Psychological considerations in the assessment and treatment of pain in neurorehabilitation and psychological factors predictive of therapeutic response: Evidence and recommendations from the Italian consensus conference on pain in neurorehabilitation

Gianluca Castelnuovo, Emanuele M. Giusti, Gian Mauro Manzoni, Donatella Saviola, Arianna Gatti, Samantha Gabrielli, Marco Lacerenza, Stefania Corti, Valentina Villa, Amelia Brunani, Paolo Capodaglio, Lorenzo Priano, Alessandro Mauro, Giuseppe Riva, Enrico Molinari, Stefano Paolucci, Giorgio Sandrini, Michela Agostini, Enrico Alfonsi, Elena AlvisiIrene Aprile, Michelangelo Bartolo, Roberto Bergamaschi, Eliana Berra, Stefano Brunelli, Maria Gabriella Buzzi, Augusto Caraceni, Elena Carraro, Roberto Casale, Ubaldo Del Carro, Rita Formisano, Barbara Gardella, Enrico Marchioni, Andrea Martinuzzi, Danilo Miotti, Marco Molinari, Giovanni Morone, Rossella Nappi, Stefano Negrini, Andrea Pace, Luca Padua, Emanuela Pagliano, Costanza Pazzaglia, Giorgio Scivoletto, Isabella Springhetti, Cristina Tassorelli, Marco Traballesi, Marco Tramontano, Andrea Turolla, Paolo Zerbinati, Italian Consensus Conference on Pain in Neurorehabilitation

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Background: In order to provide effective care to patients suffering from chronic pain secondary to neurological diseases, health professionals must appraise the role of the psychosocial factors in the genesis and maintenance of this condition whilst considering how emotions and cognitions influence the course of treatment. Furthermore, it is important not only to recognize the psychological reactions to pain that are common to the various conditions, but also to evaluate how these syndromes differ with regards to the psychological factors that may be involved. As an extensive evaluation of these factors is still lacking, the Italian Consensus Conference on Pain in Neurorehabilitation (ICCPN) aimed to collate the evidence available across these topics. Objectives: To determine the psychological factors which are associated with or predictive of pain secondary to neurological conditions and to assess the influence of these aspects on the outcome of neurorehabilitation. Methods: Two reviews were performed. In the first, a PUBMED search of the studies assessing the association between psychological factors and pain or the predictive value of these aspects with respect to chronic pain was conducted. The included papers were then rated with regards to their methodological quality and recommendations were made accordingly. In the second study, the same methodology was used to collect the available evidence on the predictive role of psychological factors on the therapeutic response to pain treatments in the setting of neurorehabilitation. Results: The first literature search identified 1170 results and the final database included 189 articles. Factors such as depression, anxiety, pain catastrophizing, coping strategies, and cognitive functions were found to be associated with pain across the various conditions. However, there are differences between chronic musculoskeletal pain, migraine, neuropathy, and conditions associated with complex disability with regards to the psychological aspects that are involved. The second PUBMED search yielded 252 studies, which were all evaluated. Anxiety, depression, pain catastrophizing, coping strategies, and pain beliefs were found to be associated to different degrees with the outcomes of multidisciplinary programs, surgery, physical therapies, and psychological interventions. Finally, sense of presence was found to be related to the effectiveness of virtual reality as a distraction tool. Conclusions: Several psychological factors are associated with pain secondary to neurological conditions and should be acknowledged and addressed in order to effectively treat this condition. These factors also predict the therapeutic response to the neurorehabilitative interventions.

Original languageEnglish
Article number00468
JournalFrontiers in Psychology
Issue numberAPR
Publication statusPublished - 2016



  • Chronic pain
  • Clinical psychology
  • Health psychology
  • Neurorehabilitation
  • Pain management

ASJC Scopus subject areas

  • Psychology(all)

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