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Background: The aim of this analysis is to evaluate the costs of 72-hour postoperative pain treatment in patients undergoing major abdominal, orthopedic and thoracic procedures in nine different Italian hospitals, defined as the cumulative cost of drugs, consumable materials and time required for anesthesiologists, surgeons and nurses to administer each analgesic technique., Methods: Nine Italian hospitals have been involved in this study through the administration of a questionnaire aimed to acquire information about the Italian clinical practice in terms of analgesia. This study uses activity-based costing (ABC) analysis to identify, measure and give value to the resources required to provide the therapeutic treatment used in Italy to manage the postoperative pain patients face after surgery. A deterministic sensitivity analysis (DSA) has been performed to identify the cost determinants mainly affecting the final cost of each treatment analyzed. Costs have been reclassified according to three surgical macro-areas (abdominal, orthopedic and thoracic) with the aim to recognize the cost associated not only to the analgesic technique adopted but also to the type of surgery the patient faced before undergoing the analgesic pathway., Results: Fifteen different analgesic techniques have been identified for the treatment of moderate to severe pain in patients who underwent a major abdominal, orthopedic or thoracic surgery. The cheapest treatment actually employed is the oral administration "around the clock" (€ 8.23), whilst the most expensive is continuous peripheral nerve block (€ 223.46). The intravenous patient-controlled analgesia costs € 277.63. In terms of resources absorbed, the non-continuous administration via bolus is the gold standard in terms of cost-related to the drugs used (€ 1.28), and when administered pro re nata it also absorbs the lowest amount of consumables (€0.58€) compared to all other therapies requiring a delivery device. The oral analgesic administration pro re nata is associated to the lowest cost in terms of health professionals involved (€ 6.25), whilst intravenous PCA is the most expensive one (€ 245.66), requiring a massive monitoring on the part of physicians and nurses., Conclusions: The analysis successfully collected information about costs of 72-hour postoperative pain treatment in patients undergoing major abdominal, orthopedic and thoracic procedures in all the nine different Italian hospitals. The interview showed high heterogeneity in the treatment of moderate to severe pain after major abdominal, orthopedic and thoracic surgeries among responding anesthesiologists, with 15 different analgesic modalities reported. The majority of the analgesic techniques considered in the analysis is not recommended by any guideline and their application in real life can be one of the reasons for the high incidence of uncontrolled pain, which is still reported in the postoperative period. Health care costs have become more and more important, although the choice of the best analgesic treatment should be a compromise between efficacy and economic considerations.

Localized neuropathic pain (LNP) is a type of neuropathic pain characterized by consistent and circumscribed area(s) of maximum pain, which are associated with negative or positive sensory signs and/or spontaneous symptoms typical of neuropathic pain. This description outlines the clinical features of a group of pathologies, in which a LNP can be diagnosed and for whom topical targeted treatment with 5% Lidocaine medicated plaster can be suggested. Indeed both American as well as European guidelines already suggest 5% Lidocaine medicated plaster as a first line treatment in post herpetic neuralgia and in general in the treatment of conditions such as diabetic painful polyneuropathy and post surgical pain where a LNP can be ascertain. In a daily practice of a Pain Unit however the usual case mix encompasses also other causes of LNP, most of them with a scanty pain control in spite of a ongoing polytherapy. Aims of this paper were to focus on 5% Lidocaine medicated plaster as a first line treatment in LNP and to add new insight on its possible use as add-on therapy reporting our data on a consecutive series of 42 patients affected by LNP under unsatisfactory polytherapy in which 5% Lidocaine medicated plaster was able to achieve a satisfactory pain control.

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

Aim: Adequate postoperative analgesia is a prerequisite for successful ambulatory surgery and continues to be a challenge for anesthesiologists. The goal of the study was to analyze what are determinants of patients' overall satisfaction in postoperative pain management after ambulatory hand surgery., Methods: Patients undergoing ambulatory hand surgery received oral fixed association tramadol/acetaminophen 37.5/325 mg every 6 hours during the first 48 hours after operation. Analgesic efficacy was evaluated by self-assessment of pain intensity by numeric rating scale. Patients also recorded total number of daily study analgesic tablets, frequency and severity of adverse events, sleep pain interference (SPI 0-10), number of rescue doses and patient global assessment (PGA) on a 4-grade scale. Success ratings on the PGA were considered "good" and "excellent". Preoperative pain intensity, analgesic use, and expectation were also recorded., Results: One hundred and forty-three subjects were evaluated in the study. The percentage of patients who reported rating of success on the PGA was 88.8%. The most significant determinant of failure on the PGA was the presence of moderate to severe adverse events (R=-0.85). Determinants of ratings of success on PGA were adequate analgesia and SPI ≤ 4. Predictors of successful patient satisfaction were preoperative pain ≤ 4 on NRS, lack of preoperative analgesic consumption, expected pain >6 on NRS, and lower education level. Weak correlation (R=0.26) was observed between mean daily pain intensity and analgesics intake., Conclusion: Results indicate that the oral association tramadol/acetaminophen 37,5/325 mg is effective for the management of postoperative pain after ambulatory hand surgery. The lack of adverse events is the most important determinant of patient satisfaction, followed by the analgesic efficacy.

The first marketing authorization for nimesulide was approved in Italy in 1985. After one quarter of a century we evaluate its peculiar characteristics compared with other NSAIDs. Nimesulide is the only NSAID related to the arylsulfonamide class and is a "COX-2 preferential NSAIDs", because despite having a prevalent effect on COX-2, has a balanced action on both cyclooxygenase. The gastrointestinal absorption is rapid and complete and explains the short onset of action. Nimesulide is rapidly distributed in the synovial fluid, where it persists longer than in the blood, thus contributing to effectiveness of the drug in pain control. From the standpoint of safety, nimesulide arises NSAIDs with lower risk of upper gastrointestinal bleeding thanks to its preferential activity on COX-2. In relation to the risk of severe hepatic reactions, the benefit/risk profile of nimesulide was considered by european regulatory authorities similar to other NSAIDs. Respecting international guidelines, the use of nimesulide in pain management, as that of other NSAIDs, must be considered as an alternative therapy when paracetamol is ineffective, or where the pain is caused or supported by an inflammatory process.

Some authors have proposed an updating of the therapeutic recommendations for some kinds of pain, such as musculoskeletal, post-traumatic and post-surgical pain for which a multimodal approach is being increasingly considered. With regard to this, an association of analgesics belonging to different pharmacological classes becomes an important option, given that analgesic efficacy can be ensured using lower dosages of single components, improving the tolerability of the drugs. The fixed combination of paracetamol (325 mg) and tramadol (37.5 mg) has a precisely dose ratio to obtain an additive analgesic effect, improving both the analgesic efficacy, which is more stronger and complete, and the duration of the action, guaranteeing a quick analgesic effect over time. A wide international literature exists for this association. This review considers particularly 15 studies. In nine of them, all double-blind, the duration of treatment was 1-10 days and, in total, 2 537 patients were admitted, affected by acute painful flares of chronic-degenerative pathologies, trauma or subjected to surgery. The mean daily dose of paracetamol/tramadol most frequently used was 4.3-4.5 tablets/day. Rigorous studies were conducted also for chronic pain; in the 6 studies considered the duration of treatment was 4-13 weeks and a total of 1 890 patients, affected by chronic musculoskeletal pain, were admitted. The mean daily dose of paracetamol/tramadol was between 3.5 and 4.2 tablets/day, showing itself to be constant and independent of the disease considered. In conclusion, the fixed association paracetamol/tramadol is a new therapeutic option, particularly useful in mild-moderate pain where paracetamol is inadequate.