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Giustino Varrassi

Giustino Varrassi
Paolo Procacci Foundation

President Paolo Procacci Foundation
Interested in education and research on Pain Medicine; directing scientific activities of #PaoloProcacciFoundation

About

504
Publications
184,040
Reads
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4,887
Citations
Introduction
Giustino Varrassi currently works at Paolo Procacci Foundation (https://www.fondazioneprocacci.org/), a Foundation devoted to research and education on pain. Giustino's researches are in Pain Medicine, Anesthesia, and Education. He is particularly interested in 'management of Inflammatory pain'.
Additional affiliations
February 2008 - present
Paolo Procacci Foundation
Position
  • CEO
Description
  • Foundation for Education and Research in Pain Management
November 2000 - June 2011
Università degli Studi dell'Aquila
Position
  • CEO
August 1993 - present
European Federation of IASP Chapters (EFIC)
Position
  • Different positions
Description
  • Different positions in the Executive board from August 1993 till September 2014
Education
November 1967 - July 1973
Sapienza University of Rome
Field of study
  • Medicine

Publications

Publications (504)
Article
Efficacy of epidural local anesthetics plus steroids for the treatment of cervicobrachial pain is uncertain. A prospective study randomized 160 patients with cervicobrachial pain resistant to conventional therapy. Patients were divided into 4 groups on the basis of the time between pain onset and treatment initiation: group A, 40 patients with pain...
Article
Full-text available
Background: Piriformis syndrome (PS) is a painful condition caused by entrapment of the sciatic nerve within the piriformis muscle. PS is typically unilateral and mainly occurs related to entrapment of the sciatic nerve. Treatments include physiotherapy, analgesics, anti-inflammatory drugs, behavioral modifications, injection therapy with local ane...
Article
Background: Piriformis syndrome (PS) is a painful condition caused by entrapment of the sciatic nerve within the piriformis muscle. PS is typically unilateral and mainly occurs related to entrapment of the sciatic nerve. Treatments include physiotherapy, analgesics, anti-inflammatory drugs, behavioral modifications, injection therapy with local an...
Article
Background Facet-mediated pain is a major cause of low back pain and as a result, is a significant cause of morbidity, including disability and reduced functionality. Setting The present investigation involved a PubMed literature review between June 1, and 2021-January 1, 2022. Methods We systematically reviewed was carried Pubmed using the searc...
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Introduction: Despite a wide range of treatment approaches and the availability of treatment recommendations or guidelines, no consensus on the most effective pharmacological therapy of low back pain (LBP) has been reached yet. Therefore, additional clinical evidence, particularly if built upon a rigorous clinical trial design, an evidence-based m...
Article
Introduction: This network meta-analysis aimed to assess the efficacy of acupuncture, intravenous lidocaine, and diet compared with other comparators such as physiotherapy and sham/placebo in fibromyalgia patients. Materials and Methods: We searched Embase, PubMed, Scopus, and Web of Science for relevant studies till September 2021. The included st...
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Atypical opioids such as tramadol, tapentadol, and cebranopadol combine two complementary mechanisms of action into a single molecule, creating novel analgesic agents. These are synthetic small molecules: cebranopadol is not yet market released; tramadol and tapentadol are commercially available and have immediate-release (IR) and extended-release...
Article
Introduction: Guidelines recommend a number of pharmacotherapeutic options used as monotherapy or in combination with others for treating the pain of trigeminal neuropathy. Areas covered: The authors examine the pharmacotherapeutic options for treating trigeminal neuralgia and supporting evidence in the literature. Guidelines reported the most e...
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Introduction: Delirium in end-of-life patients is reported to be between 13% and 42% and up to 80% in the terminal phase. It is a serious clinical situation, often a cause of death due to the frequent ineffectiveness of treatments. This study aimed to assess whether and how much precocity of diagnosis, hitherto little considered, could affect the o...
Article
Posterior tarsal tunnel syndrome (PTTS) is an entrapment neuropathy due to compression of the tibial nerve or one of its terminal branches within the tarsal tunnel in the medial ankle. The tarsal tunnel is formed by the flexor retinaculum, while the floor is composed of the distal tibia, talus, and calcaneal bones. The tarsal tunnel contains a numb...
