Chronic Pain in Italy: Exploring Patient Perspectives on Care Gaps and Opportunities

Chronic Pain in Italy: Exploring Patient Perspectives on Care Gaps and Opportunities | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Research Article Chronic Pain in Italy: Exploring Patient Perspectives on Care Gaps and Opportunities Leonardo Consoletti, Marta Gentili, Luca Giacomelli, Giulia Costantini, and 1 more This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-8967310/v1 This work is licensed under a CC BY 4.0 License Status: Under Review Version 1 posted 10 You are reading this latest preprint version Abstract Background : Chronic pain represents a significant public health burden, yet comprehensive data on patient perspectives in Italy remain limited. Despite Law 38/2010 guaranteeing access to pain therapy, gaps persist in understanding how patients experience care, navigate the healthcare system, and access treatment. This study explored patient perspectives on chronic pain management in Italy, examining therapeutic pathways, barriers to care, legal awareness, and unmet needs. Methods : A nationwide cross-sectional survey was conducted between October 31 and November 11, 2025, using Computer-Assisted Web Interviewing (CAWI). Eligible participants were adults (≥18 years) with chronic pain lasting ≥3 months, reporting pain intensity >3 on a Numerical Rating Scale (NRS 0-10) in the preceding week or receiving specific pain therapy. Of 2,989 individuals invited, 492 met inclusion criteria and completed the survey. Data were analyzed using descriptive statistics, with results presented as frequencies and percentages. Results : Participants (53% female, mean age 62 years) reported moderate-to-severe pain intensity (mean NRS 6.2±1.8), with 52% experiencing severe pain (NRS 7-10). Despite this burden, 28% received no specific pain therapy. Among those treated, initial prescribers were pathology specialists (44.1%), general practitioners (42.9%), or pain specialists (13%). Only 22% of patients initially seen by pain specialists continued under their care; conversely, 65% remained with their GP. Chronic pain significantly impacted daily functioning: sleep (74.8%), work/study (75.5%), and caregiving (64.1%). Barriers to care were prevalent: 71.7% experienced difficulty finding competent specialists, 54% encountered medication access problems, and 65.4% lacked clear treatment information. Only 7.5% had good knowledge of Law 38/2010, and 47.6% could not distinguish palliative care from pain therapy. Access to opioid/cannabinoid therapies was considered difficult by 58.8%, attributed to restrictive regulations (58%) and physician reluctance (54.9%). Most participants (74.5%) perceived chronic pain as inadequately addressed in public discourse, and 67.2% felt unsupported by the National Health Service. Conclusions : This study reveals substantial gaps in chronic pain management in Italy, characterized by high rates of untreated pain, limited specialist involvement, poor care continuity, inadequate legal awareness, and perceived institutional neglect. These findings highlight urgent needs for enhanced access to specialized care, improved primary care training in pain management, regulatory reform to facilitate appropriate opioid/cannabinoid prescribing, public awareness campaigns, and patient-centered care pathways. Addressing these challenges requires coordinated action across legislative, clinical, and educational domains to ensure chronic pain is recognized and managed as a distinct disease requiring comprehensive intervention. access to care chronic pain health literacy Italy legal rights pain management patient perspective primary care public health Figures Figure 1 Background Pain is one of the most widespread and burdensome health problems globally. Chronic pain, in particular, has a lasting impact on physical, psychological, and social well-being. Since the early 2000s, many epidemiological surveys have reported high pain prevalence across diverse populations and health systems. Early studies from Europe, North America, and beyond consistently showed that a large proportion of adults suffer from persistent, moderate-to-severe pain that interferes with daily functioning [1–5]. Several major surveys also highlighted significant gaps in care. The pan-European study by Breivik et al. found that many people with chronic pain were inadequately treated and rarely referred to pain specialists [6]. Similar trends emerged in Germany, Spain, Israel and India, where patients frequently reported dissatisfaction with treatment and limited access to specialized care [4,7–9]. These findings were echoed in studies of cancer and mixed-pain populations, which showed a strong impact on quality of life and persistent unmet therapeutic needs [10,11]. Recent reviews have reinforced the view of chronic pain as a disease in its own right, shaped by biological, psychological, and social factors [12,13]. Increasing attention has been paid to patients' beliefs, expectations, and coping strategies as key elements influencing treatment outcomes [11,14,15]. Surveys have also revealed discrepancies between patient and physician perspectives, especially concerning treatment goals and the use of long-term therapies, such as opioids [14,15]. Nonetheless, most of this research is over a decade old and often limited to specific populations, such as older adults, patients with low back or cancer pain, or focused primarily on prevalence and treatment [3,7,8,16]. Broader insights into patients' experiences with healthcare navigation, information access, and legal rights remain scarce. In Italy, this lack of comprehensive, up-to-date data is particularly apparent. Although Law 38/2010 formally guarantees the right to pain therapy, few large-scale studies have explored Italian patients' perspectives beyond specific clinical contexts, such as musculoskeletal, rheumatologic, or cancer pain [17–23]. While informative, these studies do not offer a full picture of how Italians experience chronic pain, access care, or engage with the healthcare system. Patient-centered research increasingly emphasizes that outcomes should be defined not only by pain reduction but also by improved function, participation, and perceived well-being [24,25]. These findings underscore the need for surveys that elevate patients' voices and explore pain as a multidimensional experience. This study presents findings from a nationwide Italian survey designed to explore patient perspectives on pain more broadly. By building on past international work and addressing existing gaps, it offers updated, patient-centered insights into the impact of pain, care pathways, healthcare roles, legal awareness, and unmet needs in Italy, offering a foundation for further multidisciplinary reflection and policy action. Methods This study presents the findings of a national survey conducted in Italy to investigate the perspectives of individuals living with chronic pain, focusing on their needs, expectations, and experiences with the healthcare system. The survey was promoted by the Fondazione Nora e Alberto Gentili and conducted by SWG S.p.A. with unrestricted grant support from M.A.V.A. The survey instrument, written in Italian, was specifically developed for this study and is presented, translated in English, as a supplementary material. The survey adopted a quantitative design, utilizing the Computer-Assisted Web Interviewing (CAWI) method for data collection. Eligible participants were adults (≥18 years) residing in Italy who reported experiencing chronic pain lasting at least three months. To be included, respondents had to meet at least one of the following criteria: they reported a pain intensity of >3 on a Numerical Rating Scale (NRS, 0–10) in the week preceding the survey, or they were currently undergoing specific therapy for chronic pain, regardless of reported intensity. Participants also needed sufficient proficiency in Italian to complete an online questionnaire. From a total of 2,989 individuals invited to participate, 1,540 did not respond, and 841 were excluded following screening for not meeting the eligibility criteria (i.e., either not having chronic pain or having chronic pain with intensity ≤3 and without specific treatment). An additional 25 individuals initiated but did not complete the questionnaire. After applying quality control procedures, which included the removal of respondents with completion times significantly shorter than the sample average or internal inconsistencies in their answers, 91 additional cases were excluded. Ultimately, 492 participants (16.5% of those invited) were included in the final analysis ( Figure 1 ). Data were collected between 31 October and 11 November 2025. The survey instrument included structured items addressing a range of domains: sociodemographic characteristics, underlying health conditions, pain intensity (measured using the NRS), current treatment status and prescribing physicians, the impact of pain on daily life, perceived barriers to healthcare access, knowledge of Italian Law 38/2010, access to opioid and cannabinoid therapies, and unmet informational needs. Responses were collected anonymously, and informed consent was obtained electronically prior to participation, in accordance with ethical standards for market research. No post-stratification weighting was applied to the final dataset, as the precise sociodemographic distribution of the target population (individuals with chronic pain in Italy) was not available. Therefore, descriptive statistics are presented as raw frequencies and percentages. For items that allowed for "don't know" responses, these were excluded from percentage calculations when specified. Results Demographic and clinical characteristics Among the 492 individuals included, gender distribution was relatively balanced, with 53% female and 47% male respondents. Participants spanned a wide age range: 15% were under 49 years, 27% aged 50–59 years, 31% aged 60–69 years, and 27% aged 70–85 years. Geographical representation was well distributed: 26% resided in northwest Italy, 22% in northeast Italy, 20% in central Italy, and 32% in south Italy or the Islands. Regarding clinical profiles, musculoskeletal conditions were the most frequently reported underlying cause of pain (57%), followed by autoimmune and chronic inflammatory diseases (17%), neurological/neuropathic conditions (9%), oncological pain (3%), and idiopathic or complex pain syndromes (2%). A small minority (6%) did not identify with any of the listed conditions. Demographical data are summarized in Table 1 . Pain Intensity and Treatment Status The mean pain intensity reported during the previous week was 6.2 + 1.8, indicating a moderate-to-severe level of chronic pain. Specifically, 52% of respondents rated their pain