Societal impact of pain in a rehabilitation setting chronic pain as a
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Societal impact of pain in a rehabilitation setting chronic pain as a
First EFIC® Symposium Societal Impact of Pain May 4th & 5th 2010, Brussels Societal impact of pain in a rehabilitation setting: chronic pain as a disabling disease Roberto Casale, MD Dept. of Clinical Neurophysiology & Rehabilitation Pain Unit Rehabilitation Institute of Montescano, Foundation "Salvatore Maugeri", I.R.C.C.S. Montescano, Italy Percentage of the general population reporting severe pain intensity in 16 european countries. In Italy (60 millions) roughly 25 millions of people are suffering from some form chronic pain (Breivik et al, Eur J Pain, 2004) Pain management centers in Italy: World Institute of Pain (2004): 19 www.dolorenograzie.com (2008) 199 100 up to 3000 new patients per year per center: maximum number of patients treated per year: 199 X 3.000 = 500 up to 5000 follow up per year per center : maximum number of patients followed per year: 199 X 5.000 = Maximum number of patients ( new+follow up) per year: 597.000 + 995.000 = 1.592.000 Hypothesis: triple centers in Italy maximum number of patient per year: Patients suffering from severe pain x3 = 4.776.000 25.000.000 - Treated patients WHERE ARE THEY? Missing patients = 20.224.000 Patients are not aware of the actual possibility in pain therapy GPs poorly understand what chronic pain means Inadequacy of Chronic pain management even in the patients’ perception Many specialists many different approaches but the same poor result Doctor shopping The quest Unsustainable familial, personal and societal burden of chronic pain Lack of perception of the dimension of the problem by stakeholders In Italy 34% of responders did massages and 15% used any form of physical therapy for pain relief This means that 15 up to 34 % of chronic pain sufferers used rehabilitation facilities How frequently do you use non pharmacologic therapy in your patients with chronic pain? (updated 24-4-2010) Colleagues Responded: Very frequently 29% 67% Moderately often 38% Infrequently 26% rarely 7% From MedscapeCME Family Medicine Emerging Concepts of the Pathophysiology of Chronic Pain and Implications for Treatment Presenza dolore in setting riabilitativo Pain in a rehabilitation setting, (N=541) (Bettinardi, Maini, Casale, 2008) N 541 41% Assenza dolore Presenza dolore 59% Distribuzione intensità dolore 70 Percentuali 60 59 50 39 40 30 22 20 10 0 lieve m oderato intenso Pain in a rehabilitation setting (Bettinardi, Maini, Casale 2009) N=581 Patologia 55% 45% 40% 42% Maschi femmine Cardiaca Neurologica 55% Ortopedica 18% Età media 69 ± 12 Distribuzione punteggi VAS suddivisi per patologia 45 40 35 30 Percentuale di 25 risposta 20 Cardiologica rehabilitation Orthopaedica rehabilitation 15 Neurological rehabilitation 10 5 0 vas 0 vas vas2 vas 1 3 vas 4 vas 5 vas 6 vas 7 vas 8 vas 9 vas 10 Pain in a rehabilitation setting (Bettinardi, Maini, Casale 2009) N=581 Punteggi VAS suddivisi per sesso ed età 5 4,5 4 3,5 3 2,5 m aschi 2 1,5 fem m ine 1 0,5 0 age 1950 age 5160 age 6170 age 7180 age 8197 total ANOVA per genere F= 7.,521 p=0,026 ANOVA per età F=1,89 p= n.s. ANOVA per genere ed età F=0,557 p=n.s. Pain in a rehabilitation setting (Bettinardi, Maini, Casale 2010) Incidenza dolore all'ingresso di 1477 pazienti ricoverati in riabilitazione 9% 41% 28% assenza dolore dolore lieve dolore m oderato dolore intenso 22% Pain in a rehabilitation setting (Bettinardi, Maini, Casale 2010) Incidenza dolore all'ingresso di 1477 pazienti ricoverati in riabilitazione 9% 41% 28% ass enza dolore dolore lie ve dolore m oderato dolore intenso 22% Durata dolore 17% 3% entro 1 m ese entro 3 m esi entro 6 m esi 22% 58% oltre 6 m esi Pain in a rehabilitation setting (Bettinardi, Maini, Casale 2010) Incidenza dolore alla dim issione 11% 3% assenza dolore 50% dolore lieve dolore m oderato 36% dolore intenso Pain in a rehabilitation setting (Bettinardi, Maini, Casale 2010) Giudizio di 846 pazienti sul trattam ento 2%1% 0% 16% 20% m olto buono buono sufficiente insufficiente scadente m olto scadente 61% Trend dolore di 1400 pazienti alla dim issione 45,5 35,4 19,1 Migliorati Stazionari Pe ggiorati 81% soddisfatti, 16% sufficiente 3% critico Where are they? • Prevalence of chronic pain in a rehabilitation setting is three fold (59%) the prevalence reported in the 2006 european survey in the general population (19%) • 42% of patients had pain for more than three months before the admission • Neurological as well as orthopedic patients rank the highest incidence of chronic pain. However also patients in cardiological rehabilitation reported to have some degree of pain • . • Chronic pain in a rehabilitation setting does not consider cancer pain patients Where are they? • We urge to consider the presence of chronic pain also in different settings from the “classical” pain centers. • Chronic pain is always related to disability and the data herein reported are stressing this bi-directional relationship • These data are referred only to patients within the NHS farme and they do not completely fill the gap as may sufferers use alternative or complementary therapies • Pain control in a rehabilitation setting is optimistically inadequate "Are patients with chronic pain (at least those intercepted )satisfied with their treatments?" The answer is "no" According with a 2002 survey almost half ( 47%) of people sought medical care for moderate-to-severe chronic pain changed clinicians at least once.