Article Data

  • Views 4802
  • Dowloads 333

Original Research

Open Access

Chronic non-cancer pain in primary care: an Italian cross-sectional study

  • Arianna Camilloni1
  • Giulio Nati1
  • Paolo Maggiolini2
  • Antonio Romanelli2
  • Gianni Carbone2
  • Diana Giannarelli3
  • Irene Terrenato3
  • Maria Grazia De Marinis4
  • Adriano Rossi5
  • Daniela D’Angelo6
  • Rosaria Ferrara7
  • Laura Iacorossi8
  • Antonella Paladini9
  • Giustino Varrassi10
  • Gianfranco Tarsitani1,†
  • Roberto Latina2,†

1Sapienza University,Rome, Italy

2School of Nursing & Midwifery, Sapienza University, AO San Camillo-Forlanini Hospital, Gianicolense n.87, 00152 Rome, Italy

3Biostatistic and Bioinformatic Unit, IRCCS Regina Elena National Cancer Institute,Rome, Italy

4Nursing Research Unit Campus Bio-Medico University,Rome, Italy

5School of Medicine and Surgery, University of Milano-Bicocca,Milan, Italy

6Tor Vergata University,Rome, Italy

7Department of Psychiatry CHUV, Faculty of Biology and Medicine,Lousanne, Switzerland

8School of Nursing, Sapienza University, IRCCS Regina Elena National Cancer Institute,Rome, Italy

9MESVA Università dell’Aquila,Italy

10Paolo Procacci Foundation, Roma, Italy

DOI: 10.22514/sv.2020.16.0111 Vol.17,Issue 2,March 2021 pp.54-62

Published: 08 March 2021

*Corresponding Author(s): Antonio Romanelli E-mail:
*Corresponding Author(s): Roberto Latina E-mail:

† These authors contributed equally.


Chronic non-cancer pain is a complex health condition that affects more than a quarter of the Italian population who mainly refers to general practitioners and primary care for their treatment. There are little information on the epidemiological and clinical characteristics and types of treatments for these patients who suffer from chronic pain. The aim of the study was to provide epidemiological and clinical information about patients with chronic non-cancer pain who refers to GPs for their treatment. An observational, multicentre, cross-sectional study was carried out using retrospectively reviewed clinical records from 29 GPs. Some pharmacoeconomic aspects were also investigated. A total of 1,007 patients who had chronic pain were selected for the study. Chronic pain was more common in women than in men (ratio 2.7 : 1) (P = 0.002). With regard to incomes, the women earned less than the men (P = 0.017). The chronic pain was musculoskeletal (73.4%), mixed (21.4%), neuropathic (4.9%) and visceral (0.3%). More women than men had pain in two or more sites, and 33.5% of the patients reported more than one diagnosis that related to chronic pain. The general practitioners had prescribed nonsteroidal anti-inflammatory drugs for 71.8% of the cases, opioids for 16.9%, adjuvants for 9.0% and acetaminophen for 2.4%, and about pharmacoeconomic aspects, the total cost for the sample was € 111,331.42. Primary care is the essential frontline for patients who suffer from non-cancer pain. An interdisciplinary assessment and approach should start in primary care delivery to maximize the clinical outcomes.


Primary care; Epidemiology; General Practitioner; Chronic Pain; Pain Management; Italy; General Population

Cite and Share

Arianna Camilloni,Giulio Nati,Paolo Maggiolini,Antonio Romanelli,Gianni Carbone,Diana Giannarelli,Irene Terrenato,Maria Grazia De Marinis,Adriano Rossi,Daniela D’Angelo,Rosaria Ferrara,Laura Iacorossi,Antonella Paladini,Giustino Varrassi,Gianfranco Tarsitani,Roberto Latina. Chronic non-cancer pain in primary care: an Italian cross-sectional study. Signa Vitae. 2021. 17(2);54-62.


[1] Institute of Medicine. Committee on Advancing Pain Research Care and Education. The National Academies collection: reports funded by national institutes of health. relieving pain in America: a blueprint for transforming prevention, care, education, and research. National Academies Press. 2011.

[2] Gerbershagen HU, Lindena G, Korb J, Kramer S. Health-related quality of life in patients with chronic pain. Schmerz. 2002; 16: 271-284.

