Roberto Casale, Coordinatore SIMFER Gruppo Studio Dolore e Riabilitazione Controversie sulla diagnosi e terapia del dolore neuropatico Opinioni a confronto Palermo, novembre 2012 Palazzo dei Normanni DOLORE E RIABILITAZIONE

(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 frequently29% Moderately often38% Infrequently26% rarely7% 67% (Breivik et al, Eur J Pain, 2004)

Pain in a rehabilitation setting (Bettinardi, Maini, Casale )

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 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.

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 frequently29% Moderately often 38% Infrequently26% rarely7% 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 DELLOUTCOME 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 NO