O001. The Italian Consensus Conference "Chronic Pain in Neurorehabilitation" - Group 29: headache and facial pain

esposizione di proposta metodologic

Psychological treatments and psychotherapies in the neurorehabilitation of pain. Evidences and recommendations from the italian consensus conference on pain in neurorehabilitation

BACKGROUND: It is increasingly recognized that treating pain is crucial for effective care within neurological rehabilitation in the setting of the neurological rehabilitation. The Italian Consensus Conference on Pain in Neurorehabilitation was constituted with the purpose identifying best practices for us in this context. Along with drug therapies and physical interventions, psychological treatments have been proven to be some of the most valuable tools that can be used within a multidisciplinary approach for fostering a reduction in pain intensity. However, there is a need to elucidate what forms of psychotherapy could be effectively matched with the specific pathologies that are typically addressed by neurorehabilitation teams. OBJECTIVES: To extensively assess the available evidence which supports the use of psychological therapies for pain reduction in neurological diseases. METHODS: A systematic review of the studies evaluating the effect of psychotherapies on pain intensity in neurological disorders was performed through an electronic search using PUBMED, EMBASE, and the Cochrane Database of Systematic Reviews. Based on the level of evidence of the included studies, recommendations were outlined separately for the different conditions. RESULTS: The literature search yielded 2352 results and the final database included 400 articles. The overall strength of the recommendations was medium/low. The different forms of psychological interventions, including Cognitive-Behavioral Therapy, cognitive or behavioral techniques, Mindfulness, hypnosis, Acceptance and Commitment Therapy (ACT), Brief Interpersonal Therapy, virtual reality interventions, various forms of biofeedback and mirror therapy were found to be effective for pain reduction in pathologies such as musculoskeletal pain, fibromyalgia, Complex Regional Pain Syndrome, Central Post-Stroke pain, Phantom Limb Pain, pain secondary to Spinal Cord Injury, multiple sclerosis and other debilitating syndromes, diabetic neuropathy, Medically Unexplained Symptoms, migraine and headache. CONCLUSIONS: Psychological interventions and psychotherapies are safe and effective treatments that can be used within an integrated approach for patients undergoing neurological rehabilitation for pain. The different interventions can be specifically selected depending on the disease being treated. A table of evidence and recommendations from the Italian Consensus Conference on Pain in Neurorehabilitation is also provided in the final part of the pape

What is the role of the placebo effect for pain relief in neurorehabilitation? Clinical implications from the Italian consensus conference on pain in neurorehabilitation

Background: It is increasingly acknowledged that the outcomes of medical treatments are influenced by the context of the clinical encounter through the mechanisms of the placebo effect. The phenomenon of placebo analgesia might be exploited to maximize the efficacy of neurorehabilitation treatments. Since its intensity varies across neurological disorders, the Italian Consensus Conference on Pain in Neurorehabilitation (ICCP) summarized the studies on this field to provide guidance on its use. Methods: A review of the existing reviews and meta-analyses was performed to assess the magnitude of the placebo effect in disorders that may undergo neurorehabilitation treatment. The search was performed on Pubmed using placebo, pain, and the names of neurological disorders as keywords. Methodological quality was assessed using a pre-existing checklist. Data about the magnitude of the placebo effect were extracted from the included reviews and were commented in a narrative form. Results: 11 articles were included in this review. Placebo treatments showed weak effects in central neuropathic pain (pain reduction from 0.44 to 0.66 on a 0-10 scale) and moderate effects in postherpetic neuralgia (1.16), in diabetic peripheral neuropathy (1.45), and in pain associated to HIV (1.82). Moderate effects were also found on pain due to fibromyalgia and migraine; only weak short-term effects were found in complex regional pain syndrome. Confounding variables might have influenced these results. Clinical implications: These estimates should be interpreted with caution, but underscore that the placebo effect can be exploited in neurorehabilitation programs. It is not necessary to conceal its use from the patient. Knowledge of placebo mechanisms can be used to shape the doctor-patient relationship, to reduce the use of analgesic drugs and to train the patient to become an active agent of the therapy

LATENT CYTOMEGALOVIRUS AND TOXOPLASMA INFECTIONS IN PATIENTS WITH RHEUMATIC INFLAMMATORY DISEASES TREATED WITH BIOLOGICAL AGENTS. PRELIMINARY RESULTS.

25° European Congress of Clinical Microbiology and Infectious Disease

L’interessamento del sistema nervoso periferico nelle connettiviti sistemiche

Rassegna sulle complicanze neurologiche a carico del sistema nervoso periferico in corso di connettiviti sistemich

PREDICTING THE RESPONSE TO 5\% LIDOCAINE MEDICATED PLASTER IN TRIGEMINAL NEURALGIA AND TRIGEMINAL NEUROPATHIC PAIN: A CASE SERIES

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Elevato riscontro di DNA circolante di Leishmania infantum in soggetti immunocompetenti affetti da malattie reumatologiche e trattati con farmaci biotecnologici.