Article
A migraine is a clinical diagnosis with a presentation of one or more severe unilateral or bilateral headache(s) often preceded by an aura and typically accompanied by nausea, vomiting, photophobia, and/or phonophobia. This neurological disease is often debilitating and greatly affects the quality of life of those it inflicts. In fact, a recent stu...
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Acute pain may be influenced by biopsychosocial factors. Conditioned pain modulation, distraction, peripheral nerve stimulation, and cryoneurolysis may be helpful in its treatment. New developments in opioids, such as opioids with bifunctional targets and oliceridine, may be particularly suited for acute pain care. Allosteric modulators can enhance...
Article
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Introduction: Assessment and management of pain in elderly people with cognitive impairment is particularly challenging. Physiological changes due to ageing as well as comorbidities and polypharmacy are responsible for a complex clinical approach. Concomitantly, in cognitive impairment, including advanced dementia, changes in the central nervous sy...
Article
Full-text available
Chronic postoperative pain (CPOP) is prevalent, with particularly high rates in breast surgery, thoracotomy, and amputation. As the world emerges from the coronavirus disease 2019 (COVID-19) lockdowns, it is expected that there will be an increase in surgical procedures, elevating the importance of preventing CPOP in the coming years. Risk factors...
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Introduction: The universality and complexity of pain, which is highly prevalent, yield its significance to both patients and researchers. Developing a non-invasive tool that can objectively measure pain is of the utmost importance for clinical and research purposes. Traditionally electroencephalography (EEG) has been mostly used in epilepsy; howe...
Article
Spinal Anesthesia was the first regional anesthetic technique to be performed. It was performed by Dr. August Bier, known for the Bier block, and his colleagues on August 16, 1898. Dr. Bier opted for, what he referred to at the time as “cocainization of the spinal cord" by introducing 15 mg of cocaine intrathecally prior to the operation. The surge...
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Vaccinations and therapeutics have been developed for COVID-19, but vaccine uptake varies markedly among countries. Public health responses have also varied, in particular, with lockdown efforts and school closing. All over the world, the pandemic exposed healthcare and economic weaknesses. COVID-19 exacerbated mental health issues by exposing the...
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Postoperative pain is prevalent and often undertreated. There is a risk that untreated or suboptimally treated postoperative pain may transition into chronic postoperative pain, which can be challenging to treat. Clinical guidelines recommend the use of multimodal analgesia, including non-steroidal anti-inflammatory drugs (NSAIDs), acetaminophen, a...
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Low back pain (LBP) is a prevalent condition associated with disability. Treating patients with LBP becomes further complicated by the potential presence of underlying conditions, such as cancer or traumatic injury, or biopsychosocial aspects. LBP usually has a neuropathic component that must be assessed and treated appropriately. Pharmacological m...
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Cocaine is taken frequently together with ethanol and this combination produces a psychoactive metabolite called cocaethylene which has similar properties to the parent drug and may be more cardiotoxic. Cocaethylene has a longer half-life than cocaine, so that people who combine cocaine and ethanol may experience a longer-lasting, as well as more i...
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It is crucial that acute pain be promptly and adequately treated in order to prevent it from transitioning to chronic pain, a devastating and sometimes permanent condition that is challenging to treat and associated with disability, reduced quality of life, and depression. Guidelines for the treatment of acute low-back pain (LBP) are predicated on...
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Full-text available
Neuropathic pain is defined as a painful condition caused by neurological lesions or diseases. Sometimes, neurological disorders may also be associated with neuropathic pain, which can be challenging to manage. For example, multiple sclerosis (MS) may cause chronic centralized painful symptoms due to nerve damage. Other chronic neuropathic pain syn...
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A patient-centric approach to pain control represents a paradigm shift in analgesia and one that is both easy to endorse but challenging to execute. As pain mechanisms become increasingly elucidated, the understanding of pain has changed to encompass its complexities. Multiple types and mechanisms of pain have been described, and pain must be seen...
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Acute postoperative pain is a normal and expected part of the patient’s postsurgical trajectory, and its intensity, severity, and duration vary with surgery-related and patient factors. In a subset of patients, postoperative pain does not resolve as the tissue heals but instead transitions to chronic postoperative pain, a challenging condition to t...
