What Is the Role of the Placebo Effect for Pain Relief in Neurorehabilitation? Clinical Implications From the Italian Consensus Conference on Pain in Neurorehabilitation.

BACKGROUND: It is increasingly acknowledged that the outcomes of medical treatments are influenced by the context of the clinical encounter through the mechanisms of the placebo effect. The phenomenon of placebo analgesia might be exploited to maximize the efficacy of neurorehabilitation treatments. Since its intensity varies across neurological disorders, the Italian Consensus Conference on Pain in Neurorehabilitation (ICCP) summarized the studies on this field to provide guidance on its use. METHODS: A review of the existing reviews and meta-analyses was performed to assess the magnitude of the placebo effect in disorders that may undergo neurorehabilitation treatment. The search was performed on Pubmed using placebo, pain, and the names of neurological disorders as keywords. Methodological quality was assessed using a pre-existing checklist. Data about the magnitude of the placebo effect were extracted from the included reviews and were commented in a narrative form. RESULTS: 11 articles were included in this review. Placebo treatments showed weak effects in central neuropathic pain (pain reduction from 0.44 to 0.66 on a 0-10 scale) and moderate effects in postherpetic neuralgia (1.16), in diabetic peripheral neuropathy (1.45), and in pain associated to HIV (1.82). Moderate effects were also found on pain due to fibromyalgia and migraine; only weak short-term effects were found in complex regional pain syndrome. Confounding variables might have influenced these results. CLINICAL IMPLICATIONS: These estimates should be interpreted with caution, but underscore that the placebo effect can be exploited in neurorehabilitation programs. It is not necessary to conceal its use from the patient. Knowledge of placebo mechanisms can be used to shape the doctor-patient relationship, to reduce the use of analgesic drugs and to train the patient to become an active agent of the therapy.

Range of motion limitations of the upper body in obese female workers.

BACKGROUND: The prevalence of obesity is increasing worldwide, and the economic consequences of an increased percentage of obese workers are relevant in terms of health costs and absences from work. Obesity is associated with reduced participation in the workforce, increased absence from work, disability and health costs, lower salaries and reduced productivity. OBJECTIVES: We aimed at quantifying the limitations in range of motion (ROM) of the upper limb and the trunk of obese workers during basic occupational tasks. METHODS: One group of 15 obese female subjects (BMI: 42.10±9.10 kg/m2) and one control group of 13 normal-weight female subjects were recruited. Three group of tasks were selected as representative of basic occupational movements: 1) upper limb movements (reaching, abduction-adduction, frontal elevation); 2) trunk movements (lateral bending, rotation); 3) whole body movement (target task). RESULTS: We observed significant range of motion limitations in lateral and frontal upper arm elevation. Statistically significant difference in terms of center of pressure (the point of application of the ground reaction force measured by means of force platform) excursions was observed for lateral bending and trunk rotation tasks. CONCLUSIONS: Our results show that obese subjects have significant range of motion limitations of the upper body during basic occupational activities. This study provides quantitative evidence of these limitations of obese workers and may serve occupational specialists to allocate them to adequate jobs and reduce the rate of work-related musculoskeletal disorders.