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Front Psychol. 2016 Feb 19;7:115. doi: 10.3389/fpsyg.2016.00115. eCollection 2016.

Psychological Treatments and Psychotherapies in the Neurorehabilitation of Pain: Evidences and Recommendations from the Italian Consensus Conference on Pain in Neurorehabilitation.

Author information

1
Psychology Research Laboratory, Istituto Auxologico Italiano IRCCS, San Giuseppe HospitalVerbania, Italy; Department of Psychology, Catholic University of MilanMilan, Italy.
2
Department of Psychology, Catholic University of Milan Milan, Italy.
3
Psychology Research Laboratory, Istituto Auxologico Italiano IRCCS, San Giuseppe HospitalVerbania, Italy; Faculty of Psychology, eCampus UniversityNovedrate (Como), Italy.
4
Cardinal Ferrari Rehabilitation Center, Santo Stefano Rehabilitation Istitute Fontanellato, Italy.
5
Private Practice Parma, Italy.
6
Casa di Cura San Pio X S.r.l., HUMANITAS Milan, Italy.
7
Psychology Research Laboratory, Istituto Auxologico Italiano IRCCS, San Giuseppe Hospital Verbania, Italy.
8
IRCCS Galeazzi Orthopedic Institute Milan, Italy.
9
Department of Dynamic and Clinical Psychology Sapienza University of Rome, Italy.
10
Department of Psychology, Catholic University of MilanMilan, Italy; Department of Psychology, Harvard UniversityCambridge, MA, USA.
11
Department of Psychology, University of Turin Turin, Italy.
12
Villa Scassi Hospital Genova, Italy.
13
Department of Neuroscience "Rita Levi Montalcini" University of Turin, Italy.
14
Rehabilitation Unit, Istituto Auxologico Italiano IRCCS, San Giuseppe Hospital Verbania, Italy.
15
Psychology Research Laboratory, Istituto Auxologico Italiano IRCCS, San Giuseppe HospitalVerbania, Italy; Department of Neuroscience "Rita Levi Montalcini"University of Turin, Italy.
16
Department of Neurology and Neurorehabilitation, Istituto Auxologico Italiano IRCCS, San Giuseppe Hospital Verbania, Italy.
17
Department of Neuroscience "Rita Levi Montalcini"University of Turin, Italy; Department of Neurology and Neurorehabilitation, Istituto Auxologico Italiano IRCCS, San Giuseppe HospitalVerbania, Italy.
18
"Pain Center II Level - Department of Surgery" - ASST Grande Ospedale Metropolitano Niguarda Milano, Italy.
19
Fondazione Santa Lucia IRCCS Rome, Italy.
20
Department of Brain and Behavioral Sciences, C. Mondino National Neurological Institute, University of Pavia Pavia, Italy.
21
School of Psychology, Social Work and Social Policy University of South Australia, Australia.
22
Virtual Reality Medical Institute Brussels, Belgium.
23
Department of Neurological and Movement Sciences, University of Verona Verona, Italy.

Abstract

BACKGROUND:

It is increasingly recognized that treating pain is crucial for effective care within neurological rehabilitation in the setting of the neurological rehabilitation. The Italian Consensus Conference on Pain in Neurorehabilitation was constituted with the purpose identifying best practices for us in this context. Along with drug therapies and physical interventions, psychological treatments have been proven to be some of the most valuable tools that can be used within a multidisciplinary approach for fostering a reduction in pain intensity. However, there is a need to elucidate what forms of psychotherapy could be effectively matched with the specific pathologies that are typically addressed by neurorehabilitation teams.

OBJECTIVES:

To extensively assess the available evidence which supports the use of psychological therapies for pain reduction in neurological diseases.

METHODS:

A systematic review of the studies evaluating the effect of psychotherapies on pain intensity in neurological disorders was performed through an electronic search using PUBMED, EMBASE, and the Cochrane Database of Systematic Reviews. Based on the level of evidence of the included studies, recommendations were outlined separately for the different conditions.

RESULTS:

The literature search yielded 2352 results and the final database included 400 articles. The overall strength of the recommendations was medium/low. The different forms of psychological interventions, including Cognitive-Behavioral Therapy, cognitive or behavioral techniques, Mindfulness, hypnosis, Acceptance and Commitment Therapy (ACT), Brief Interpersonal Therapy, virtual reality interventions, various forms of biofeedback and mirror therapy were found to be effective for pain reduction in pathologies such as musculoskeletal pain, fibromyalgia, Complex Regional Pain Syndrome, Central Post-Stroke pain, Phantom Limb Pain, pain secondary to Spinal Cord Injury, multiple sclerosis and other debilitating syndromes, diabetic neuropathy, Medically Unexplained Symptoms, migraine and headache.

CONCLUSIONS:

Psychological interventions and psychotherapies are safe and effective treatments that can be used within an integrated approach for patients undergoing neurological rehabilitation for pain. The different interventions can be specifically selected depending on the disease being treated. A table of evidence and recommendations from the Italian Consensus Conference on Pain in Neurorehabilitation is also provided in the final part of the paper.

KEYWORDS:

chronic pain; clinical psychology; health psychology; neurological rehabilitation; pain; psychological treatments; psychotherapy

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