Assessment of chronic pain and access to pain therapy: a cross-sectional population-based study

Abstract

Background

Chronic pain (CP) has been shown as an important public health problem, and several studies emphasize the need to strengthen the health care and social systems to reduce its marginalization. This study aimed to: evaluate the epidemiology of CP in the general population in an Italian area; and assess the awareness of a specific law, unanimously approved in Parliament, which provides citizens the right to access pain management (Italian Law 38/2010).

Methods

A cross-sectional population-based study carried out during the spring of 2014 at Narni, Umbria, Italy. All the citizens residing in that area, aged >18, were enrolled in the study. Outcome measures were: prevalence of CP and therapies. The awareness of the Italian Law 38/2010 was also recorded.

Results

Data of 1293 questionnaires were analyzed. The prevalence of CP was 28.4%. In 51.5% of cases, pain was severe, with higher prevalence in females (p<0.001). Moreover, pain was generally increasing with age (p<0.001). The risk of suffering from severe pain was modeled using logistic regression. Significant predictors were female gender (OR 2.59; 95% CI: 1.77–3.79), living in an urban area (OR 0.63; 95% CI 0.45–0.88), and age (OR 1.06; 95% CI: 1.04–1.08). Among people with CP, 77.9% were receiving therapy; the proportion of individuals in therapy for severe pain significantly increased with age (OR 1.03; 95% CI: 1.02–1.05) and was smaller in individuals with light pain (OR 0.21; 95% CI: 0.07–0.66). The majority of subjects (61.9%) are not aware of the existence of a specific law stating their rights to receive pain management.

Conclusion

CP, at least in the rural part of the community investigated in Italy, is not perceived as a chronic disease in its own right. A socio-cultural transformation in patients and in the health care system seems necessary.

Keywords:

• cross-sectional study
• chronic pain
• palliative care
• pain therapy
• pain control

Acknowledgments

We thank the City of Narni (Italy) for access to the Registry Office of the Municipality; the association “Memorial Lida Proietti”, Narni (Italy) and the association “Narni Against Cancer Association”, Narni (Italy) for their help in collecting the questionnaires. None of these individuals received compensation for their contributions.

Author contributions

RDG and SC developed the study concept and oversaw research. RDG, SC, and PF managed, checked, and analyzed data. RDG, SC, AP, and GV wrote the paper and prepared tables and figures. All authors contributed toward data analisis, drafting and revising the paper and agree to be accountable for all aspects of the work.

Disclosure

The authors report no conflicts of interest in this work.