2017). Celle-ci se situe au niveau du territoire de provenance cutanée de la branche perforante

antérieure du 12e nerf thoracique gauche (Th12). Il lui est demandé de stimuler avec un tissu

très doux cette zone de travail 8 fois par jour pendant 1 minute (ou moins longtemps) et si

possible avant 16h.

Ensuite, lorsque l’AMS a disparu, la rééducation de l’hypoesthésie sous-jacente est débutée. La

contre-indication de toucher la zone est levée. Le patient va venir appliquer différentes matières

sur la zone hypoesthésique (déterminée par l’esthésiographie secondaire) en suivant un

protocole précis pour éviter une récidive de l’allodynie.

RÉSULTATS

Au total, le traitement aura duré 16 mois : 1 mois pour atteindre un stade IV de lésions axonales,

2 mois pour un stade III de lésions axonales et 10 mois pour arriver au stade I de lésions

axonales, c’est-à-dire une hypoesthésie sans névralgie.

Tableau I : Evolution, du 13/03/17 au 21/11/17, du Questionnaire de la Douleur Saint-Antoine

(QDSA), de l’Echelle Visuelle Analogique (EVA) et des stades de lésions axonales, durant le

traitement de l’allodynie mécanique.

Pour le QDSA, il a été choisi de réaliser le score des moyennes, car lorsque celui-ci diminue et

passe la barre des 20pts, le traitement n’est pas terminé, mais la situation est stabilisée (Spicher

& Clément-Favre, 2008). En 2 mois, le QDSA atteint une diminution de 30pts. Au bout de 6

mois, la situation est stable (Tableau I).

Dates (2017) 13.03 3.04 14.04 22.05 28.06 2.08 13.09 11.10 21.11

QDSA (pts)

Non réalisé 56 55 26 20 20 18 17 11

EVA (cm) 6 2 4 3 3 2 2 0 0

Stades V (SDRC) + allodynie

IV + allodynie III (névralgie intermittente) + allodynie III +

hypoesthésie

#NeuroPainRehab 60th #eNewsSomatosens 2019 16(2)

59

La superficie de l’allodynographie montre une régression conséquente (Fig.1). Au 8e mois de

traitement, l’allodynographie est négative.

Fig. 1 Fig. 2

Concernant l’hypoesthésie sous-jacente, l’évolution des esthésiographies secondaires (Fig.2) et

du Seuil Perception à la Pression passation courte (SPP(c)), révèlent une progression en 6 mois

½ (Tableau II).

Tableau II : Evolution, du 21/11/17 au 08/06/17, du Questionnaire de la Douleur Saint-Antoine

(QDSA), du Seuil de Pecetpion à la Pressions (SPP) et des stades de lésions axonales, durant le

traitement de l’hypoesthésie sous-jacente.

Durant les 7 mois suivants, l’hypoesthésie persiste. Il a été décidé, en accord commun avec le

patient, de suspendre les séances de rééducation.

DISCUSSION

Un impact très positif de la rééducation sensitive sur la douleur du patient est mis en évidence,

malgré la persistance d’une hypoesthésie. Effectivement, il aura fallu 2 mois pour faire chuter

la douleur et 6 mois pour la stabiliser. Dans un cas clinique similaire la durée pour faire chuter

Dates 21.11.17 12 .12.17 10.01.18 6.02.18 13.03.18 27.04.18 8.06.18

QDSA

(pts) 11 16 10 11 11 10 14

SPP

(g) 5,3 1,1 2,1 1,5 2,0 3,4 2,0

Stades III III I I I I I

#NeuroPainRehab 60th #eNewsSomatosens 2019 16(2)

60

la douleur est de 5 mois (Riou, 2014). C’est proche de nos résultats mais reste éloigné de la

moyenne de 3 mois (81j) de traitement pour un SDRC avec AMS sur le membre supérieur

(Packahm et al., 2018). Cela s’explique par des difficultés pour le patient de poursuivre les

consignes de rééducation lors de son retour au domicile. Mais aussi par les moyens

institutionnels de ne pas pouvoir revoir le patient toutes les semaines comme ce qui est

préconisé dans la méthode. A partir du 8e mois, la rééducation de l’hypoesthésie sous-jacente

débute. Au 9e mois, le patient peut de nouveau supporter ses chaussures de sécurité sans limite

de temps. Une reprise professionnelle peut être alors envisagée8, ce qui reste rapide étant donné