as severe (7–10), 40% as moderate (4–6), and only 8% as mild (0–3). Data are further detailed in Supplementary Table S1. Despite this high burden, 28% of participants were not receiving any specific pain therapy at the time of the survey. Among those receiving treatment, the initial prescriber was most often a specialist related to the underlying pathology (44.1%), followed closely by general practitioners (42.9%). Only 13% had their first pain treatment initiated by a pain specialist. These findings are further detailed in Table 2 . Continuity of Care and Professional Management Patterns of clinical management revealed that continuity with pain specialists is rare. Among patients who initially received treatment from a pain specialist, only 22% continued to be followed by one at the time of the survey. Conversely, 65% of those who began treatment with a general practitioner (GP) remained under their care. Currently, 40% of respondents were followed by their general practitioner, 26% by a pathology specialist, 18% by physiotherapists or allied professionals, and only 4% by a pain therapist. Notably, 9% reported that no healthcare professional was managing their pain. These patterns are summarized in Table 3 . Impact on Daily Life Chronic pain had a broad and substantial impact across domains of daily functioning. The quality of sleep was affected in 74.8% of respondents, with 29.8% reporting severe or completely limitations. Work or study activities were impaired in 75.5% of cases. Additionally, 64,1% experienced difficulties caring for others, and 51.9% reported limitations in self-care. Participants also reported restrictions in social functioning and leisure activities. These findings underscore the pervasive effect of pain on independence and psychosocial well-being. These findings are further illustrated in Table 4 . Barriers to Care and Treatment Access Barriers to care emerged as a central concern. 71.7% of respondents reported difficulties identifying a competent pain specialist, and in 40.7% of cases, these difficulties persisted over time. More than half (54%) encountered issues accessing prescribed medications, and in 27.8% of these cases, the problem was chronic. A significant proportion (65.4%) also reported challenges in accessing clear information about treatment options, drug exemptions, and the healthcare system more broadly. Perceptions of Healthcare Professionals Patients expressed mixed confidence in their healthcare providers. While 89.8% believed that pathology specialists were competent in managing chronic pain, only 65.6% expressed similar confidence in their general practitioner, highlighting a potential gap between patient expectations and the perceived preparedness of primary care providers. Communication between providers was often perceived as insufficient: 48.5% reported inadequate communication between GPs and specialists, and 48.6% noted poor interprofessional collaboration. Importantly, 44.1% of patients felt that their GP considered chronic pain a secondary issue, and 38.1% believed the same was true of their disease specialist. Legal Awareness and Health Literacy Awareness of Law 38/2010, Italy's legislation guaranteeing the right to palliative care and pain therapy, was limited. Only 7.5 of respondents knew the law well, 53.3% had a superficial understanding, and 39.2% had never heard of it. Knowledge was slightly higher among patients under the care of a pain specialist (15.2%) compared to those without any treatment (5.1%). Additionally, 47,6% of respondents could not distinguish between palliative care and pain therapy, suggesting a broader issue of health literacy. Access to Opioid and Cannabinoid Therapies When asked about access to advanced pharmacological options such as opioids and cannabinoids, 58.8% of respondents described access in Italy as difficult. Reported barriers included restrictive national regulations (58%) and reluctance among physicians to prescribe these agents (54.9). Patients perceived general practitioners as the least informed on this topic: 47% considered GPs poorly or not at all informed, compared to 47.3% for pharmacists and 29.9% for medical specialists. Almost half (47.8%) had experienced bureaucratic or administrative difficulties in obtaining these therapies, indicating the persistence of procedural and regulatory challenges in ensuring timely access to advanced therapies. Public Visibility and Information Needs The public and institutional recognition of chronic pain as a legitimate health priority was perceived as minimal. Approximately 74.5% of participants believed that chronic pain was inadequately addressed in the public and social sphere, and 80.5% believed it was underrepresented in media coverage. Moreover, 73.1% stated that political and health institutions did not pay sufficient attention to the needs of people with chronic pain. Two-thirds (67.2%) felt that they received inadequate support from the National Health Service, and 65.9% believed that chronic pain was still regarded as a symptom, rather than a distinct clinical entity. Finally, participants expressed clear informational needs. The most frequently cited areas of interest were: identifying specialist services for pain management (51.6%), understanding lifestyle modifications (41%), drug information and side effects (39.6%), guidance on access to exemptions (38.6%), and awareness of non-pharmacological therapies (36.9%). Discussion This study highlights a series of persistent challenges in the management of chronic pain in Italy, revealing some areas for improvement in therapeutic access, specialist involvement, legal awareness, and institutional accountability. Despite the existence of Law 38/2010, which enshrines the right to pain therapy, the findings indicate that this legal safeguard is not yet consistently translated into practice for all patients, as suggested before in the specific setting of cancer pain [21,22]. One of the most concerning findings is the high prevalence of untreated pain: 28% of respondents reported receiving no specific therapy despite experiencing moderate to severe chronic pain Among those not receiving specific pain therapy, 77.5% were still under the care of a healthcare professional, 27.1% managed by allied figures and 50.4% by a physician, while 22.5% reported having no clinician involved in their care. This level of therapeutic disengagement echoes findings from other European settings, where underdiagnosis and undertreatment remain common despite formal care structures [6,7]. It underscores a need to strengthen the connection between patients' rights and actual service delivery. Specialized care remains relatively limited. Although pain specialists initiated therapy for approximately 13% of patients, only 22% continued under their care, a retention rate of just 21.7%. Currently, among those treated, only 5.4% of patients are followed by pain specialists. This limited continuity contrasts with international recommendations for multidisciplinary pain management and reflects similar trends observed in earlier European and Israeli studies [4,11]. Improving continuity and access to specialized care remains an important goal. Instead, GPs have emerged as the mainstay of chronic pain care, managing 39.5% of respondents. While this may reflect their accessibility, it is essential to support general practitioners with enhanced training and resources in pain management. A significant proportion of patients perceived their GP as insufficiently prepared to manage chronic pain, and nearly half rated GP knowledge of opioid and cannabinoid therapies as poor. It is important, however, to interpret such perceptions with caution and to distinguish between subjective dissatisfaction and objective clinical performance. Noteworthy, the limited training and structural support available to GPs may contribute to suboptimal care and therapeutic stagnation; strengthening these areas through targeted education and system-level resources could enhance their central role in managing chronic pain. Multiple intersecting barriers emerged, collectively amounting to an uneven landscape of therapeutic opportunities. Geographic disparities were evident, with higher pain intensity reported in southern regions despite similar access rates, possibly indicating unmeasured socioeconomic burdens. Access to opioid and cannabinoid therapies was perceived as difficult by 58.8% of patients, and reluctance to prescribe these agents, reported in 55% of cases, points to a persistent climate of opiophobia. Furthermore, 57.5% agreed that current regulations themselves serve as barriers, suggesting a misalignment between legislative intent and administrative practice. Similar regulatory and cultural obstacles have been documented in the management of cancer pain, reinforcing the view that legal frameworks alone are insufficient without operational and educational support [21,22]. The impact of chronic pain extended far beyond physical discomfort, permeating every aspect of daily life. Disruption to sleep (74.8%), occupational functioning (75.5%), and caregiving responsibilities (64.1%) were reported at high rates. This constellation of limitations contributes to economic marginalization and social dependency. Particularly distressing is the perception, shared by over half of respondents, that their pain is considered a secondary issue by clinicians. While these data highlight a need to improve clinical responsiveness and communication, they also reflect the emotional toll and vulnerability often experienced by people living with chronic pain. Legal and informational deficits compound these challenges. Only 7.5% of respondents were familiar with Law 38/2010, and nearly 47.6% could not distinguish between palliative care and pain therapy. These gaps hinder patient empowerment and signal broader failures in both public communication and professional education. Information needs were particularly focused on identifying specialist care and navigating available treatment options, needs that reflect not only knowledge deficits but structural disorientation within the health system. Prior surveys across multiple countries have similarly noted poor legal literacy among patients and a lack of clarity around care pathways [11,12]. Cultural and systemic issues further marginalize chronic pain. The condition remains underrepresented in both media and public discourse, with 74.5% of patients perceiving it as socially invisible. This invisibility contributes to stigma, weakens policy advocacy, and isolates patients. Fragmentation between GPs and specialists, reported by nearly half of respondents, exemplifies the lack of integrated care pathways. In such a disjointed system, the burden of care coordination often falls to the patient, exacerbating inequality for those with