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This article reports about the developments of the journal (Pain and Therapy) during 2021. The year was really challenging, but the journal increased significantly all its numbers, starting from its impact factor (5.725).
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Introduction: Opioid-induced constipation (OIC) is the most common adverse effect of opioid therapy, but it is underdiagnosed and undertreated. Last year, a survey among Italian healthcare providers revealed important differences in the clinical management of OIC across physician specialties, the need of standardization of diagnosis and treatment,...
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Premature babies often suffer apnea of prematurity as a physiological consequence of an immature respiratory system. Hypercapnia may develop, and neonates with apnea of prematurity are at an increased risk of morbidity and mortality. The long-term effects of apnea of prematurity or their treatments are less clear. While a number of treatment option...
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Palliative medicine is an important topic, especially during the COVID pandemia. The authors present a review of many of the critical aspects and challenges. They conclude that at the moment, due to the general situation of the global health care systems, palliative medicine would deserve an increasing attention and a more scientific approach. They...
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Introduction: Postherpetic neuralgia (PHN) is associated with moderate to severe pain with peripheral and central mechanisms. While there is no clear-cut first-line therapeutic approach to PHN pain control, lidocaine patches are frequently used as monotherapy or part of a multimodal pain regimen. Methods: An online survey, the first of its kind, wa...
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Quality of life in fibromyalgic patients is always a psychological health problem. During the COVID pandemia it is even more challenging. We have tried to explore the topic, with good results.
Article
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Success of Signa Vitae during the COVID tine
Chapter
Continue improvements in management of acute and chronic cardiovascular diseases (CVD) and the increasing prevalence of “pain diseases” have resulted in a significant number of patients with, or at high risk for, CVD also requiring analgesic drugs due to painful syndromes. Pathophysiological changes characterizing both acute and chronic pain are co...
Chapter
The knowledge of how to achieve effective pain relief is of major importance to all doctors and healthcare professionals that is treating patients undergoing surgery. Pain relief provides significant physiological benefits; hence, monitoring pain relief and its impact is increasingly becoming an important postoperative measurement of quality. The g...
Preprint
Background: Assessment and management of pain in elderly people with cognitive impairment is particularly challenging. Physiological changes due to aging as well as comorbidities and polypharmacy are responsible for a complex clinical approach. Concomitantly, in cognitive impairment, including advanced dementia, changes in central nervous system al...
Article
Chronic pain significantly worsens the quality of life. Unlike neuropathic, musculoskeletal, postoperative pain, and cancer pain, chronic primary pain cannot be explained by an underlying disease or condition, making its treatment arduous. This manuscript intends to provide a comprehensive review of the use of ketamine as a treatment option for spe...
Article
Bertolotti’s Syndrome is defined as chronic back pain caused by transitional lumbosacral vertebra. The transitional vertebra may present with numerous clinical manifestations leading to a myriad of associated pain types. The most common is pain in the sacroiliac joint, groin, and hip region and may or may not be associated with radiculopathy. Diagn...
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Full-text available
A clinical conundrum can occur when a patient with active opioid use disorder (OUD) or at elevated risk for the condition presents with cancer and related painful symptoms. Despite earlier beliefs that cancer patients were relatively unaffected by opioid misuse, it appears that cancer patients have similar risks as the general population for OUD bu...
Article
Introduction Physical exercise appeared to be effective, when implemented as an adjuvant to the pharmacotherapy option, in a variety of painful conditions. Peripheral neuropathic pain (PNP) is very prevalent and it affects up to two-thirds of individuals with polyneuropathy (PN), regardless of etiology. The aim of this systematic review was to eval...
Article
Background: Chronic non-specific low back pain (NLBP) affects people of all ages and pose a serious threat to human health. Fu's subcutaneous needling (FSN) has been reported to be effective in treating such disorders, but the control group is lacking. The aim of this randomized parallel study is to compare the long-term efficiency of FSN therapy w...
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Benzodiazepines are one of the most commonly used medications in the field of anesthesia. They offer excellent anxiolytic and amnestic properties ideal for the perioperative period when patient anxiety is understandably heightened. Remimazolam has presented a favorable alternative to some of the common intravenous anesthetic agents used given its f...
