title: Care strategies and therapeutic pathways for chronic pain patients in Abruzzo Region, Italy.
abstract: Chronic pain is considered to be among the most disabling and costly diseases in North America, Europe and Australia. A large survey was conducted on chronic pain in Europe, called Pain in Europe. Italy ranks third in Europe in terms of prevalence, with 26% of the population suffering from chronic pain at some point. In 2010 Italy passed Law 38/2010, to ensure treatment for pain control in patients with oncological diseases as well as in patients with chronic non-cancer pain through a network of care services. This study aims to provide preliminary information regarding the application of L.38/2010 in the Abruzzo region of Italy.
  
  
  
  A descriptive study was conducted on a non-probabilistic sample of people who attended pain therapy centres of the local health service in 2014. The patients (129) were interviewed by centre staff using a validated questionnaire. Recruitment was carried out by enrolling consecutive cases over a three-month period (February to April).
  
  
  
  Almost two-thirds of the patients had visited several physicians before requesting help. The initial visit to the pain therapy centre was made after some months in 37.2% of cases, and in 38% of patients it was made years after the onset of pain. The reasons given for this long wait before seeking specialist medical treatment for chronic pain reveal a wait-and-see attitude on the part of patients, who controlled their pain by taking painkillers. Responsibility for this delay in requesting assistance can however also be attributed 'externally' to the fact that patients were not aware that this kind of centre was available.
  
  
  
  The results of the study describe, in a regional context, a situation in which L.38/2010 is hard to apply. The study showed how the care pathway for these patients is still characterised by difficulty in accessing the network of local services. Clearly, more effort needs to be directed towards an effective application of L.38/2010, with increased availability of resources to develop and strengthen the network of services at regional level.
authors.affiliation: Department of Life, Health and Environmental Sciences, University of L'Aquila, Italy.
authors.forename: C
authors.initials: C
authors.lastname: Leuter
authors.affiliation: Department of Life, Health and Environmental Sciences, University of L'Aquila, Italy.
authors.forename: A
authors.initials: A
authors.lastname: Piroli
authors.affiliation: Department of Life, Health and Environmental Sciences, University of L'Aquila, Italy.
authors.forename: A
authors.initials: A
authors.lastname: Paladini
authors.affiliation: Anaesthesiology and Intensive Care at the Medical School, University of L'Aquila, Italy.
authors.forename: M
authors.initials: M
authors.lastname: Tudini
authors.affiliation: The Paolo Procacci Foundation, Rome, Italy; European League against Pain, EuLaP®.
authors.forename: G
authors.initials: G
authors.lastname: Varrassi
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002908:Chronic Disease / Q000453:epidemiology*; D059350:Chronic Pain / Q000453:epidemiology* / Q000209:etiology / Q000628:therapy*; D005060:Europe / Q000453:epidemiology; D005260:Female; D006801:Humans; D007558:Italy / Q000453:epidemiology; D008297:Male; D008875:Middle Aged; D009369:Neoplasms / Q000150:complications / Q000453:epidemiology*; D018710:Pain Clinics / Q000331:legislation & jurisprudence / Q000706:statistics & numerical data*; D015995:Prevalence; D011795:Surveys and Questionnaires
keywords: Accessibility; Chronic pain; Impact of law; Pain centres; Pain management