title: Psychological Considerations in the Assessment and Treatment of Pain in Neurorehabilitation and Psychological Factors Predictive of Therapeutic Response: Evidence and Recommendations from the Italian Consensus Conference on Pain in Neurorehabilitation.
abstract: BACKGROUND
  In order to provide effective care to patients suffering from chronic pain secondary to neurological diseases, health professionals must appraise the role of the psychosocial factors in the genesis and maintenance of this condition whilst considering how emotions and cognitions influence the course of treatment. Furthermore, it is important not only to recognize the psychological reactions to pain that are common to the various conditions, but also to evaluate how these syndromes differ with regards to the psychological factors that may be involved. As an extensive evaluation of these factors is still lacking, the Italian Consensus Conference on Pain in Neurorehabilitation (ICCPN) aimed to collate the evidence available across these topics.
  
  
  OBJECTIVE
  To determine the psychological factors which are associated with or predictive of pain secondary to neurological conditions and to assess the influence of these aspects on the outcome of neurorehabilitation.
  
  
  METHODS
  Two reviews were performed. In the first, a PUBMED search of the studies assessing the association between psychological factors and pain or the predictive value of these aspects with respect to chronic pain was conducted. The included papers were then rated with regards to their methodological quality and recommendations were made accordingly. In the second study, the same methodology was used to collect the available evidence on the predictive role of psychological factors on the therapeutic response to pain treatments in the setting of neurorehabilitation.
  
  
  RESULTS
  The first literature search identified 1170 results and the final database included 189 articles. Factors such as depression, anxiety, pain catastrophizing, coping strategies, and cognitive functions were found to be associated with pain across the various conditions. However, there are differences between chronic musculoskeletal pain, migraine, neuropathy, and conditions associated with complex disability with regards to the psychological aspects that are involved. The second PUBMED search yielded 252 studies, which were all evaluated. Anxiety, depression, pain catastrophizing, coping strategies, and pain beliefs were found to be associated to different degrees with the outcomes of multidisciplinary programs, surgery, physical therapies, and psychological interventions. Finally, sense of presence was found to be related to the effectiveness of virtual reality as a distraction tool.
  