: « que la durée moyenne des arrêts de travail touchant le membre inférieur est de 20 mois (+ /-

11) » (Makos, 2016). Un autre article révèle l’importance d’un diagnostic et la mise en place

d’un traitement précoce : « Les patients diagnostiqués après 8 mois ont été moins susceptibles

de travailler. » (Joo et al., 2012). Dans le cas de Mr T., le SDRC a été rapidement décelé avec

l’aide de la rééducation sensitive (en accord avec l’équipe médicale) et a permis la mise en

place précoce de séances de rééducation.

CONCLUSION

En complément des traitements habituels, l’utilisation précoce de la méthode de rééducation

sensitive des douleurs neuropathiques lors d’un SDRC parait avoir plusieurs avantages :

améliorer le dépistage, diminuer efficacement et rapidement les douleurs ; cela dans l’objectif

de réduire la durée des arrêts de travail pour favoriser la réinsertion professionnelle. Une étude

complémentaire serait intéressante pour affiner ces résultats.

REFERENCES BIBLIOGRAPHIQUES • Bruehl, S., Harden, R.N., Galer, B.S., Saltz, S., Bertram, M., Backonja, M., Gayles, R.,

Rudin, N., Bhudra, M.K. & Stanton-Hicks, M. (1999). External validation of IASP diagnostic criteria for Complex Regional Pain Syndrome and proposed research diagnostic criteria. PAIN®, 81, 147-154.

• Haute Autorité de Santé (HAS) (2008). Douleur chronique  : reconnaître le syndrome douloureux chronique, l’évaluer et orienter le patient. Recommandations professionnelles. Téléchargeable (14/05/2019) : https://www.has-sante.fr/portail/upload/docs/application/pdf/2009-01/douleur_chronique_synthese.pdf

• Joo, E.K., Yong, C.K., Sang, C.L. & Jae, H.K. (2012). Relationship between Complex Regional Pain Syndrome and Working Life : A Korean Study J Korean Med Sci. 27(8), 929-933. Téléchargeable en français (14/05/2019) : http://algosdrc.free.fr/ALGO_ET_TRAVAIL.pdf

8 Le médecin du travail n’a pas accordé la reprise professionnelle, à causes de ses antécédents de lombalgie.

#NeuroPainRehab 60th #eNewsSomatosens 2019 16(2)

61

• Makos, T. (2016). Etude descriptive de 30 patients avec syndrome douloureux régionalcomplexe pris en charge dans le Centre Régional d’Etude et de Traitement de la Douleurde Poitiers. Thèse de la Faculté de médecine de l’Université de Poitier.

• Packham, T.L., Spicher, C.J., MacDermid, C.J., Michlovitz, S. & Buckley, N. (2018).Somatosensory rehabilitation for allodynia in complex regional pain syndrome of theupper limb: a retrospective cohort study. J Hand Ther, 31(1), 10-19. Téléchargeable :https://www.jhandtherapy.org/article/S0894-1130(17)30039-X/pdf (14/05/2019)

• Riou, G. (2014). Intervention interdisciplinaire pour le traitement d’une patienteprésentant un syndrome douloureux regional complexe au pied gauche par la méthodede rééducation sensitive de la douleur. e-New Somatosens Rehab, 11(4), 118-123.

• Spicher, C.J., Buchet, N., Quintal I. & Sprumont, P. (2017). Atlas des territoires cutanéspour le diagnostic des douleurs neuropathiques (3e édition) - Préface : J. Frayer.Montpellier, Paris : Sauramps Médical.

• Spicher C.J., & Clément-Favre, S. (2008). Chronic Neuropathic Pain decreases throughSomatosensory Rehabilitation. RAE : Recueil Annuel francophone belged’Ergothérapie, 1, 25-37. Téléchargeable (14/05/2019) :http://kasitera.asiakkaat.sigmatic.fi/wp-content/uploads/2009/02/spicher-clement-favre-2008.pdf

• Spicher, C.J. & Degrange, B. (2008). Rapid Relief of a long-standing PosttraumaticComplex Regional Pain Syndrome type II Treated by Somatosensory Rehabilitation andit’s 4-year follow-up. e-News Somatosens Rehab, 5(4),132-142.

