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

Natoli, Silvia; Vittori, Alessandro; Cascella, Marco; Innamorato, Massimo; Finco, Gabriele; Giarratano, Antonino; Marinangeli, Franco; Cuomo, Arturo

doi:10.3390/ijerph20010551

Cited by 7 publications

(9 citation statements)

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“…Therefore, fulfilling educational needs in pain management should be a lifelong process involving the anesthesiologists/pain therapists. Clear critical issues emerge from our results, being chronic pain, cancer pain, pediatric pain, MSK pain 32–36 and the risk of addiction, 37–39 in agreement with what has already been underlined by other studies and documents 20,28,40 . Although in Italy the average percapita/a year morphine equivalent dose (MED) is 144, which is far below the average of 693 MED a year in the USA and other European and non‐European countries (taking in consideration the six most common opioids), addiction, abuse, and misuse of prescription opioid analgesics remain a concern 22,41–44 .…”

Section: Discussionsupporting

confidence: 85%

“…Clear critical issues emerge from our results, being chronic pain, cancer pain, pediatric pain, MSK pain [32][33][34][35][36] and the risk of addiction, [37][38][39] in agreement with what has already been underlined by other studies and documents. 20,28,40 Although in Italy the average percapita/a year morphine equivalent dose (MED) is 144, which is far below the average of 693 MED a year in the USA and other European and non-European countries (taking in consideration the six most common opioids), addiction, abuse, and misuse of prescription opioid analgesics remain a concern. 22,[41][42][43][44] Interestingly, the participants reported lower competence scores (range 0.67-0.76) when managing drugs with abuse potential compared to the reported competence scores when using opioids (0.78-0.89) or preventing their related adverse effects (range 0.72-0.90).…”

Section: Discussionmentioning

confidence: 99%

“…11 Therefore, multiple educational needs should be effectively addressed 12 by improving both undergraduate and postgraduate training and making pain medicine a mandatory core subject. 13 However, education in pain management is a marginalized issue [14][15][16][17][18][19][20] and monitoring the progressive competency in pain management appears actually unnecessary to health professionals to earn a license to practice. 18 Promoting educational programs may provide the pain medicine field with meaningful benefits.…”

Section: Introductionmentioning

confidence: 99%

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Strategies to build and maintain competence in pain management: Insights from a SIAARTI survey on educational needs among Italian anesthesiologists

et al. 2023

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Purpose Fulfilling educational needs in pain management should be a lifelong process, even involving physicians board certified in pain medicine such as the anesthesiologists/pain therapists. The aim of the study was to investigate Italian anesthesiologists' self‐perceived competency, confidence, and interest to attend educational programs in relation to their seniority in pain management. Methods SIAARTI members were sent an online questionnaire addressing the following items: education, skills (both soft and hard skills), technical expertise and engaged to participate between December 2020 and January 2021. Participants rated their competence based on the following range (no knowledge, knowledge, competence) while their agreement to attend educational courses was assessed using a 5‐point Likert‐type scale. Results Less than one in four participants declare to be dedicated to pain medicine activity with greater proportion among older (over 61 years) compared to younger ones (31–40 years). Regarding cancer and chronic noncancer pain a positive gradient of self‐perceived competence has been observed in relation to seniority. In contrast, no gradient of self‐perceived competence was reported about musculoskeletal and low back pain. Participants self‐perceived competent in both opioid use and prevention of opioid‐related adverse event while feeling less competent when managing drugs with abuse potential. The lowest competence has been observed in pediatric pain along with the lowest interest to attend educational courses. Participants were much and very much interested to education regarding cancer, noncancer, musculoskeletal, and low back pain, invasive analgesic procedures but less regarding items for which they declared less competence, such as use of pain scales, pain management in children, and use of drugs with abuse potential. Conclusion This work provides first evidence of a summative assessment of competency and related educational needs' profile of anesthesiologists/pain therapists thus paving the way for developing a nationwide educational program to improve chronic pain care in Italy.

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Section: Discussionsupporting

confidence: 85%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Strategies to build and maintain competence in pain management: Insights from a SIAARTI survey on educational needs among Italian anesthesiologists

et al. 2023

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“…In Italy the context is completely different, so much so that a law (38/2010) was necessary to encourage the use of opioids and eliminate the excess of bureaucracy that weighed on the prescription of opioids [31,34]. Opioid epidemics shifted attention to a problem that did not concern us, blocking a virtuous process that had seen an increase in the prescription of opioids in the right contexts.…”

