Techno-Algos Center

Chronic pain is the most prevalent disease among the Italian population. According to data from the Ministry of Health, more than 13 million of our countrymen suffer from it, and 4 million of them fail to get the treatment they would need to alleviate their daily suffering.

According to the definition provided by theInternational Association for the Study of Pain (IASP), pain represents “an unpleasant sensory and emotional experience associated with or similar to that associated with actual or potential tissue damage.”

In March 2010, Law 38 was enacted to ensure patient access to palliative care and pain therapy as part of the essential levels of care, which is still unimplemented in some regional settings.

The treatment

Pain therapy aims to recognize, assess, and treat chronic-type pain in the most appropriate way. The goal is, therefore, to control the often refractory algic stimulus in order to improve patients’ quality of life. To counter pain, several classes of drugs can be used for treatment.

The type of medication to be used may vary depending on the origin, nature, and intensity of the pain stimulus being treated. However, it should be pointed out that nonpharmacological treatments such as physical, physiotherapeutic and psychological therapies can also be used in pain therapy.

Chronic pain, the target of analgesic therapy, persists over time, is highly debilitating, and is capable of causing not only physical, but also psychological, social, and economic harm to patients who are afflicted by it.

Sometimes the patient experiences dysesthetic sensations from the parts of the body located below the level of the lesion that are characterized by persistent pain that manifests with different types of pain . The painful picture is often associated with both exteroceptive and proprioceptive paresthesias that implement the person’s state of distress and result in the need to implement specific treatments. A complex picture that has a spinal cord genesis where the damage has created a disconnection of the physiological transmission pathway of peripheral thermotactile and pain sensations with a dysnociceptive centralization that amplifies the painful perception complicated by peripheral sprouts: in the specific pathological condition of myelolysis, different types of pain can be recognized such as supralesional, perilesional, sublesional and visceral. A state of chronic pain that manifests itself with different clinical pictures also by virtue of bio-psycho-social factors that are not perfectly known on which are often triggered painful pathologies with different genesis with an ongoing pathogenesis of a different nature such as discogenic neuropathy or degenerative osteopathy pictures that complicate the differential diagnosis but that it is always necessary to implement in order to avoid generalizing each painful pathology as secondary to the ongoing nerve injury.

The treatment

Pain therapy aims to recognize, assess, and treat chronic-type pain in the most appropriate way. The goal is, therefore, to control the often refractory algic stimulus in order to improve patients’ quality of life. To counter pain, several classes of drugs can be used for treatment.

The type of medication to be used may vary depending on the origin, nature, and intensity of the pain stimulus being treated. However, it should be pointed out that nonpharmacological treatments such as physical, physiotherapeutic and psychological therapies can also be used in pain therapy.

Chronic pain, the target of analgesic therapy, persists over time, is highly debilitating, and is capable of causing not only physical, but also psychological, social, and economic harm to patients who are afflicted by it.

Sometimes the patient experiences dysesthetic sensations from the parts of the body located below the level of the lesion that are characterized by persistent pain that manifests with different types of pain . The painful picture is often associated with both exteroceptive and proprioceptive paresthesias that implement the person’s state of distress and result in the need to implement specific treatments. A complex picture that has a spinal cord genesis where the damage has created a disconnection of the physiological transmission pathway of peripheral thermotactile and pain sensations with a dysnociceptive centralization that amplifies the painful perception complicated by peripheral sprouts: in the specific pathological condition of myelolysis, different types of pain can be recognized such as supralesional, perilesional, sublesional and visceral. A state of chronic pain that manifests itself with different clinical pictures also by virtue of bio-psycho-social factors that are not perfectly known on which are often triggered painful pathologies with different genesis with an ongoing pathogenesis of a different nature such as discogenic neuropathy or degenerative osteopathy pictures that complicate the differential diagnosis but that it is always necessary to implement in order to avoid generalizing each painful pathology as secondary to the ongoing nerve injury.

The protocol of the San Raffaele Sulmona Nursing Home.