fewer resources or lower health literacy. These findings should prompt reflection not only on care structures but also on how chronic pain is framed and prioritized in policy and culture. These findings underscore the need for progressive and pragmatic reforms. Expanding access to specialized pain services, equipping primary care providers with structured training in multimodal pain management, and streamlining referral pathways are critical steps. Equally important is regulatory reform to ensure that prescribing rules support, rather than impede, legitimate therapeutic needs. Public awareness campaigns and provider education must emphasize that chronic pain is a disease in its own right, requiring systematic and compassionate intervention [12,13]. Despite its strengths, including national representation and a comprehensive survey instrument, this study has limitations. Online data collection may exclude digitally underserved populations, and the cross-sectional design precludes causal inference. Self-reported measures of pain and diagnoses were not clinically verified, which may introduce reporting bias. Nevertheless, this research provides a detailed snapshot of chronic pain care in Italy, as seen through the eyes of those most affected. It reveals not only areas of dissatisfaction but also valuable opportunities for systemic improvement. Conclusion This nationwide survey provides comprehensive evidence of substantial unmet needs in chronic pain management across Italy. Despite legislative safeguards under Law 38/2010, nearly one-third of patients with moderate-to-severe pain receive no specific therapy, and fewer than 5% benefit from specialized pain services. The findings reveal a healthcare landscape marked by fragmented care pathways, limited continuity with specialists, inadequate legal and health literacy, and persistent barriers to accessing advanced therapies. General practitioners have emerged as the primary care providers, yet many lack the training and resources necessary to manage complex chronic pain effectively. Regulatory and cultural obstacles continue to impede appropriate use of opioid and cannabinoid therapies, while the condition itself remains underrepresented in public discourse and policy priorities. Addressing this neglected epidemic will require coordinated action across legislative, clinical, and educational domains. The voices of these 492 patients provide a compelling mandate: to listen, to understand, and to act, not in opposition to the health system, but in collaboration with its strengths and committed professionals. Future initiatives should aim to co-design solutions with patients, clinicians, and institutions to ensure that chronic pain management becomes an integrated and responsive component of public health strategy. Abbreviations GP: General practitioner Declarations Ethics approval and consent to participate: This study was conducted in accordance with the Declaration of Helsinki. The survey was administered online using the Computer-Assisted Web Interviewing (CAWI) method among members of the SWG S.p.A. community panel. Given the observational and non-interventional nature of the study, and the absence of collection of sensitive personal health data, formal ethics committee approval was not required under applicable Italian regulations (D.Lgs. 211/2003 and subsequent amendments). Prior to completing the questionnaire, all participants provided explicit informed consent to the processing of their personal data in accordance with the General Data Protection Regulation (EU) 2016/679 (GDPR). All respondents provided informed consent to participate in this survey. Consent for publication: All responders provided informed consent to the publication of the data of the present survey. Availability of data and materials: All data are available from the corresponding Author upon reasonable request. Competing interests: The authors declare that they have no competing interests. Funding: This study was supported by an unrestricted grant from M.A.V.A. Authors’ contributions: Conceptualization: M.G.; Data analysis and curation: All; Writing—Original Draft Preparation: L.G., M.G.; Writing—Review & Editing: All; Supervision: M.G.; Approval to submit: All. Acknowledgments: The authors thank Fondazione Nora e Alberto Gentili for promoting the study. 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Characteristic n (%) Total Sample 492 (100.0) Gender Male 231 (47.0) Female 261 (53.0) Age Groups <50 years 74 (15.0) 50-59 years 133 (27.0) 60-69 years 152 (31.0) 70-85 years 133 (27.0) Geographic Area Northwest Italy 128 (26.0) Northeast Italy 108 (22.0) Central Italy 98 (20.0) South and Islands 158 (32.0) Educational Level Low (elementary/middle school) 88 (17.9) Medium (high school) 236 (48.0) High (university degree) 168 (34.1) Primary Pathology Musculoskeletal conditions 281 (57.0) Autoimmune and chronic inflammatory diseases 84 (17.0) Neurological conditions (neuropathic pain) 44 (9.0) Cancer-related pain 15 (3.0) Complex or idiopathic pain syndromes 10 (2.0) None of these 93 (19.0) Other conditions* 30 (6.0) *Multiple conditions possible; percentages may sum to >100% Table 2. Initial Prescribers of Pain Therapy. Distribution of healthcare professionals who first prescribed treatment for chronic pain among surveyed patients (n=492). Characteristic No therapy n (%) General Practitioner n (%) Pain Specialist n (%) Other Specialist n (%) Overall Distribution 138 (28.0) 152 (30.9) 44 (8.9) 158 (32.1) By Age Group Under 49 years 21 (28.4) 22 (29.7) 10 (13.5) 21 (28.4) 50-59 years 37 (27.8) 49 (36.8) 7 (5.3) 40 (30.1) 60-69 years 50 (32.9) 47 (30.9) 17 (11.2) 38 (25.0) 70-85 years 30 (22.6) 34 (25.6) 10 (7.5) 59 (44.4) By Primary Pathology Musculoskeletal (n=281) 84 (29.9) 76 (27.0) 28 (10.0) 93 (33.1) Neurological (n=44) 4 (9.1) 14 (31.8) 6 (13.6) 20 (45.5) Autoimmune/Chronic inflammatory (n=84) 24 (28.6) 24 (28.6) 6 (7.1) 30 (35.7) Table 3. Continuity of Care: Initial Prescriber Versus Current Healthcare Provider. Comparison between the healthcare professional who initially prescribed pain therapy and the one currently managing the participant's chronic pain. Data highlight the rate of retention for each provider type and the frequency of patient transition to other care providers. Percentages refer to the proportion of patients remaining under the same type of provider or switching to different ones. Current Healthcare Provider Patients WITHOUT Therapy n (%) First Therapy by GP n (%) First Therapy by Pain Specialist n (%) First Therapy by Other Specialist n (%) Sample size 138 152 44 158 General Practitioner 58 (42.0) 99 (65.1) 12 (27.3) 27 (17.1) Pathology Specialist 19 (13.8) 24 (15.8) 12 (27.3) 74 (46.8) Pain Specialist 1 (0.7) 6 (3.9) 10 (22.7) 35 (22.2) Other Professionals 28 (20.3) 20 (13.2) 7 (15.9) 47 (29.7) No healthcare provider 32 (23.2) 3 (2.0) 2 (4.5) 6 (3.8) Multiple conditions possible; percentages may sum to >100% Table 4. Impact of Chronic Pain on Daily Activities. Self-reported limitations experienced by participants across key functional domains, including leisure, sleep, work/study, caregiving, self-care, and social relationships (n=492). The table presents the proportion of respondents indicating no impact, partial limitation, strong limitation, or complete inability to perform each activity. Activity Domain No Impact (%) Partial Limitation (%) Strong Limitation (%) Unable to Perform (%) Leisure activities 18 49 26 7 Sleep regularity 25 44 28 3 Household tasks 23 57 17 3 Caring for others 36 46 16 2 Work/study activities 24 59 14 3 Social relationships 48 35 15 2 Self-care 48 42 9 1 Additional Declarations No competing interests reported. Supplementary Files TableS1.docx Supplementarymaterial.docx Cite Share Download PDF Status: Under Review Version 1 posted Editorial decision: Revision requested 07 Apr, 2026 Reviews received at journal 23 Mar, 2026 Reviews received at journal 09 Mar, 2026 Reviewers agreed at journal 08 Mar, 2026 Reviewers agreed at journal 07 Mar, 2026 Reviewers invited by journal 07 Mar, 2026 Editor assigned by journal 07 Mar, 2026 Editor invited by journal 06 Mar, 2026 Submission checks completed at journal 06 Mar, 2026 First submitted to journal 06 Mar, 2026 You are reading this latest preprint version Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. As a division of Research Square Company, we’re committed to making research communication faster, fairer, and more useful. We do this by developing innovative software and high quality services for the global research community. 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Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {"props":{"pageProps":{"initialData":{"identity":"rs-8967310","acceptedTermsAndConditions":true,"allowDirectSubmit":false,"archivedVersions":[],"articleType":"Research Article","associatedPublications":[],"authors":[{"id":613286752,"identity":"845a308b-8619-4b71-839d-447d062856df","order_by":0,"name":"Leonardo Consoletti","email":"","orcid":"","institution":"University Hospital of Foggia","correspondingAuthor":false,"prefix":"","firstName":"Leonardo","middleName":"","lastName":"Consoletti","suffix":""},{"id":613286753,"identity":"feb00a06-0022-40e8-b731-f20a30aec150","order_by":1,"name":"Marta Gentili","email":"","orcid":"","institution":"Fondazione Nora e Alberto Gentili ETS","correspondingAuthor":false,"prefix":"","firstName":"Marta","middleName":"","lastName":"Gentili","suffix":""},{"id":613286754,"identity":"3bc11b4e-82ed-41dd-80a6-1b556f0aec8c","order_by":2,"name":"Luca Giacomelli","email":"data:image/png;base64,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","orcid":"","institution":"Polistudium SRL","correspondingAuthor":true,"prefix":"","firstName":"Luca","middleName":"","lastName":"Giacomelli","suffix":""},{"id":613286755,"identity":"73e2d441-2454-4465-b2e0-555784052c9d","order_by":3,"name":"Giulia Costantini","email":"","orcid":"","institution":"SWG S.p.A.","correspondingAuthor":false,"prefix":"","firstName":"Giulia","middleName":"","lastName":"Costantini","suffix":""},{"id":613286756,"identity":"f801d85b-4d15-4574-8ffc-e46b8305b9f9","order_by":4,"name":"Diego MM Fornasari","email":"","orcid":"","institution":"Università degli Studi di Milano","correspondingAuthor":false,"prefix":"","firstName":"Diego","middleName":"MM","lastName":"Fornasari","suffix":""}],"badges":[],"createdAt":"2026-02-25 11:40:35","currentVersionCode":1,"declarations":"","doi":"10.21203/rs.3.rs-8967310/v1","doiUrl":"https://doi.org/10.21203/rs.3.rs-8967310/v1","draftVersion":[],"editorialEvents":[],"editorialNote":"","failedWorkflow":false,"files":[{"id":105874935,"identity":"51becf59-af45-4ddf-976e-751a2130246a","added_by":"auto","created_at":"2026-04-01 05:32:38","extension":"png","order_by":1,"title":"Figure 1","display":"","copyAsset":false,"role":"figure","size":410407,"visible":true,"origin":"","legend":"\u003cp\u003e\u003cstrong\u003eFlow of participants through the study, from initial invitation to final inclusion.