Violini (Siaarti): “12-13 milioni di abitanti italiani soffrono di dolore cronico”
(Adnkronos) - “È difficile stabilire quanti tipi di dolore esistano perché i pazienti possono essere affetti da dolore acuto, da dolore persistente o da dolore cronico e ognuno di queste tipologie di dolore può essere sostenuta da meccanismi fisiopatologici differenti che generano e sostengono il dolore anche per un periodo di tempo lungo. Sono molti i pazienti che soffrono di dolore cronico in Italia, fino a poco tempo fa non avevamo dei dati epidemiologici precisi, si faceva riferimento a studi europei ancora datati, 2016, che stimavano una prevalenza abbastanza importante intorno al 10-15%.
I recenti dati epidemiologici che abbiamo acquisito negli ultimi mesi con il rapporto Censis definiscono
in termini di 9 milioni e 800 mila abitanti adulti italiani che soffrono di dolore moderato.” Così Alessia Violini, responsabile scientifica del 23.esimo Congresso Area culturale dolore (Acd) e responsabile della Società italiana di anestesia, analgesia, rianimazione e terapia intensiva (Siaarti) Area culturale Medicina del dolore e cure palliative, a Palermo, in occasione dell'apertura del 23.esimo Congresso nazionale dell'Area culturale dolore (Acd).
I recenti dati epidemiologici che abbiamo acquisito negli ultimi mesi con il rapporto Censis definiscono
in termini di 9 milioni e 800 mila abitanti adulti italiani che soffrono di dolore moderato.” Così Alessia Violini, responsabile scientifica del 23.esimo Congresso Area culturale dolore (Acd) e responsabile della Società italiana di anestesia, analgesia, rianimazione e terapia intensiva (Siaarti) Area culturale Medicina del dolore e cure palliative, a Palermo, in occasione dell'apertura del 23.esimo Congresso nazionale dell'Area culturale dolore (Acd).
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00:00It is difficult to establish how many types of pain exist because patients can be affected
00:11by acute pain, persistent pain or chronic pain and each of these types of pain can
00:19be sustained by different physiopathological mechanisms that generate and support pain
00:26also for a long period of time.
00:30There are different definitions, in the literature we have many, also with regard to the complexity
00:39of the pain phenomenon, we are currently talking about primary chronic pain and secondary
00:45chronic pain when the nociceptive afferents come from the central nervous system respectively
00:54or from the periphery, but in the maximum complexity of the chronic pain that persists
01:01for a considerable period of time, we are currently also talking about nociplastic pain
01:07which seems to be the one in which we have the greatest difficulty of treatment.
01:12There are many patients who suffer from chronic pain in Italy, until recently we did not have
01:19precise epidemiological data, we referred to European studies, still dated 2016, which
01:30estimated a fairly significant prevalence, around 10-15%.
01:39The recent epidemiological data that we have acquired in recent months with the Censys report
01:47define around 9,800,000 Italian adults who suffer from severe moderate pain, with a prevalence
01:58that is around 19.7%, but the data also report in other cases an even greater prevalence,
02:08so we are talking about 12-13 million Italian inhabitants who suffer from chronic pain.
02:15It is difficult to establish which are the most important issues for the specialist and for the patient
02:21affected by chronic pain, certainly the appointment is a crucial and important node, because it consists
02:32in the interception of patients affected by chronic pain, which is not always an obvious thing,
02:41and also by the knowledge from the citizens of the existence of centers of pain therapy
02:47that can take care of their pathology.
02:52The important issue for the specialist is certainly to define an appropriate clinical path for the patient,
03:03which takes him by the hand and leads him to obtain a satisfactory pain benefit,
03:12which allows him to rehabilitate him in his social and work life.
03:18The current regulations are very rich in documents, starting from the law 38 of 2010,
03:25which defines the right for the citizen to access pain therapy and palliative care,
03:31up to the regional agreements of 2012 and 2020, which defines in a precise way
03:40and characterizes the networks of regional pain therapy in the context of a collaboration
03:48between centers that are defined as HUB and SPOC centers, where the HUB centers are the reference centers
03:55where the pain therapy takes place in the context of greater complexity,
04:02and the SPOC centers are centers where procedures are performed at an intermediate complexity,
04:11and which can therefore refer to the HUB centers to send the most complex patients.
04:18Certainly, these regulations already define the human resources to be dedicated to pain therapy centers,
04:28resources that are not always easily found, as the anesthetists and reanimators
04:35who are deputies to the coordination of these centers, as well as to the regional coordination,
04:42are still a small number, and even smaller is the number of anesthetists and reanimators
04:50who have a specific training in pain medicine.
04:55That is why SIARTI has a very important role in terms of training,
05:01a training that must be continuous, also in view of continuous updates of international research
05:11and therapeutic possibilities, not only pharmacological, but also minimally invasive and interventional.
05:18We currently have innovative therapeutic possibilities, especially in the field of technological innovations.
05:26If we think of the post-pandemic period, it has certainly enriched us with methodologies
05:35that until before the pandemic were used very little.
05:40For example, telemedicine and teleconsultation, which allow us to be close to our patients
05:48even when we have difficulties in reaching them from a logistical point of view.
05:54A very important service to manage pain complexity remotely, in terms of therapeutic adherence.
06:08In addition, some technologies, such as virtual reality, which seems to be very promising,
06:19are also facing the international panorama, not only to manage procedural pain, acute pain, but also chronic pain.
06:26In particular, in chronic pain of difficult treatment,
06:30when those mechanisms of pain perception are now altered.
06:36In addition, speaking of artificial intelligence, we can think of an important role of this sector in the field of pain,
06:46especially in terms of the predictiveness that artificial intelligence can help us achieve in the field of pain,
06:56in particular persistent pain and chronic pain.
07:00It is therefore necessary to open the possibilities for collaboration between doctors, specialists in pain medicine
07:09and artificial intelligence engineers or experts,
07:14who can help us create those algorithms that can certainly guide our therapeutic choices
07:23in order to achieve a more tailored therapy for the patient.
07:28The pain centers in Italy are currently organized, according to law 38, in a hub-and-spoke model,
07:36to which another level of assistance is added, represented by numerous ambulatories scattered throughout the national territory.
07:46They are not framed as spoke centers,
07:49but they are certainly essential for managing the patient's first access to a pain therapy network.
07:58In fact, Italian pain centers are inserted in regional networks that collaborate with each other,
08:07but above all that integrate and should integrate more and more with palliative care networks.
08:14An intra-hospital pain therapy network manages patients who are hospitalized or ambulatory,
08:22while the palliative care network is territorial and has the possibility of following the patient at home.
08:30The integration between the two networks is a virtuous model,
08:34certainly to be implemented to ensure the assistance continuity for the patient.
08:41Arti is our scientific association of Italian reference of anesthesia, analgesia, intensive care and pain.
08:50And precisely in its definition, Contra Dolorem Semper,
08:55it contains those concepts of fundamental importance that are transversal in all,
09:03not only our discipline, but in all medical disciplines,
09:08because any professional can always have to deal with a patient affected by acute, persistent or chronic pain.
09:17Arti has a very important role, not only in the training of specialists,
09:23but also in the creation of recommendations and guidelines
09:31that define the fundamental pillars for our discipline of physiopathology and pain medicine,
09:39from a clinical, organizational and technological point of view.
09:46Our scientific association plays a role of reference in this discipline,
09:53which will certainly continue in the future, hoping to find more and more feedback from the institutions.