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

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

Corrosion Behaviour of Cemented Carbides with Co- and Ni-Alloy Binders in the Presence of Abrasion

More and more often, cemented carbides are employed for the production of wear resistant components and have to face highly demanding service conditions that combine different damage mechanisms. A key example is the range of tetraphasic (sea water, sand, liquid and gaseous hydrocarbons) flows encountered in the Oil and Gas extraction industry. Notwithstanding the importance of operating regimes of this type, the availability of fundamental and quantitative information on the corrosion performance of cemented carbides in the presence of abrasion is still limited. In this paper, we report a systematic study of the corrosion behaviour of cemented tungsten carbide grades with binders containing different amounts of cobalt (Co), nickel (Ni), chromium (Cr) and noble metal additions, subjected to controlled mechanical abrasion, impacting the stability and nature of pseudopassivation films. In this work, special attention is devoted to Cr, a classical of additive that inhibits the Ostwald ripening of tungsten carbide (WC) particles and notably improves the corrosion resistance of grades with ultrafine-to-fine WC grain size and low-to-medium binder content. We assessed the impact of binder composition on the anodic behaviour by means of linear-sweep voltammetry and chronopotentiometry as well as on the mechanical properties. The application of controlled abrasion conditions under electrochemical control is carried out with an in-house modified ASTM B611 apparatus, equipped with a three-electrode system, enabling the systematic investigation of the synergy of electrochemical and mechanical damaging conditions. Increased corrosion resistance in environments without and with added chloride—both in the absence and in the presence of abrasion—was observed in all the Co- and Ni-based grades to which growing quantities of Cr were added. Moreover, doping with ruthenium (Ru) further enhances corrosion resistance. Regarding corrosion in the presence of abrasion, the addition of Cr and Ru increases the ability of regenerating the pseudopassivation film. The optimized compositions of the binder have been highlighted that open up attractive opportunities of improved service behaviour and deployment in new applications

In-Depth Understanding of Hardmetal Corrosion Performance Reveals a Path to the Electrochemical Demolition of Scrap

Recycling of hardmetal scrap is strategic for critical raw materials recovery. Available recycling processes are polluting and have a large carbon footprint. Attempts to exploit controlled corrosion failed in industrial practice, owing to self-limiting processes. We revisit the corrosion route, in view of gaining the fundamental knowledge enabling high-throughput recovery. We selected the worst-case approach of highly corrosion-resistant CoNiWC-based hardmetal grades and neutral aqueous electrolyte at room temperature. Systematic electrochemical measurements, UV–Vis spectroscopy and SEM microscopy disclosed that, even though there is no hope to overcome the self-limiting corrosion rate, nevertheless, by exploiting the mechanical action of anodic O2 evolution acting precisely at the interface between the residual active material and the corrosion film, the latter can be efficiently removed, periodically reactivating the hardmetal corrosion in a way that results in an ultra-high scrap destruction rate, of interest for real-life industrial processes

'Broken Pillars': The Counter-Monumental Texture of Ulysses

... Using an interdisciplinary theoretical-literary approach, this essay offers a fresh perspective on Joyce’s representations of monuments: what I refer to as Joyce against monuments. My aim is to explore the ways in which Joyce’s texts expand, qualify, and supplement the historical, cultural geographical, and theoretical material in relation to this counter-monumental dynamic. This essay is one example of this approach, though here I am limiting the study to only certain monuments, in particular Nelson’s Pillar, as it is represented in Ulysses In complementary ways this essay is both a revisioning of Henri Lefebvre’s thoughts on monuments through Ulysses and a reconsideration of monumental space in Ulysses along and against Lefebvre. Furthermore, it engages with a theoretical and critical matrix comprising the ideas and perspectives of Maurice Blanchot, Michel de Certeau, Michel Foucault, Jean- Luc Nancy, Pierre Nora, W.J.T. Mitchell, James E. Young, and historical and cultural geographers.3 The starting point has to be a rather long, but extremely useful quotation from Lefebvre’s The Production of Space..