Psychological Considerations in the Assessment and Treatment of Pain in Neurorehabilitation and Psychological Factors Predictive of Therapeutic Response: Evidence and Recommendations from the Italian Consensus Conference on Pain in Neurorehabilitation

doi:10.3389/fpsyg.2016.00468

Review

. 2016 Apr 19:7:468.

doi: 10.3389/fpsyg.2016.00468. eCollection 2016.

Psychological Considerations in the Assessment and Treatment of Pain in Neurorehabilitation and Psychological Factors Predictive of Therapeutic Response: Evidence and Recommendations from the Italian Consensus Conference on Pain in Neurorehabilitation

Gianluca Castelnuovo¹, Emanuele M Giusti², Gian Mauro Manzoni³, Donatella Saviola⁴, Arianna Gatti⁵, Samantha Gabrielli⁶, Marco Lacerenza⁶, Giada Pietrabissa¹, Roberto Cattivelli⁷, Chiara A M Spatola¹, Stefania Corti⁷, Margherita Novelli⁷, Valentina Villa⁷, Andrea Cottini⁸, Carlo Lai⁹, Francesco Pagnini¹⁰, Lorys Castelli¹¹, Mario Tavola¹², Riccardo Torta¹³, Marco Arreghini¹⁴, Loredana Zanini¹⁴, Amelia Brunani¹⁴, Paolo Capodaglio¹⁴, Guido E D'Aniello⁷, Federica Scarpina¹⁵, Andrea Brioschi¹⁶, Lorenzo Priano¹⁷, Alessandro Mauro¹⁷, Giuseppe Riva¹, Claudia Repetto², Camillo Regalia², Enrico Molinari¹, Paolo Notaro¹⁸, Stefano Paolucci¹⁹, Giorgio Sandrini²⁰, Susan G Simpson²¹, Brenda Wiederhold²², Stefano Tamburin²³

Affiliations

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, 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 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 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 TurinTurin, 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 TurinTurin, 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 Magill, SA, Australia.
²² Virtual Reality Medical Institute Brussels, Belgium.
²³ Department of Neurological and Movement Sciences, University of Verona Verona, Italy.

PMID: 27148104
PMCID: PMC4835496
DOI: 10.3389/fpsyg.2016.00468

Review

Psychological Considerations in the Assessment and Treatment of Pain in Neurorehabilitation and Psychological Factors Predictive of Therapeutic Response: Evidence and Recommendations from the Italian Consensus Conference on Pain in Neurorehabilitation

Gianluca Castelnuovo et al. Front Psychol. 2016.

. 2016 Apr 19:7:468.

doi: 10.3389/fpsyg.2016.00468. eCollection 2016.

Authors

Affiliations

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, 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 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 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 TurinTurin, 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 TurinTurin, 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 Magill, SA, Australia.
²² Virtual Reality Medical Institute Brussels, Belgium.
²³ Department of Neurological and Movement Sciences, University of Verona Verona, Italy.

PMID: 27148104
PMCID: PMC4835496
DOI: 10.3389/fpsyg.2016.00468

Abstract

Background: In order to provide effective care to patients suffering from chronic pain secondary to neurological diseases, health professionals must appraise the role of the psychosocial factors in the genesis and maintenance of this condition whilst considering how emotions and cognitions influence the course of treatment. Furthermore, it is important not only to recognize the psychological reactions to pain that are common to the various conditions, but also to evaluate how these syndromes differ with regards to the psychological factors that may be involved. As an extensive evaluation of these factors is still lacking, the Italian Consensus Conference on Pain in Neurorehabilitation (ICCPN) aimed to collate the evidence available across these topics.

Objectives: To determine the psychological factors which are associated with or predictive of pain secondary to neurological conditions and to assess the influence of these aspects on the outcome of neurorehabilitation.

Methods: Two reviews were performed. In the first, a PUBMED search of the studies assessing the association between psychological factors and pain or the predictive value of these aspects with respect to chronic pain was conducted. The included papers were then rated with regards to their methodological quality and recommendations were made accordingly. In the second study, the same methodology was used to collect the available evidence on the predictive role of psychological factors on the therapeutic response to pain treatments in the setting of neurorehabilitation.

