Pursuing the Recovery of Severe Chronic Musculoskeletal Pain in Italy: Clinical and Organizational Perspectives from a SIAARTI Survey

Alessandro Vittori; Emiliano Petrucci; Marco Cascella; Massimo Innamorato; Arturo Cuomo; Antonino Giarratano; Flavia Petrini; Franco Marinangeli

doi:10.2147/JPR.S328434

Pursuing the Recovery of Severe Chronic Musculoskeletal Pain in Italy: Clinical and Organizational Perspectives from a SIAARTI Survey

J Pain Res. 2021 Oct 29:14:3401-3410. doi: 10.2147/JPR.S328434. eCollection 2021.

Authors

Alessandro Vittori¹, Emiliano Petrucci², Marco Cascella³, Massimo Innamorato⁴, Arturo Cuomo³, Antonino Giarratano⁵, Flavia Petrini⁶, Franco Marinangeli⁷

Affiliations

¹ Department of Anesthesia and Critical Care, ARCO ROMA, Ospedale Pediatrico Bambino Gesù, IRCCS, Rome, Italy.
² Department of Anesthesia and Intensive Care Unit, San Salvatore Academic Hospital of L'Aquila, L'Aquila, Italy.
³ Department of Anesthesia and Critical Care, Istituto Nazionale Tumori - IRCCS, Fondazione Pascale, Naples, Italy.
⁴ Department of Neuroscience, Pain Unit, Santa Maria delle Croci Hospital, AUSL Romagna, Ravenna, Italy.
⁵ Department of Surgical, Oncological and Oral Science (Di.Chir.On.S.), Section of Anaesthesia, Analgesia, Intensive Care and Emergency, Policlinico Paolo Giaccone, University of Palermo, Palermo, Italy.
⁶ SIAARTI (Italian Society of Anaesthesia, Analgesia, Reanimation and Intensive Care Medicine), Rome, Italy.
⁷ Department of Anesthesiology, Intensive Care and Pain Treatment, University of L'Aquila, L'Aquila, Italy.

Abstract

Background: Increased attention to the functional impact of chronic pain (CP), as highlighted by the 11th revision of the International Classification of Diseases (ICD-11) and advocated by the International Classification of Functioning, Disability and Health (ICF), is an important step forward for optimizing its management. Evidence about perspectives of Italian physicians on the relevance of musculoskeletal (MSK) pain care to improve patients' functioning and Quality of Life is scant. The study aimed to investigate the physicians' perception of the value of functional recovery in severe MSK pain patients, their attitude towards its assessment and achievement in Italy.

Methods: A survey was conducted in Italy between October 2020 and January 2021. Specialist centers members of the SIAARTI (n = 395) were sent an online questionnaire encompassing the Italian pain therapy network. Participants rated their agreement to questionnaire items according to a 5-point Likert-type scale.

Results: A total of 305 centers (77%) completed the survey. Most physicians rated the recovery of functioning as very relevant in MSK pain treatment and, when they assessed it, devoted great attention to the ability to perform daily activities, pain, ability to ambulate and sleep quality. Multidimensional questionnaires were less employed in favor of physical examination and pain intensity scales. Pharmacological therapy, rehabilitation and lifestyle changes and/or physical exercise were all rated optimal strategies to pursue the recovery of patients' functioning. When considering pharmacological therapy, weak and strong opioids, either alone or combined with paracetamol, were the most frequently employed analgesics.

Conclusion: Clinicians seem to recognize the recovery of functioning as equally important as pain intensity reduction, but there is a need of streamlining available tools to effectively assess both across different MSK pain patients.

Keywords: chronic musculoskeletal pain; pain care models; recovery of functioning.

Grants and funding

This work was carried out thanks to an unrestricted grant from Grunenthal Italia S.r.l. The sponsor had no involvement in any of the stages from study design to submission of the paper for publication. Grunenthal was given the opportunity to review the manuscript for medical and scientific accuracy, as well as intellectual property considerations.