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IntroductionSpinal cord stimulation (SCS) is a commonly utilized therapy for the treatment of neuropathic pain conditions. The Neurostimulation Appropriateness Consensus Committee (NACC) has recommended that the placement of percutaneous SCS leads be performed in an awake patient capable of providing feedback. It is not currently known how commonly...
Article
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The majority of patients who have undergone surgery experience moderate-to-severe postoperative pain. Asian patients tend to under-report pain and are consequently under-treated. Poor postoperative pain management increases the risk of morbidity, prolonged opioid use, lower quality of life outcomes and the risk of chronic post-surgical pain. Multim...
Article
Opioid toxicity can result in life-threatening respiratory depression. Opioid-overdose mortality in the United States is high and increasing, but it is difficult to determine what proportion of those deaths might actually be suicides. The exact number of Americans who died of an opioid overdose but whose deaths might be classified as suicide remain...
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Mortality data in most countries are reported using the International Classification of Diseases (ICD), managed by the WHO. In this paper, we show how the ICD is ill-suited for classifying drug-involved deaths, many of which involve polysubstance abuse and/or illicitly manufactured fentanyl (IMF). Opioids identified in death certificates are categ...
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Introduction: Spinal endoscopic techniques have recently been applied to complex degenerative conditions or failed back surgery syndrome. We performed a systematic review and meta-analysis to assess transforaminal endoscopic lumbar foraminotomy (TELF) outcomes and adverse event rates. We also analyzed the effectiveness of the technique for chronic...
Article
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Stroke is considered one of the main causes of adult disability and the second most serious cause of death worldwide. The combination of botulinum toxin type A (BTX) with rehabilitation techniques such as modified constraint-induced movement therapy (mCIMT) has emerged as a highly efficient intervention for stroke patients to start synchronized mot...
Article
Introduction The definition of nociplastic pain in 2016 has changed the way maladaptive chronic pain is viewed in that it may emerge without neural lesions or neural disease. Many endogenous and pharmacologic substances are being investigated for their role in treating the pain associated with neuronal plasticity. Areas Covered The authors review...
Article
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The article previously published in Pain and Therapy was questioned for some scientific aspects. The authors are punctually replying to the criticisms publicly made by some valued Colleagues.
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IntroductionWheelchair users are at a high risk of experiencing non-neuropathic pain of musculoskeletal origin as a result of being wheelchair-bound. The aim of this systematic review was to establish the prevalence of musculoskeletal pain in wheelchair users that is attributable to wheelchair use, and to describe the different pain syndromes and d...
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Objective: Osteoarthritis (OA) is the most common cause of chronic knee pain, often a debilitating condition that can cause a significant reduction in functional capacity. Radiofrequency is a form of neuromodulation that modulates pain signal transmission and has become progressively more common as a treatment for knee pain. This retrospective stu...
Article
Chronic pain is a major health concern, albeit underestimated in times of a pandemic. With about a third of pain patients without a diagnosis and delayed referral to pain therapy specialists, the current management of chronic pain requires significant re-evaluation. The COVID-19 pandemic has, on the one hand, made the gaps in health systems more ev...
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Purpose The exact nature of sex and gender differences in knee osteoarthritis (OA) among patient candidates for total knee arthroplasty (TKA) remains unclear and requires better elucidation to guide clinical practice. The purpose of this investigation was to survey physician practices and perceptions about the influence of sex and gender on knee OA...
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Objective Since skeletal muscle spasms are prevalent and can cause moderate to severe pain, the authors created a narrative review to describe the various types of skeletal muscle spasms and their treatment. Methods This is a narrative review based on a literature search of clinical trials and randomized clinical trials about “skeletal muscle sp...
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Objective The severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) pandemic has diverse manifestations including neurological. Chronic pain can lead to a number of detrimental health issues such as mental health problems, opioid use disorder, and potentially suicide. Chronic pain is a prevalent condition around the world and it is not yet c...
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Objective Transdermal buprenorphine is approved to manage chronic pain, but may be considered for acute pain management in the clinical setting, such as postoperative pain control. Methods The authors completed a literature search and created a narrative review with emphasis on clinical studies using transdermal buprenorphine to manage pain. Mos...
