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.