[3] Dysvik E, Lindstrøm TC, Eikeland OJ, Natvig GK. Health-related quality of life and pain beliefs among people suffering from chronic pain. Pain Management Nursing. 2004; 5: 66-74.

[4] Paterniani A, Sperati F, Esposito G, Cognetti G, Pulimeno AML, Rocco G, et al. Quality of life and disability of chronic non-cancer pain in adults patients attending pain clinics: A prospective, multicenter, observational study. Applied Nursing Research. 2020; 14: 151332.

[5] Von Korff M, Lin EH, Fenton JJ, Saunders K. Frequency and priority of pain patients’ health care use. Clinical Journal of Pain. 2007; 23: 400-408.

[6] Leadley RM, Armstrong N, Lee YC, Allen A, Kleijnen J. Chronic diseases in the European Union: the prevalence and health cost implications of chronic pain. Journal of Pain and Palliative Care Pharmacotherapy. 2012; 26: 310-325.

[7] Lynch ME, Schopflocher D, Taenzer P, Sinclair C. Research funding for pain in Canada. Pain Res Manag. 2009; 14: 113-115.

[8] Angeles RN, Guenter D, McCarthy L, Bauer M, Wolfson M, Chacon M, et al. Group interprofessional chronic pain management in the primary care setting: a pilot study of feasibility and effectiveness in a family health team in Ontario. Pain Research and Management. 2013; 18: 237-242.

[9] Treede RD, Rief W, Barke A, Aziz Q, Bennett MI, Benoliel R, et al. Chronic painas a symptom or a disease: the IASP Classification of chronic pain for the International Classification of Diseases (ICD-11). Pain. 2019; 160: 19-27.

[10] Andrew R, Derry S, Taylor RS, Straube S, Phillips CJ. The costs and consequences of adequately managed chronic non‐cancer pain and chronic neuropathic pain. Pain Practice. 2014; 14: 79-94.

[11] Del Giorno R, Frumento P, Varrassi G, Paladini A, Coaccioli S. Assessment of chronic pain and access to pain therapy: a cross-sectional population-based study. Journal of Pain Research. 2017; 10: 2577-2584.

[12] Azevedo LF, Costa-Pereira A, Mendonça L, Dias CC, Castro-Lopes JM. Epidemiology of chronic pain: a population-based nationwide study on its prevalence, characteristics and associated disability in Portugal. Journal of Pain. 2012; 13: 773-783.

[13] Kurita GP, Sjøgren P, Juel K, Højsted J, Ekholm O. The burden of chronic pain: a cross-sectional survey focussing on diseases, immigration, and opioid use. Pain. 2012; 153: 2332-2338.

[14] Flüß E, Bond CM, Jones GT, Macfarlane GJ. The re-evaluation of the measurement of pain in population-based epidemiological studies: The SHAMA study. Brazilian Journal of Pain. 2015; 9: 134-41.

[15] Patel KV, Guralnik JM, Dansie EJ, Turk DC. Prevalence and impact of pain among older adults in the united states: findings from the 2011 national health and aging trends study. Pain. 2013; 154: 2649-57.

[16] Raftery MN, Sarma K, Murphy AW, De la Harpe D, Normand C, McGuire BE. Chronic pain in the Republic of Ireland-community prevalence, psychosocial profile and predictors of pain-related disability: results from the prevalence, impact and cost of chronic pain (PRIME) study, part 1. Pain. 2011; 152: 1096-103.

[17] Molton IR, Terrill AL. Overview of persistent pain in older adults. American Psychologist. 2014; 69: 197-207.

[18] Mogil JS. Sex differences in pain and pain inhibition: multiple expla-nations of a controversial phenomenon. Nature Reviews Neuroscience. 2012; 13: 859-866.

[19] Latina R, De Marinis MG, Giordano F, Osborn JF, Giannarelli D, Di Biagio E, et al. Epidemiology of chronic pain in the Latium region, Italy: A cross-sectional study on the clinical characteristics of patients attending pain clinics. Pain Management Nursing. 2019; 20: 373-381.

[20] Langley PC, Ruiz-Iban MA, Molina JT, De Andres J, Castellón JR. The prevalence, correlates and treatment of pain in Spain. Journal of Medical Economics. 2011; 14: 367-380.

