Che la lotta contro il dolore rappresenti uno dei capisaldi della professione medica è dimostrato dal fatto che già nel 400 a.c. con Ippocrate si fanno strada i concetti che il dolore deve essere dominato attraverso il gesto tecnico e che “Il medico e il malato devono, insieme, combattere contro la sofferenza”.

Con la pubblicazione della Legge 38 del 15 Marzo 2010 lo Stato Italiano ha sancito il diritto di ogni paziente affetto da dolore cronico ad essere curato, 1 ponendosi di fatto all’avanguardia in Europa come prima nazione dotata di una legge specifica sul trattamento del dolore cronico. Sostenendo il diritto di ogni cittadino a non soffrire, la legge riconosce che il dolore, da solo, può costituire una malattia e disciplina l’esercizio di tale diritto, attraverso novità assistenziali che coinvolgono sia il personale sanitario che i pazienti. Dalla definizione di “malato” come, fra l’altro, “persona affetta da patologia dolorosa cronica da moderata a severa”, a quella di “terapia del dolore” come “l’insieme di interventi (…), rivolti a elaborare percorsi diagnostico-terapeutici per la soppressione ed il controllo del dolore”, appare chiaro lo sforzo del legislatore di contribuire a creare una nuova cultura di cura del dolore, mettendo concretamente a disposizione del medico tutti gli strumenti terapeutici disponibili in farmacopea, inclusi i farmaci oppiacei e non, tra i quali hanno un ruolo rilevante i miorilassanti.

Ai sensi della legge, il personale sanitario ha adesso l’obbligo di monitorare il dolore dei pazienti, a prescindere dalla patologia per la quale vengono ricoverati o valutati. La rilevazione del dolore e la somministrazione di farmaci antalgici devono essere annotate sulla cartella clinica, con dosaggi e risultati di sollievo raggiunti (concetto di “Dolore come quinto segno vitale” insieme a pressione arteriosa, frequenza cardiaca, temperatura corporea, frequenza respiratoria).

La grande innovazione rappresentata dalla legge 38 è stata riconosciuta a livello internazionale, tanto che la Organizzazione delle Nazioni Unite (ONU) ha chiesto di adottare la legge italiana 38/2010 sulle cure palliative quale “model law” per la legislazione mondiale in materia.

La dimensione del problema. I dati dello studio “Pain Proposal. Improving the current and future management of chronic pain. A European consensus report”

Il dolore cronico rappresenta senza dubbio un problema di importanza sociale, innanzi tutto per la sua elevata prevalenza, ma anche in quanto influenza pesantemente la qualità di vita del paziente. Oltre all’impatto sociale, sono molto gravi anche le ripercussioni economiche: ogni anno in Italia vengono perse circa 200 milioni di giornate lavorative ed a livello europeo è stato calcolato che i costi complessivi del dolore cronico per i sistemi sanitari dei vari paesi sono pari a 300 miliardi di euro (circa il 2-3% del PIL per ogni stato). Questi dati sono tratti dal report pubblicato dalla European Pain Federation (EFIC) nel 2010, denominato “Pain Proposal” che ha coinvolto esperti provenienti da 15 paesi europei. 2 

Dall’esame dei dati riportati si evince che il 19% dei cittadini europei è affetto da dolore cronico riportando un devastante impatto sulla qualità della vita. Di questi infatti, il 29% rischia di perdere il posto di lavoro, nel 27% dei casi i pazienti si sentono socialmente isolati a causa del dolore e il 62% è convinto che ci sia poca consapevolezza da parte del sistema sanitario riguardo a questo problema. Per quanto attiene diagnosi e terapia, i pazienti con dolore cronico si rivolgono al medico curante circa 2 volte al mese, il 25% si è rivolto al Pronto Soccorso ed il 22% è stato ricoverato a causa del dolore, la latenza media tra insorgenza del dolore e diagnosi varia da 2,2 a 5 anni, nel 38% dei casi il dolore risulta non adeguatamente trattato. Nel 20% circa dei pazienti con dolore cronico addirittura non viene fatta la diagnosi

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