• Spicher, C.J., Fehlmann, P., Maihöfner, C., Spumont, P., Letourneau, E., Dyer, J.O.,Masse, J., Lopez-Sola, M., Maupas, E. & Annoni, J.M. (2016). Management Algorithmof Spontaneous Neuropathic Pain and/or Touch-evoked Neuropathic Pain illustrated byprospective observations in clinical practice of 66 chronic Neuropathic Pain Patients. e-News Somatosens Rehab, 13(1), 5-32.

• Spicher, C.J., Quintal, I. & Vittaz, M. (2015). Rééducation sensitive des douleursneuropathiques (3e édition) - Préface : S. Marchand. Montpellier, Paris : SaurampsMédical, 387 pages.

• Vittaz, M., Behar, E. & Clement-Favre, S. (2013). Traitement d’un Complex RegionaPain Syndrome par la méthode de rééducation sensitive de la douleur. e-NewsSomatosens Rehab, 10(1), 15-21.

#NeuroPainRehab 60th #eNewsSomatosens 2019 16(2)

62

de Andrade Melo Knaut, S.9

Adapted from : Corder, G., Ahanonu, B., Grewe, B.F., Wang, D., Schnitzer, M.J. & Scherrer, G. (2019). An amygdalar neural ensemble that encodes the unpleasantness of pain. Science, 363(6424), 276-281.

The professionals who work with individuals with chronic pain and neuropathic

pain live daily with the suffering of these people. Understanding the

mechanisms responsible for pain and everything it encompasses is necessary to

complement the currently available therapeutic strategies or to develop new

treatment strategies.

It is quite widespread that chronic pain is a sensory and affective experience.

Protective behaviors that limit exposure to noxious stimuli justify the affective

dimension of pain. However, the neural mechanisms involved in the process of

emotional pain perception and its integration with the sensory domain of pain is

still unclear.

In the study of Corder et al., published recently (2019) in Science, they revealed

the role of basolateral amygdala in the control of emotional pain. An increased

activity of the basolateral amygdala (BLA) has been reported in situations of

fear or aversive perception of pain. Likewise, a lesion in this area does not

9 Physiotherapist, PhD in biomedical sciences – rehabilitation. Academic Director of Faculdade Inspirar – R: Inácio Lustosa, 792, São Francisco, Curitiba - PR, 80510000 (Brazil) President of the Brazilian Association of Neurofunctional Physiotherapy - ABRAFIN e-mail: sibelemelo@gmail.com

Article Supra-spinal sensitization mechanisms

To medical doctors To neuroscientists To patients To therapists

#NeuroPainRehab 60th #eNewsSomatosens 2019 16(2)

63

interfere with the sensation threshold of pain, but it diminishes the negative

affective perception of pain. In fact, this hyperactivity and altered functional

connectivity in the amygdala is parallel to the onset of chronic pain.

Thus, these authors suggest that the BLA nociceptive ensemble transmits

abstracted valence information to the central amygdala, striatal, and cortical

networks, in order to contribute to the construction of a pain experience (defensive

responses and sensory-discriminative information). Any and all changes in one of

these structures involved in the pain experience process may lead to a change in

the sensory and / or affective perception of pain.

So, it is clear that although pain is a sensorial and emotional experience, these are

activated by different areas of the nervous system, which in normal situation, are

integrated to allow the individual does not lose the function of protection against

pain or harmful situations. However it remains unclear how the BLA influence de

acute pain and dysfunctional pain where no known structural nervous system

lesion or active inflammation.

Probably in cases of chronic pain and mechanical allodynia, there is a

change in the processing threshold of somatosensory information which

also affects the neural set of basolateral amygdala (BLA), leading to

perceived aversion and protective behavioral responses when

encountering stimuli usually not painful. The mechanism responsible for

this change in the neural pool may be spinal, supra-spinal and / or cortical

sensitization.

