Pain Prevalence and Management in an Internal Medicine Setting in Italy

Background. Since data on pain evaluation and management in patients admitted to internal medicine wards (IMWs) are limited, we aimed to evaluate these aspects in a cohort of internistic patients. Methods. We considered all patients consecutively admitted from June to December 2011 to our unit. Age, gender, and length-of-hospital-stay (LOS) were recorded. Comorbidities were arbitrarily defined, and pain severity was evaluated by Numeric Rating Scale (NRS) on admission and discharge. Results. The final sample consisted of 526 patients (mean age years; 308 women). Significant pain (NRS ≥ 3) was detected in 63% of cases, and severe (NRS ≥ 7) in 7.6%. Pain was successfully treated, and NRS decreased from 4.65 ± 2.05 to 0.89 ± 1.3 ( ). Compared with subjects with NRS < 3, those with significant pain were older (75.5 ± 13.9 versus 72.9 ± 14.5 years, ), and had a higher LOS (7.9 ± 6.1 versus 7.3 ± 6.8, ). Significant pain was independently associated with age (OR 0.984, ), cancer (OR 3.347, ), musculoskeletal disease (OR 3.054, ), biliary disease (OR 3.100, ), and bowel disease (OR 3.100, ). Conclusion. In an internal medicine setting, multiple diseases represent significant cause of pain. Prompt pain evaluation and management should be performed as soon as possible, in order to avoid patients’ suffering and reduce the need of hospital stay. 1. Introduction Pain is a common symptom and moderate-to-severe pain has been reported to affect up to 50% of community dwelling older adults and up to 80% of nursing home residents [1]. In Italy, since March 2010, a complete report of assessment of pain in clinical records described as type, measurement, treatment, and degree of relief became compulsory by law n° 8 “Provision aimed at ensuring access to palliative care and pain therapy.” Comorbidity is actually the main problem that physicians have to deal with, especially in internal medicine wards (IMWs) [2], due to mean age of patients and multiple-organ dysfunction. A survey analyzing the quality of documentation related to pain measurement and treatment in patients discharged from hospitals of the Tuscany Region of Italy has been recently published [3]. Out of 2,459 subjects investigated, the majority were aged 70 to 79 years, and 63.77% reported medical Diagnosed Related Groups (DRGs), mainly cardiovascular diseases. These data defined pain as a very frequent compliant in hospital settings. The great majority of papers published on pain management are focused on disease-specific conditions, whereas data describing pain management in patients admitted in IMWs are