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\u2014Behavioral 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\u2014Stroke 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 paper

Time for a consensus conference on pain in neurorehabilitation

Time for a Consensus Conference on pain in neurorehabilitation

Time for a consensus conference on pain in neurorehabilitation

O uso do enxerto autólogo de gordura ou lipoenxertia (termo em inglês - “lipofilling”) na reconstrução imediata da cirurgia conservadora de mama vem sendo aplicada a fim de atingir resultado estético satisfatório na primeira cirurgia para o câncer de mama em pacientes com relação tumor/mama desfavorável ou em localização de difícil reparo. A segurança oncológica da técnica ainda é discutida devido ao pouco número de pacientes em seguimento. Objetivo: determinar se há diferença nas taxas de recidiva local e sobrevida livre de doença em relação à realização ou não de lipoenxertia imediata na cirurgia conservadora. Metodologia: Foram selecionados retrospectivamente os pacientes submetidos à cirurgia conservadora com ou sem lipoenxertia entre 2004 e 2016. Os grupos foram pareados por idade, estadiamento, grau e perfil imuno-histoquímico do tumor. Os pacientes foram acompanhados por uma média de 60 meses e as taxas de recorrência e sobrevida livre de doença foram avaliadas. Resultados: 320 pacientes acompanhadas, casos pareados com controles na proporção de 1:4. Não foram observadas diferenças significativas na recorrência loco-regional (LRR) das pacientes que foram submetidas à lipoenxertia simultaneamente à cirurgia conservadora em comparação com os controles, LRR 0,86% ao ano x 0,70% ao ano, p => 0,05, respectivamente. Não houve diferenças na sobrevida livre de doença entre os grupos. Conclusão: Após 60 meses de seguimento, não houve diferença significativa nas taxas de recorrência loco-regional entre o grupo de lipoenxertia imediata e o grupo controle. Esses achados sugerem a segurança oncológica da reconstrução imediata com a lipoenxertia, propondo a técnica como eficaz, segura e com ótimo resultado estético para o câncer de mama.Importance: Autologous fat grafting (AFG), or lipofilling, has been used for immediate reconstruction at the time of breast-conserving surgery in order to achieve a satisfactory cosmetic outcome in patients with breast cancer and an unfavorable tumor-to-breast volume ratio or unfavorable tumor location. However, the oncologic safety of this technique is still unclear. Objective: To determine whether AFG performed simultaneously with breast-conserving surgery is associated with differences in local relapse rates and disease-free survival. Design: Matched retrospective cohort study. Setting: Tertiary referral center. Participants: Patients undergoing breast-conserving surgery with or without AFG between 2004 and 2016 were retrospectively enrolled and matched for age, staging, grade, tumor histology, and tumor immunohistochemical profile. Main Outcome(s) And Measure(s): The cumulative incidence of locoregional recurrence (LRR) and disease-free survival were the primary end points, while distant recurrence and overall survival were the secondary end points. Results: A total of 320 patients were followed. Cases were matched with controls at a 1:4 ratio. There was no difference in LRR or distant recurrence of breast cancer between the two groups. The annual LRR rate was 0.86% in patients who received immediate AFG vs. 0.7% in patients undergoing breast-conserving surgery alone (P≥0.05). Number of lymph nodes was the sole independent risk factor for local recurrence (p=0.045). No significant differences in disease-free survival rates were found between the groups. Conclusions and Relevance: At a mean follow-up of 5 years, no significant differences in locoregional recurrence rates were found between patients who received immediate AFG and those who underwent breast-conserving surgery alone. These findings corroborate previous research demonstrating the oncological safety of immediate AFG reconstruction, further suggesting that this technique as a safe, effective way to achieve optimal cosmetic outcomes in primary breast cancer surgery without jeopardizing oncologic outcomes

Time for a Consensus Conference on pain in neurorehabilitation.

Pain represents a common problem in the setting of neurorehabilitation, in that it is a common outcome measure but may also have a negative effect on motor and cognitive outcomes. Guidelines, expert opinions or consensus statements on pain in neurorehabilitation are largely lacking. The Italian Consensus Conference on Pain in Neurorehabilitation (ICCPN) was promoted to answer some questions on this topic, and its recommendations may offer practical and useful information and represent the basis for future studies on pain in neurorehabilitation