#NeuroPainRehab 60th #eNewsSomatosens 2019 16(2)

64

Porter le regard sur l’autre en espérant s’y voir. Se définir à travers l’autre ou encore s’oublier face à l’autre, entre identités affirmées et identités assignées.

Les boîtes à clichés, les a priori, les pré-jugés, les amalgames, les certitudes engendrent un trop-plein de soi-même.

Notre nature propre est profondément enfouie. Une fois retirées, toutes les couches protectrices que nous y avons ajoutées peuvent refaire surface et se présenter à l’autre sans artifice. Mais en-deça des dissemblances apparentes, la rencontre, le possible face-à-face, le regard qui arrête imperceptiblement la rotation de la terre existent.

L’enjeu du maintenant se joue dans la rétraction / tsimtsoum / צמצום : si je ne laisse pas de place à l’autre, il reste peu de chances qu’autre chose que moi advienne.

Mais le kairos / Καιρός, l’immédiat dans la fulgurance du toujours précède le déploiement des ailes. Cet instant à saisir nous donne accès à qui nous sommes. Lorsque s’ouvre cette brèche dans le carpe diem, j’ai la responsabilité de la saisir pour réussir à mieux me définir comme être vivant dans toute ma globalité et dans toute mon essence.

Au risque de transformer nos identités-rhizomes, faire preuve d’à-propos, trouver le bon moment, avoir le courage d’envisager un espoir, être présent à ce qui est, porter le regard vers une singulière altérité de l’autre sont le creuset de l’intolérable exigence de la liberté. Cette exigence morale qui permet à un être humain de s’accomplir, car l’action est la VIE même. Elle me guide vers l’autre, ce même autre sur lequel je risque de poser mes yeux emplis d’a priori.

Une relation riche est ce vers quoi je tends lorsque je porte un regard sur l’autre.

Marylène Dufort & Claude Spicher

OMBRE & PÉNOMBRE

Porter le regard vers une singulière altérité de l’autre Aux médecins Aux scientifiques en neurosciences Aux patients Aux thérapeutes

#NeuroPainRehab 60th #eNewsSomatosens 2019 16(2)

65

Rose : sorte d'absence dans une présence exacerbée, perte abominablement douloureuse peut devenir réceptive, accueillante. Je la vois telle une petite barque sur une mer agitée s'approcher d'une falaise dans laquelle le vent a creusé un pied dont le bout est dévasté ; puis, la barque, pleine de pétales de Rose, s'engouffre dans le creux de craie violenté, œuvrant à la douce reconstruction du pied. Je vois et perçois de mieux en mieux ce mouvement vibrant de reconduction. Allez, de 33 fillette je dois chausser un 34 pré-adolescente...

ATMOSPHÈRE DOULOUREUSE No 8

« À la lisière de la mutilation » Murray Estèle

#NeuroPainRehab 60th #eNewsSomatosens 2019 16(2)

66

« Créer c'est laisser venir, accueillir simplement ce qui est. » Marion Muller-Colard 10

„Erschaffen ist ankommen lassen und einfach umarmen was entstanden ist.“

“To create is letting arrive and simply embrace what is.”

« Crear es simplemente dejar que llegue el resultado y acogerlo tal como es. »

« Criar é deixar entrar, simplesmente receber o que está acontecendo. »

”At skabe, det er at lade komme, blot at byde velkommen til hvad findes”

「創造とは、物事をそのまま迎え受け入れることなのです。」

“Om te scheppen, laat het gebeuren en omarm simpelweg wat is.”

10 Muller-Colard, M. (2019). L'éternité ainsi de suite. Genève : Labor et Fides & Montrouge : Bayard

APHORISM – LEITMOTIV – AFORISMO

#NeuroPainRehab 60th #eNewsSomatosens 2019 16(2)

67

132l_S1_Neuropathische_Schmerzen_Diagnostik_2012_verlaengert.pdf (23.9.2017)

z

In 1992, the first communication about somatosensory rehabilitation of pain was done at the occasion of the 1st Congress of the swiss society for hand therapy. In 2001, this method was taught for the first time. On May 25th 2019, 1253 therapists, surgeons and medical doctors from 42 countries have been trained to somatosensory rehabilitation of neuropathic pain.