[21] Andersson HIEG, Leden I, Schersten B. Impact of chronic pain on health care seeking, self care, and medication. Results from a population-based Swedish study. Journal of Epidemiology and Community Health. 1999; 53: 503-509.

[22] Mäntyselkä PT, Turunen JH, Ahonen RS, Kumpusalo EA. Chronic pain and poor self-rated health. Journal of the American Medical Association. 2003; 290: 2435-2442.

[23] Smith BH, Hardman JD, Stein A, Colvin L. Managing chronic pain in the non-specialist setting: a new SIGN guideline. British Journal of General Practice. 2014; 64: e462-e4.

[24] Dobscha SK, Corson K, Perrin NA, Hanson GC, Leibowitz RQ, Doak MN, et al. Collaborative care for chronic pain in primary care: a cluster randomized trial. Journal of the American Medical Association. 2009; 301: 1242-1252.

[25] D’Angelo D, Chiara M, Vellone E, Alvaro R, Casale G, Stefania L, et al. Transitions between care settings after enrolment in a palliative care service in Italy: a retrospective analysis. International Journal of Palliative Nursing. 2013; 19: 110-115.

[26] Koleva D, Krulichova I, Bertolini G, Caimi V, Garattini L. Pain in primary care: an Italian survey. European Journal of Public Health. 2005; 15: 475-9.

[27] Leuter C, Piroli A, Paladini A, Tudini M, Varrassi G. Care strategies and therapeutic pathways for chronic pain patients in Abruzzo Region, Italy. Annali di Igiene. 2017; 29: 63-72.

[28] Guthrie B, Payne K, Alderson P, McMurdo ME, Mercer SW. Adapting clinical guidelines to take account of multimorbidity. British Medical Journal. 2012; 345: e6341.

[29] Pannek J, Pannek-Rademacher S, Wöllner J. Use of complementary and alternative medicine in persons with spinal cord injury in Switzerland: a survey study. Spinal Cord. 2015; 53: 569-72.

[30] Smith BH, Hopton JL, Chambers WA. Chronic pain in primary care. Family Practice. 1999; 16: 475-482.

[31] Dworkin RH, Turk DC, Wyrwich KW, Beaton D, Cleeland CS, Farrar JT, et al. Interpreting the clinical importance of treatment outcomes in chronic pain clinical trials: IMMPACT recommendations. Journal of Pain. 2008; 9: 105-121.

[32] Dubois MY, Follett KA. Pain medicine: the case for an independent medical specialty and training programs. Academic Medicine. 2014; 89: 863-868.

[33] Damico V, Murano L, Cazzaniga F, Dal Molin A. Pain prevalence, severity, assessment and management in hospitalized adult patients: a result of a multicenter cross-sectional study. Annali dell’Istituto Superiore di Sanita. 2018; 54: 194-200.

[34] Corsi N, Roberto A, Cortesi L, Nobili A, Mannucci PM, Corli O, et al. Prevalence, characteristics and treatment of chronic pain in elderly patients hospitalized in internal medicine wards. European Journal of Internal Medicine. 2018; 55: 35-39.

[35] Latina R, De Marinis MG, Baglìo G, Cattaruzza MS, Notaro P, Guzzetti V, et al. Features and organization of pain centers in the Lazio Region, Italy, in 2011. Annali di Igiene. 2014; 26: 367-379.

[36] von Elm E, Altman DG, Egger M, Pocock SJ, Gøtzsche PC, Van-denbroucke JP, et al. The strengthening the reporting of observational studies in epidemiology (STROBE) statement: guidelines for reporting observational studies. Annals of Internal Medicine. 2007; 147: 573-577.

[37] International Association for the Study of Pain (IASP). Classification of chronic pain. Descriptions of chronic pain syndromes and definitions of pain terms. IASP Press. 1994.

[38] Cabrera-León A, Cantero-Braojos MÁ, Garcia-Fernandez L, Guerra de Hoyos JA. Living with disabling chronic pain: results from a face-to-face cross-sectional population-based study. BMJ Open. 2018; 8: e020913.

[39] Pieretti S, Di Giannuario A, Di Giovannandrea R, et al. Gender differences in pain and its relief. Annali dell’Istituto Superiore di Sanita. 2016; 52: 184-189.