\u003c/strong\u003e\u003c/p\u003e","description":"","filename":"Figure1.png","url":"https://assets-eu.researchsquare.com/files/rs-8967310/v1/eb13deb80a23968e8c548c0c.png"},{"id":107704709,"identity":"ec03cf03-68b3-44e0-b435-7d1d33e58047","added_by":"auto","created_at":"2026-04-24 08:55:02","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":447558,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-8967310/v1/64776248-1b92-4d2d-ba01-bf636b1a6f31.pdf"},{"id":105905128,"identity":"c23718c4-ad1f-4bbc-980b-19ccc40de44f","added_by":"auto","created_at":"2026-04-01 10:11:31","extension":"docx","order_by":0,"title":"","display":"","copyAsset":false,"role":"supplement","size":16601,"visible":true,"origin":"","legend":"","description":"","filename":"TableS1.docx","url":"https://assets-eu.researchsquare.com/files/rs-8967310/v1/d95c62a72dbdc3c1c416a277.docx"},{"id":105874934,"identity":"867ef61f-54cc-4061-814b-a99d1467c357","added_by":"auto","created_at":"2026-04-01 05:32:38","extension":"docx","order_by":1,"title":"","display":"","copyAsset":false,"role":"supplement","size":30488,"visible":true,"origin":"","legend":"","description":"","filename":"Supplementarymaterial.docx","url":"https://assets-eu.researchsquare.com/files/rs-8967310/v1/6c007a53a5ff434cec0f4d44.docx"}],"financialInterests":"No competing interests reported.","formattedTitle":"Chronic Pain in Italy: Exploring Patient Perspectives on Care Gaps and Opportunities","fulltext":[{"header":"Background","content":"\u003cp\u003ePain is one of the most widespread and burdensome health problems globally. Chronic pain, in particular, has a lasting impact on physical, psychological, and social well-being. Since the early 2000s, many epidemiological surveys have reported high pain prevalence across diverse populations and health systems. Early studies from Europe, North America, and beyond consistently showed that a large proportion of adults suffer from persistent, moderate-to-severe pain that interferes with daily functioning [1\u0026ndash;5].\u003c/p\u003e\n\u003cp\u003eSeveral major surveys also highlighted significant gaps in care. The pan-European study by Breivik et al. found that many people with chronic pain were inadequately treated and rarely referred to pain specialists [6]. Similar trends emerged in Germany, Spain, Israel and India, where patients frequently reported dissatisfaction with treatment and limited access to specialized care [4,7\u0026ndash;9]. These findings were echoed in studies of cancer and mixed-pain populations, which showed a strong impact on quality of life and persistent unmet therapeutic needs [10,11].\u003c/p\u003e\n\u003cp\u003eRecent reviews have reinforced the view of chronic pain as a disease in its own right, shaped by biological, psychological, and social factors [12,13]. Increasing attention has been paid to patients\u0026apos; beliefs, expectations, and coping strategies as key elements influencing treatment outcomes [11,14,15]. Surveys have also revealed discrepancies between patient and physician perspectives, especially concerning treatment goals and the use of long-term therapies, such as opioids [14,15].\u003c/p\u003e\n\u003cp\u003eNonetheless, most of this research is over a decade old and often limited to specific populations, such as older adults, patients with low back or cancer pain, or focused primarily on prevalence and treatment [3,7,8,16]. Broader insights into patients\u0026apos; experiences with healthcare navigation, information access, and legal rights remain scarce.\u003c/p\u003e\n\u003cp\u003eIn Italy, this lack of comprehensive, up-to-date data is particularly apparent. Although Law 38/2010 formally guarantees the right to pain therapy, few large-scale studies have explored Italian patients\u0026apos; perspectives beyond specific clinical contexts, such as musculoskeletal, rheumatologic, or cancer pain [17\u0026ndash;23]. While informative, these studies do not offer a full picture of how Italians experience chronic pain, access care, or engage with the healthcare system.\u003c/p\u003e\n\u003cp\u003ePatient-centered research increasingly emphasizes that outcomes should be defined not only by pain reduction but also by improved function, participation, and perceived well-being [24,25]. These findings underscore the need for surveys that elevate patients\u0026apos; voices and explore pain as a multidimensional experience.\u003c/p\u003e\n\u003cp\u003eThis study presents findings from a nationwide Italian survey designed to explore patient perspectives on pain more broadly. By building on past international work and addressing existing gaps, it offers updated, patient-centered insights into the impact of pain, care pathways, healthcare roles, legal awareness, and unmet needs in Italy, offering a foundation for further multidisciplinary reflection and policy action.\u003c/p\u003e"},{"header":"Methods","content":"\u003cp\u003eThis study presents the findings of a national survey conducted in Italy to investigate the perspectives of individuals living with chronic pain, focusing on their needs, expectations, and experiences with the healthcare system. The survey was promoted by the Fondazione Nora e Alberto Gentili and conducted by SWG S.p.A. with unrestricted grant support from M.A.V.A. The survey instrument, written in Italian, was specifically developed for this study and is presented, translated in English, as a supplementary material.\u003c/p\u003e\n\u003cp\u003eThe survey adopted a quantitative design, utilizing the Computer-Assisted Web Interviewing (CAWI) method for data collection. Eligible participants were adults (\u0026ge;18 years) residing in Italy who reported experiencing chronic pain lasting at least three months. To be included, respondents had to meet at least one of the following criteria: they reported a pain intensity of \u0026gt;3 on a Numerical Rating Scale (NRS, 0\u0026ndash;10) in the week preceding the survey, or they were currently undergoing specific therapy for chronic pain, regardless of reported intensity. Participants also needed sufficient proficiency in Italian to complete an online questionnaire.\u003c/p\u003e\n\u003cp\u003eFrom a total of 2,989 individuals invited to participate, 1,540 did not respond, and 841 were excluded following screening for not meeting the eligibility criteria (i.e., either not having chronic pain or having chronic pain with intensity \u0026le;3 and without specific treatment). An additional 25 individuals initiated but did not complete the questionnaire. After applying quality control procedures, which included the removal of respondents with completion times significantly shorter than the sample average or internal inconsistencies in their answers, 91 additional cases were excluded. Ultimately, 492 participants (16.5% of those invited) were included in the final analysis (\u003cem\u003eFigure 1\u003c/em\u003e).\u003c/p\u003e\n\u003cp\u003eData were collected between 31 October and 11 November 2025. The survey instrument included structured items addressing a range of domains: sociodemographic characteristics, underlying health conditions, pain intensity (measured using the NRS), current treatment status and prescribing physicians, the impact of pain on daily life, perceived barriers to healthcare access, knowledge of Italian Law 38/2010, access to opioid and cannabinoid therapies, and unmet informational needs. Responses were collected anonymously, and informed consent was obtained electronically prior to participation, in accordance with ethical standards for market research.\u003c/p\u003e\n\u003cp\u003eNo post-stratification weighting was applied to the final dataset, as the precise sociodemographic distribution of the target population (individuals with chronic pain in Italy) was not available. Therefore, descriptive statistics are presented as raw frequencies and percentages. For items that allowed for \u0026quot;don\u0026apos;t know\u0026quot; responses, these were excluded from percentage calculations when specified.\u003c/p\u003e"},{"header":"Results","content":"\u003cp\u003e\u003cem\u003eDemographic and clinical characteristics\u003c/em\u003e\u003c/p\u003e\n\u003cp\u003eAmong the 492 individuals included, gender distribution was relatively balanced, with 53% female and 47% male respondents. Participants spanned a wide age range: 15% were under 49 years, 27% aged 50\u0026ndash;59 years, 31% aged 60\u0026ndash;69 years, and 27% aged 70\u0026ndash;85 years. Geographical representation was well distributed: 26% resided in northwest Italy, 22% in northeast Italy, 20% in central Italy, and 32% in south Italy or the Islands.\u003c/p\u003e\n\u003cp\u003eRegarding clinical profiles, musculoskeletal conditions were the most frequently reported underlying cause of pain (57%), followed by autoimmune and chronic inflammatory diseases (17%), neurological/neuropathic conditions (9%), oncological pain (3%), and idiopathic or complex pain syndromes (2%). A small minority (6%) did not identify with any of the listed conditions. Demographical data are summarized in \u003cem\u003eTable 1\u003c/em\u003e.\u003c/p\u003e\n\u003cp\u003e\u003cem\u003ePain Intensity and Treatment Status\u003c/em\u003e\u003c/p\u003e\n\u003cp\u003eThe mean pain intensity reported during the previous week was 6.2\u003cu\u003e+\u003c/u\u003e1.8, indicating a moderate-to-severe level of chronic pain. Specifically, 52% of respondents rated their pain as severe (7\u0026ndash;10), 40% as moderate (4\u0026ndash;6), and only 8% as mild (0\u0026ndash;3). Data are further detailed in Supplementary Table S1.\u003c/p\u003e\n\u003cp\u003eDespite this high burden, 28% of participants were not receiving any specific pain therapy at the time of the survey. Among those receiving treatment, the initial prescriber was most often a specialist related to the underlying pathology (44.1%), followed closely by general practitioners (42.9%). Only 13% had their first pain treatment initiated by a pain specialist. These findings are further detailed in \u003cem\u003eTable 2\u003c/em\u003e.\u003c/p\u003e\n\u003cp\u003e\u003cem\u003eContinuity of Care and Professional Management\u003c/em\u003e\u003c/p\u003e\n\u003cp\u003ePatterns of clinical management revealed that continuity with pain specialists is rare. Among patients who initially received treatment from a pain specialist, only 22% continued to be followed by one at the time of the survey. Conversely, 65% of those who began treatment with a general practitioner (GP) remained under their care. Currently, 40% of respondents were followed by their general practitioner, 26% by a pathology specialist, 18% by physiotherapists or allied professionals, and only 4% by a pain therapist. Notably, 9% reported that no healthcare professional was managing their pain. These patterns are summarized in \u003cem\u003eTable 3\u003c/em\u003e.