In early 2021, the San Raffaele Sulmona Nursing Home, as part of its study of patient needs, conducted a survey of the negative symptoms that occurred in patients who had not taken advantage of the periodic follow-up in the Spinal Unit. On this occasion, a questionnaire was made in which 106 patients were asked to report about some clinical features such as spasticity, bowel and bladder function, anxiety and depression, and pain and its location, assessed by NRS scale. Among the data that emerged from the in-person or telephone interview, of the patients who responded from the questionnaire, the high percentage of the presence of pain symptomatology, present in 86% of the participating respondents, was highlighted.

Based on this knowledge and the common intent to provide appropriate specialized care on pain symptomatology, in June 2021, the ISAL Foundation and the San Raffaele Sulmona Nursing Home have finalized an agreement through the signing of a Memorandum of Understanding of Collaborative Care – Scientific – Educational Collaboration. which has as its primary goal to develop a “Pain Area” specialty defined Techno-Algos Center within the Sulmonese health facility, dedicated specifically to the study and treatment of complex pain secondary to neuro-dysfunctional nervous system injury. The protocol defined its scientific and clinical coordination as well as implemented its mission in bio-technology and clinical research.

After the activation of this protocol, the Parties formed a multidisciplinary staff within the Techno-Algos Center that initiated specialized algological training both with field training, especially in the use of the equipment provided, and through the support of the ISAL Training School.

In order to ensure appropriate and effective clinical management of pain in complex conditions, Tecno-Algos staff developed new models of specialized assessment of pain patterns and activation of a specific setting of pharmacological and instrumental treatments for people hospitalized with pain. After an initial phase of surveillance and analysis of the prevalence status of pain present in patients admitted to the Spinal Unit and the Neuromotor Unit and current treatments, pain management patterns were revisited with the creation of a specific medical record Tecno–Algos where the clinical features of the current pain patterns are described and the therapeutic strategies that will be implemented both instrumental and pharmacological in nature are prescribed. The folder is included in the records of every inpatient with painful conditions.

A protocol was then structured for the identification and discussion of clinical cases so that their treatment and evaluation could be shared with all Spinal Unit staff, and, in parallel, a training and awareness program on pain management dedicated to nursing and technical staff working on myelopathy patients was activated.

At the conclusion of this phase, the working model and tools tested will be presented to the scientific community working in the field of myelogenous disorders to obtain validation at the National level.

The protocol of the San Raffaele Sulmona Nursing Home.

In early 2021, the San Raffaele Sulmona Nursing Home, as part of its study of patient needs, conducted a survey of the negative symptoms that occurred in patients who had not taken advantage of the periodic follow-up in the Spinal Unit. On this occasion, a questionnaire was made in which 106 patients were asked to report about some clinical features such as spasticity, bowel and bladder function, anxiety and depression, and pain and its location, assessed by NRS scale. Among the data that emerged from the in-person or telephone interview, of the patients who responded from the questionnaire, the high percentage of the presence of pain symptomatology, present in 86% of the participating respondents, was highlighted.

Based on this knowledge and the common intent to provide appropriate specialized care on pain symptomatology, in June 2021, the ISAL Foundation and the San Raffaele Sulmona Nursing Home have finalized an agreement through the signing of a Memorandum of Understanding of Collaborative Care – Scientific – Educational Collaboration. which has as its primary goal to develop a “Pain Area” specialty defined Techno-Algos Center within the Sulmonese health facility, dedicated specifically to the study and treatment of complex pain secondary to neuro-dysfunctional nervous system injury. The protocol defined its scientific and clinical coordination as well as implemented its mission in bio-technology and clinical research.

After the activation of this protocol, the Parties formed a multidisciplinary staff within the Techno-Algos Center that initiated specialized algological training both with field training, especially in the use of the equipment provided, and through the support of the ISAL Training School.

In order to ensure appropriate and effective clinical management of pain in complex conditions, Tecno-Algos staff developed new models of specialized assessment of pain patterns and activation of a specific setting of pharmacological and instrumental treatments for people hospitalized with pain. After an initial phase of surveillance and analysis of the prevalence status of pain present in patients admitted to the Spinal Unit and the Neuromotor Unit and current treatments, pain management patterns were revisited with the creation of a specific medical record Tecno–Algos where the clinical features of the current pain patterns are described and the therapeutic strategies that will be implemented both instrumental and pharmacological in nature are prescribed. The folder is included in the records of every inpatient with painful conditions.

