Dossier n. 195/2010 [Abstract] Survey on pain in Emilia-Romagna hospitals and hospices

Pain 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. The control of pain, acute and chronic, of oncologic and non oncologic 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 Hospital Service of the Emilia-Romagna Region has coordinated a survey on pain in regional hospitals and hospices, as one of the initiatives of the National Relief Day.

All the regional Health Trusts, the Italian Association of Private Hospitals, the Regional Advisory Committee for quality control from citizen’s point of view, voluntary associations and many patients participated in the survey.

On May 28, 2009 (only day) simplified questionnaires - defined “relief form” - were distributed to people hospitalized in regional hospitals and hospices, to acquire - directly from citizens - evaluation elements on perceived pain and relief needs that can be useful to improve the implementation path of the “Hospital without pain” regional project.

58.6% people hospitalized in the chosen date adhered to the survey (7,913 out of 13,497).

The prevalence of intense pain is 18.7% out of the entire sample (1,623/8,676); in day hospital patients, this prevalence is 12.4%, as expected lower than in ordinary hospitalization.

In 2002-2009 period, intense pain shows a significant decrease, from 24.2% to 18.7%, while “no pain” significantly increases, from 11.7% to 18.9%. This trend - which is registered in the various hospitalization areas - is probably due to the implementation of good clinical practices and of the guidelines of the “Hospital without pain” project.

In medical are, although decreasing intense pain is still a relevant issue. Patients associate the relief desire with “presence of loved people”  (42%), “feeling less pain” (41%), “not being a burden to the family” (36%), “more self-sufficiency” (34%), “precise information on care” (32%). In oncology area, hospitalized people mainly wish to be reassured (F 43%; M 35%) and not to be a burden to the family (F 42%; M 35%); they also ask for information on their therapies (F 36%; M 29%) and for the presence of loved ones (F 31%; M 35%).

Relief is perceived as care humanization, self-sufficiency, independence in choices and true knowledge of one’s health conditions.

Information received from health personnel is judged as adequate by most patients (68%) and inadequate by 6%; 10% patients declared not to have received any information: this aspect implies the need to improve communication and relationship issues.

As for hospices, it is important to consider the peculiarity of these structures, that host provide care for people in the last phases of an incurable disease. Pain experience acquires here the characteristics of global pain and is more widely spread than in other contexts: 67% people hospitalized in hospice declare to feel pain, vs only 56% in hospital context.

In general, notwithstanding the significant progresses observed, perceived pain - in particular intense pain - remains a relevant health issue in all ages and for both genders, even if with different degrees.

The recent trend of stabilization reinforces the need to maintain and even intensify the commitment. In application of Law no. 38/2010 “Provisions to guarantee access to palliative care and pain therapy”, the Emilia-Romagna Regional Committee to contrast pain has elaborated the “Guidelines to treat pain in medical area”, mainly addressed to professionals working in hospitals and local services (Dossier no. 194/2010).