title: Assessing and treating pain in movement disorders, amyotrophic lateral sclerosis, severe acquired brain injury, disorders of consciousness, dementia, oncology and neuroinfectivology. Evidence and recommendations from the Italian Consensus Conference on Pain in Neurorehabilitation.
abstract: Pain is an important non-motor symptom in several neurological diseases, such as Parkinson's disease, cervical dystonia, amyotrophic lateral sclerosis, severe acquired brain injury, disorders of consciousness and dementia, as well as in oncology and neuroinfectivology. To overcome the lack of evidence-based data on pain management in these diseases, the Italian Consensus Conference on Pain in Neurorehabilitation (ICCPN) has defined criteria for good clinical practice among Italian neurorehabilitation professionals. Here a review of the literature (PubMed, EMBASE and gray literature) on pain characteristics, treatment and impact of pain in a neurorehabilitation setting is provided. Despite the heterogeneity of data, a consensus was reached on pain management for patients with these diseases: it is an approach originating from an analysis of the available data on pain characteristics in each disease, the evolution of pain in relation to the natural course of the disease and the impact of pain on the overall process of rehabilitation. There was unanimous consensus regarding the utility of a multidisciplinary approach to pain therapy, combining the benefits of pharmacological therapy with the techniques of physiotherapy and neurorehabilitation for all the conditions considered. While some treatments could be different depending on pathology, a progressive approach to the pharmacological treatment of pain is advisable, starting with non-opioid analgesics (paracetamol) and nonsteroidal anti-inflammatory drugs as a first-line treatment, and opioid analgesics as a second-line treatment. In cases of pain secondary to spasticity, botulinum neurotoxin, and, in some cases, intrathecal baclofen infusion should be considered. Randomized controlled trials and prospective multicenter studies aimed at documenting the efficacy of pain treatment and their risk-benefit profile are recommended for these conditions.
authors: Neurorehabilitation Unit, Department of Rehabilitation, HABILITA, Zingonia di Ciserano, Bergamo, Italy.
authors: Michelangelo
authors: M
authors: Bartolo
authors: ALS Center, &quot;Rita Levi Montalcini&quot; Department of Neuroscience, University of Turin, Turin, Italy.
authors: Adriano
authors: A
authors: Chiò
authors: Section of Neurology, Department of Neurosciences, Biomedicine and Movement Sciences, University of Verona, Verona, Italy.
authors: Sergio
authors: S
authors: Ferrari
authors: Neurorehabilitation Unit, &quot;C. Mondino&quot; National Neurological Institute, Pavia, Italy.|Department of Brain and Behavioral Sciences, University of Pavia, Pavia, Italy.
authors: Cristina
authors: C
authors: Tassorelli
authors: Section of Neurology, Department of Neurosciences, Biomedicine and Movement Sciences, University of Verona, Verona, Italy.
authors: Stefano
authors: S
authors: Tamburin
authors: Neurorehabilitation Unit, &quot;C. Mondino&quot; National Neurological Institute, Pavia, Italy.|Department of Brain and Behavioral Sciences, University of Pavia, Pavia, Italy.
authors: Micol
authors: M
authors: Avenali
authors: Post-Coma Unit, Santa Lucia Foundation and Scientific Institute for Care and Research, Rome, Italy.
authors: Eva
authors: E
authors: Azicnuda
authors: ALS Center, &quot;Rita Levi Montalcini&quot; Department of Neuroscience, University of Turin, Turin, Italy.
authors: Andrea
authors: A
authors: Calvo
authors: Palliative Care, Pain Therapy and Rehabilitation Unit, Istituto Nazionale dei Tumori, Milan, Italy.
authors: Augusto T
authors: AT
authors: Caraceni
authors: Department of Basic Medical Sciences, Neuroscience and Sense Organs, University of Bari, Bari, Italy.
authors: Giovanni
authors: G
authors: Defazio
authors: Neurorehabilitation Unit, &quot;C. Mondino&quot; National Neurological Institute, Pavia, Italy.|Department of Brain and Behavioral Sciences, University of Pavia, Pavia, Italy.
authors: Roberto
authors: R
authors: DE Icco
authors: Post-Coma Unit, Santa Lucia Foundation and Scientific Institute for Care and Research, Rome, Italy.
authors: Rita
authors: R
authors: Formisano
authors: Department of Geriatrics, &quot;Poliambulanza&quot; Foundation, Brescia, Italy.
authors: Simone
authors: S
authors: Franzoni
authors: Section of Neurology, Department of Neurosciences, Biomedicine and Movement Sciences, University of Verona, Verona, Italy.
authors: Elena
authors: E
authors: Greco
authors: Oncological Rehabilitation Unit, Functional Recovery Unit, &quot;Salvatore Maugeri&quot; Foundation and Scientific Institute for Care and Research, Pavia, Italy.
authors: Iwona
authors: I
authors: Jedrychowska
authors: Section of Neurology, Department of Neurosciences, Biomedicine and Movement Sciences, University of Verona, Verona, Italy.
authors: Francesca
authors: F
authors: Magrinelli
authors: ALS Center, &quot;Rita Levi Montalcini&quot; Department of Neuroscience, University of Turin, Turin, Italy.
authors: Umberto
authors: U
authors: Manera
authors: Neurooncology Unit, &quot;C. Mondino&quot; National Neurological Institute, Pavia, Italy.
authors: Enrico
authors: E
authors: Marchioni
authors: Section of Neurology, Department of Neurosciences, Biomedicine and Movement Sciences, University of Verona, Verona, Italy.
authors: Sara
authors: S
authors: Mariotto
authors: Section of Neurology, Department of Neurosciences, Biomedicine and Movement Sciences, University of Verona, Verona, Italy.
authors: Salvatore
authors: S
authors: Monaco
authors: Neurooncology Unit, &quot;Regina Elena&quot; Scientific Institute for Care and Research, Rome, Italy.
authors: Andrea
authors: A
authors: Pace
authors: &quot;Cardinal Ferrari&quot; Rehabilitation Center, Parma, Italy.
authors: Donatella
authors: D
authors: Saviola
authors: Oncological Rehabilitation Unit, Functional Recovery Unit, &quot;Salvatore Maugeri&quot; Foundation and Scientific Institute for Care and Research, Pavia, Italy.
authors: Isabella
authors: I
authors: Springhetti
authors: Section of Neurology, Department of Neurosciences, Biomedicine and Movement Sciences, University of Verona, Verona, Italy.
authors: Michele
authors: M
authors: Tinazzi
authors: &quot;Cardinal Ferrari&quot; Rehabilitation Center, Parma, Italy - antonio.detanti@centrocardinalferrari.it.
authors: Antonio
authors: A
authors: DE Tanti
mesh_terms: D000690:Amyotrophic Lateral Sclerosis / Q000150:complications*; D001927:Brain Diseases / Q000150:complications* / Q000382:microbiology*; D001930:Brain Injuries / Q000150:complications*; D003131:Combined Modality Therapy; D003244:Consciousness Disorders / Q000150:complications*; D003704:Dementia / Q000150:complications*; D019317:Evidence-Based Medicine; D006801:Humans; D007558:Italy; D009069:Movement Disorders / Q000150:complications*; D009369:Neoplasms / Q000150:complications*; D000066530:Neurological Rehabilitation / Q000379:methods*; D017063:Outcome Assessment, Health Care; D010146:Pain / Q000209:etiology* / Q000534:rehabilitation*; D059408:Pain Management / Q000379:methods*; D010147:Pain Measurement; D057170:Translational Research, Biomedical