Results: The first literature search identified 1170 results and the final database included 189 articles. Factors such as depression, anxiety, pain catastrophizing, coping strategies, and cognitive functions were found to be associated with pain across the various conditions. However, there are differences between chronic musculoskeletal pain, migraine, neuropathy, and conditions associated with complex disability with regards to the psychological aspects that are involved. The second PUBMED search yielded 252 studies, which were all evaluated. Anxiety, depression, pain catastrophizing, coping strategies, and pain beliefs were found to be associated to different degrees with the outcomes of multidisciplinary programs, surgery, physical therapies, and psychological interventions. Finally, sense of presence was found to be related to the effectiveness of virtual reality as a distraction tool.

Conclusions: Several psychological factors are associated with pain secondary to neurological conditions and should be acknowledged and addressed in order to effectively treat this condition. These factors also predict the therapeutic response to the neurorehabilitative interventions.

Keywords: chronic pain; clinical psychology; health psychology; neurorehabilitation; pain management.

PubMed Disclaimer

Cited by

Development of a Clinical Prediction Rule for Treatment Success with Transcranial Direct Current Stimulation for Knee Osteoarthritis Pain: A Secondary Analysis of a Double-Blind Randomized Controlled Trial.
Teixeira PEP, Tavares DRB, Pacheco-Barrios K, Branco LC, Slawka E, Keysor J, Trevisani VFM, Gross DK, Fregni F. Teixeira PEP, et al. Biomedicines. 2022 Dec 20;11(1):4. doi: 10.3390/biomedicines11010004. Biomedicines. 2022. PMID: 36672512 Free PMC article.
Validation of the Ocular Pain Assessment Survey Instrument With Rasch Analysis.
Ng DM, Wang X, Liu C, Yu M, Lee IXY, Wong JHF, Wong RKT, Chan DXH, Liu YC, Tong LHT. Ng DM, et al. Transl Vis Sci Technol. 2025 Feb 3;14(2):20. doi: 10.1167/tvst.14.2.20. Transl Vis Sci Technol. 2025. PMID: 39964334 Free PMC article.
Breaking the cycle: unraveling the diagnostic, pathophysiological and treatment challenges of refractory migraine.
Robblee J. Robblee J. Front Neurol. 2023 Sep 27;14:1263535. doi: 10.3389/fneur.2023.1263535. eCollection 2023. Front Neurol. 2023. PMID: 37830088 Free PMC article. Review.
Factor Structure, Validity, and Reliability of the STarT Back Screening Tool in Italian Obese and Non-obese Patients With Low Back Pain.
Giusti EM, Varallo G, Abenavoli A, Manzoni GM, Aletti L, Capodaglio P, Castelnuovo G, Maggiani A. Giusti EM, et al. Front Psychol. 2021 Oct 20;12:740851. doi: 10.3389/fpsyg.2021.740851. eCollection 2021. Front Psychol. 2021. PMID: 34744912 Free PMC article.
Mindfulness and pharmacological prophylaxis have comparable effect on biomarkers of inflammation and clinical indexes in chronic migraine with medication overuse: results at 12 months after withdrawal.
Grazzi L, D'Amico D, Raggi A, Leonardi M, Ciusani E, Corsini E, D'Andrea G, Bolner A, Salgado-García F, Andrasik F, Sansone E. Grazzi L, et al. Neurol Sci. 2017 May;38(Suppl 1):173-175. doi: 10.1007/s10072-017-2874-0. Neurol Sci. 2017. PMID: 28527073

See all "Cited by" articles

References

1. Alschuler K. N., Jensen M. P., Goetz M. C., Smith A. E., Verrall A. M., Molton I. R. (2012). Effects of pain and fatigue on physical functioning and depression in persons with muscular dystrophy. Disabil. Health J. 5, 277–283. 10.1016/j.dhjo.2012.07.002 - DOI - PubMed
1. Amtmann D., Askew R. L., Kim J., Chung H., Ehde D. M., Bombardier C. H., et al. . (2015). Pain affects depression through anxiety, fatigue, and sleep in multiple sclerosis. Rehabil. Psychol. 60, 81–90. 10.1037/rep0000027 - DOI - PMC - PubMed
1. Andrews N. E., Strong J., Meredith P. J. (2012). Activity pacing, avoidance, endurance, and associations with patient functioning in chronic pain: a systematic review and meta-analysis. Arch. Phys. Med. Rehabil. 93, 2109–2121 e2107. 10.1016/j.apmr.2012.05.029 - DOI - PubMed
1. Apkarian A. V., Baliki M. N., Farmer M. A. (2013). Predicting transition to chronic pain. Curr. Opin. Neurol. 26, 360–367. 10.1097/WCO.0b013e32836336ad - DOI - PMC - PubMed
1. Apkarian A. V., Bushnell M. C., Treede R. D., Zubieta J. K. (2005). Human brain mechanisms of pain perception and regulation in health and disease. Eur. J. Pain 9, 463–484. 10.1016/j.ejpain.2004.11.001 - DOI - PubMed