≥ 300 ≥ 100 < 100

1 France 446 17 Turkey 3 33 Japan 1 2 Canada (F) 231 18 Austria 3 34 Estonia 1 3 Switzerland (F) 225 19 Italy 2 35 Mauritius Island 1 4 Switzerland (G) 125 20 Roumania 2 36 Monaco 1 5 The Netherlands 53 21 Egypt 2 37 Martinique 1 6 Belgium 32 22 Denmark 2 38 Vietman 1 7 Switzerland (I) 19 23 Israel 2 39 Tibet 1 8 Canada (E) 18 24 United-Kingdom 2 40 Iran 1 9 India 17 25 Czech Republic 1 41 China 1

10 Reunion Island 17 26 Australia 1 42 Lebanon 1 11 Germany 11 27 Argentina 1 12 Luxemburg 8 28 South Africa 1 13 Spain 7 29 USA 1 14 Portugal 4 30 Brazil 1 TOTAL

15 Greece 3 31 Syria 1 1253 16 Finland 3 32 Saudi Arabia 1

1253 Somatosensory Therapists of Pain from 42 different countries

To MD To neuroscientist To patient To therapist

#NeuroPainRehab 60th #eNewsSomatosens 2019 16(2)

68

Rééducation sensitive des douleurs neuropathiques : une méthode au

niveau 2b d’évidence basé sur des données probantes http://www.neuropain.ch/fr/enseignement/calendrier

Formation continue modulaire de 8 jours, sur un, deux ou trois ans : 56

heures de cours, ~64 heures de travail personnel, puis rédaction d’un fait

clinique pour l’obtention du titre de RSDC® et ainsi intégrer la communauté

de pratique d’experts en rééducation sensitive des douleurs neuropathiques

– soit 5 ECTS de 30 heures = 150 heures de formation.

An evidence-based practice method level 2b

124th course for somatosensory rehabilitation of neuropathic pain http://www.neuropain.ch/education

To become CSTP® Certified Somatosensory Therapist of Pain

23–26 Sept. 2019 1st PART NeuroPain Rehab (Day 1 to Day 4) with Rebekah Della Casa CSTP® & Claude J. Spicher

Place Somatosensory Rehab Ctr (Fribourg - Switzerland)

Observation of three live treatments

Registration form on page 74 or on neuropain.ch

Continuous Education – Formation continue

#NeuroPainRehab 60th #eNewsSomatosens 2019 16(2)

69

Rééducation sensitive des douleurs neuropathiques Formation modulaire de 8 jours sur 2 ans

Une méthode au niveau 2b d’évidence basé sur des données probantes

122e cours Depuis 2009 au Québec

2e PARTIE J5, J6, J7 & J8

Dates : mercredi 11, jeudi 12, vendredi 13 & samedi 14 septembre 2019

Gestion du lien thérapeutique, Anatomie clinique I & II, Analyse de pratiques Equivalence accordée pour un Module 3

Formateurs Eva Létourneau, BSc erg., Maîtrise en pratiques de la réadaptation de l’Université de

Sherbrooke, RSDC® Claude Spicher, ergothérapeute, thérapeute de la main certifié suisse (2003-2028),

collaborateur scientifique universitaire en neurophysiologie Lieu

Institut de tourisme et d’hôtellerie du Québec (ITHQ) 3535, Rue Saint-Denis, Montréal, QC H2X 3P1

Info http://www.neuropain.ch/fr/enseignement/calendrier

Spicher, C., Quintal, I. & Vittaz, M. (2015). Rééducation sensitive des douleurs neuropathiques (3e édition). Montpellier, Paris : Sauramps Médical, 387 pages. Spicher, C., Buchet, N., Quintal, I. & Sprumont, P. (2017). Atlas des territoires cutanés pour le diagnostic des douleurs neuropathiques (3e édition) – Montpellier, Paris : Sauramps Médical, 102 pages au NOUVEAU format : 21 x 27 cm.

