1. April 8­9 2008
Hotel Radisson, Bogotá
Latin­American Expert Consensus on
Neuropathic Pain Management
Preliminary Agenda

2. Preliminary Agenda (I)
Latin­American Expert Consensus on Neuropathic Pain Management,
Bogota, April 8th­9th of 2008
n April 7th Arrival of participants
n 20:00 “Get together” and welcome dinner at the Hotel Radisson
n April 8th: First Day consensus meeting (Salón Roble)
n 8:30 – 9:00 Welcome and Methodology
Neuropathic Pain Management Dr. Eduardo Ibarra
n 9:00 –10:00 Neuropathic Pain Treatment in Europe Dr. J.J. Hernandez
n European Guidelines for Neuropathic Pain Treatment
n Experience with Versatis (lidocaine patch)
n 10:00 – 10:15 Break
n 10:15 – 11:00 Neuropathic Pain Treatment in US Dr. Leon­Casasola
n Clinical experience in US
n Experience with lidocaine patch
n 11:00 Moderated group work in different expert panels
n Pain Assessment, Treatment recommendations, Monitoring
n 13:00 – 14:00 Lunch

3. Preliminary Agenda (II)
Latin­American Expert Consensus on Neuropathic Pain Management,
Bogota, April 8th­9th of 2008
n Cont. April 8th:
n 14:00 ­ 16:00 Continuation of group work
n 16:00 ­ 18:00 (app.) Presentations and discussion of first results of the 6
working groups in the working rooms using the pin walls
n 20:00 Dinner (Restaurant Ochenta Sillas)
n April 9th: Second day consensus meeting
n 09:00 – 12:00 Continuation of group work and finalization of the
results into checklists
n 12:00 – 13.00 Bringing the results in a presentable format, suitable
for understanding and consensus finding
n 13:00 – 14:00 Lunch
n 14:00 ­ 17:30 Report in plenum: results and discussion
Consensus findings in plenum
n 17:30 – 18:00 Closing remarks and farewell
n 20:00 Dinner (Restaurant Harry & Sassón)
n April 10th: Departure or staying for the Colombian Pain Congress

4. Preliminary Agenda (III)
Latin­American Expert Consensus on Neuropathic Pain Management,
Bogota, April 8th­9th of 2008
n Location of the Consensus Meeting:
Hotel Radisson Royal
Address: Calle 113 N° 7­65
Bogotá, Colombia
Phone: +57­16295009, +57­16578720

5. More detailed information
on the working Group works

6. Target of the Meeting
n Develop a set of recommendations for assessment and
treatment of neuropathic pain
n For the routine situation at the GP practice
n With checklists on the most important facts
n Develop first draft of recommendations (algorithm) for
Latin America
n Basis
n Given NP diagnosis
n Recently published clinical guidelines and studies
n What we shall not do in the workshop
n Revise clinical guidelines (this is a “homework” previous to the
meeting)
n Assess differences in the different health care systems

7. Principal structure of the decision process
History
Examination
Investigation
yes
Red Flags? Exit point
no
Therapy
decisions
Follow up

8. Organisation of the Meeting
n Overall sequence
n Introduction
n Work group Group works (in parallel)
n Topic 1: Pain Assessment
n Topic 2: Therapy recommendations
n Topic 3: Checklist for monitoring
n Consensus

9. Principal structure and topics
History
Examination
Investigation Topic 1: Pain assessment
yes
Red Flags? Exit point
no
Therapy
decisions Topic 2: Therapy recommendations
Follow up
Topic 3: Checklist for monitoring

10. Topics and Working groups
History Working group A
Examination
1 Working group B
Investigation
yes
Red Flags? Exit point Working group C
no
Drug treatment Working group D
Therapy
2 decisions
Non­pharmacological Working group E
treatment
Follow up Working group F
3

11. Meeting: Work group participants
WG Theme Participants
A NP definition and
Clinical history
B Examinations and
investigations
C Red flags
D Drug treatment
E Non­pharmacological
treatment
F Monitoring

12. Flow of the group work (example history)
Literature, Guidelines
Knowledge and skills of
the WG
(3­4 participants)
Description (text) of history
What should be asked?
Appropriate? Plenary audit Consensus
Check list

13. Meeting: Work group topics
n Topic 1: Pain Assessment
n Working groups A, B, C
n A= History
n B= Examinations and investigations
n C= Red flags
n Topic 2 : Therapy recommendations
n Working groups D, E
n D: Drug treatment
n E: Non­pharmacological treatment
n Topic 3: Monitoring
n Working group F

