Analysis on chronic pain management: Focus on the Italian network

Abstract

The Italian Law 38/2010, 'Dispositions to guarantee access to Palliative Care and Pain Management' orders that the health care systems of Italian regions create dedicated structures for palliative care and pain therapies, according to a specific organizational model called 'Hub-Spoke', to ensure the diagnostic-therapeutic continuity of patients affected by chronic pain (CP). The aim of our study was to

Raising Awareness on the Clinical and Social Relevance of Adequate Chronic Pain Care

“…Law 38/2010 has been groundbreaking in Europe to address the disregarded rights of people eligible for CP and palliative care (Table 1) and over the last few years, several appraisals of the degree of Law 38/2010 implementation and the related achievements have been performed [18,20,22,29]. Overall, as suggested by Marinangeli et al, Law 38/2010 can be regarded as the "magnificent unfinished": optimal and well organized in its essence but hard to make it real to effectively serve patients with CP [22].…”

“…Such findings highlight the achievements and pitfalls of Law 38/2010: The former is greater appropriateness of the use of such drugs for CP patients, as suggested by the tight surveillance of opioid use achieved in our country [57] and the latter is the need for harmonizing the access to pain care according to the equality principles of the law. Nevertheless, standardized protocols for opioid titration as well as for the management of opioid abuse are not currently available in many pain centers [20].…”

“…The main objective of Law 38 was to ensure continued patterns of care for patients established through the hospital-primary medicine network. However, only 32.6% of the pain facilities guaranteed a homogeneous care continuity within the network via the use of the electronic medical record (EMR) of patients [20]. In addition, a comprehensive mapping of the Italian pain therapy centers unveiled significant organizational issues that might have contributed to the inhomogeneity of care delivery across regions.…”

“…Overall, the missed or partial enforceability of the right not to suffer demands a call to action to mitigate the CP burden, and a greater awareness of rights can no longer be disregarded among the general population and within the medical community. In the last few years, several initiatives intended to both assess the degree of implementation of Law 38/2010 at a national level and bridge the clinical, organizational, and cultural gaps that hamper CP patients' access to the care they are eligible for were organized [20][21][22]. Recently, a Social Manifesto against pain, spearheaded by the Italian Society of Anesthesia, Analgesia, Resuscitation, and Intensive Care (SIAARTI) and signed by seventeen scientific societies and patient associations, has been issued to foster awareness of the burdensome impact of CP at both individual and societal level [23].…”