Introduzione. In Italia, casi di Leishmaniosi (L) si registrano più frequentemente al Sud, in zone rurali e peri-urbane. Recenti dati epidemiologici hanno dimostrato una diffusione del parassita e del vettore competente anche in alcune regioni Settentrionali, a causa dei recenti cambiamenti climatici con incremento della T°. In Emilia-Romagna, tra il 1999 e il 2011, sono stati diagnosticati 44 casi di L di cui 26 viscerale (Lv) e 18 cutanea (Lc). Nel 2013, l’incidenza è aumentata (30 casi Lv, 9 Lc). La provincia di Bologna è risultata la più interessata (20 casi), in particolare, Valle del Samoggia, Sasso Marconi, Monterenzio, Pianoro ed Imola. L’incremento potrebbe essere attribuito anche all’impiego di farmaci immunosoppressivi (chemioterapici, cortisonici, farmaci biotecnologici [FB]) per il trattamento di malattie autoimmuni, neoplasie e trapianti, arricchendo quindi la categoria dei soggetti potenzialmente vulnerabili nei confronti di questa parassitosi. Obiettivo dello studio è stato quello di attestare la prevalenza (DNA circolante) dell’infezione da L. infantum (Li) in pazienti immunocompetenti affetti da reumatismi infiammatori cronici in trattamento immunosoppressivo con FB, correlando l’eventuale positività genomica alla zona di residenza. Materiali e Metodi. Sono stati retrospettivamente analizzati PBMC di pazienti affetti da artrite reumatoide, spondilite anchilosante ed artrite psoriasica, in trattamento con FB da almeno 5 anni (2009-2014). Ciascun campione è stato sottoposto a PCR per Li presso la Sezione Malattie Infettive dell’Università di Ferrara. L’analisi statistica è stata condotta mediante Test del Chi Quadro corretto secondo Yates. Risultati. Dei 55 campioni analizzati, 38 erano donne (69%) e 17 uomini (30%) con età media di 53.2 (range 29-78 anni). In 21/55 (38%) si riscontrava DNA circolante di Li; di essi 14 (66%) erano donne e 7 (33%) uomini. 15 pazienti (71%) risiedevano in zone rurali, mentre 6 (28%) in aree urbane, contro i 34 pazienti risultati negativi per Li DNA, di cui solo 9 risiedevano in aree rurali (26%) e 25 in aree urbane (73%) (p≤0.0028). Le province con più elevata incidenza sono risultate quelle di Ravenna (9 casi), Imola (7 casi) e Rovigo (3 casi), mentre solo 2 pazienti erano residenti a Ferrara, entrambi in zone rurali. Conclusioni. Riattivazioni di infezioni da L sono state sporadicamente descritte in pazienti con malattie reumatiche sottoposti a trattamento con FB anche se dati definitivi sulla loro reale incidenza non sono disponibili. Lo screening di routine non contempla attualmente, la ricerca preliminare di infezioni subcliniche da patogeni opportunisti e da L spesso difficilmente identificabili. In assenza di dati epidemiologici omogenei e di indicazioni sulla gestione di tali infezioni in pazienti esposti ad FB ed esenti da deficit immunitari, potrebbe rivelarsi opportuna una sorveglianza capillare ed accurato screening, soprattutto in aree rurali ad elevata prevalenza di DNA

Full-Dose Intraoperative Electron Radiotherapy for Early Breast Cancer: Evidence from a Single Center’s Experience

To evaluate the clinical response rate and cosmetic outcome after full-dose intraoperative electron radiotherapy (IOERT) in early breast cancer (BC) treated with conserving surgery. Inclusion criteria were: >60 years old, clinical tumor size ≤2 cm, luminal A carcinoma, patological negative lymph nodes, excluded lobular carcinoma histology. IOERT was delivered with a dose of 21 Gy at 90% isodose. Clinical, cosmetic and/or instrumental follow-up were performed 45 days after IOERT, 6 months after the first check, and every 12 months thereafter. Acute and late toxicities were assessed with the CTCAE v.4.03 and EORTC-RTOG scales, respectively. Cosmetic outcome was evaluated using the Harvard/NSABO/RTOG Breast Cosmesis Grading Scale. Overall, 162 consecutive patients were included in this analysis (median follow-up: 54 months, range: 1–98 months). The overall response rate was 97.5% (CI 95%: 0.93–0.99%). Locoragional relapse occurred in 2.5% of patients. No patient showed distant metastases. No patient showed radiation-related acute complications, with 3.7% showing late G2–3 toxicity. Only 3.7% of patients showed poor cosmetic results. Our data confirmed that IOERT is a feasible and valid therapeutic option in low-risk BC patients treated with lumpectomy. A low local recurrence rate combined with good cosmetic results validates the settings of our operative method in routinely clinical practice