123e cours Depuis 2009 au Québec

1e PARTIE J1, J2, J3 & J4

Dates : lundi 16, mardi 17, mercredi 18 & jeudi 19 septembre 2019

Troubles de base I & II, Complications douloureuses I & II

Formateurs, Lieu & Info Comme ci-desus, pour la 1ère partie

Ces formations peuvent être comptabilisées pour l’obtention du titre : RSDC® Rééducatrice Sensitive de la Douleur Certifiée

#NeuroPainRehab 60th #eNewsSomatosens 2019 16(2)

70

Cours à venir

2019

2020

2021

Jours J1 J2 J3 J4 J5 J6 J7 J8 2 jours

Montréal, ITHQ Depuis 2009 J1, J2, J3 & J4 J5, J6, J7 & J8

Obs

erva

tions

de

patie

nts e

t thé

orie

à

Frib

ourg

(Sui

sse)

R

RSD

et A

NFE

et E

PE

Paris ANFE Depuis 2016 J5, J6, J7 & J8

Montpellier EPE Depuis 2005 J1, J2, J3 & J4 J5, J6, J7 & J8

Lyon Depuis 2020 J1, J2, J3 & J4

Lyon Depuis 2020 J5, J6, J7 & J8

Il ne reste plus que quelques places

3-5 février 2020 Module niveau 4 réservé aux 122 RSDC® Lieu Centre de rééducation sensitive du corps humain (Fribourg)

avec18 illustrations de séances réelles

24 places pour 24 RSDC®

Cette 126e formation continue peut être comptabilisée pour la re-certification du titre RSDC®

#NeuroPainRehab 60th #eNewsSomatosens 2019 16(2)

71

#NeuroPainRehab 60th #eNewsSomatosens 2019 16(2)

72

SOMATOSENSORY REHABILITATION of

PAIN

NETWORK

Montreal | Freiburg | Brussels | Montpellier | Paris | Bordeaux | Amsterdam

www.neuropain.ch 6, Hans-Geiler Street

Department of CH - 1700 FREIBURG Continuous education info@neuropain.ch

SO

MA

TOS

ENS

OR

Y R

EHA

B o

f P

AIN

– 2

01

9 –

PA

RT

I

(sin

ce 2

00

1)

What can we offer our patients suffering from neuropathic pain?

1st PART NeuroPain Rehab (Day 1 to Day 4) Observation of three live treatments www.neuropain.ch/education/calendar

The 124th course for somatosensory rehabilitation of neuropathic pain is a four day comprehensive theoretical and hands-on course for therapists, physicians and others, about a method to treat neuropathic pain patients (NPP).

Somatosensory Rehabilitation of Pain (Spicher, 2006) includes: Assessment of cutaneous sense disorders and their painful complications (CRPS, mechanical allodynia, neuralgia i.e post carpal tunnel syndrome release) and also rehabilitation.

Problem Cutaneous somatosensory disorders, including hypoaesthesia and/or mechanical allodynia are often significant contributors to chronic pain, interfering with activities.

The normalisation of the cutaneous sense has a positive impact on neuropathic pain. The shooting pain, the burning sensations decrease and hypersensitivity resolves, offering NPP a better quality of life.

Concepts The concept of Aβ pain was proposed by Marshall Devor [Exp Brain Res 2009] many years after Tinel (1917) suggested that neuropathic pain is conducted partly through the Aβ fibers. The etiology of neuropathic pain hinges on this idea. It means that chronic neuropathic pain can arise from the alteration of the somatosensory system and not only from the alteration of the C fibers. Therefore, the painful area must be carefully assessed in order to determine the presence of Aβ fibers lesions (tactile

#NeuroPainRehab 60th #eNewsSomatosens 2019 16(2)

73

Spicher, C.J. (2006). Handbook for Somatosensory Rehabilitation. Montpellier, Paris: Sauramps Médical. Spicher, C.J., Buchet, N., Quintal, I. & Sprumont, P. (2017). Atlas des territoires cutanés pour le diagnostic des douleurs neuropathiques (3e éd.). Montpellier, Paris: Sauramps Médical. Please note that the course is entirely based on : Spicher, C.J., Quintal, I. & Vittaz, M. (2015). Rééducation sensitive des douleurs neuropathiques (3e édition) – Préface: Serge Marchand. Montpellier, Paris: Sauramps Médical.

hypoaesthesia and/or mechanical allodynia). Consequently, the normalisation of the cutaneous sense has a positive impact on neuropathic pain.

