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: chronic pain; cross-sectional study; pain control; pain therapy; palliative care.

Figure 1

Estimated effects of age on different outcomes. Notes: Effect of age estimated through a natural cubic spline with 3 degrees of freedom which has been used to include age in models summarized in Table 3, A, B, C, and in Table 4, D. Dashed lines represent pointwise 95% CI. (A) was adjusted for residence area, gender, civil status; (B–D) were adjusted for no associated chronic diseases and moderate/severe chronic pain. A significant (p<0.001) deviation from linearity was found in (B), where the awareness of the law is increasing until the age of 65–70 years, and falls rapidly afterwards.