Professor Andrew RiceIASP President
I am a clinical academic who for more than 35 years has been intrigued by the conundrum of neuropathic pain.
I am Professor of Pain Research at Imperial College, London, UK. At Imperial, I lead an interdisciplinary research group interested in elucidating neuropathic pain in the context of infectious disease (HIV, Herpes Zoster, HTLV-1 and leprosy), diabetic neuropathy and limb amputation. Our current research activity embraces a variety of pre-clinical and clinical facets –enabling preclinical evidence synthesis and enhancing methodological rigour, through “deep phenotyping” of patients with a view to enabling precision medicine and understanding risk factors and on to clinical trials and evidence synthesis. I also enjoy collaborating with historians to uncover historical aspects of neuropathic pain. |
|
Prior to being entrusted with the daunting responsibility of IASP President, I had the privilege of serving IASP members in a number of roles, including: IASP Councillor, liaison to South-East (ASEAPS) and South Asian Federations (SARPS) (continues) Federations, Chair of the Scientific Programme Committee for the 18th World Congress on Pain and of the Presidential Task Force on Cannabinoid Analgesia. In the more distant past, I held leadership positions in our Special Interest Group on Neuropathic Pain (NeuPSIG) and IASP’s UK Chapter, the British Pain Society.
Away from work, my family are very tolerant of my obsession with watching cricket and pretending to be an amateur historian. I also enjoy snow sports in winter and playing around on or in water in the summer.
Away from work, my family are very tolerant of my obsession with watching cricket and pretending to be an amateur historian. I also enjoy snow sports in winter and playing around on or in water in the summer.
IASP Global Year: Update on Diagnosis and Treatment of Neuropathic Pain
Andrew will start by introducing the 2026 IASP Global Year before giving a general overview of neuropathic pain. He will then emphasise the critical importance of employing rigorous diagnostic approaches and advocate for the IASP Neuropathic Pain Special Interest Group (NeuPSIG) diagnostic algorithm (1, 2).
This will be followed by a description of the 2025 NeuPSIG systemic review and meta-analysis of 313 randomised controlled trials (RCTs) trials (284 pharmacological and 29 neuromodulation) (3) which represents an almost doubling of the number of RCTs since the previous iteration in 2015. Despite this substantial increase in the number of RCTs, there is little change in the “headline” recommendations.
He will then present a critical reflection on these data, their relevance for people living with neuropathic pain and the clinicians advising them. He will highlight, for example, an almost complete lack of translation from the massive investments in basic science studies, the poor efficacy of even the pharmacological interventions designated as “first line” and the limitations in quality/trustworthiness of evidence. He will point out the lack of placebo-controlled evidence exploring neuromodulation and needle based physical interventions which are advocated in some quarters. He will explore the consequences of a historical over overemphasis of pharmacological interventions which focus more on the “bio” rather the “psycho” and “social” aspects of neuropathic pain and hence the paucity of availability of non-pharmacological approaches such as self-management and cognitive approaches.
Andrew will wrap up by exploring two themes of the IASP 2026 Global Year:
IASP 2026 Global Year https://www.iasp-pain.org/advocacy/global-year/neuropathic-pain-2026/
ENTRUST-PE https://entrust-pe.org/
This will be followed by a description of the 2025 NeuPSIG systemic review and meta-analysis of 313 randomised controlled trials (RCTs) trials (284 pharmacological and 29 neuromodulation) (3) which represents an almost doubling of the number of RCTs since the previous iteration in 2015. Despite this substantial increase in the number of RCTs, there is little change in the “headline” recommendations.
He will then present a critical reflection on these data, their relevance for people living with neuropathic pain and the clinicians advising them. He will highlight, for example, an almost complete lack of translation from the massive investments in basic science studies, the poor efficacy of even the pharmacological interventions designated as “first line” and the limitations in quality/trustworthiness of evidence. He will point out the lack of placebo-controlled evidence exploring neuromodulation and needle based physical interventions which are advocated in some quarters. He will explore the consequences of a historical over overemphasis of pharmacological interventions which focus more on the “bio” rather the “psycho” and “social” aspects of neuropathic pain and hence the paucity of availability of non-pharmacological approaches such as self-management and cognitive approaches.
Andrew will wrap up by exploring two themes of the IASP 2026 Global Year:
- The need for rigorous, trustworthy and impactful research methods for neuropathic pain and in particular opportunities offered by the ENTRUST-PE framework.
- The hypothesis of “precision medicine” approaches to neuropathic pain management for improving treatment options at the individual level. He will discuss the “deep phenotyping” approaches used to document the holistic impact of neuropathic pain and determine areas of heterogeneity which might be appropriate for clinical stratification. He will illustrate using early studies which used sensory profiling as a predictive efficacy biomarker and discuss what research designs might be used to test this hypothesis at scale.
IASP 2026 Global Year https://www.iasp-pain.org/advocacy/global-year/neuropathic-pain-2026/
ENTRUST-PE https://entrust-pe.org/
- N. B. Finnerup et al., Neuropathic pain: an updated grading system for research and clinical practice. Pain 157, 1599-1606 (2016).
- A. Truini et al., Joint European Academy of Neurology-European Pain Federation-Neuropathic Pain Special Interest Group of the International Association for the Study of Pain guidelines on neuropathic pain assessment. Eur J Neurol 30, 2177-2196 (2023).
- N. Soliman et al., Pharmacotherapy and non-invasive neuromodulation for neuropathic pain: a systematic review and meta-analysis. Lancet Neurol 24, 413-428 (2025).
Challenging the Perception of Cannabinoid Safety
Andrew will draw on, and update, the outputs of the International Association for the Study of Pain (IASP) Taskforce on Cannabis and Cannabinoid Analgesia. This collective body of work represents the most rigorous, detailed and unbiased appraisal of the preclinical and clinical evidence relating to the hypothesis of cannabinoid analgesia published to date. It led IASP to conclude that it “does not currently endorse general use of cannabis and cannabinoids for pain relief”.
He will briefly present and update the data from Randomised Controlled Trials (RCTs) which in general demonstrate a lack of efficacy for medicinal cannabis and cannabinoids as analgesics.
Turning to the question of harms and recognising the limitations of RCTs in elucidating harms, the main discussion will be around epidemiological data with a particular focus on risks of psychosis and cannabis use disorder.
Finally, IASP’s concerns about the bypassing of well-established regulatory processes for assessment of the efficacy, safety, manufacturing and marketing of medicines and the influences on political decision making will be highlighted.
The IASP Position Statement on cannabinoids and analgesia and the associated collection of publications can be accessed at: https://journals.lww.com/pain/pages/collectiondetails.aspx?TopicalCollectionId=23
He will briefly present and update the data from Randomised Controlled Trials (RCTs) which in general demonstrate a lack of efficacy for medicinal cannabis and cannabinoids as analgesics.
Turning to the question of harms and recognising the limitations of RCTs in elucidating harms, the main discussion will be around epidemiological data with a particular focus on risks of psychosis and cannabis use disorder.
Finally, IASP’s concerns about the bypassing of well-established regulatory processes for assessment of the efficacy, safety, manufacturing and marketing of medicines and the influences on political decision making will be highlighted.
The IASP Position Statement on cannabinoids and analgesia and the associated collection of publications can be accessed at: https://journals.lww.com/pain/pages/collectiondetails.aspx?TopicalCollectionId=23
