#EFIC2022 GP Sessions

1. define the key features of three orofacial pains
2. appreciate the impact a co- morbidity can have on management
3. compare how management differs between three orofacial pain conditions

Three case presentations will set the scene for the workshop. The cases will be temporomandibular disorder associated with migraines, trigeminal neuralgia associated with multiple sclerosis and trigeminal neuropathic pain with comorbid depression.  Once the audience have reached consensus on diagnosis and potential management each speaker will address the key diagnosis features based on the new classifications.  The use of questionnaires both for diagnosis and assessment of outcomes, imaging and neurophysiological tests will be discussed for each of the three diagnosis. Management will then be discussed based on the best current evidence but also highlighting how it will be affected by the co-morbidity and the need to adopt a holistic patient centred approach.

Three cases will be presented and participants will be asked to come up with a potential diagnosis and management plan (15 minutes). Short talks by the three presenters (15 minutes), individual Q&A ( 5 mins) followed by general discussion (15 mins)

To give an overview of relevant and recent insights on important comorbidities of (chronic) pain, in particular sleep problems and obesity.
To increase awareness on the importance of promoting a healthy lifestyle and self-management in the context of pain, and show how it can be implemented through behavioral change principles

Lifestyle factors increasingly gain interest for pain management, both in scientific literature and clinical practice. Two factors known to impact pain are poor sleep and obesity. Sleep problems, such as difficulties falling asleep or frequent nighttime awakening, are strongly linked to pain amplification and a greater impact of pain on daily functioning and life satisfaction. The same is true for obesity: pain intensity and disability dose-dependently increase with higher body mass index, waist circumference, percent fat and fat mass. Additionally, obesity is not only related to pain persistence, but also to higher rates of health care seeking. Yet, current treatments often overlook these factors which have the potential to negatively impact treatment outcome. Thus, if sleep problems and obesity are left untreated, they can act as strong barriers against effective pain management. The greatest common divisor for targeting lifestyle factors within pain management is behavioral change, for which intrinsic motivation is key. Therefore, this workshop will not only inform participants on the latest evidence of the impact of sleep problems and obesity on (chronic) pain, but will also dive into the role of motivation and the use of behavioral change principles to tackle comorbidities and to pursue a healthy lifestyle.

To increase interaction with the audience (both online and on site) will use polls, and we will request input from the audience on cases used during the presentation as well as on an “umbrella”-debate (on lifestyle, behavioral change, pain) that we will hold at the end of the session.

Knowledge of the quality of evidence of conventional and new treatment approaches for treatment-resistant patients with episodic or chronic cluster headaches
Knowledge of the treatment algorithms for treatment-resistant patients with episodic or chronic cluster headaches 
Knowledge of designs of studies in patients with treatment-resistant patients episodic or chronic cluster headaches 

Cluster headaches are one of the primary headache syndromes. It is characterized by unilateral short attacks of excruciating pain located in the (supra) orbital or temporal regions with simultaneous ipsilateral cranial autonomic phenomena such as lacrimation, conjunctival injection and nasal congestion. Attacks last 15-180 minutes and happen from 1 every 2 days to more than 8 a day. There are 2 types of cluster headaches, the episodic and the chronic form. Cluster headaches are associated with a lower quality of life and have a significant social impact. Prevalence is 1 in 1000, male to female ratio is 4.3: 1. Pathophysiology is unknown. The hypothalamus may play an important role in cluster headaches.
Diagnosis is made by using the ICH criteria. Treatment consists of a combination of acute and prophylactic treatment in the majority of patients. In acute treatment, the first choice is O2 inhalation and / or 5-HT 1B / 1D agonist sumatriptan. As a prophylactic medication, the first choice is verapamil. Not all patients respond to this. During the last years a growing range of new treatments has become available for those patients.

To highlight the importance of understanding vulvodynia from a pain perspective, by applying and adjusting current biopsychosocial models of pain to fit vulvodynia, as a prerequisite for providing more effective treatments. The most recent treatment advances will be outlined, and key issues for clinical implication will be pointed out.

Women with vulvodynia suffer serious consequences in their sexual, emotional, and relational health, and there has been a lack of effective treatments. The last decade of research underscores the importance of embracing a broad biopsychosocial perspective for treatment advancement. Although biological mechanisms set the stage, psychosocial mechanisms seem equally important, in particular pain-related fear and avoidance are key maintaining factors. Yet, there are some fundamental distinctions from other pain conditions, such as the intimate interpersonal context. As such, there is a need for adjusting the biopsychosocial model to fit the specificities of vulvodynia. This workshop will delineate insights gleaned from recent research around the applicability of a biopsychosocial model to vulvodynia, and how this may inform treatment development. Dr. Bohm-Starke will provide an overview of the biological factors and their role in treatment. Dr. ter Kuile will elaborate on psychosocial factors, such as pain-related fear and avoidance, and treatments based on this perspective. Lastly, Dr Chisari will present innovative treatment options and how the ACT-model of psychological flexibility may be applied to this patient group. Altogether, this workshop will highlight novel insights regarding the applicability of a biopsychosocial model to vulvodynia and clinical implications will be discussed.

Theoretical models will briefly be outlined, and recent studies supporting the proposed links will be presented. The three presentations build upon each other, emphasizing the similarities and continuous theoretical development. The audience will be involved through interactive tools, to maximize learning and facilitate clinical use of the workshop content.