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A Journal on Internal Medicine

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Minerva Medica 2011 August;102(4):289-307


language: English, Italian

Change pain: changing the approach to chronic pain

Coluzzi F. 1, Berti M. 2

1 Department of Medical Surgery Sciences and Biotechnologies, Sapienza University of Rome, Rome, Italy; 2 Unit of Anesthesiology and Resuscitation, Department of Surgery, Parma University Hospital, Parma, Italy


In Italy, chronic pain has a prevalence of about 26%, a rate that warrants efforts by specialists and primary care physicians to improve its treatment. From a study of various treatment systems, it is clear that a radical change in the approach to pain pathology is needed. To this end, the Change Pain International Advisory Board*, an international panel of experts, highlighted the limits to current treatment schemes and proposed new strategies. Among the criticalities are poor or inadequate communication between physician and patient, difficulty in qualitative and quantitative measurement of pain, management of adverse effects, and the “vicious circle” generated by current therapies, often the cause of poor compliance with pain treatment or discontinuation of analgesic therapy. A further limitation to current therapeutic practice is to consider pain intensity as the sole reference parameter in its treatment. In light of these considerations, the Advisory Board has drawn up a strategy to improve outcomes of pain therapy: 1) a shared therapeutic pact between physician and patient based on efficacious communication rather than on information alone; 2) identification of defined therapeutic objectives that allow for reaching a balance between reduction of pain and occurrence of adverse effects; 3) adoption of drug therapies that respond at least in part to an approach based on the pathogenic mechanism of pain rather than on pain intensity alone.

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