[40] Mansfield KE, Sim J, Jordan JL, Marzoli F, Piccaro G, Minosi P, et al. A systematic review and meta-analysis of the prevalence of chronic widespread pain in the general population. Pain. 2016; 157: 55-64.

[41] Kyranou M, Puntillo K. The transition from acute to chronic pain: might intensive care unit patients be at risk? Annals of Intensive Care. 2012; 2: 36.

[42] Newman AK, Kapoor S, Thorn BE. Health care utilization for chronic pain in low-income settings. Pain Medicine. 2018; 19: 2387-2397.

[43] Day MA, Thorn BE. The relationship of demographic and psychosocial variables to pain-related outcomes in a rural chronic pain population. Pain. 2010; 151: 467-74.

[44] Grimby-Ekman A, Gerdle B, Björk J, Larsson B. Comorbidities, intensity, frequency and duration of pain, daily functioning and health care seeking in local, regional, and widespread pain-a descriptive population-based survey (SwePain). BMC Musculoskeletal Disorders. 2015; 16: 165.

[45] Hemp P. Presenteeism: at work-but out of it. Harvard Business Review. 2004; 82: 49-58.

[46] Quintana R, Silvestre AM, Goñi M, García V, Mathern N, Jorfen M, et al. Prevalence of musculoskeletal disorders and rheumatic diseases in the indigenous Qom population of Rosario, Argentina. Clinical Rheumatology. 2016; 35: 5-14.

[47] Fredheim OM, Skurtveit S, Breivik H, Borchgrevink PC. et al. Increasing use of opioids from 2004 to 2007-pharmacoepidemiological data from a complete national prescription database in Norway. European Journal of Pain. 2010; 14: 289-294.

[48] National Institute for Health and Care Excellence (NICE). Neuropathic pain in adults: pharmacological management in non-specialist settings. Clinical guideline [CG173]. 2013. Available at: https://www.nice.

[49] O’Connor AB. Neuropathic pain: quality-of-life impact, costs and cost effectiveness of therapy. Pharmacoeconomics. 2009; 27: 95-112.

[50] Iacorossi L, Gambalunga F, Fabi A, Giannarelli D, Facchinetti G, Piredda M, et al. Adherence to hormone therapy in women with breast cancer: a quantitative study. Professioni Infermieristiche. 2016; 69: 113-121.

Abstracted / indexed in

Science Citation Index Expanded (SciSearch) Created as SCI in 1964, Science Citation Index Expanded now indexes over 9,200 of the world’s most impactful journals across 178 scientific disciplines. More than 53 million records and 1.18 billion cited references date back from 1900 to present.

Journal Citation Reports/Science Edition Journal Citation Reports/Science Edition aims to evaluate a journal’s value from multiple perspectives including the journal impact factor, descriptive data about a journal’s open access content as well as contributing authors, and provide readers a transparent and publisher-neutral data & statistics information about the journal.

Chemical Abstracts Service Source Index The CAS Source Index (CASSI) Search Tool is an online resource that can quickly identify or confirm journal titles and abbreviations for publications indexed by CAS since 1907, including serial and non-serial scientific and technical publications.

Index Copernicus The Index Copernicus International (ICI) Journals database’s is an international indexation database of scientific journals. It covered international scientific journals which divided into general information, contents of individual issues, detailed bibliography (references) sections for every publication, as well as full texts of publications in the form of attached files (optional). For now, there are more than 58,000 scientific journals registered at ICI.

Geneva Foundation for Medical Education and Research The Geneva Foundation for Medical Education and Research (GFMER) is a non-profit organization established in 2002 and it works in close collaboration with the World Health Organization (WHO). The overall objectives of the Foundation are to promote and develop health education and research programs.

Scopus: CiteScore 1.0 (2022) Scopus is Elsevier's abstract and citation database launched in 2004. Scopus covers nearly 36,377 titles (22,794 active titles and 13,583 Inactive titles) from approximately 11,678 publishers, of which 34,346 are peer-reviewed journals in top-level subject fields: life sciences, social sciences, physical sciences and health sciences.

Embase Embase (often styled EMBASE for Excerpta Medica dataBASE), produced by Elsevier, is a biomedical and pharmacological database of published literature designed to support information managers and pharmacovigilance in complying with the regulatory requirements of a licensed drug.

Submission Turnaround Time