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, Adriano Chiò, Sergio Ferrari, Cristina Tassorelli, Stefano Tamburin, Micol Avenali, Eva Azicnuda, Andrea Calvo, Augusto T Caraceni, Giovanni Defazio, Roberto De Icco, Rita Formisano, Simone Franzoni, Elena Greco, Iwona Jedrychowska, Francesca Magrinelli, Umberto Manera, Enrico Marchioni, Sara Mariotto, Salvatore MonacoAndrea Pace, Donatella Saviola, Isabella Springhetti, Michele Tinazzi, Antonio De Tanti, Italian Consensus Conference on Pain in Neurorehabilitation (ICCPN)

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Abstract

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.

Original languageEnglish
Pages (from-to)841-854
Number of pages14
JournalEuropean Journal of Physical and Rehabilitation Medicine
Volume52
Issue number6
Publication statusPublished - Dec 2016

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Bartolo, M., Chiò, A., Ferrari, S., Tassorelli, C., Tamburin, S., Avenali, M., Azicnuda, E., Calvo, A., Caraceni, A. T., Defazio, G., De Icco, R., Formisano, R., Franzoni, S., Greco, E., Jedrychowska, I., Magrinelli, F., Manera, U., Marchioni, E., Mariotto, S., ... Italian Consensus Conference on Pain in Neurorehabilitation (ICCPN) (2016). 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. European Journal of Physical and Rehabilitation Medicine, 52(6), 841-854.