\u003c/p\u003e\n\u003cp\u003e\u003cem\u003eImpact on Daily Life\u003c/em\u003e\u003c/p\u003e\n\u003cp\u003eChronic pain had a broad and substantial impact across domains of daily functioning. The quality of sleep was affected in 74.8% of respondents, with 29.8% reporting severe or completely limitations. Work or study activities were impaired in 75.5% of cases. Additionally, 64,1% experienced difficulties caring for others, and 51.9% reported limitations in self-care. Participants also reported restrictions in social functioning and leisure activities. These findings underscore the pervasive effect of pain on independence and psychosocial well-being. These findings are further illustrated in \u003cem\u003eTable 4\u003c/em\u003e.\u003c/p\u003e\n\u003cp\u003e\u003cem\u003eBarriers to Care and Treatment Access\u003c/em\u003e\u003c/p\u003e\n\u003cp\u003eBarriers to care emerged as a central concern. 71.7% of respondents reported difficulties identifying a competent pain specialist, and in 40.7% of cases, these difficulties persisted over time. More than half (54%) encountered issues accessing prescribed medications, and in 27.8% of these cases, the problem was chronic.\u003c/p\u003e\n\u003cp\u003eA significant proportion (65.4%) also reported challenges in accessing clear information about treatment options, drug exemptions, and the healthcare system more broadly.\u003c/p\u003e\n\u003cp\u003e\u003cem\u003ePerceptions of Healthcare Professionals\u003c/em\u003e\u003c/p\u003e\n\u003cp\u003ePatients expressed mixed confidence in their healthcare providers. While 89.8% believed that pathology specialists were competent in managing chronic pain, only 65.6% expressed similar confidence in their general practitioner, highlighting a potential gap between patient expectations and the perceived preparedness of primary care providers. Communication between providers was often perceived as insufficient: 48.5% reported inadequate communication between GPs and specialists, and 48.6% noted poor interprofessional collaboration. Importantly, 44.1% of patients felt that their GP considered chronic pain a secondary issue, and 38.1% believed the same was true of their disease specialist.\u003c/p\u003e\n\u003cp\u003e\u003cem\u003eLegal Awareness and Health Literacy\u003c/em\u003e\u003c/p\u003e\n\u003cp\u003eAwareness of Law 38/2010, Italy\u0026apos;s legislation guaranteeing the right to palliative care and pain therapy, was limited. Only 7.5 of respondents knew the law well, 53.3% had a superficial understanding, and 39.2% had never heard of it. Knowledge was slightly higher among patients under the care of a pain specialist (15.2%) compared to those without any treatment (5.1%).\u003c/p\u003e\n\u003cp\u003eAdditionally, 47,6% of respondents could not distinguish between palliative care and pain therapy, suggesting a broader issue of health literacy.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cem\u003eAccess to Opioid and Cannabinoid Therapies\u003c/em\u003e\u003c/p\u003e\n\u003cp\u003eWhen asked about access to advanced pharmacological options such as opioids and cannabinoids, 58.8% of respondents described access in Italy as difficult. Reported barriers included restrictive national regulations (58%) and reluctance among physicians to prescribe these agents (54.9). Patients perceived general practitioners as the least informed on this topic: 47% considered GPs poorly or not at all informed, compared to 47.3% for pharmacists and 29.9% for medical specialists.\u003c/p\u003e\n\u003cp\u003eAlmost half (47.8%) had experienced bureaucratic or administrative difficulties in obtaining these therapies, indicating the persistence of procedural and regulatory challenges in ensuring timely access to advanced therapies.\u003c/p\u003e\n\u003cp\u003e\u003cem\u003ePublic Visibility and Information Needs\u003c/em\u003e\u003c/p\u003e\n\u003cp\u003eThe public and institutional recognition of chronic pain as a legitimate health priority was perceived as minimal. Approximately 74.5% of participants believed that chronic pain was inadequately addressed in the public and social sphere, and 80.5% believed it was underrepresented in media coverage.\u003c/p\u003e\n\u003cp\u003eMoreover, 73.1% stated that political and health institutions did not pay sufficient attention to the needs of people with chronic pain. Two-thirds (67.2%) felt that they received inadequate support from the National Health Service, and 65.9% believed that chronic pain was still regarded as a symptom, rather than a distinct clinical entity.\u003c/p\u003e\n\u003cp\u003eFinally, participants expressed clear informational needs. The most frequently cited areas of interest were: identifying specialist services for pain management (51.6%), understanding lifestyle modifications (41%), drug information and side effects (39.6%), guidance on access to exemptions (38.6%), and awareness of non-pharmacological therapies (36.9%).\u003c/p\u003e"},{"header":"Discussion","content":"\u003cp\u003eThis study highlights a series of persistent challenges in the management of chronic pain in Italy, revealing some areas for improvement in therapeutic access, specialist involvement, legal awareness, and institutional accountability. Despite the existence of Law 38/2010, which enshrines the right to pain therapy, the findings indicate that this legal safeguard is not yet consistently translated into practice for all patients, as suggested before in the specific setting of cancer pain [21,22].\u003c/p\u003e\n\u003cp\u003eOne of the most concerning findings is the high prevalence of untreated pain: 28% of respondents reported receiving no specific therapy despite experiencing moderate to severe chronic pain Among those not receiving specific pain therapy, 77.5% were still under the care of a healthcare professional, 27.1% managed by allied figures and 50.4% by a physician, while 22.5% reported having no clinician involved in their care. This level of therapeutic disengagement echoes findings from other European settings, where underdiagnosis and undertreatment remain common despite formal care structures [6,7]. It underscores a need to strengthen the connection between patients\u0026apos; rights and actual service delivery.\u003c/p\u003e\n\u003cp\u003eSpecialized care remains relatively limited. Although pain specialists initiated therapy for approximately 13% of patients, only 22% continued under their care, a retention rate of just 21.7%. Currently, among those treated, only 5.4% of patients are followed by pain specialists. This limited continuity contrasts with international recommendations for multidisciplinary pain management and reflects similar trends observed in earlier European and Israeli studies [4,11]. Improving continuity and access to specialized care remains an important goal.\u003c/p\u003e\n\u003cp\u003eInstead, GPs have emerged as the mainstay of chronic pain care, managing 39.5% of respondents. While this may reflect their accessibility, it is essential to support general practitioners with enhanced training and resources in pain management. A significant proportion of patients perceived their GP as insufficiently prepared to manage chronic pain, and nearly half rated GP knowledge of opioid and cannabinoid therapies as poor. It is important, however, to interpret such perceptions with caution and to distinguish between subjective dissatisfaction and objective clinical performance. Noteworthy, the limited training and structural support available to GPs may contribute to suboptimal care and therapeutic stagnation; strengthening these areas through targeted education and system-level resources could enhance their central role in managing chronic pain.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eMultiple intersecting barriers emerged, collectively amounting to an uneven landscape of therapeutic opportunities. Geographic disparities were evident, with higher pain intensity reported in southern regions despite similar access rates, possibly indicating unmeasured socioeconomic burdens. Access to opioid and cannabinoid therapies was perceived as difficult by 58.8% of patients, and reluctance to prescribe these agents, reported in 55% of cases, points to a persistent climate of opiophobia. Furthermore, 57.5% agreed that current regulations themselves serve as barriers, suggesting a misalignment between legislative intent and administrative practice. Similar regulatory and cultural obstacles have been documented in the management of cancer pain, reinforcing the view that legal frameworks alone are insufficient without operational and educational support [21,22].\u003c/p\u003e\n\u003cp\u003eThe impact of chronic pain extended far beyond physical discomfort, permeating every aspect of daily life. Disruption to sleep (74.8%), occupational functioning (75.5%), and caregiving responsibilities (64.1%) were reported at high rates. This constellation of limitations contributes to economic marginalization and social dependency. Particularly distressing is the perception, shared by over half of respondents, that their pain is considered a secondary issue by clinicians. While these data highlight a need to improve clinical responsiveness and communication, they also reflect the emotional toll and vulnerability often experienced by people living with chronic pain.\u003c/p\u003e\n\u003cp\u003eLegal and informational deficits compound these challenges. Only 7.5% of respondents were familiar with Law 38/2010, and nearly 47.6% could not distinguish between palliative care and pain therapy. These gaps hinder patient empowerment and signal broader failures in both public communication and professional education. Information needs were particularly focused on identifying specialist care and navigating available treatment options, needs that reflect not only knowledge deficits but structural disorientation within the health system. Prior surveys across multiple countries have similarly noted poor legal literacy among patients and a lack of clarity around care pathways [11,12].\u003c/p\u003e\n\u003cp\u003eCultural and systemic issues further marginalize chronic pain. The condition remains underrepresented in both media and public discourse, with 74.5% of patients perceiving it as socially invisible. This invisibility contributes to stigma, weakens policy advocacy, and isolates patients. Fragmentation between GPs and specialists, reported by nearly half of respondents, exemplifies the lack of integrated care pathways. In such a disjointed system, the burden of care coordination often falls to the patient, exacerbating inequality for those with fewer resources or lower health literacy. These findings should prompt reflection not only on care structures but also on how chronic pain is framed and prioritized in policy and culture.