A protocol was then structured for the identification and discussion of clinical cases so that their treatment and evaluation could be shared with all Spinal Unit staff, and, in parallel, a training and awareness program on pain management dedicated to nursing and technical staff working on myelopathy patients was activated.

At the conclusion of this phase, the working model and tools tested will be presented to the scientific community working in the field of myelogenous disorders to obtain validation at the National level.

The team

Currently, the team dedicated to the Techno-Algos Center consists of the Dr. William Raffaeli, anesthesiologist-algologist and president of the ISAL Foundation, from the Dr. Giovanni Morone, a physiatrist, researcher at the University of L’Aquila and a physician attached to the Neuromotor Department at San Raffaele Sulmona, from the Dr. Maria Pia D’Eramo, a doctor attached to the Spinal Department at San Raffaele Sulmona and from the Dr. Luca Greco, psychotherapist at St. Raphael Sulmona; also to be considered is the supervision of the Dr. Giorgio Felzani, physiatrist, Chief of the Spinal Unit at San Raffaele Sulmona, and the collaboration of the Dr. Michael Tenti, psychologist and researcher at the ISAL Foundation for Clinical Research Support in Psychology.

The team

Currently, the team dedicated to the Techno-Algos Center consists of the Dr. William Raffaeli, anesthesiologist-algologist and president of the ISAL Foundation, from the Dr. Giovanni Morone, a physiatrist, researcher at the University of L’Aquila and a physician attached to the Neuromotor Department at San Raffaele Sulmona, from the Dr. Maria Pia D’Eramo, a doctor attached to the Spinal Department at San Raffaele Sulmona and from the Dr. Luca Greco, psychotherapist at St. Raphael Sulmona; also to be considered is the supervision of the Dr. Giorgio Felzani, physiatrist, Chief of the Spinal Unit at San Raffaele Sulmona, and the collaboration of the Dr. Michael Tenti, psychologist and researcher at the ISAL Foundation for Clinical Research Support in Psychology.

The rehabilitation offerings of the facility

From May 1, 2022 to May 31, 2023, No. 79 patients were taken in charge, 50 of whom manifested subdural algic symptoms referable to spinal cord injury of either traumatic or medical origin, corresponding to 63.2% of the patients admitted.

In order to optimize the organization in the management of patients in the pre-hospitalization phase, a protocol has been initiated whereby eligible individuals are contacted by telephone to conduct preventive assessments prior to admission to the facility, in order to have a meaningful picture of pain symptoms as early as the time of admission.

Therefore, therehabilitation offerings of the San Raffaele Sulmona Nursing Home include several pathways that can be activated either individually or simultaneously:

  1. After admission to the ward, the patient is initiated to an initial phase of accurate assessment on the presence of pain symptoms and the specific characteristics manifested with the compilation of the “Tecno – Algos” pain chart and psychological evaluation.

    Patients with complex pain who have no benefit with drug treatments are recruited and undergo Transcranial Magnetic Stimulation (TMS) treatments. On a monthly basis, subjects undergoing treatment undergo a multidisciplinary clinical evaluation, with a discussion of all cases and possible rescheduling of drug therapy and implementation of specific treatments where necessary.

    To this end, drugs have been selected for inclusion in the in-house pharmaceutical formulary in order to implement precision therapy offerings.

  2. Following the aforementioned evaluation and possible modification of drug therapy, the rehabilitation protocol shared with the “Tecno-Algos” working group is activated, which includes, in addition to conventional physical therapies, the use of equipment provided by the facility.
  3. Patients, throughout the course of the course, are also followed psychologically in the form of supportive pathways, psychotherapy courses, relaxation practices and through the use of techniques such as EMDR and Autogenic Training for pain management.
  4. Transcranial Magnetic Stimulation (TMS) is applied to individuals who are poorly responsive to rehabilitative, pharmacological and instrumental therapies. TMS is a noninvasive technique of electromagnetic stimulation of brain tissue performed by placing powerful magnets near the skin. With this technique it is possible to stimulate and study the functioning of neuronal circuits and connections in the brain, causing a rather small and transient alteration of electrical activity that is mostly limited to the outermost tissues. The treatment magnetically stimulates brain structures and networks related to neuropathic pain. TMS can be used to modulate cortical excitability and inhibit painful perception in the brain making significant improvements in the patient’s quality of life.

