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European Journal of Physical and Rehabilitation Medicine 2016 December;52(6):855-66


lingua: Inglese

Diagnosis and treatment of pain in plexopathy, radiculopathy, peripheral neuropathy and phantom limb pain. Evidence and recommendations from the Italian Consensus Conference on Pain on Neurorehabilitation

Francesco FERRARO 1, Marco JACOPETTI 2, Vincenza SPALLONE 3, Luca PADUA 4, 5, Marco TRABALLESI 6, Stefano BRUNELLI 6, Cristina CANTARELLA 7, Cristina CIOTTI 7, Daniele CORACI 8, Elena DALLA TOFFOLA 9, 10, Silvia MANDRINI 9, Giovanni MORONE 6, Costanza PAZZAGLIA 5, Marcello ROMANO 11, Angelo SCHENONE 12, Rossella TOGNI 9, Stefano TAMBURIN 13

1 Section of Neuromotor Rehabilitation, Department of Neuroscience, ASST Carlo Poma, Mantova, Italy; 2 University of Parma, Parma, Italy; 3 Department of Systems Medicine, University of Tor Vergata, Rome, Italy; 4 Department of Geriatrics, Neurosciences and Orthopaedics, Catholic University, Rome, Italy; 5 Don Carlo Gnocchi Foundation, Milan, Italy; 6 IRCCS Santa Lucia Foundation, Rome, Italy; 7 Physical and Rehabilitation Medicine Unit, University of Tor Vergata, Rome, Italy; 8 Department of Orthopedics, Sapienza University, Rome, Italy; 9 Department of Clinical, Surgical, Diagnostic and Pediatric Sciences, University of Pavia, Pavia, Italy; 10 Physical Medicine and Rehabilitation Unit, IRCCS Policlinico San Matteo Foundation, Pavia, Italy; 11 Neurology Unit, Villa Sofia Cervello Hospitals, Palermo, Italy; 12 Department of Neuroscience, Rehabilitation, Ophthalmology, Genetics, and Maternal and Child Health, DiNOGMI, University of Genoa, Genoa, Italy; 13 Department of Neurosciences, Biomedicine and Movement Sciences, University of Verona, Verona, Italy


Pain may affect all aspects of social life and reduce the quality of life. Neuropathic pain (NP) is common in patients affected by plexopathy, radiculopathy, mononeuropathy, peripheral neuropathy. Phantom limb pain (PLP) is a painful sensation that is common after amputation, and its pathophysiological mechanisms involve changes in the peripheral and central nervous system. Given the lack of conclusive evidence and specific guidelines on these topics, the aim of the Italian Consensus Conference on Pain on Neurorehabilitation (ICCPN) was to collect evidence and offer recommendations to answer currently open questions on the assessment and treatment of NP associated with the above conditions and PLP. When no evidence was available, recommendations were based on consensus between expert opinions. Current guidelines on the assessment and pharmacological treatment of NP can be applied to plexopathy, radiculopathy, mononeuropathy, peripheral neuropathy, while evidence for invasive treatments and physical therapy is generally poor because of the low quality of studies. Treatment of PLP is still unsatisfactory. Data on the functional outcome and impact of pain on neurorehabilitation outcome in these conditions are lacking. In most cases, a multidisciplinary approach is recommended to offer a better outcome and reduce side effects. High quality studies are requested to address the unmet needs in this field.

KEY WORDS: Pain - Brachial plexus neuropathies - Radiculopathy - Mononeuropathies - Peripheral nervous system diseases - Phantom limb

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