Dossier n. 229/2012 [Abstract] Survey on pain in hospitals, hospices and home care in Emilia-Romagna

The International Association for the Study of Pain (1986) defines pain as “an unpleasant sensory and emotional experience associated with actual or potential tissue damage, or described in terms of such damage”.

Pain is recognized by the World Health Organization as one of the major health issues; in Italy Law no. 38/2010 considers pain as a disease to evaluate and treat with the same attention as other pathologies.

Since 2002 Emilia-Romagna Region is involved in a project to contrast pain, coordinates the information and sensitization initiatives of the National Relief Day at local level, and every two years in collaboration with Health Trusts realizes surveys on pain prevalence in regional hospitals and hospices.

The Dossier reports the results of the new regional survey on perceived pain, held in May 2011 and presented during the regional conference “Hospital and local areas without pain” organized in Bologna on May 23, 2012 during the National Relief Day.

The results also represent an indicator of the change path.

The survey was conducted in hospitals, hospices, and for the first time also in home care, to acquire - directly from citizens - informative elements on perceived pain and hospitalization and on relief needs, that can be useful to evaluate the implementation path of the regional project.

Regional Health Trusts, the Italian Association of private hospitals and voluntary associations participated in the survey.

Data were acquired through the questionnaire called “Relief form”: 10,456 questionnaires were collected from 101 public and private health structures and from people cared in their homes. Participation increased 11.5% in comparison to the previous survey held in 2009, when 9,370 questionnaires were collected.

Pain measurement is articulated in 4 levels: no pain (in a numeric scale, = 0), light pain (1-3), moderate pain (4-7), intense pain (8-10).

The prevalence of intense pain is 15.9% out of the entire sample, decreasing in comparison to 2009 (18.7%) and even more significantly in respect to 2002 (24.2%); also moderate pain is diminishing (37.1% vs 38.4% in 2009), while the number of people declaring “no pain” is strongly increasing, from 11.7% in 2002 to 19.4% in 2011.

This trend is probably due to the implementation of the regional guidelines on pain management in hospitalization settings and of the National Law 38/2010 “Regulation for access to palliative care and pain therapy”.

The survey shows a correlation between age and pain, which is more intense in the medical area where the mean age of hospitalized people is higher (61.4 years for women, 53.5 for men). In this area, although decreasing intense pain is still a relevant issue (17.19% in 2011, 21.5% in 2009).

The study confirms that women are more likely to experience uneasiness (more intense pain, less no pain) in comparison to men; in particular, perception of intense pain is higher both in general and in the surgery and medical areas (no difference is registered in the oncological area).

Anti-pain therapies are efficacious for nearly 65% of the sample (more for women than for men, 65.8% vs 62.1%), while 11% in both genders reveal scarce results; no one considers the therapy completely inefficacious.

Patients associate the relief desire with “feeling less pain” (40.2% in women, 36.5% in men), “presence of loved people” (F 39.4%, M 34.7%), “not being a burden to the family” (F 35.6%, M 30.4%), “more self-sufficiency” (F 33.8%, M 29.2%), “precise information on care” (F 31.6%, M 33.2%), “being reassured” (F 28.8%, M 26.2%). In oncology area, hospitalized people mainly wish not to be a burden to the family (F 40.6%; M 36.3%), to be reassured (F 35.6%; M 30.3%) and ask for the presence of loved people (F 34.9%; M 28.6%).

In general, relief is associated with care humanization, self-sufficiency, psychological reassurance, all aspects that underline the need to improve relationships in the care process.

From the questionnaires collected in Emilia-Romagna hospices, that host people with late stage diseases, pain perception is still considered: although very little, moderate and intense pain perception is decreasing (59.2% in 2011, 61.8% in 2009).

In home care, 19.9% of the sample declares to experience intense pain; this value can be due to the co-presence of other aspects of disease and uneasiness and to the old age of people.