Section: Discussionmentioning

confidence: 99%

Pain prevalence and pain management in children and adolescents in an italian third level pediatric hospital: a cross-sectional study

et al. 2023

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Background In 2016, we performed a one-day investigation to analyze the prevalence of pain, pain intensity, and pain therapy in the Departments of Surgery and Onco-Hematology of the Ospedale Pediatrico Bambino Gesù. To improve the knowledge gap highlighted in the previous study, refresher courses and even personalized audits have been carried out during these years. The purpose of this study is to evaluate if, after 5 years, there have been improvements in the management of pain. Methods The study was conducted on 25 January 2020. Pain assessment, pain therapies, pain prevalence and intensity in the preceding 24 h and during the recovery period were recorded. Pain outcomes were compared with previous audit results. Results Out of the 63 children with at least one documented pain assessment (starting from 100 eligible), 35 (55.4%) experienced pain: 32 children (50.7%) experienced moderate /severe pain while 3 patients (4%) felt mild pain. In the preceding 24 h, 20 patients (31.7%) reported moderate/severe pain while 10 (16%) reported moderate or severe pain during the interview. The average value of the Pain Management Index (PMI) was − 1.3 ± 0.9 with a minimum of -3 and a maximum of 0. 28 patients (87%) undergoing analgesic therapy for moderate/severe pain had a PMI of less than 0 (undertreated pain), while 3 patients (13%) scored value of 0 or higher (adequate pain therapy), 4 patients (12.5%) received multimodal analgesia with opioids and 2 patients (6%) opioids alone. Time-based therapy was prescribed to 20 patients (62.5%), intermittent therapy was prescribed to 7 patients (22%) and 5 patients (15.5%) did not receive any therapy. The prevalence of pain was higher during hospitalization and 24 h before the interview, while at the time of the interview, the proportion was the same. In this audit, the daily prescription modality of the therapy had some improvements (time-based: 62.5% vs. 44%; intermittent: 22%vs 25%; no therapy: 15.5% vs. 31%). Conclusion Pain management in hospitalized children constantly requires special daily attention from health professionals aimed at mitigating the components of intractable pain and resolving those of treatable pain. Trial registration : This study is registered with ClinicalTrials.gov, number (NCT04209764), registered 24 December 2019, https://clinicaltrials.gov/ct2/show/NCT04209764?term=NCT04209764&draw=2&rank=1.

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“…However, a previous survey of anesthesiologists reported a low interest concerning the use of pain scales in the treatment of chronic pain [ 8 ], suggesting that chronic pain, including neuropathic pain, is difficult to treat. Adequate pain care should be regarded as a right and be effectively guaranteed to patients with chronic pain [ 9 ]. In this context, accurate evaluation and treatment of chronic pain and related neuropathic pain are desirable.…”

Section: Introductionmentioning

confidence: 99%

Relationship between Nontraumatic Shoulder Disorders and Neuropathic Pain: Retrospective Observational Analyses of Clinical Features and Background Factors

Sasaki,

Shitara,

Tajika

et al. 2023

Anesthesiology Research and Practice

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Background. Accurate identification of neuropathic pain is necessary for appropriate treatment; however, the relationship between nontraumatic shoulder disorders and neuropathic pain remains unknown. Therefore, this retrospective observational study aimed to investigate the relationship, features, background factors, and prevalence of neuropathic pain among patients with nontraumatic shoulder disorders. Methods. We evaluated 198 patients who visited our outpatient clinic, which specializes in shoulder disorders, from April 2015 to March 2016. The patients’ age, sex, affected side, diagnosis, and pain duration were recorded, and the results of physical examination, including passive range of motion, impingement sign, and muscular strength assessments, were analyzed. The presence of neuropathic pain was assessed using the painDETECT questionnaire. Participants were divided into two groups according to the presence of neuropathic pain. Pain intensity was assessed using a visual analog scale, and the patient’s mental status was assessed using the short-form McGill Pain Questionnaire and Hospital Anxiety and Depression Scale. The scores were compared between the groups. Results. Neuropathic pain was observed in 7.6% of patients. The visual analog scale score for pain, short-form McGill Pain Questionnaire score, and Hospital Anxiety and Depression Scale score were significantly associated with the presence of neuropathic pain in the univariate analysis. Patient background factors and physical function were not associated with the presence of neuropathic pain. The prevalence of neuropathic pain in patients with frozen shoulder was 33.3%, which was significantly higher than that in patients with other shoulder disorders. Conclusion. The occurrence of neuropathic pain may aggravate pain in patients with nontraumatic shoulder disorders. Neuropathic pain was not a rare condition in patients with nontraumatic shoulder disorders, particularly in those with frozen shoulder. The coexistence of neuropathic pain cannot be determined from background factors or physical function. Accurate diagnosis of neuropathic pain is essential in patients with nontraumatic shoulder disorders.

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

Cited by 7 publications

References 50 publications

Strategies to build and maintain competence in pain management: Insights from a SIAARTI survey on educational needs among Italian anesthesiologists

Strategies to build and maintain competence in pain management: Insights from a SIAARTI survey on educational needs among Italian anesthesiologists

Pain prevalence and pain management in children and adolescents in an italian third level pediatric hospital: a cross-sectional study

Relationship between Nontraumatic Shoulder Disorders and Neuropathic Pain: Retrospective Observational Analyses of Clinical Features and Background Factors

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