Neuropathic pain is characterized as pain arising from damage or dysfunction within the somatosensory nervous system(1). Recognized as one of the most challenging pain syndromes to diagnose and manage(1) , it often goes unidentified by many clinicians, primarily due to insufficient assessment criteria, resulting in suboptimal medication usage and unsatisfactory therapeutic approaches.
Numerous conditions, such as diabetes, herpes zoster, surgery, stroke, spinal cord injury, multiple sclerosis,
rheumatic disease, and mechanical trauma, can inflict harm to the nervous system (2) (3). Affecting an estimated 3-10% of the general population, as indicated by largescale epidemiological studies (4), peripheral neuropathy represents a category of nerve damage and can manifest in a wide variety of pathologies necessitating specific evaluation and treatment. These disorders involve nerve cells and their fibers.(5) Peripheral polyneuropathies are often secondary to pathological conditions, although compressive or irritative causes are undoubtedly the most prevalent factors for mono-neuropathies. Examples include nerve roots (radiculopathy), divisions of nerve trunks, somatic peripheral nerves, and nerves of the autonomic nervous system.(6)
Neuropathic pain can be alleviated through the mobilization of peripheral nervous tissue. This evidencebased therapeutic intervention is effective in treating compressive mononeuropathies accompanied by neurogenic or nociceptive pain, as well as inflammation and cellular injury.(7)
Manual neurodynamics can bolster nerve conduction velocity, blood flow, axonal transport, and nerve regeneration, thereby mitigating pain and enhancing function.(8) (9) (10) (11) (12)
This Continuing Professional Development (CPD) program is firmly grounded in the latest evidence and
consistently integrates new findings and advancements in the field of manual therapy for peripheral nerve
6 hours of pre-recorded videos (in-depth review of the phenomenon involved in neuropathic compressive symptoms for both the cranial nerves and limbs).
• Comprehensive review of essential micro and macroanatomy.
• Understanding the phenomenon of compressive neuropathy: neurobiology of inflammation and cellular injury.
• Examining tissue and cellular injury types, and assessing mononeuropathy lesions based on current evidence
• Differentiating between positive and negative signs.
• Recognizing red flags in radicular and neuropathic pain.
• Exploring current scientific evidence for therapeutic interventions in compressive mononeuropathies.
• Introduction to general and segmental neuromechanics.
• Neurological exam in mononeuropathies.
• Neural mobilization techniques and clinical assessment for the upper limb:
- Median nerve entrapment (anterior interosseus syndrome; carpal tunnel (syndrome)
- Ulnar nerve entrapment (cubital syndrome; Guyon’s tunnel syndrome)
- Radial nerve entrapment (posterior interosseus syndrome; distal radial nerve compression)
- Dorsal-scapular syndrome
- Supra-scapular and axillary nerves entrapment
- Radiculopathies of brachial plexus (management and assessment)
- Common peroneal nerve entrapment
- Deep peroneal nerve entrapment
- Superficial peroneal nerve entrapment
- Tibial nerve entrapment (medial, lateral and interdigital nerves)
- Greater sciatic neuropathy vs “piriformis syndrome”. Debunk of the piriformis syndrome as a prevalent cause of sciatic pain.
- Obturador nerve entrapment.
- Genito-femoral nerve entrapment.
- Lumbar radiculopathies (management and clinical reasoning).
• Reviewing neurocranium anatomy.
• Exploring current understanding of cranio- cervical pain, headache types, red flags and clinical diagnostic criteria.
• Grasping the fundamentals of cranial neuromobilization and neurocranium mechanics.
• Mastering clinical assessment of peripheral cranial nerves: clinical reasoning in depth to distinguish common causes of central and peripheral neuropathy.
• Cervicogenic headache: diagnostic criteria and manual techniques management
• Neural mobilization techniques and clinical assessment of the cranial nerves:
• Trigeminal neuralgia and neuropathy (trochlear/ supra-orbital branches and mandibular\ auriculo- temporal branches)
• Facial nerve neuropathy (Bell’s palsy management)
• Vestibulo-cochlear neuropathy (BBPV management; tinnitus and hidropsy etiologies- nerve mobilization for specific conditions)
• Investigating the relationship between the autonomic nervous system (ANS) and inflammation.
• The potential of vagus nerve mobilization for complex pain patients.
• Every day tools for balancing sleep, the ANS and the response to inflammation in chronic conditions.
Upon completion of this course, participants will be able to:
• Recognize the most prevalent symptoms of mono-neuropathies.
• Grasp the fundamental aspects of pain, neuropathic pain, and the extent of neurogenic pain, inflammation, and potential damage to peripheral nerve cells (neuropraxia, axonotmesis).
• Differentiate between positive and negative signs concerning the pathophysiology of compressive neuropathies.
• Conduct a comprehensive clinical examination of the somatic peripheral nervous system, including the cranial nervous system.
• Identify and evaluate the most frequent sites of compression or irritation for mononeuropathies in the upper limb, lower limb, and cranium.