  
  CONCLUSIONS
  Several psychological factors are associated with pain secondary to neurological conditions and should be acknowledged and addressed in order to effectively treat this condition. These factors also predict the therapeutic response to the neurorehabilitative interventions.
authors.affiliation: Psychology Research Laboratory, Istituto Auxologico Italiano IRCCS, San Giuseppe HospitalVerbania, Italy; Department of Psychology, Catholic University of MilanMilan, Italy.
authors.forename: Gianluca
authors.initials: G
authors.lastname: Castelnuovo
authors.affiliation: Department of Psychology, Catholic University of Milan Milan, Italy.
authors.forename: Emanuele M
authors.initials: EM
authors.lastname: Giusti
authors.affiliation: Psychology Research Laboratory, Istituto Auxologico Italiano IRCCS, San Giuseppe HospitalVerbania, Italy; Faculty of Psychology, eCampus UniversityNovedrate, Italy.
authors.forename: Gian Mauro
authors.initials: GM
authors.lastname: Manzoni
authors.affiliation: Cardinal Ferrari Rehabilitation Center, Santo Stefano Rehabilitation Istitute Fontanellato, Italy.
authors.forename: Donatella
authors.initials: D
authors.lastname: Saviola
authors.affiliation: Private Practice Parma, Italy.
authors.forename: Arianna
authors.initials: A
authors.lastname: Gatti
authors.affiliation: Casa di Cura San Pio X S.r.l., HUMANITAS Milan, Italy.
authors.forename: Samantha
authors.initials: S
authors.lastname: Gabrielli
authors.affiliation: Casa di Cura San Pio X S.r.l., HUMANITAS Milan, Italy.
authors.forename: Marco
authors.initials: M
authors.lastname: Lacerenza
authors.affiliation: Psychology Research Laboratory, Istituto Auxologico Italiano IRCCS, San Giuseppe HospitalVerbania, Italy; Department of Psychology, Catholic University of MilanMilan, Italy.
authors.forename: Giada
authors.initials: G
authors.lastname: Pietrabissa
authors.affiliation: Psychology Research Laboratory, Istituto Auxologico Italiano IRCCS, San Giuseppe Hospital Verbania, Italy.
authors.forename: Roberto
authors.initials: R
authors.lastname: Cattivelli
authors.affiliation: Psychology Research Laboratory, Istituto Auxologico Italiano IRCCS, San Giuseppe HospitalVerbania, Italy; Department of Psychology, Catholic University of MilanMilan, Italy.
authors.forename: Chiara A M
authors.initials: CA
authors.lastname: Spatola
authors.affiliation: Psychology Research Laboratory, Istituto Auxologico Italiano IRCCS, San Giuseppe Hospital Verbania, Italy.
authors.forename: Stefania
authors.initials: S
authors.lastname: Corti
authors.affiliation: Psychology Research Laboratory, Istituto Auxologico Italiano IRCCS, San Giuseppe Hospital Verbania, Italy.
authors.forename: Margherita
authors.initials: M
authors.lastname: Novelli
authors.affiliation: Psychology Research Laboratory, Istituto Auxologico Italiano IRCCS, San Giuseppe Hospital Verbania, Italy.
authors.forename: Valentina
authors.initials: V
authors.lastname: Villa
authors.affiliation: IRCCS Galeazzi Orthopedic Institute Milan, Italy.
authors.forename: Andrea
authors.initials: A
authors.lastname: Cottini
authors.affiliation: Department of Dynamic and Clinical Psychology, Sapienza University of Rome Rome, Italy.
authors.forename: Carlo
authors.initials: C
authors.lastname: Lai
authors.affiliation: Department of Psychology, Catholic University of MilanMilan, Italy; Department of Psychology, Harvard UniversityCambridge, MA, USA.
authors.forename: Francesco
authors.initials: F
authors.lastname: Pagnini
authors.affiliation: Department of Psychology, University of Turin Turin, Italy.
authors.forename: Lorys
authors.initials: L
authors.lastname: Castelli
authors.affiliation: Villa Scassi Hospital Genova, Italy.
authors.forename: Mario
authors.initials: M
authors.lastname: Tavola
authors.affiliation: Department of Neuroscience "Rita Levi Montalcini", University of Turin Turin, Italy.
authors.forename: Riccardo
authors.initials: R
authors.lastname: Torta
authors.affiliation: Rehabilitation Unit, Istituto Auxologico Italiano IRCCS, San Giuseppe Hospital Verbania, Italy.
authors.forename: Marco
authors.initials: M
authors.lastname: Arreghini
authors.affiliation: Rehabilitation Unit, Istituto Auxologico Italiano IRCCS, San Giuseppe Hospital Verbania, Italy.
authors.forename: Loredana
authors.initials: L
authors.lastname: Zanini
authors.affiliation: Rehabilitation Unit, Istituto Auxologico Italiano IRCCS, San Giuseppe Hospital Verbania, Italy.
authors.forename: Amelia
authors.initials: A
authors.lastname: Brunani
authors.affiliation: Rehabilitation Unit, Istituto Auxologico Italiano IRCCS, San Giuseppe Hospital Verbania, Italy.
authors.forename: Paolo
authors.initials: P
authors.lastname: Capodaglio
authors.affiliation: Psychology Research Laboratory, Istituto Auxologico Italiano IRCCS, San Giuseppe Hospital Verbania, Italy.
authors.forename: Guido E
authors.initials: GE
authors.lastname: D'Aniello
authors.affiliation: Psychology Research Laboratory, Istituto Auxologico Italiano IRCCS, San Giuseppe HospitalVerbania, Italy; Department of Neuroscience "Rita Levi Montalcini", University of TurinTurin, Italy.
authors.forename: Federica
authors.initials: F
authors.lastname: Scarpina
authors.affiliation: Department of Neurology and Neurorehabilitation, Istituto Auxologico Italiano IRCCS, San Giuseppe Hospital Verbania, Italy.
authors.forename: Andrea
authors.initials: A
authors.lastname: Brioschi
authors.affiliation: Department of Neuroscience "Rita Levi Montalcini", University of TurinTurin, Italy; Department of Neurology and Neurorehabilitation, Istituto Auxologico Italiano IRCCS, San Giuseppe HospitalVerbania, Italy.
authors.forename: Lorenzo
authors.initials: L
authors.lastname: Priano
authors.affiliation: Department of Neuroscience "Rita Levi Montalcini", University of TurinTurin, Italy; Department of Neurology and Neurorehabilitation, Istituto Auxologico Italiano IRCCS, San Giuseppe HospitalVerbania, Italy.
authors.forename: Alessandro
authors.initials: A
authors.lastname: Mauro
authors.affiliation: Psychology Research Laboratory, Istituto Auxologico Italiano IRCCS, San Giuseppe HospitalVerbania, Italy; Department of Psychology, Catholic University of MilanMilan, Italy.
authors.forename: Giuseppe
authors.initials: G
authors.lastname: Riva
authors.affiliation: Department of Psychology, Catholic University of Milan Milan, Italy.
authors.forename: Claudia
authors.initials: C
authors.lastname: Repetto
authors.affiliation: Department of Psychology, Catholic University of Milan Milan, Italy.
authors.forename: Camillo
authors.initials: C
authors.lastname: Regalia
authors.affiliation: Psychology Research Laboratory, Istituto Auxologico Italiano IRCCS, San Giuseppe HospitalVerbania, Italy; Department of Psychology, Catholic University of MilanMilan, Italy.
authors.forename: Enrico
authors.initials: E
authors.lastname: Molinari
authors.affiliation: "Pain Center II Level - Department of Surgery" - ASST Grande Ospedale Metropolitano Niguarda Milano, Italy.
authors.forename: Paolo
authors.initials: P
authors.lastname: Notaro
authors.affiliation: Fondazione Santa Lucia IRCCS Rome, Italy.
authors.forename: Stefano
authors.initials: S
authors.lastname: Paolucci
authors.affiliation: Department of Brain and Behavioral Sciences, C. Mondino National Neurological Institute, University of Pavia Pavia, Italy.
authors.forename: Giorgio
authors.initials: G
authors.lastname: Sandrini
authors.affiliation: School of Psychology, Social Work and Social Policy, University of South Australia Magill, SA, Australia.
authors.forename: Susan G
authors.initials: SG
authors.lastname: Simpson
authors.affiliation: Virtual Reality Medical Institute Brussels, Belgium.
authors.forename: Brenda
authors.initials: B
authors.lastname: Wiederhold
authors.affiliation: Department of Neurological and Movement Sciences, University of Verona Verona, Italy.
authors.forename: Stefano
authors.initials: S
authors.lastname: Tamburin
keywords: chronic pain; clinical psychology; health psychology; neurorehabilitation; pain management