    This therapy is implemented to patients with pain of a central neuropathic nature afferent within the Spinal Unit and Neuromotor Department. A protocol of use was characterized with regard to both the site to be stimulated and the parameters to be used in it. The cycle consists of thirty treatment sessions at a daily frequency, with weekly monitoring.

    TMS is made possible through the use of a Magstim Rapid2 model Magnetic Stimulator; along with the stimulation technology, a Softaxic Optical Neuro Navigation System is also used, which allows for more accurate identification of the areas of the brain to be treated.
    Ninety percent of treated patients responded positively on pain reduction. Here, too, the process is constantly monitored through the completion of an updated form at every single session.

  5. Another activity of fundamental importance to the center is that reserved for experimental research; as a first act, in May 2022, research was initiated, submitted to and authorized by the ASL1 Ethics Committee, on the use of a nutriceutical product (NACVAN), in subjects with spinal cord injury pain who had been found to be intolerant or unresponsive to drugs belonging to the anticonvulsant category such as the Pregabalyn which is the drug of first choice in central neuropathic pain. From May 2022 to May 2023, 30 patients afferent to the Spinal Unit of San Raffaele Sulmona Nursing Home were identified, selected and evaluated. The data obtained through analysis of the validated scales showed a significant improvement in pain control and thus its possible usefulness for individuals who have no possibility of appropriate dose use of anticonvulsant drugs. Regarding the clinical research activity inherent in the NACVAN supplement, on Sept. 16, the article “
    A Nutritional Supplement as Adjuvant of Gabapentinoids for Adults with Neuropathic Pain following Spinal Cord Injury and Stroke: Preliminary Results
    “. The set of clinical and research activities, carried out by the “Tecno-Algos” working group, are producing in the care activity a greater attention to the components of pain in patients attending the San Raffaele Sulmona Nursing Home.

 

The research being developed by the “Tecno-Algos” group is aimed at identifying which anatomical targets to focus TMS treatment on, targets that can ensure a standard of therapeutic appropriateness in its clinical use. A research group was formed in July 2023 to prepare a scientific protocol aimed at participating in upcoming European and national research calls. The research project is dedicated to the development of new models of care using virtual technology. A specific Virtual Reality model, designed by the “Tecno-Algos” group itself, has been defined, which will require the creation of new tools not found in the literature. The Virtual Reality research group consists of the components of the Techno Center – Algos to which was added the specialized expertise of theEng. Francesco Infarinato and its clinical engineering working group afferent to theIRCCS San Raffaele of Rome, a sign of the ongoing collaboration between the San Raffaele Sulmona nursing home and the research laboratories of the same IRCCS.

 

The rehabilitation offerings of the facility

From May 1, 2022 to May 31, 2023, No. 79 patients were taken in charge, 50 of whom manifested subdural algic symptoms referable to spinal cord injury of either traumatic or medical origin, corresponding to 63.2% of the patients admitted.

In order to optimize the organization in the management of patients in the pre-hospitalization phase, a protocol has been initiated whereby eligible individuals are contacted by telephone to conduct preventive assessments prior to admission to the facility, in order to have a meaningful picture of pain symptoms as early as the time of admission.

Therefore, therehabilitation offerings of the San Raffaele Sulmona Nursing Home include several pathways that can be activated either individually or simultaneously:

  1. After admission to the ward, the patient is initiated to an initial phase of accurate assessment on the presence of pain symptoms and the specific characteristics manifested with the compilation of the “Tecno – Algos” pain chart and psychological evaluation.

    Patients with complex pain who have no benefit with drug treatments are recruited and undergo Transcranial Magnetic Stimulation (TMS) treatments. On a monthly basis, subjects undergoing treatment undergo a multidisciplinary clinical evaluation, with a discussion of all cases and possible rescheduling of drug therapy and implementation of specific treatments where necessary.

