BackgroundIt 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.MethodsA 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.Results11 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 implicationsThese 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.

In Italy as well as in other earthquake-prone countries, the large number of existing buildings requiring seismic retrofitting calls for sustainable solutions able to reduce both costs and downtime. To this purpose, in this paper, the High-Performance Dissipating Frame system (HPDF), a new strengthening solution for the seismic rehabilitation of existing buildings, is presented. HPDF is based on external precast reinforced concrete (RC) frames rigidly connected to the existing structures and equipped with shear damper devices in order to provide high dissipation capacity. The proposed solution permits: (i) to increase sustainability through works made up from the outside without removing/demolishing infills/other non-structural components, (ii) rapid execution by adopting precast resisting members mutually restrained with steel connections, and (iii) effectiveness due to shear damper devices able to dissipate a large amount of shaking energy. In the paper, a displacement-based design procedure is proposed and applied to a numerical example.

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