• Cultivate strong clinical reasoning skills in relation to neurogenic pain and peripheral neuropathy.
• Comprehend the essential concepts of neuromechanics integrated within the “nervi continuum” (nervous connective tissue tensegrity).
• Apply neurodynamic principles (tension and glide) to address specific symptomatic stages of neuropathic pain.
1) Finnerup NB, Haroutounian S, Kamerman P, Baron R, Bennett DLH, Bouhassira D, Cruccu G, Freeman R, Hansson P, Nurmikko T, Raja SN, Rice ASC, Serra J, Smith BH, Treede RD, Jensen TS. Neuropathic pain: an updated grading system for research and clinical practice. Pain. 2016 Aug;157(8):1599-1606. doi: 10.1097/j.pain.0000000000000492. PMID: 27115670; PMCID: PMC4949003.
2) Colloca L, Ludman T, Bouhassira D, Baron R, Dickenson AH, Yarnitsky D, Freeman R, Truini A, Attal N, Finnerup NB, Eccleston C, Kalso E, Bennett DL, Dworkin RH, Raja SN. Neuropathic pain. Nat Rev Dis Primers. 2017 Feb 16;3:17002. doi: 10.1038/nrdp.2017.2. PMID: 28205574; PMCID: PMC5371025.
3) Hicks CW, Selvin E. Epidemiology of Peripheral Neuropathy and Lower Extremity Disease in Diabetes. Curr Diab Rep. 2019 Aug 27;19(10):86. doi: 10.1007/s11892-019-1212-8. PMID: 31456118; PMCID: PMC6755905.
4) Attal N, Bouhassira D, Baron R. Diagnosis and assessment of neuropathic pain through questionnaires. Lancet Neurol. 2018 May;17(5):456-466. doi: 10.1016/S1474-4422(18)30071-1. Epub 2018 Mar 26. PMID: 29598922.
5) Schmid AB, Campbell J, Hurley SA, Jbabdi S, Andersson JL, Jenkinson M, et al. Feasibility of Diffusion Tensor and Morphologic Imaging of Peripheral Nerves at Ultra-High Field Strength. Invest Radiol. 2018;53(12):705-13.
6) Remiche G, Kadhim H, Maris C, Mavroudakis N. Les neuropathies périphériques, du diagnostic au traitement, revue de la littérature et enseignements de l’expérience locale [Peripheral neuropathies, from diagnosis to treatment, review of the literature and lessons from the local experience]. Rev Med
Brux. 2013 Sep;34(4):211-20. French. PMID: 24195230.
7) Pfau DB, Geber C, Birklein F, Treede RD. Quantitative sensory testing of neuropathic pain patients: potential mechanistic and therapeutic implications. Curr Pain Headache Rep. 2012;16(3):199-206.
8) Schmid AB, Fundaun J, Tampin B. Entrapment neuropathies: a contemporary approach to pathophysiology, clinical assessment and management. Pain Reports. 2020;in press.
9) Schmid AB, Hailey L, Tampin B. Entrapment Neuropathies: Challenging Common Beliefs With Novel Evidence. J Orthop Sports Phys Ther. 2018;48(2):58-62.
10) • Skaper SD. Impact of inflammation on the blood-neural barrier and blood-nerve interface: from review to therapeutic preview. Int Rev Neurobiol. 2017;137:29–45. doi: 10.1016/bs.irn.2017.08.004.
11) Kerry K Gilbert, C Roger James, Gail Apte, Cynthia Brown, Phillip S Sizer, JeanMichel Brismée, Michael P Smith, Effects of simulated neural mobilization on fluid movement in cadaveric peripheral nerve sections: implications for the treatment of neuropathic pain and dysfunction, Journal of Manual & Manipulative Therapy 2015, 23 (4): 219-25
12) Santos FM, Silva JT, Giardini AC, et al. Neural Mobilization Reverses Behavioral and Cellular Changes That Characterize Neuropathic Pain in Rats. Molecular Pain. January 2012.
Bruno Campos has been a dedicated osteopath for over 15 years, maintaining a clinical practice in Portugal while simultaneously teaching at the undergraduate level in higher education.
As the creator of the Neuromobilization Course (NMC®) in 2012, he has provided invaluable Continuing Professional Development opportunities for osteopaths.
In addition to his role as a guest lecturer
at the International College of Osteopathic Medicine in Milan and his involvement in the Medi-Cine Online project, Bruno registered with the General Osteopathic Council in the UK in
2011. Around this time, he developed a keen interest in neurology and neuropathies,
driven by a desire to better understand the relationship between the nervous system and
Bruno’s academic pursuits led him to enroll in a master’s program in neurological rehabilitation. He continues to explore the realm of entrapment neuropathies and therapeutic intervention and his work is closely aligned with contemporary scientific advancements, particularly in the neuroscience of pain.
Outside of his professional and academic endeavors, Bruno indulges his passion for the
field by hosting the Osteotalks podcast as a hobby.