Controversie sulla diagnosi e terapia
del dolore neuropatico”
Opinioni a confronto
“
Palermo, 29-30 novembre 2012
Palazzo dei Normanni
DOLORE E RIABILITAZIONE
Roberto Casale, Coordinatore
SIMFER Gruppo Studio Dolore e Riabilitazione
(Breivik et al, Eur J Pain, 2004)
(Breivik et al, Eur J Pain, 2004)
In Italy 15 up to 34 % of chronic pain sufferers used physical
therapies and/or rehabilitation facilities not always covered
by the NHS or insurances
(Breivik et al, Eur J Pain, 2004)
Colleagues
Responded:
Very frequently
29%
Moderately often
38%
Infrequently
26%
rarely
7%
67%
Pain in a rehabilitation setting (Bettinardi, Maini, Casale 2010-2011)
Durata dolore
Incidenza dolore all'ingresso di 1477 pazienti ricoverati in
riabilitazione
17%
9%
3%
28%
entro 1 mese
assenza dolore
41%
entro 3 mesi
dolore lieve
entro 6 mesi
dolore moderato
58%
22%
dolore intenso
22%
Trend dolore
di 1400 pazienti alla dim issione
45,5
35,4
19,1
Migliorati
Stazionari
Peggiorati
oltre 6 mesi
Number of respondents by Nation, from
white (0 to1 respondents) to red (more
than 36 respondents).
Those in gray are the nations that were not
present in the European Society of
Physical and Rehabilitation
Medicine mailing list during the survey.
Chronic Disabling Pain: A Scotoma in the Eye of both Pain Medicine and Rehabilitation in Europe
Casale R, Negrini S, Franceschini M, Michail X. Am J Phys Med Rehab January 2013.
• If PRM specialists are not interest/aware
of pain in their patients, who is the
“prescriber” of the physical therapies in
this wide number of patients with chronic
pain
• Why we have so scanty results in pain
control also when patients are hospitalized
Who is the prescriber (if any)?
Willing to
prescribe phys.
Ther.
GP
Responded:
Very frequently
29%
Moderately
often
38%
Infrequently
26%
rarely
7%
67%
Chronic Disabling Pain: A Scotoma in the Eye of both Pain Medicine and Rehabilitation in Europe
Casale R, Negrini S, Franceschini M, Michail X. Am J Phys Med Rehabil January 2013.
Chronic Disabling Pain: A Scotoma in the Eye of both Pain Medicine and Rehabilitation in Europe
Casale R, Negrini S, Franceschini M, Michail X.
Am J Phys Med Rehabil January 2013.
PILOT ACTION
• Daily recording of pain as a V° vital sigh with a minimum evaluation
core set (EFIC Montescano School)
• Opiates utilization within a rehabilitation project where chronic pain
is considered and treated as an invalidating disease (HGK)
• Change in the perception of the impact of chronic pain in the
rehabilitation program (SIMFER & SIRN project)
• Active involvement of PT and OT in the pain management
• Educational strategies (ECM) (HPH)
– Doctors, nurses, PT, OT
– Patients &Caregiver
• Controversie sulla diagnosi e terapia del dolore neuropatico”
Opinioni a confronto
“EFIC Montescano School ”
EFIC Klagenfurth Autumn Pain
School
Scuola Euro-Mediterranea PM&R
“ HAIM RING ”
•Chronic Pain as a disabling disease in its own right
Common
educational action
between National
and European
scientific societies
•Creation of a common background as a basis for making a
better diagnostic and integrated therapeutic procedures
• Recognition, in rehabilitation, of the importance of a better
pain control
•Recognition, in pain medicine, of the disability related to
chronic pain and the need for rehabilitation
•Creating a synergy between pharmacological, interventional
therapies and tailored rehabilitation programs toward a
better functional and social recovery
ESPRM
Key messages
• We urge to consider the presence of chronic pain also in different
settings from the “classical” pain centers.
• Chronic pain is always related to disability and the data herein
reported are stressing this bi-directional relationship
• Pain control in a rehabilitation setting is optimistically inadequate and
its contribution to the societal burden of pain-related disability is
underestimated
• A close partnership with pain medicine specialists is mandatory
RIABILITAZIONE SENZA
DOLORE
Presa in carico globale
NO
DOLORE E
DISABILIT
A’
SI
ASSESSMENT COMPLETO
MONITORAGGIO
PERCORSO TERAPEUTICO
RIABILITATIVO
TRATT. FARMACOLOGICO
RIABILITAZIONE
•BLOCCANTI CA++
•SEROT./ NA
•FANS
•OPPIACEI
•FKT
•TERAPIE FISICHE
SCHEDA ALGOLOGICA
MEDICO
VERIFICA DELL’OUTCOME
NO
DOLORE E
DISABILITA’
SI
CAPOSALA
TERAPISTA