Overall Learning Aims • To integrate precise techniques for identification and

treatment of somatosensory changes;• To rehabilitate cutaneous somatosensory disorders on the

basis of the somatosensory system neuroplasticity;• To avert the outbreak of painful complications by

rehabilitating the cutaneous sense;• To build bridges between rehabilitation, medicine and the

neurosciences.

Some of these instructors of the Somatosensory Rehab of Pain Network • Since 2001, Claude J. Spicher, Scientific collaborator

(University of Freiburg – Faculty of Sciences and Medicine),Certified Hand Therapist Switzerland (2003 – 2028);

• Since 2008, Rebekah Della Casa, Certified SomatosensoryTherapist of Pain (CSTP®) in the Somatosensory Rehab Ctr

Course Information

Date Time Duration Location Price

23rd to 26th of September 2019 9 am – 12 am & 1 pm – 5 pm 28 hours 6, Hans-Geiler Street, 1700 Fribourg, Switzerland All together CHF 690.- (Work Documents in English + Handbook + Atlas).

References

#NeuroPainRehab 60th #eNewsSomatosens 2019 16(2)

74

124th Course for Somatosensory Rehabilitation of Neuropathic Pain

(Since 2001)

23rd to 26th of September 2019

REGISTRATION FORM

Deadline: Monday, 26th August 2019

Name:

First (given) name:

Professional occupation:

Address:

e-mail address:

Please fill and return to:

Somatosensory Rehabilitation of Pain Network Department of Continuous Education 6, Hans-Geiler Street CH-1700 Fribourg Switzerland

e-mail : info@neuropain.ch

or

Fax: +41 26 350 06 35

#NeuroPainRehab 60th #eNewsSomatosens 2019 16(2)

75

EDITORIAL BOARD International Standard Serial Number (ISSN): 1664-445X

Editor-in-chief @claudejspicher, University scientific collaborator, Swiss Certified HT, OT

Co-editor Sibele de Andrade Melo KNAUT, PhD, pht (Brazil)

Editor Méloé SPICHER, BA(c) (Switzerland)

International assistant editors @TaraLPackham, PhD, MSc, OT Reg. CSTP® (Ontario, Canada)

Julie MASSE, MSc OT (Québec, Canada) Renée HAMILTON, BSc OT (Québec, Canada) Séverine GLANOWSKI, CSTP®, OT (France)

Elodie GOERES, CSTP®, OT (France) Aurélie RICHARD, CSTP®, OT (France)

Guillaume LEONARD, PhD, MSc, pht (Québec, Canada) Eva LÉTOURNEAU, MSc OT, CSTP® (Québec, Canada)

Rebekah DELLA CASA, CSTP®, OT (Switzerland) Sandra B FRIGERI, OT (Argentina) Sarah RIEDO, zert. SST (Schweiz)

Noemi TROYON, BSc OT (Israel, Switzerland) Noëmie MERMET-JORET, PhD (Denmark, France) Clàudia PERIS Fonte, CSTP®, pht (Catalonia, Spain)

Thomas OSINSKI, PhD, pht (France) Maya HAMMOUD, MSc(c), pht (Liban, Québec, Canada)

Honorary members Prof EM ROUILLER, PhD (Switzerland)

Prof AL DELLON, MD, PhD (USA) Prof R MELZACK, OC, OQ, FRSC, PhD (Québec, Canada)

Peer-reviewed since 2012

Published: 4 times per year since 2004 Deadline: 10th February, 10th May, 10th August, 10th November

Price: Free Sponsor: Somatosensory Rehabilitation of Pain Network, Switzerland, Europe.

27 languages: Français, English, Dansk, Deutsch, Español, Português, Рускиӣ, Italiano, Lingala, Shqip, Srpski i Hrvatski, Corse, Česky, Svenska, Türkçe, Suomea, Ελληνικά,

Nederlands, Hindi, עברית, , 日本語, 한글, Norsk, Catala, བོད་ཡིག, 汉语。

e-News’s Library: www.neuropain.ch #eNewsSomatosense-mail : info@neuropain.ch

Who are you? You are 43’186 neuroscientists, medical doctors, therapists & patients in 140 countries

who are receiving e-News for Somatosensory Rehabilitation of Neuropathic Pain.