14. Topic 1: Pain Assessment
Working groups A, B, C
n Group A: History
n Group B: Examinations and investigations
n Group C: Red Flags

15. Group work 1:
Pain Assessment
Objectives (for each group):
describe the information needed to objectify
neuropathic pain and red flags
n History
n What information is needed to know that there is probably
neuropathic pain
n Examinations an investigations
n Which examinations/investigations will confirm for neuropathic
pain?
n Red flag procedures
n Which red flags should the GP know? How to recognize a red flag?
n History
n Examinations
n Investigations

16. Elements of the assessment phase
C
Red
Decision step Information
flags
A History What to ask for?
Examination What to examine
B
Investigation What to invest?

17. Topic 1: Pain Assessment
n Read the literature
n List all the relevant information you can think of
n Check the list on completeness
n Check the list on appropriateness for the goal of the assessment
(reduction to the essential information)
n Method: Brainstorming on the pin wall
n the group members name elements of the list
n one person is writing on the pin wall
n one person in the group is checking in parallel
whether all nominations are written down
n Do not !!!
n criticize any nomination
n discuss any item
n look for any topic
n After completion of the brainstorming
n check your results on appropriateness
n Make changes step by step
n Finalize in a presentable check list format

18. Topic 2: Therapy recommendations
Working groups D, E
n Group D: Drug treatment of neuropathic pain
Ø Peripheral focal and multi­focal
Ø Peripheral generalized
Ø CNS induced
Ø Mixed Pain Syndrome
n Group E: Non pharmacological treatment of neuropathic pain
Ø Peripheral focal and multi­focal
Ø Peripheral generalized
Ø CNS induced
Ø Mixed Pain Syndrome (neuropathic + nociceptive)

19. Topic 2: Therapy recommendations
Objectives:
give your therapy recommendations for each type of
neuropathy in a priority list, with literature references
n Therapy
n Drug
n Non pharmacological
n Literature reference
n Please name the supportive literature

20. Group work 2:
Therapy recommendations
Type Treatment recommendation Literature
n Gabapentin
Peripheral focalized n Topical Lidocaine Finnerup…
NP n Pregabalin Dworkin….
n …

21. Topic 2: Therapy recommendations
n Fill the left column: 4 neuropathic pain types
n Read the literature
n Assign possible therapies to the NP type
n Assign the literature
n Brainstorm on recommendation/prioritizing
n How effective?
n How safe?
n Nature and frequency of adverse events?
n Method: Brainstorming on the pin wall
n the group members name elements in the list
n one person is writing on the pin wall
n one person in the group is checking in parallel
whether all nominations are written down
n Do not !!!
n criticize any nomination
n discuss any item
n look for any topic
n After completion of the brainstorming
n check your results
n Make changes step by step
n Finalize in a presentable format

22. Group work 3: Monitoring
Objectives:
what information should be collected for monitoring the
patient?
n History
n Examinations
n Investigations
n Report as check lists
n Add literature references

23. Topic 3: Monitoring
n Read the literature
n Write down all the information you will use for monitoring
n History
n Examinations
n Investigations
n Brainstorm on appropriateness
n What is really relevant to know?
n Which validated patient questionnaire could be used?
n Assign the supportive literature
n Method: Brainstorming on the pin wall
n the group members name elements in the list
n one person is writing on the pin wall
n one person in the group is checking in parallel
whether all nominations are written down
n Do not !!!
n criticize any nomination
n discuss any item
n look for any topic
n After completion of the brainstorming
n check your results
n Make changes step by step
n Finalize in a presentable format

24. General rules for working in a working group
n Read the literature
n First write down all the items relevant for your topic
n Then brainstorm on appropriateness (what could be missed)
n Check constantly on the goal of your task, to stay on track
n “ Small is beautiful”
n Decide on who should present the result
n Method: Brainstorming on the pin wall
n the group members name the topics for the list
n one person is writing on the pin wall
n one person in the group is checking in parallel
whether all nominations are written down
n Do not !!!
n criticize any nomination
n discuss any item
n look for any topic
n After completion of the brainstorming
n check your results again on completeness
n Make changes item by item
n Finalize your result in a computer­presentable format

25. Consensus
n Present the result of the 6 working groups
n Discuss the result for last comments
n Ask for agreement:
n If agreement is >= 80% : consensus
n If agreement is < 80% : ask who disagrees, ask for
arguments, adapt if wanted the result and vote again;
proceed when consensus has been achieved
n Follow the procedure for the next work group
results