\u003c/p\u003e\n\u003cp\u003eThese findings underscore the need for progressive and pragmatic reforms. Expanding access to specialized pain services, equipping primary care providers with structured training in multimodal pain management, and streamlining referral pathways are critical steps. Equally important is regulatory reform to ensure that prescribing rules support, rather than impede, legitimate therapeutic needs. Public awareness campaigns and provider education must emphasize that chronic pain is a disease in its own right, requiring systematic and compassionate intervention [12,13].\u003c/p\u003e\n\u003cp\u003eDespite its strengths, including national representation and a comprehensive survey instrument, this study has limitations. Online data collection may exclude digitally underserved populations, and the cross-sectional design precludes causal inference. Self-reported measures of pain and diagnoses were not clinically verified, which may introduce reporting bias.\u003c/p\u003e\n\u003cp\u003eNevertheless, this research provides a detailed snapshot of chronic pain care in Italy, as seen through the eyes of those most affected. It reveals not only areas of dissatisfaction but also valuable opportunities for systemic improvement.\u0026nbsp;\u003c/p\u003e"},{"header":"Conclusion","content":"\u003cp\u003eThis nationwide survey provides comprehensive evidence of substantial unmet needs in chronic pain management across Italy. Despite legislative safeguards under Law 38/2010, nearly one-third of patients with moderate-to-severe pain receive no specific therapy, and fewer than 5% benefit from specialized pain services. The findings reveal a healthcare landscape marked by fragmented care pathways, limited continuity with specialists, inadequate legal and health literacy, and persistent barriers to accessing advanced therapies.\u003c/p\u003e\n\u003cp\u003eGeneral practitioners have emerged as the primary care providers, yet many lack the training and resources necessary to manage complex chronic pain effectively. Regulatory and cultural obstacles continue to impede appropriate use of opioid and cannabinoid therapies, while the condition itself remains underrepresented in public discourse and policy priorities.\u003c/p\u003e\n\u003cp\u003eAddressing this neglected epidemic will require coordinated action across legislative, clinical, and educational domains. The voices of these 492 patients provide a compelling mandate: to listen, to understand, and to act, not in opposition to the health system, but in collaboration with its strengths and committed professionals. Future initiatives should aim to co-design solutions with patients, clinicians, and institutions to ensure that chronic pain management becomes an integrated and responsive component of public health strategy.\u003c/p\u003e"},{"header":"Abbreviations","content":"\u003cp\u003eGP: General practitioner\u0026nbsp;\u003c/p\u003e"},{"header":"Declarations","content":"\u003cp\u003e\u003cstrong\u003eEthics approval and consent to participate:\u0026nbsp;\u003c/strong\u003eThis study was conducted in accordance with the Declaration of Helsinki. The survey was administered online using the Computer-Assisted Web Interviewing (CAWI) method among members of the SWG S.p.A. community panel. Given the observational and non-interventional nature of the study, and the absence of collection of sensitive personal health data, formal ethics committee approval was not required under applicable Italian regulations (D.Lgs. 211/2003 and subsequent amendments). Prior to completing the questionnaire, all participants provided explicit informed consent to the processing of their personal data in accordance with the General Data Protection Regulation (EU) 2016/679 (GDPR). All respondents provided informed consent to participate in this survey.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConsent for publication:\u0026nbsp;\u003c/strong\u003eAll responders provided informed consent to the publication of the data of the present survey.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAvailability of data and materials:\u0026nbsp;\u003c/strong\u003eAll data are available from the corresponding Author upon reasonable request.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eCompeting interests:\u0026nbsp;\u003c/strong\u003eThe authors declare that they have no competing interests.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eFunding:\u0026nbsp;\u003c/strong\u003eThis study was supported by an unrestricted grant from M.A.V.A.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAuthors\u0026rsquo; contributions:\u0026nbsp;\u003c/strong\u003eConceptualization: M.G.; Data analysis and curation: All; Writing\u0026mdash;Original Draft Preparation: L.G., M.G.; Writing\u0026mdash;Review \u0026amp; Editing: All; Supervision: M.G.; Approval to submit: All.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAcknowledgments:\u0026nbsp;\u003c/strong\u003eThe authors thank Fondazione Nora e Alberto Gentili for promoting the study. The survey was conducted by SWG S.p.A. Editorial assistance was provided by Aashni Shah (Polistudium SRL, Milan, Italy) and was supported by Fondazione Nora e Alberto Gentili.\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\n\u003cli\u003eCatal\u0026agrave; E, Reig E, Art\u0026eacute;s M, Aliaga L, L\u0026oacute;pez JS, Seg\u0026uacute; JL. Prevalence of pain in the Spanish population: telephone survey in 5000 homes. Eur J Pain. 2002;6(2):133-40. doi: 10.1053/eujp.2001.0310.\u003c/li\u003e\n\u003cli\u003eCosby AG, Hitt HC, Thornton-Neaves T, McMillen RC, Koch K, Sitzman BT, et al. Profiles of pain in Mississippi: results from the Southern Pain Prevalence Study. J Miss State Med Assoc. 2005;46(10):301-9.\u003c/li\u003e\n\u003cli\u003eMir\u0026oacute; J, Paredes S, Rull M, Queral R, Miralles R, Nieto R, et al. Pain in older adults: a prevalence study in the Mediterranean region of Catalonia. Eur J Pain. 2007;11(1):83-92. doi: 10.1016/j.ejpain.2006.01.001. \u003c/li\u003e\n\u003cli\u003eNeville A, Peleg R, Singer Y, Sherf M, Shvartzman P. Chronic pain: a population-based study. Isr Med Assoc J. 2008;10(10):676-80.\u003c/li\u003e\n\u003cli\u003eK\u0026ouml;nig HH, Bernert S, Angermeyer MC, Matschinger H, Martinez M, Vilagut G, et al. Comparison of population health status in six european countries: results of a representative survey using the EQ-5D questionnaire. Med Care. 2009;47(2):255-61. doi: 10.1097/MLR.0b013e318184759e.\u003c/li\u003e\n\u003cli\u003eBreivik H, Collett B, Ventafridda V, Cohen R, Gallacher D. Survey of chronic pain in Europe: prevalence, impact on daily life, and treatment. Eur J Pain. 2006;10(4):287-333. doi: 10.1016/j.ejpain.2005.06.009.\u003c/li\u003e\n\u003cli\u003eM\u0026uuml;ller-Schwefe GH. European survey of chronic pain patients: results for Germany. Curr Med Res Opin. 2011;27(11):2099-106. doi: 10.1185/03007995.2011.621935.\u003c/li\u003e\n\u003cli\u003eP\u0026eacute;rez C, Margarit C, Serrano M; Spanish group of CHANGE PAIN patient survey. Survey of European patients assessing their own noncancer chronic pain: results from Spain. Curr Med Res Opin. 2013;29(6):643-51. doi: 10.1185/03007995.2013.787978. \u003c/li\u003e\n\u003cli\u003eDureja GP, Jain PN, Shetty N, Mandal SP, Prabhoo R, Joshi M, et al. Prevalence of chronic pain, impact on daily life, and treatment practices in India. Pain Pract. 2014;14(2):E51-62. doi: 10.1111/papr.12132.\u003c/li\u003e\n\u003cli\u003eBedard G, Hawley P, Zhang L, Slaven M, Gagnon P, Bisland S, et al. A survey of Canadian cancer patients\u0026apos; perspectives on the characteristics and treatment of breakthrough pain. Support Care Cancer. 2013;21(9):2557-63. doi: 10.1007/s00520-013-1817-4.\u003c/li\u003e\n\u003cli\u003eMcCarberg BH, Nicholson BD, Todd KH, Palmer T, Penles L. The impact of pain on quality of life and the unmet needs of pain management: results from pain sufferers and physicians participating in an Internet survey. Am J Ther. 2008;15(4):312-20. doi: 10.1097/MJT.0b013e31818164f2.\u003c/li\u003e\n\u003cli\u003eMills SEE, Nicolson KP, Smith BH. Chronic pain: a review of its epidemiology and associated factors in population-based studies. Br J Anaesth. 2019;123(2):e273-e283. doi: 10.1016/j.bja.2019.03.023. \u003c/li\u003e\n\u003cli\u003eFayaz A, Croft P, Langford RM, Donaldson LJ, Jones GT. Prevalence of chronic pain in the UK: a systematic review and meta-analysis of population studies. BMJ Open. 2016;6(6):e010364. doi: 10.1136/bmjopen-2015-010364. \u003c/li\u003e\n\u003cli\u003eM\u0026uuml;ller-Schwefe GH, Wimmer AM, Dejonckheere J, Eggers A, Vellucci R. Patients\u0026apos; and physicians\u0026apos; perspectives on opioid therapy for chronic cancer and musculoskeletal pain in Germany, Italy, and Turkey: PAin RESearch (PARES) survey. Curr Med Res Opin. 2014;30(3):339-47. doi: 10.1185/03007995.2013.861349.\u003c/li\u003e\n\u003cli\u003eVarrassi G, M\u0026uuml;ller-Schwefe GH. The international CHANGE PAIN physician survey: does specialism influence the perception of pain and its treatment? Curr Med Res Opin. 2012;28(5):823-31. doi: 10.1185/03007995.2012.674499.\u003c/li\u003e\n\u003cli\u003eTse MM, Pun SP, Benzie IF. Pain relief strategies used by older people with chronic pain: an exploratory survey for planning patient-centred intervention. J Clin Nurs. 2005;14(3):315-20. doi: 10.1111/j.1365-2702.2004.00976.x.\u003c/li\u003e\n\u003cli\u003eVittori A, Petrucci E, Cascella M, Innamorato M, Cuomo A, Giarratano A, et al. Pursuing the recovery of severe chronic musculoskeletal pain in italy: clinical and organizational perspectives from a SIAARTI survey. J Pain Res. 2021;14:3401-3410. doi: 10.2147/JPR.S328434.\u003c/li\u003e\n\u003cli\u003eIolascon G, Migliore A, Beretta G, Bernetti A, Bortolotti R, Celano A, et al. Pain Management in Knee Osteoarthritis: Insights from an Exploratory Online Survey of Italian Patients and Physicians. Healthcare (Basel). 2024;12(20):2077. doi: 10.3390/healthcare12202077.\u003c/li\u003e\n\u003cli\u003eCascella M, Innamorato MA, Natoli S, Bellini V, Piazza O, Pedone R, et al. Opportunities and barriers for telemedicine in pain management: insights from a SIAARTI survey among Italian pain physicians. J Anesth Analg Crit Care. 2024;4(1):64. doi: 10.1186/s44158-024-00202-1. \u003c/li\u003e\n\u003cli\u003eForte M, Nasti F, Schiavone S, Cioeta M, Lullo G, Cataldi F, et al. A population-based survey of beliefs about neck pain and its associated disorders: a cross-sectional study. BMC Musculoskelet Disord. 2025;26(1):1098. doi: 10.1186/s12891-025-09328-x.\u003c/li\u003e\n\u003cli\u003eAglietta M, Berardi R, Biasco G, Bossi P, Gentili M, Giacomelli L, et al. Are we doing enough to treat cancer pain? The urgent need for action in oncology practice. Future Oncol. 