Chronic pain management in non-oncologic patients: multicentric study on adult patients referring to the centers for pain management in the Lazio Region (Italy). Doctoral Thesis, available from: http://padis.uniroma1.it/handle/10805/2127

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Abstract

Introduction Chronic pain is a complex phenomenon usually associated with psychological stress, which implies falling back on the National Health Service and reducing work capacities, indeed affecting Activities of Daily Living. Studies based on efficacy have identified the multidisciplinary approach as the most effective means to obtain therapeutic results. These programs can be provided by the Centers for Pain Management (CPMs), where multidisciplinary teams are likely to provide the necessary expertise to outline the best treatments for the diagnosis and management of chronic pain. To date, very little information is available on the kind of assistance and support these centers can provide, as well as on the clinical and socio-demographic characteristics of patients who refer to these facilities. Aims The present investigation has the following objectives: • to describe what kind of assistance the centers for pain management (CPMs) in the Lazio Region are able to provide; • to describe the clinical and socio-demographic characteristics of the population referring to the CPMs; • to describe the type of pharmacologic, complementary and intervention treatments; • to describe the clinical characteristics of patients who turn to the two different levels of available assistance (hub and spoke system). Methods In 2011 a non-profit, retrospective and multicentric study was performed on all the CPMs existing in the Lazio region. All relevant information on the centers was collected. As well, the health records of patients between the age of 18 and 71 (paper and digitized documents) affected by chronic benign pain for at least six months were analyzed. Patients suffering from migraine and from cancer pains were excluded. The study was approved by the Ethic Committee (CE) of each participating center and of the preeminent CPM (Tor Vergata). An average number of 1600 patients was estimated. All data were collected in a SPSS database and processed according to a statistical analysis. Results Data collected between January 2012 and February 2013 from 1606 patients from all the twenty-six (26) participating CPMs in the Lazio Region were analyzed. Centers characteristics: CPMs are generally located in University and General Hospitals (among these, 2 hubs) and in public or private hospital facilities. They are all equipped with a clinic, some of them are able to provide Day Hospital surgery and day-beds. CPMs are managed by anesthetists and in most instances they do not have multidisciplinary staff members. As well, the number of health professionals, nurses, psychologists and physiotherapists is scarce. CPMs mainly supply patients with pharmacotherapy, Complementary Alternative Medicine (CAM) and with interventional treatments which may be complex, as well. The median waiting time is of about 90 days. The clinics are not homogeneously distributed in the Region; Rome turned out to be the city with a greater range of offers, while in the provincial areas there is an under-utilization of the existing facilities. 6 Characteristics of the population: Most of the patients referring to the CPMs had been previously evaluated by the General Practitioner (38%), 34% of them were directed to the pain centers by a specialist different from an anesthesiologist, while 28% of patients refer to a CPM on their own choice. 33.1% of patients are male, 66.9% are female (ratio 1:2); the most representative category of patients was of an age between 65-69. In most cases, marital status, employment and education were not documented. Almost all patients, regardless of the
Lingua originaleItalian
Numero di pagine167
Stato di pubblicazionePublished - 2013

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