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SPECIAL ARTICLE  THE ITALIAN CONSENSUS CONFERENCE ON PAIN IN NEUROREHABILITATION - PART II Freefree

European Journal of Physical and Rehabilitation Medicine 2016 December;52(6):827-40

Copyright © 2016 EDIZIONI MINERVA MEDICA

language: English

Assessing and treating pain associated with stroke, multiple sclerosis, cerebral palsy, spinal cord injury and spasticity. Evidence and recommendations from the Italian Consensus Conference on Pain in Neurorehabilitation

Stefano PAOLUCCI 1, Andrea MARTINUZZI 2, Giorgio SCIVOLETTO 1, Nicola SMANIA 3, 4, Claudio SOLARO 5, Irene APRILE 6, Michela ARMANDO 7, Roberto BERGAMASCHI 8, Eliana BERRA 8, Giulia BERTO 3, 4, Elena CARRARO 2, Monica CELLA 5, Marialuisa GANDOLFI 3, 4, Marcella MASCIULLO 1, Marco MOLINARI 1, Emanuela PAGLIANO 9, Cristiano PECCHIOLI 6, Laura RONCARI 3, 4, Monica TORRE 1, Erika TRABUCCO 5, 10, Gabriella VALLIES 3, 4, Paolo ZERBINATI 11, Stefano TAMBURIN 3

1 IRCCS Santa Lucia Foundation, Rome, Italy; 2 IRCCS E. Medea Scientific Institute, Conegliano, Treviso, Italy; 3 Department of Neurosciences, Biomedicine and Movement Sciences, University of Verona, Verona, Italy; 4 Neuromotor and Cognitive Rehabilitation Research Centre, University of Verona, Verona, Italy; 5 Neurology Unit, Head and Neck Department, ASL 3 Genovese, Genoa, Italy; 6 Don Gnocchi Foundation, Milan, Italy; 7 Department of Neuroscience and Neurorehabilitation, IRCCS Bambino Gesù Children’s Hospital, Rome, Italy; 8 C. Mondino National Neurological Institute, Pavia, Italy; 9 Developmental Neurology Unit, C. Besta Neurological Institute Foundation, Milan, Italy; 10 Department of Experimental Medicine, Section of Diagnostic Radiology, University of Genoa, Genoa, Italy; 11 Hand Surgery Department, Santa Maria Hospital, Multimedica, Castellanza, Varese, Italy


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Pain is a common and disabling symptom in patients with stroke, multiple sclerosis (MS), cerebral palsy (CP), spinal cord injury (SCI) and other conditions associated with spasticity, but data on its prevalence, and natural history, as well as guidelines on its assessment and treatment in the field of neurorehabilitation, are largely lacking. The Italian Consensus Conference on Pain in Neurorehabilitation (ICCPN) searched and evaluated current evidence on the frequency, evolution, predictors, assessment, and pharmacological and non-pharmacological treatment of pain in patients with stroke, MS, CP, SCI and other conditions associated with spasticity. Patients with stroke, MS, CP, and SCI may suffer from pain related to spasticity, as well as nociceptive and neuropathic pain (NP), whose prevalence, natural history, impact on functional outcome, and predictors are only partially known. Diagnosis and assessment of the different types of pain in these patients is important, because their treatment may differ. Botulinum neurotoxin is the first choice treatment for spasticity, while some antidepressant and antiepileptic drugs may be effective on NP, but pharmacological treatment varies according to the underlying disease. In most cases, a single therapy is not sufficient to treat pain, and a multidisciplinary approach, which include pharmacological and non-pharmacological treatments is needed. Further studies, and in particular randomized controlled trials, are needed on these topics.


KEY WORDS: Pain - Rehabilitation - Muscle spasticity - Stroke - Cerebral palsy - Multiple sclerosis

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