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Objective Treating acute or chronic pain with more than one analgesic agent or with an analgesic agent and an adjuvant is a well-established principle of pain medicine. Combinations can be opioid-sparing without sacrificing efficacy. Our objective was to write about the current knowledge of combination therapy for pain control. Methods This is a...
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Objective A subset of patients who survive acute COVID infection may have a postviral syndrome of prolonged symptoms which may or may not be the same as their acute symptoms. There is a paucity of evidence and studies about Long COVID although emerging information, largely from patient self-reports, has helped to describe the condition. Our goal w...
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Objective Adverse childhood experiences (ACEs) such as emotional, physical, or sexual abuse, parental separation or imprisonment, and household substance use disorder have been reported in about 16% of Americans. The number of ACEs has also been positively correlated to opioid use disorder (OUD) later in life. The aim of this study was to consider...
Article
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Objective Opioids are effective analgesics with notable limitations which may include; side effects, possible dependence and tolerance, exposure to the risk of opioid use disorder, and potentially life-threatening respiratory depression. The objective was to evaluate the safety and efficacy of nonopioids, as monotherapy or in combination with opio...
Article
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Objective Cancer pain is prevalent and with cancer patients living longer with “managed disease,” pain control is increasingly important. While cancer patients are not at higher risk than others for OUD, they are frequently prescribed opioids. The aim of our study was to explore how to manage patients with cancer pain with active OUD or at high ri...
Article
Full-text available
Objective Chronic pain is the result of the complex bidirectional neuronal signaling, neuroinflammation, neural transmission cascades, and other factors including the balance between ascending and descending pain pathways. Our objective was to explore maladaptive neuronal plasticity and its role in chronic pain syndromes. Methods The authors did...
Article
Full-text available
Objective The onset of pain in cancer patients is prevalent and significant. A subset of cancer patients that have been diagnosed with and treated for Prostate Cancer have developed higher levels of oxidative stress indicators. Oxidative stress indicators can result in inflammatory responses and can diminish the efficacy of the treatment. CAM ther...
Article
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Despite the urgency of the public health crisis of opioid overdose morbidity and mortality, and the widespread intense attention and effort directed toward its elimination, or at least its mitigation, deaths due to drug overdose are on the rise, and in fact are reaching all-time record highs. Fentanyl (real or counterfeit) and its legal and illicit...
Article
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Lumbar spinal stenosis (LSS), which often occurs concurrently with degenerative spondy-lolisthesis (DS), is a common disease in the elderly population, affecting the quality of life of aged people significantly. Notwithstanding the frequently good effect of conservative therapy on LSS, a minority of the patients ultimately require surgery. Surgery...
Article
Full-text available
Background: Opioid-induced constipation (OIC) remains an important clinical obstacle despite the availability of several guidelines and pharmacological options for its management. Here, we surveyed common practices and perceptions about OIC among physicians who prescribe opioids in Italy. Methods: The online survey included 26 questions about OI...
Article
Full-text available
Effective treatment of postoperative acute pain, together with early mobilization and nutrition, is one of the perioperative strategies advocated to improve surgical outcome and reduce the costs of hospitalization. Moreover, adequate pain control reduces perioperative morbidity related to surgical stress and can also prevent the incidence of chroni...
Article
Full-text available
Traditional, complementary, and integrative medicine (TCIM) approaches to COVID-19 represent a paradigm shift from Western medicine, in that TCIM emphasizes prevention, encouraging wellness, and supporting health and recovery. A wide range of TCIM approaches exist: whole medical systems (such as traditional Chinese medicine), mind-body approaches,...
Article
Full-text available
Suprascapular nerve entrapment syndrome (SNES) is an often-overlooked etiology of shoulder pain and weakness. Treatment varies depending on the location and etiology of entrapment, which can be described as compressive or traction lesions. In some cases, treating the primary cause of impingement (ie. rotator cuff tear, ganglion cyst, etc.) is suffi...
Article
Background: Chronic pain significantly worsens the quality of life. Unlike neuropathic, musculoskeletal, postoperative pain, and cancer pain, chronic primary pain cannot be explained by an underlying disease or condition, making its treatment arduous. Objectives: This manuscript intends to provide a comprehensive review of the use of ketamine as...