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Diapositiva 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 (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 (Breivik et al, Eur J Pain, 2004) Colleagues Responded: Very frequently 29% Moderately often 38% Infrequently 26% rarely 7% 67% Pain in a rehabilitation setting (Bettinardi, Maini, Casale 2010-2011) Durata dolore Incidenza dolore all'ingresso di 1477 pazienti ricoverati in riabilitazione 17% 9% 3% 28% entro 1 mese assenza dolore 41% entro 3 mesi dolore lieve entro 6 mesi dolore moderato 58% 22% dolore intenso 22% Trend dolore di 1400 pazienti alla dim issione 45,5 35,4 19,1 Migliorati Stazionari Peggiorati oltre 6 mesi 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. • 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 Who is the prescriber (if any)? Willing to prescribe phys. Ther. GP Responded: Very frequently 29% Moderately often 38% Infrequently 26% rarely 7% 67% 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. 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 “EFIC Montescano School ” EFIC Klagenfurth Autumn Pain School Scuola Euro-Mediterranea PM&R “ HAIM RING ” •Chronic Pain as a disabling disease in its own right Common educational action between National and European scientific societies •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 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 RIABILITAZIONE SENZA DOLORE Presa in carico globale NO DOLORE E DISABILIT A’ SI ASSESSMENT COMPLETO MONITORAGGIO PERCORSO TERAPEUTICO RIABILITATIVO TRATT. FARMACOLOGICO RIABILITAZIONE •BLOCCANTI CA++ •SEROT./ NA •FANS •OPPIACEI •FKT •TERAPIE FISICHE SCHEDA ALGOLOGICA MEDICO VERIFICA DELL’OUTCOME NO DOLORE E DISABILITA’ SI CAPOSALA TERAPISTA