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

European Journal of Physical and Rehabilitation Medicine 2016 December;52(6):841-54

Copyright © 2016 EDIZIONI MINERVA MEDICA

lingua: Inglese

Assessing and treating pain in movement disorders, amyotrophic lateral sclerosis, severe acquired brain injury, disorders of consciousness, dementia, oncology and neuroinfectivology. Evidence and recommendations from the Italian Consensus Conference on Pain in Neurorehabilitation

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 ✉

¹ Neurorehabilitation Unit, Department of Rehabilitation, HABILITA, Zingonia di Ciserano, Bergamo, Italy; ² ALS Center, “Rita Levi Montalcini” Department of Neuroscience, University of Turin, Turin, Italy; ³ Section of Neurology, Department of Neurosciences, Biomedicine and Movement Sciences, University of Verona, Verona, Italy; ⁴ Neurorehabilitation Unit, “C. Mondino” National Neurological Institute, Pavia, Italy; ⁵ Department of Brain and Behavioral Sciences, University of Pavia, Pavia, Italy; ⁶ Post-Coma Unit, Santa Lucia Foundation and Scientific Institute for Care and Research, Rome, Italy; ⁷ Palliative Care, Pain Therapy and Rehabilitation Unit, Istituto Nazionale dei Tumori, Milan, Italy; ⁸ Department of Basic Medical Sciences, Neuroscience and Sense Organs, University of Bari, Bari, Italy; ⁹ Department of Geriatrics, “Poliambulanza” Foundation, Brescia, Italy; ¹⁰ Oncological Rehabilitation Unit, Functional Recovery Unit, “Salvatore Maugeri” Foundation and Scientific Institute for Care and Research, Pavia, Italy; ¹¹ Neurooncology Unit, “C. Mondino” National Neurological Institute, Pavia, Italy; ¹² Neurooncology Unit, “Regina Elena” Scientific Institute for Care and Research, Rome, Italy; ¹³ “Cardinal Ferrari” Rehabilitation Center, Parma, Italy

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. To overcome the lack of evidence-based data on pain management in these diseases, the Italian Consensus Conference on Pain in Neurorehabilitation (ICCPN) has defined criteria for good clinical practice among Italian neurorehabilitation professionals. Here a review of the literature (PubMed, EMBASE and gray literature) on pain characteristics, treatment and impact of pain in a neurorehabilitation setting is provided. Despite the heterogeneity of data, a consensus was reached on pain management for patients with these diseases: it is an approach originating 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. There was unanimous consensus regarding the utility of a multidisciplinary approach to pain therapy, combining the benefits of pharmacological therapy with the techniques of physiotherapy and neurorehabilitation for all the conditions considered. While some treatments could be different depending on pathology, a progressive approach to the pharmacological treatment of pain is advisable, starting with non-opioid analgesics (paracetamol) and nonsteroidal anti-inflammatory drugs as a first-line treatment, and opioid analgesics as a 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 multicenter studies aimed at documenting the efficacy of pain treatment and their risk-benefit profile are recommended for these conditions.

KEY WORDS: Movement disorders - Motor neuron disease - Brain injuries - Dementia - Medical oncology - Infectious disease medicine