2025;21(14):1699-1701. doi: 10.1080/14796694.2025.2501522.\u003c/li\u003e\n\u003cli\u003eGentili M, Cellini F, Consoletti L, Di Maio M, Fornasari DMM, Fortini G, et al. Bridging Gaps in Cancer Pain Care: Barriers, Solutions, and a Path Forward for Integrated Management. Curr Oncol. 2025;32(11):610. doi: 10.3390/curroncol32110610.\u003c/li\u003e\n\u003cli\u003eBaraliakos X, Navarro-Comp\u0026aacute;n V, Nikiphorou E, Pham T, Ciccia F, Truman I, et al. Rheumatologist and patient perspectives on axial spondyloarthritis management and treatment satisfaction in Europe. Semin Arthritis Rheum. 2025;76:152884. doi: 10.1016/j.semarthrit.2025.152884.\u003c/li\u003e\n\u003cli\u003eJavadian Kootenayi R, Mofateh R, Seyedtabib M. Recovery indicators from the perspective of patients with chronic low back pain: a cross-sectional survey. Pain Manag. 2025;15(11):835-843. doi: 10.1080/17581869.2025.2552631.\u003c/li\u003e\n\u003cli\u003eSantiago BVM, Oliveira ABG, Silva GMRD, Silva MFD, Bergamo PE, Parise M, et al. Prevalence of chronic pain in Brazil: A systematic review and meta-analysis. Clinics (Sao Paulo). 2023;78:100209. doi: 10.1016/j.clinsp.2023.100209.\u003c/li\u003e\n\u003c/ol\u003e"},{"header":"Tables","content":"\u003cp\u003e\u003cstrong\u003eTable 1. Demographic and Clinical Characteristics of the Study Sample.\u0026nbsp;\u003c/strong\u003eOverview of participants\u0026apos; sociodemographic data, geographic distribution, and primary pain-related diagnoses.\u003c/p\u003e\n\u003ctable border=\"1\" cellspacing=\"0\" cellpadding=\"0\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003eCharacteristic\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003en (%)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003eTotal Sample\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003e492 (100.0)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003eGender\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003eMale\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e231 (47.0)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003eFemale\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e261 (53.0)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003eAge Groups\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u0026lt;50 years\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e74 (15.0)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e50-59 years\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e133 (27.0)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e60-69 years\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e152 (31.0)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e70-85 years\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e133 (27.0)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003eGeographic Area\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003eNorthwest Italy\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e128 (26.0)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003eNortheast Italy\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e108 (22.0)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003eCentral Italy\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e98 (20.0)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003eSouth and Islands\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e158 (32.0)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003eEducational Level\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003eLow (elementary/middle school)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e88 (17.9)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003eMedium (high school)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e236 (48.0)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003eHigh (university degree)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e168 (34.1)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003ePrimary Pathology\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003eMusculoskeletal conditions\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e281 (57.0)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003eAutoimmune and chronic inflammatory diseases\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e84 (17.0)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003eNeurological conditions (neuropathic pain)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e44 (9.0)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003eCancer-related pain\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e15 (3.0)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003eComplex or idiopathic pain syndromes\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e10 (2.0)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003eNone of these\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e93 (19.0)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003eOther conditions*\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e30 (6.0)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003e*Multiple conditions possible; percentages may sum to \u0026gt;100%\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eTable 2. Initial Prescribers of Pain Therapy.\u0026nbsp;\u003c/strong\u003eDistribution of healthcare professionals who first prescribed treatment for chronic pain among surveyed patients (n=492).\u003c/p\u003e\n\u003ctable border=\"1\" cellspacing=\"0\" cellpadding=\"0\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003eCharacteristic\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003eNo therapy n (%)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003eGeneral Practitioner n (%)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003ePain Specialist n (%)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003eOther Specialist n (%)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003eOverall Distribution\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003e138 (28.0)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003e152 (30.9)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003e44 (8.9)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003e158 (32.1)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003eBy Age Group\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003eUnder 49 years\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e21 (28.4)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e22 (29.7)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e10 (13.5)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e21 (28.4)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e50-59 years\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e37 (27.8)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e49 (36.8)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e7 (5.3)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e40 (30.1)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e60-69 years\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e50 (32.9)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e47 (30.9)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e17 (11.2)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e38 (25.0)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e70-85 years\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e30 (22.6)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e34 (25.6)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e10 (7.5)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e59 (44.4)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003eBy Primary Pathology\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003eMusculoskeletal (n=281)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e84 (29.9)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e76 (27.0)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e28 (10.0)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e93 (33.1)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003eNeurological (n=44)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e4 (9.1)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e14 (31.8)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e6 (13.6)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e20 (45.5)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003eAutoimmune/Chronic inflammatory (n=84)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e24 (28.6)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e24 (28.6)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e6 (7.1)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e30 (35.7)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003e\u003cbr\u003e\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eTable 3. Continuity of Care: Initial Prescriber Versus Current Healthcare Provider.\u0026nbsp;\u003c/strong\u003eComparison between the healthcare professional who initially prescribed pain therapy and the one currently managing the participant\u0026apos;s chronic pain. Data highlight the rate of retention for each provider type and the frequency of patient transition to other care providers. Percentages refer to the proportion of patients remaining under the same type of provider or switching to different ones.\u003c/p\u003e\n\u003ctable border=\"1\" cellspacing=\"0\" cellpadding=\"0\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003eCurrent Healthcare Provider\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003ePatients WITHOUT Therapy n (%)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003eFirst Therapy by GP n (%)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003eFirst Therapy by Pain Specialist n (%)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003eFirst Therapy by Other Specialist n (%)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003eSample size\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003e138\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003e152\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003e44\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003e158\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003eGeneral Practitioner\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e58 (42.0)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e99 (65.1)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e12 (27.3)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e27 (17.1)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003ePathology Specialist\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e19 (13.8)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e24 (15.8)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e12 (27.3)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e74 (46.8)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003ePain Specialist\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e1 (0.7)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e6 (3.9)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e10 (22.7)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e35 (22.2)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003eOther Professionals\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e28 (20.3)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e20 (13.2)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e7 (15.9)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e47 (29.7)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003eNo healthcare provider\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e32 (23.2)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e3 (2.0)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e2 (4.5)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e6 (3.8)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003eMultiple conditions possible; percentages may sum to \u0026gt;100%\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eTable 4. Impact of Chronic Pain on Daily Activities.