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EUROPEAN JOURNAL OF PHYSICAL AND REHABILITATION MEDICINE

Rivista di Medicina Fisica e Riabilitativa dopo Eventi Patologici


Official Journal of the Italian Society of Physical and Rehabilitation Medicine (SIMFER), European Society of Physical and Rehabilitation Medicine (ESPRM), European Union of Medical Specialists - Physical and Rehabilitation Medicine Section (UEMS-PRM), Mediterranean Forum of Physical and Rehabilitation Medicine (MFPRM), Hellenic Society of Physical and Rehabilitation Medicine (EEFIAP)
In association with International Society of Physical and Rehabilitation Medicine (ISPRM)
Indexed/Abstracted in: CINAHL, Current Contents/Clinical Medicine, EMBASE, PubMed/MEDLINE, Science Citation Index Expanded (SciSearch), Scopus
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REVIEWS  MUSCULOSKELETAL DISORDERS MANAGEMENT AND THE ROLE OF PHYSICAL AND REHABILITATION MEDICINE PHYSICIANS. THE EUROPEAN PERSPECTIVE BASED ON THE BEST EVIDENCE


European Journal of Physical and Rehabilitation Medicine2013 Agosto;49(4):535-49

lingua: Inglese

Generalised and regional soft tissue pain syndromes. The role of Physical and Rehabilitation Medicine Physicians. The European perspective based on the best evidence. A paper by the UEMS-PRM Section Professional Practice Committee

Oral A. 1, Ilieva E. M. 2, Küçükdeveci A. A. 3, Varela E. 4, Valero R. 5, Berteanu M. 6, Christodoulou N. 7

1 Member, Board Committee, UEMS Board of PRM, Department of Physical Medicine and Rehabilitation, Istanbul Faculty of Medicine, Istanbul University, Istanbul, Turkey;
2 Member, Professional Practice Committee, UEMS Section of PRM, Department of Physical and Rehabilitation Medicine, Medical Faculty, Medical University of Plovdiv Plovdiv, Bulgaria;
3 Member, Professional Practice Committee, UEMS Section of PRM, Department of Physical Medicine and Rehabilitation, Faculty of Medicine, Ankara University, Ankara, Turkey;
4 Member, Professional Practice Committee, UEMS Section of PRM, Departamento de Medicina Física y Rehabilitación, Facultad de Medicina UCM, Ciudad Universitaria, Madrid, Spain;
5 Member, Board Committee, UEMS Board of PRM, Departamento de Medicina Física y Rehabilitacion, Facultad de Medicina UCM, Ciudad Universitaria, Madrid, Spain;
6 Chairman, Professional Practice Committee, UEMS Section of PRM, Department of Physical and Rehabilitation Medicine, University Hospital Elias, Bucharest, Romania;
7 President, UEMS Section of PRM, Department of Health Sciences, School of Sciences, European University Cyprus, Nicosia, Cyprus


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One of the objectives of the Professional Practice Committee (PPC) of the Physical and Rehabilitation Medicine (PRM) Section of the Union of European Medical Specialists (UEMS) is the development of the field of competence of PRM physicians in Europe. To achieve this objective, UEMS PRM Section PPC has adopted a systematic action plan of preparing a series of papers describing the role of PRM physicians in a number of disabling health conditions, based on the evidence of effectiveness of PRM interventions. Generalised and regional soft tissue pain syndromes constitute a major problem leading to loss of function and disability, resulting in enormous societal burden. The aim of this paper is to describe the unique role of PRM physicians in the management of these disabling conditions that require not only pharmacological interventions but also a holistic approach including the consideration of body functions, activities and participation as well as contextual factors as described in the ICF. Evidence-based effective PRM interventions include exercise and multicomponent treatment including a psychotherapeutic intervention such as cognitive behavioural therapy (CBT) in addition to exercise, the latter based on strong evidence for reducing pain and improving quality of life in fibromyalgia syndrome (FMS). Balneotherapy, meditative movement therapies, and acupuncture have also been shown as efficacious in improving symptoms in FMS. Emerging evidence suggests the use of transcranial magnetic or direct current stimulation (rTMS or tDCS) in FMS patients with intractable pain not alleviated by other interventions. Graded exercise therapy and CBT are evidence-based options for chronic fatigue syndrome. The use of some physical modalities and manipulation for myofascial pain syndrome is also supported by evidence. As for complex regional pain syndrome (CRPS), strong evidence exists for rTMS and graded motor imagery as well as moderate evidence for mirror therapy. Interventional techniques such as blocks and spinal cord stimulation may also be considered for CRPS based on varying levels of evidence. PRM physicians’ functioning oriented approaches on the assessment and management, adopting the ICF as a reference, may well meet the needs of patients with soft tissue pain syndromes, the common problems for whom are loss of function and impaired quality of life. Available evidence for the effectiveness of PRM interventions serves as the basis for the explicit role of PRM specialists in the management of these health conditions.

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