    To this end, drugs have been selected for inclusion in the in-house pharmaceutical formulary in order to implement precision therapy offerings.

  2. Following the aforementioned evaluation and possible modification of drug therapy, the rehabilitation protocol shared with the “Tecno-Algos” working group is activated, which includes, in addition to conventional physical therapies, the use of equipment provided by the facility.
  3. Patients, throughout the course of the course, are also followed psychologically in the form of supportive pathways, psychotherapy courses, relaxation practices and through the use of techniques such as EMDR and Autogenic Training for pain management.
  4. Transcranial Magnetic Stimulation (TMS) is applied to individuals who are poorly responsive to rehabilitative, pharmacological and instrumental therapies. TMS is a noninvasive technique of electromagnetic stimulation of brain tissue performed by placing powerful magnets near the skin. With this technique it is possible to stimulate and study the functioning of neuronal circuits and connections in the brain, causing a rather small and transient alteration of electrical activity that is mostly limited to the outermost tissues. The treatment magnetically stimulates brain structures and networks related to neuropathic pain. TMS can be used to modulate cortical excitability and inhibit painful perception in the brain making significant improvements in the patient’s quality of life.

    This therapy is implemented to patients with pain of a central neuropathic nature afferent within the Spinal Unit and Neuromotor Department. A protocol of use was characterized with regard to both the site to be stimulated and the parameters to be used in it. The cycle consists of thirty treatment sessions at a daily frequency, with weekly monitoring.

    TMS is made possible through the use of a Magstim Rapid2 model Magnetic Stimulator; along with the stimulation technology, a Softaxic Optical Neuro Navigation System is also used, which allows for more accurate identification of the areas of the brain to be treated.
    Ninety percent of treated patients responded positively on pain reduction. Here, too, the process is constantly monitored through the completion of an updated form at every single session.

  5. Another activity of fundamental importance to the center is that reserved for experimental research; as a first act, in May 2022, research was initiated, submitted to and authorized by the ASL1 Ethics Committee, on the use of a nutriceutical product (NACVAN), in subjects with spinal cord injury pain who had been found to be intolerant or unresponsive to drugs belonging to the anticonvulsant category such as the Pregabalyn which is the drug of first choice in central neuropathic pain. From May 2022 to May 2023, 30 patients afferent to the Spinal Unit of San Raffaele Sulmona Nursing Home were identified, selected and evaluated. The data obtained through analysis of the validated scales showed a significant improvement in pain control and thus its possible usefulness for individuals who have no possibility of appropriate dose use of anticonvulsant drugs. Regarding the clinical research activity inherent in the NACVAN supplement, on Sept. 16, the article “
    A Nutritional Supplement as Adjuvant of Gabapentinoids for Adults with Neuropathic Pain following Spinal Cord Injury and Stroke: Preliminary Results
    “. The set of clinical and research activities, carried out by the “Tecno-Algos” working group, are producing in the care activity a greater attention to the components of pain in patients attending the San Raffaele Sulmona Nursing Home.

 

The research being developed by the “Tecno-Algos” group is aimed at identifying which anatomical targets to focus TMS treatment on, targets that can ensure a standard of therapeutic appropriateness in its clinical use. A research group was formed in July 2023 to prepare a scientific protocol aimed at participating in upcoming European and national research calls. The research project is dedicated to the development of new models of care using virtual technology. A specific Virtual Reality model, designed by the “Tecno-Algos” group itself, has been defined, which will require the creation of new tools not found in the literature. The Virtual Reality research group consists of the components of the Techno Center – Algos to which was added the specialized expertise of theEng. Francesco Infarinato and its clinical engineering working group afferent to theIRCCS San Raffaele of Rome, a sign of the ongoing collaboration between the San Raffaele Sulmona nursing home and the research laboratories of the same IRCCS.

 

Strutture

St. Raphael Sulmona

St. Raphael Sulmona

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P.IVA 08253151008
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Copyright 2023 © San Raffaele S.p.A.
P.IVA 08253151008
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