Diabetes and Obesity as Independent Risk Factors for Osteoporosis: Updated Results from the ROIS/EMEROS Registry in a Population of Five Thousand Post-Menopausal Women Living in a Region Characterized by Heavy Environmental Pressure

EMEROS/ROIS Registry is a project funded by ISBEM and supported by Medicina Futura Research

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

Mental practice is effective in upper limb recovery after stroke: a randomized single-blind cross-over study.

Abstract Aim: To investigate the role of Mental Practice (MP) in functional recovery of upper limbs in stroke patients. Methods: 36 hemiparetic stroke patients (15 women and 21 men) were enrolled in a randomized single blind cross-over study. Patients were randomly divided into two groups, (A and B) each comprising 18 patients. Patients in group A underwent the conventional neuro-rehabilitation protocol (therapeutic exercise and occupational therapy) for three weeks (3 hours a day, 5 days a week) and in the following 3 weeks, they received an additional 60 minutes of Mental Practice training. Patients in group B, instead, underwent, in the first 3 weeks, the rehabilitation program plus Mental Practice training and in the following 3 weeks, only the conventional neurorehabilitation program. All patients were evaluated at baseline (T0), at 3 weeks (T1) and at 6 weeks (T2) with the Motricity Index (MI) and the Arm Functional Test (AFT). Results: At baseline (T0) there were no significant differences at MI and AFT between the two groups. At T1 the differences between the two groups became significant. At T2 the difference was once again minimal. Conclusion: Our results suggest that Mental Practice could be used to complement to the conventional neurorehabilitative treatments usually prescribed for post-stroke neuromotor recovery. However, there is still much to be tested and discussed regarding the role that Mental Practice might play in the treatment of neurological patients

Prevention of falls and role of calcium and vitamin D

Falls in the elderly are very common and represent a serious cause of morbidity, severe disability and death. Impairments of the mechanisms of postural stability with age and the presence of acute and chronic diseases may favour the occurrence of falls in the elderly. Together with the adoption of non-pharmacological measures, supplementation of calcium and vitamin D demonstrated to reduce hip fracture risk, particularly in institutionalized people. (Aging Clin Exp Res 2011; 23 (Suppl. to No. 2): 20-21) (C) 2011, Editrice Kurti