Roberto Casale, Coordinatore SIMFER Gruppo Studio Dolore e Riabilitazione Controversie sulla diagnosi e terapia del dolore neuropatico Opinioni a confronto.

Roberto Casale, Coordinatore

SIMFER Gruppo Studio Dolore e Riabilitazione

Controversie sulla diagnosi e terapia del dolore neuropatico”

Opinioni a confronto“

Palermo, 29-30 novembre 2012Palazzo dei Normanni

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

Colleagues Responded:

Very frequently 29%

Moderately often 38%

Infrequently 26%

rarely 7%

67%

(Breivik et al, Eur J Pain, 2004)

Incidenza dolore all'ingresso di 1477 pazienti ricoverati in riabilitazione

41%

22%

28%

9%

assenza dolore

dolore lieve

dolore moderato

dolore intenso

Pain in a rehabilitation setting (Bettinardi, Maini, Casale 2010-2011)

Durata dolore

58%22%

3%

17%

entro 1 mese

entro 3 mesi

entro 6 mesi

oltre 6 mesi

45,5

35,4

19,1

Migliorati Stazionari Peggiorati

Trend dolore di 1400 pazienti alla dimissione

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.

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 RehabilitationMedicine mailing list during the survey.

• 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

Willing to prescribe phys. Ther.

GP Responded:

Very frequently 29%

Moderately often

38%

Infrequently 26%

rarely 7%

67%

Who is the prescriber (if any)?

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.

• 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

PILOT ACTION

Scuola Euro-Mediterranea PM&R “ HAIM RING ”

“EFIC Montescano School ”EFIC Klagenfurth Autumn Pain School

•Chronic Pain as a disabling disease in its own right

•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

Common educational action between National and European scientific societies

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

Presa in carico globale

ASSESSMENT COMPLETO

SCHEDA ALGOLOGICA

VERIFICA DELL’OUTCOME

DOLORE E DISABILIT

A’

MONITORAGGIO

TRATT. FARMACOLOGICO•BLOCCANTI CA++

•SEROT./ NA•FANS•OPPIACEI

RIABILITAZIONE•FKT•TERAPIE FISICHE

DOLORE E DISABILITA

’

PERCORSO TERAPEUTICO RIABILITATIVO

RIABILITAZIONE SENZA DOLORE

CAPOSALA

MEDICO

TERAPISTA

SI

SI

NO

NO