Non-Pharmacological Interventions for Chronic Pain and Depression: any Possible Applications of Multisensory Feedback Approaches Based on Body Representation?

Chronic pain is a clinical condition that can severely affect the patient’s quality of life, and it represents a major socio-sanitary concern, especially for an increasing ageing population. Indeed, it is estimated that about 20% of the European population [1] and 30% of the US population is afflicted by it [2] and its prevalence increases with age [3]. Traditional pharmaceutical interventions such as opioids and non-steroidal anti-inflammatory drugs (NSAIDs), may lead to iatrogenic outcomes, substance abuse and side effects [4]. The recent decease of two notorious pop stars like Michael J. Jackson and Prince Rogers Nelson, is just one prominent example of the powerful adverse potential of painkillers. A gloomier picture is depicted when considering that chronic pain is commonly associated with mood disorders such as anxiety and depression [5]. Indeed, pain and depression share common neurological alterations such as increased limbic area activation, atrophy of the hippocampus and a decreased prefrontal cortex (PFC) activity [6], and it has been deemed that they can co-occur in up to 80% of patients [7]. When this comorbidity is present, the pharmacological aid is usually represented by tricyclic antidepressants, anticonvulsants, or serotonin-norepinephrine reuptake inhibitors (SNRIs), which have been shown to be effective both for chronic pain and mood disorders, especially depression [8]. However, extra pyramidal Abstract