Chair: Catherine Blake, Ireland
Catherine Blake, Ireland
Neuropathic pain 1
Roberto Casale, Italy
The patient with neuropathic pain, that is a pain raising from an injury or a pathology of the somatosensory system, has often also associated motor disorders making his/her disability even worst. For this reason, very often, in rehabilitation we are faced with requests for rehabilitation -motor and functional recovery- without any therapeutic indication on the concomitant presence of pain that can make the application of the usual physiotherapy techniques inadequate if applied alone without an adequate pain control.
In addition, the use of physical therapy and rehabilitation in general in patients with neuropathic pain poses problems relating to what type of fibers have been damaged and consequently what type of stimulus / physical therapy (including movement) can be applied. In rehabilitation, it is therefore essential to identify, through the examination of the sensory system, the type of injury underlying both positive and negative sensory symptoms. For example, in a painful condition following a nerve injury, the semeiological examination must not stop at identifying the anatomical site where there is the lesion along the nervous system, but has to go deep in identifying also what type of fiber/s were injured and, as far as possible, what are the mechanisms of maintenance/generation of pain.
Each physical and rehabilitative therapy acts through the interaction between exteroceptive and proprioceptive stimuli and the response they generate within the nervous system. This is possible if the "chosen communication channels" allow this interaction. That is, for estero- and proprioceptive stimuli, if the afferent sensory pathways are intact.
In the case of neuropathic pain this integrity is not guaranteed and therefore ,before choosing a specific physical energy (in term of therapeutical dose and also where to apply it) or a specific physiotherapy rehabilitation scheme, it is necessary to know what kind of communication channel (in this case what type of fiber) allows us this interaction.
Neuropathic pain 2
Roberto Casale, Italy
An de Groef, Belgium
Pain during and after cancer treatment and its under-treatment is clearly a problem and with the increasing survival rates and advances in cancer treatments, this problem is likely to get bigger. Moreover, both patients and health care providers are not aware of potential benefits of rehabilitation strategies for the management of pain during and following cancer treatment. In this presentation, first, an overview will be given of the most common painful side effects of different cancer treatment modalities, including chemotherapy-induced neuropathy, post-surgical pain, and hormone therapy related arthralgia. Second, the best evidence rehabilitation modalities for patients having (persistent) pain during and following cancer treatment, including educational interventions, specific exercise therapies, manual therapies, general exercise therapies and mind-body exercise therapies will be summarized from a clinical perspective and discussed from a scientific perspective.