Publication types

Actions

LinkOut - more resources

Full Text Sources
Other Literature Sources
- scite Smart Citations
Research Materials
- NCI CPTC Antibody Characterization Program

[1] Alschuler K. N., Jensen M. P., Goetz M. C., Smith A. E., Verrall A. M., Molton I. R. (2012). Effects of pain and fatigue on physical functioning and depression in persons with muscular dystrophy. Disabil. Health J. 5, 277–283. 10.1016/j.dhjo.2012.07.002 - DOI - PubMed

[2] Alschuler K. N., Jensen M. P., Goetz M. C., Smith A. E., Verrall A. M., Molton I. R. (2012). Effects of pain and fatigue on physical functioning and depression in persons with muscular dystrophy. Disabil. Health J. 5, 277–283. 10.1016/j.dhjo.2012.07.002 - DOI - PubMed

[3] Amtmann D., Askew R. L., Kim J., Chung H., Ehde D. M., Bombardier C. H., et al. . (2015). Pain affects depression through anxiety, fatigue, and sleep in multiple sclerosis. Rehabil. Psychol. 60, 81–90. 10.1037/rep0000027 - DOI - PMC - PubMed

[4] Amtmann D., Askew R. L., Kim J., Chung H., Ehde D. M., Bombardier C. H., et al. . (2015). Pain affects depression through anxiety, fatigue, and sleep in multiple sclerosis. Rehabil. Psychol. 60, 81–90. 10.1037/rep0000027 - DOI - PMC - PubMed

[5] Andrews N. E., Strong J., Meredith P. J. (2012). Activity pacing, avoidance, endurance, and associations with patient functioning in chronic pain: a systematic review and meta-analysis. Arch. Phys. Med. Rehabil. 93, 2109–2121 e2107. 10.1016/j.apmr.2012.05.029 - DOI - PubMed

[6] Andrews N. E., Strong J., Meredith P. J. (2012). Activity pacing, avoidance, endurance, and associations with patient functioning in chronic pain: a systematic review and meta-analysis. Arch. Phys. Med. Rehabil. 93, 2109–2121 e2107. 10.1016/j.apmr.2012.05.029 - DOI - PubMed

[7] Apkarian A. V., Baliki M. N., Farmer M. A. (2013). Predicting transition to chronic pain. Curr. Opin. Neurol. 26, 360–367. 10.1097/WCO.0b013e32836336ad - DOI - PMC - PubMed

[8] Apkarian A. V., Baliki M. N., Farmer M. A. (2013). Predicting transition to chronic pain. Curr. Opin. Neurol. 26, 360–367. 10.1097/WCO.0b013e32836336ad - DOI - PMC - PubMed

[9] Apkarian A. V., Bushnell M. C., Treede R. D., Zubieta J. K. (2005). Human brain mechanisms of pain perception and regulation in health and disease. Eur. J. Pain 9, 463–484. 10.1016/j.ejpain.2004.11.001 - DOI - PubMed

[10] Apkarian A. V., Bushnell M. C., Treede R. D., Zubieta J. K. (2005). Human brain mechanisms of pain perception and regulation in health and disease. Eur. J. Pain 9, 463–484. 10.1016/j.ejpain.2004.11.001 - DOI - PubMed

Save citation to file

Email citation

Add to Collections

Add to My Bibliography

Your saved search

Create a file for external citation management software

Your RSS Feed

Psychological Considerations in the Assessment and Treatment of Pain in Neurorehabilitation and Psychological Factors Predictive of Therapeutic Response: Evidence and Recommendations from the Italian Consensus Conference on Pain in Neurorehabilitation

Affiliations

Psychological Considerations in the Assessment and Treatment of Pain in Neurorehabilitation and Psychological Factors Predictive of Therapeutic Response: Evidence and Recommendations from the Italian Consensus Conference on Pain in Neurorehabilitation

Authors

Affiliations

Abstract

Similar articles

Cited by

References

Publication types

LinkOut - more resources

Full Text Sources

Other Literature Sources

Research Materials

Abstract

Similar articles

Cited by

References

Publication types

Related information

LinkOut - more resources

Full Text Sources

Other Literature Sources

Research Materials