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Indexed/Abstracted in: CINAHL, Current Contents/Clinical Medicine, EMBASE, PubMed/MEDLINE, Science Citation Index Expanded (SciSearch), Scopus
Impact Factor 2,063
Online ISSN 1973-9095
Michelangelo BARTOLO 1, Adriano CHIÒ 2, Sergio FERRARI 3, Cristina TASSORELLI 4, 5, Stefano TAMBURIN 3, Micol AVENALI 4, 5, Eva AZICNUDA 6, Andrea CALVO 2, Augusto T. CARACENI 7, Giovanni DEFAZIO 8, Roberto DE ICCO 4, 5, Rita FORMISANO 6, Simone FRANZONI 9, Elena GRECO 3, Iwona JEDRYCHOWSKA 10, Francesca MAGRINELLI 3, Umberto MANERA 2, Enrico MARCHIONI 11, Sara MARIOTTO 3, Salvatore MONACO 3, Andrea PACE 12, Donatella SAVIOLA 13, Isabella SPRINGHETTI 10, Michele TINAZZI 3, Antonio DE TANTI 13, on behalf of the Italian Consensus Conference on Pain in Neurorehabilitation (ICCPN)
1 Department of Rehabilitation, Neurorehabilitation Unit, HABILITA, Zingonia di Ciserano, Bergamo, Italy; 2 ALS Center, "Rita Levi Montalcini" Department of Neuroscience, University of Turin, Italy; 3 Department of Neurosciences, Biomedicine and Movement Sciences, Section of Neurology, University of Verona, Italy; 4 Neurorehabilitation Unit, C. Mondino National Neurological Institute, Pavia, Italy; 5 Department of Brain and Behavioral Sciences, University of Pavia, Italy; 6 Post-Coma Unit, Santa Lucia Foundation IRCCS, Roma, Italy; 7 Palliative Care, Pain Therapy and Rehabilitation Unit, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy; 8 Department of Basic Medical Sciences, Neuroscience and Sensory Organs, University of Bari, Bari, Italy; 9 Department of Geriatrics, Poliambulanza Foundation, Brescia, Italy; 10 Oncological Rehabilitation Unit, Functional Recovery Unit, IRCCS S. Maugeri Foundation, Pavia, Italy; 11 Neurooncology Unit, C. Mondino National Neurological Institute, Pavia, Italy; 12 Neurooncology Unit, IRCCS Regina Elena Institute, Rome, Italy; 13 Cardinal Ferrari Rehabilitation Centre, Parma, Italy
BACKGROUND: Pain is an important non-motor symptom in several neurological diseases, such as Parkinson’s disease, cervical dystonia, amyotrophic lateral sclerosis, severe acquired brain injury, disorders of consciousness and dementia, as well as in oncology and neuroinfectivology.
AIMS: To overcome the lack of evidence-based data on pain management in these diseases, the Italian Consensus Conference on Pain in Neurorehabilitation (ICCPN) defined criteria for good clinical practice among Italian neurorehabilitation professionals. Here we review the literature (PubMed, Embase and gray literature) on pain characteristics, treatment and impact of pain in a neurorehabilitation setting.
RESULTS: Despite the heterogeneity of data, we reached a consensus on pain management for patients with these diseases. This approach springs from an analysis of the available data on pain characteristics in each disease, the evolution of pain in relation to the natural course of the disease and the impact of pain on the overall process of rehabilitation.
CONCLUSIONS: There was unanimous consensus regarding the utility of a multiprofessional approach to pain therapy, combining the benefits of pharmacological therapy with the techniques of physiotherapy and neurorehabilitation for all the conditions we considered. While some treatments could be different in relation to the pathology, we advise a progressive approach to pharmacological treatment of pain, starting with non-opioid analgesics (paracetamol) and nonsteroidal anti-inflammatory drugs as first line, and opioid analgesics as second line treatment. In cases of pain secondary to spasticity, botulinum neurotoxin, and, in some cases, intrathecal baclofen infusion should be considered. Randomized controlled trials and prospective multicentric studies aimed at documenting the efficacy of pain treatment and their risk-benefit profile are recommended for these conditions.