Dossier n. 194/2010 [Abstract] Guidelines to treat pain in medical area

Pain in medical area represents on of the major health issues at global level, both because of ageing population and for the increase of chronic degenerative (osteoarticular, neurological, vascular) diseases and of cancer. People with these pathologies are usually taken care in “dedicated” environments but also in Internal medicine units and by local health services. The control of pain, acute and chronic, of oncological and non oncological origin, is efficacious in the clinical outcome and also on the therapeutic response to the original pathology, thus allowing to prevent secondary invalidities and to obtain a significant improvement in life quality.

The regional document is meant to promote and integrated clinical approach and the development of relationships between care team, patient and his/her family in every single phase of the diagnostic, therapeutic and care process. The main goals of the document are:

• to spread a culture that is attentive to pain/suffering of the person, to favour humanization of care and to prevent consequences of pain chronicization;
• to sensibilize health personnel on pain assessment and control;
• to promote clinical appropriateness;
• to valorise therapeutic-care continuity;
• to guarantee to all patients the measurement of subjective pain intensity as any other vital parameter, using validated scales;
• to guarantee the treatment of pain using evidence-based therapeutic protocols;
• to promote integration paths between hospital and local services, involving general practitioners, primary care nurses and the whole care network.

To reach these goals a cultural change is necessary, where the ill person is central and actively involved in the care paths (patient empowerment).

The document is articulated in 10 chapters that deal with the following aspects:

• epidemiological data;
• physiopathology and setting strategies;
• assessment and scales of measurement;
• management of the patient with pain;
• general principles of the treatment;
• role of the general practitioner;
• referral to a specialist;
• invasive techniques;
• non pharmacological strategies, with particular focus on pain at the end of life;
• communication and education.

In application of Law no. 38/2010, the Emilia-Romagna Regional Committee to contrast pain, that approved the present document, has agreed to adopt the numerical rating scale (NRS) - already widely spread - as regional shared tool to measure pain, both in hospitals and in local health services.

Also communication and education are strategic, and have to support the implementation of guidelines of the “Hospital and local area without pain” project.

con la collaborazione del Gruppo di lavoro multidisciplinare “Dolore in area medica” del Comitato regionale per la lotta al dolore della Regione Emilia-Romagna