Quality of life, pain, and psychological factors in patients undergoing surgery for primary tumors of the spine.

PURPOSE: Knowledge about quality of life (QOL), pain, and psychological factors in patients with primary tumors of the spine is limited, but is important in planning rehabilitation after surgery. Aims of this study were to assess the preoperative levels and improvement after surgery of these factors, and to identify the predictors of postoperative pain and QOL. METHODS: Patients with primary tumors undergoing spine surgery were matched for sex and age with patients with metastatic tumors. QOL was measured at baseline and three months after surgery with the physical (PCS) and mental (MCS) components SF-12 subscales, pain intensity with a numeric rating scale (NRS), depression with the Beck Depression Inventory (BDI). Preoperative SF-12, NRS, and BDI levels and differences in follow-up improvement in SF-12 and NRS were compared across samples. LASSO regressions were performed to find predictors of follow-up SF-12 and NRS. RESULTS: Patients with primary tumors showed better PCS and NRS, and similar BDI and MCS than patients with metastatic tumors. At follow-up, they showed stronger improvement in the MCS and no improvement in the PCS. All QOL scores were below those of the general population. Follow-up PCS was predicted by baseline PCS and BDI; MCS by baseline MCS; pain intensity by baseline pain intensity and BDI. CONCLUSION: Patients with primary tumors of the spine suffer from moderate levels of physical and mental impairment. Depression influences surgical outcomes.

Quality parameters of hunted game meat: Sensory analysis and pH monitoring.

The aim of the present research is to propose a new, quick and objective method for the certification of hunted and/or culled wild game meat quality and to monitor its origin and the hunting practices adopted by hunters. The expected deliverable is a new labelling scheme for Italian hunted wild game meat that will guarantee high quality and safety standards for consumers and will decrease transaction costs of the supply chains. During the 2015, 2016 and 2017 hunting seasons, 1,056 hunted wild ungulates were sampled. Specifically, alpine chamois (n=537), roe deer (n=113), red deer (n=342) and wild boar (n=64), which were all hunted in the VCO2-Ossola Nord hunting district (Verbania Province, Piedmont, Italy). Samples of the longissimus dorsi were collected to evaluate the nutritional parameters and the acid profiles of the products. As a measure of meat quality, pH values have been recorded after slaughtering by inserting a probe in the semimembranosus muscle. The results were categorized as DFD (pH≥6,2), intermediate DFD (5,8≤pH<6,2) and high-quality meat (pH <5,8). As explanatory variables for the quality of wild game meat, differences based on age, gender and hunting practices were considered. Concerning the latter variables, measures were collected from animals received at hunting districts control centers by trained technicians who also collected information on the hunting practices, i.e., bleeding and evisceration of the carcasses and number of shots. Nutritional values showed low fat (<3 g per 100 g), low saturated fat (<1,5 g per 100 g) and high protein contents. Furthermore, wild game meat has high values of ω3 and CLA, ensuring a positive ω6/ω3 ratio. Differences were found in the concentrations of fat between age and gender, considering that during the mating season, adult males' weight loss can exceed 40%. Hunting practices seem to affect meat quality.

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.

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.

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.

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

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.