Role of the nervous system

Round Table Discussion 9

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11:3511:55The Autonomic System and the Pelvis – How much is understood?Thomas Chelimsky
11:5512:15Pain in Mice and Man: Ironic Adventures in TranslationJeffrey Mogil
12:1512:35Clinical neuromodulation – What does the future look likeEmmanuel Chartier-Kastler

Thomas Chelimsky
That autonomic abnormalities occur in people with chronic pain of all types has been known for years. These have generally been assumed to be secondary to the pain experience. However our data suggest otherwise. Autonomic changes may precede and lead the pain experience, through changes in a region of the brain called the periaqueductal gray. This region specializes in threat response, and may “set” the entire brain in chronic threat mode, initialized through autonomic signals to the end-organs, and leading to the chronic pain state. This talk will review what we currently know and some preliminary data from ICECAN, an NIH funded trial to further investigate this perspective.

Jeffrey S. Mogil
Recent decades have seen an explosion in our understanding of the molecular and cellular underpinnings of pain, but virtually none of this knowledge has resulted in new clinical therapies. The first part of the talk will explore the reasons for this lack of translation, including a mismatch between clinical characteristics and preclinical experimental design choices, species-specific gene expression, and emerging challenges in clinical trials. The second part of the talk will focus on recent studies in our laboratory concerning the modulation of pain by social factors. One would imagine these would be even harder to translate into humans, but in this domain translation between mice and undergraduates has been surprisingly successful. These observations collectively challenge assumptions commonly made about the biopsychosocial model, and have important philosophical implications for animal research.

Emmanuel Chartier-Kastler
As sacral neuromodulation (Interstim 1 and 2TM) went to a full clinical development (OAB/UR/FI) within the last 20 years, the role of neuromodulation of bladder/sphincter nervous system came to an increased interest. Next steps may be looked for through various aspects:
Technical improvements of SNM devices, specially rechargeable devices that will be soon available
Neurological targets may be modified/improved. The evaluation of peripheral targets as tibial nerve, popliteal nerve, pudendal nerve have to be looked for, upon technical improvements and adaptation including devices that may be wireless.
Clinical evaluation have to be revised taking into account not only quality of life but Patient Reported Outcome Measurement (PROMS) or combined parameters. In the mean time new indication may emerge.
The future of neuromodulation will also improve through new indications and other specialties applications.