\u003c/strong\u003e Self-reported limitations experienced by participants across key functional domains, including leisure, sleep, work/study, caregiving, self-care, and social relationships (n=492). The table presents the proportion of respondents indicating no impact, partial limitation, strong limitation, or complete inability to perform each activity.\u003c/p\u003e\n\u003ctable border=\"1\" cellspacing=\"0\" cellpadding=\"0\" class=\"fr-table-selection-hover\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003eActivity Domain\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003eNo Impact (%)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003ePartial Limitation (%)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003eStrong Limitation (%)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003eUnable to Perform (%)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003eLeisure activities\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e18\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e49\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e26\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e7\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003eSleep regularity\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e25\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e44\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e28\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e3\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003eHousehold tasks\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e23\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e57\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e17\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e3\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003eCaring for others\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e36\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e46\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e16\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e2\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003eWork/study activities\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e24\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e59\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e14\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e3\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003eSocial relationships\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e48\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e35\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e15\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e2\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003eSelf-care\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e48\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e42\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e9\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":false,"highlight":"","institution":"","isAcceptedByJournal":false,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"bmc-health-services-research","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"bhsr","sideBox":"Learn more about [BMC Health Services Research](http://bmchealthservres.biomedcentral.com/)","snPcode":"","submissionUrl":"https://www.editorialmanager.com/BHSR/default.aspx","title":"BMC Health Services Research","twitterHandle":"BMC_series","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"em","reportingPortfolio":"BMC Series","inReviewEnabled":true,"inReviewRevisionsEnabled":true},"keywords":"access to care, chronic pain, health literacy, Italy, legal rights, pain management, patient perspective, primary care, public health","lastPublishedDoi":"10.21203/rs.3.rs-8967310/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-8967310/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003cp\u003e\u003cem\u003e\u003cstrong\u003eBackground\u003c/strong\u003e\u003c/em\u003e\u003cem\u003e:\u003c/em\u003e Chronic pain represents a significant public health burden, yet comprehensive data on patient perspectives in Italy remain limited. Despite Law 38/2010 guaranteeing access to pain therapy, gaps persist in understanding how patients experience care, navigate the healthcare system, and access treatment. This study explored patient perspectives on chronic pain management in Italy, examining therapeutic pathways, barriers to care, legal awareness, and unmet needs.\u003c/p\u003e\n\u003cp\u003e\u003cem\u003e\u003cstrong\u003eMethods\u003c/strong\u003e\u003c/em\u003e\u003cem\u003e:\u003c/em\u003e A nationwide cross-sectional survey was conducted between October 31 and November 11, 2025, using Computer-Assisted Web Interviewing (CAWI). Eligible participants were adults (≥18 years) with chronic pain lasting ≥3 months, reporting pain intensity \u0026gt;3 on a Numerical Rating Scale (NRS 0-10) in the preceding week or receiving specific pain therapy. Of 2,989 individuals invited, 492 met inclusion criteria and completed the survey. Data were analyzed using descriptive statistics, with results presented as frequencies and percentages.\u003c/p\u003e\n\u003cp\u003e\u003cem\u003e\u003cstrong\u003eResults\u003c/strong\u003e\u003c/em\u003e\u003cem\u003e:\u003c/em\u003e Participants (53% female, mean age 62 years) reported moderate-to-severe pain intensity (mean NRS 6.2±1.8), with 52% experiencing severe pain (NRS 7-10). Despite this burden, 28% received no specific pain therapy. Among those treated, initial prescribers were pathology specialists (44.1%), general practitioners (42.9%), or pain specialists (13%). Only 22% of patients initially seen by pain specialists continued under their care; conversely, 65% remained with their GP. Chronic pain significantly impacted daily functioning: sleep (74.8%), work/study (75.5%), and caregiving (64.1%). Barriers to care were prevalent: 71.7% experienced difficulty finding competent specialists, 54% encountered medication access problems, and 65.4% lacked clear treatment information. Only 7.5% had good knowledge of Law 38/2010, and 47.6% could not distinguish palliative care from pain therapy. Access to opioid/cannabinoid therapies was considered difficult by 58.8%, attributed to restrictive regulations (58%) and physician reluctance (54.9%). Most participants (74.5%) perceived chronic pain as inadequately addressed in public discourse, and 67.2% felt unsupported by the National Health Service.\u003c/p\u003e\n\u003cp\u003e\u003cem\u003e\u003cstrong\u003eConclusions\u003c/strong\u003e\u003c/em\u003e\u003cem\u003e:\u003c/em\u003e This study reveals substantial gaps in chronic pain management in Italy, characterized by high rates of untreated pain, limited specialist involvement, poor care continuity, inadequate legal awareness, and perceived institutional neglect. These findings highlight urgent needs for enhanced access to specialized care, improved primary care training in pain management, regulatory reform to facilitate appropriate opioid/cannabinoid prescribing, public awareness campaigns, and patient-centered care pathways. Addressing these challenges requires coordinated action across legislative, clinical, and educational domains to ensure chronic pain is recognized and managed as a distinct disease requiring comprehensive intervention.\u003c/p\u003e","manuscriptTitle":"Chronic Pain in Italy: Exploring Patient Perspectives on Care Gaps and Opportunities","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2026-04-01 05:32:34","doi":"10.21203/rs.3.rs-8967310/v1","editorialEvents":[{"type":"communityComments","content":0},{"type":"decision","content":"Revision requested","date":"2026-04-07T17:33:17+00:00","index":"","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2026-03-23T15:04:58+00:00","index":"hide","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2026-03-09T18:37:28+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"171786130710631273726133802374118901697","date":"2026-03-08T11:54:59+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"315931357285965173502780018631839282884","date":"2026-03-07T19:21:03+00:00","index":"hide","fulltext":""},{"type":"reviewersInvited","content":"","date":"2026-03-07T18:51:23+00:00","index":"","fulltext":""},{"type":"editorAssigned","content":"","date":"2026-03-07T18:50:20+00:00","index":"","fulltext":""},{"type":"editorInvited","content":"","date":"2026-03-06T17:45:41+00:00","index":"","fulltext":""},{"type":"checksComplete","content":"","date":"2026-03-06T11:16:53+00:00","index":"","fulltext":""},{"type":"submitted","content":"BMC Health Services Research","date":"2026-03-06T09:58:43+00:00","index":"","fulltext":""}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"bmc-health-services-research","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"bhsr","sideBox":"Learn more about [BMC Health Services Research](http://bmchealthservres.biomedcentral.com/)","snPcode":"","submissionUrl":"https://www.editorialmanager.com/BHSR/default.aspx","title":"BMC Health Services Research","twitterHandle":"BMC_series","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"em","reportingPortfolio":"BMC Series","inReviewEnabled":true,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"4fce4c7d-c8ed-4455-b2a8-46b12010853e","owner":[],"postedDate":"April 1st, 2026","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"under-review","subjectAreas":[],"tags":[],"updatedAt":"2026-04-20T09:54:15+00:00","versionOfRecord":[],"versionCreatedAt":"2026-04-01 05:32:34","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-8967310","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-8967310","identity":"rs-8967310","version":["v1"]},"buildId":"XKTyCvWXoU3ODBz1xrDgd","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}