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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
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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: [email protected]
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
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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
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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
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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
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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
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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.
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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.
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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
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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
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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
.
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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: [email protected] [email protected] 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
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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
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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
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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.
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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 : [email protected]
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
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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
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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
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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
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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.
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• 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.
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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: [email protected]
Article Supra-spinal sensitization mechanisms
To medical doctors To neuroscientists To patients To therapists
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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.
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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
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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
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« 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
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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
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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
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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
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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®
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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 [email protected]
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
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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
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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:
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Address:
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#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)
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