Roberto Casale, Coordinatore SIMFER Gruppo Studio Dolore e Riabilitazione

1. 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

2. (Breivik et al, Eur J Pain, 2004)

3. (Breivik et al, Eur J Pain, 2004)

4. 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) 67%

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

6. 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.

7. 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

8. Who is the prescriber (if any)? 67%

9. 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.

10. 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.

11. 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

12. EFIC Klagenfurth Autumn Pain School Scuola Euro-Mediterranea PM&R “ HAIM RING ” “EFIC Montescano 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

13. 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

14. Presa in carico globale DOLORE E DISABILITA’ NO SI RIABILITAZIONE SENZA DOLORE ASSESSMENT COMPLETO MONITORAGGIO PERCORSO TERAPEUTICO RIABILITATIVO • RIABILITAZIONE • FKT • TERAPIE FISICHE • TRATT. FARMACOLOGICO • BLOCCANTI CA++ • SEROT./ NA • FANS • OPPIACEI SCHEDA ALGOLOGICA MEDICO VERIFICA DELL’OUTCOME CAPOSALA SI DOLORE E DISABILITA’ NO TERAPISTA