Giustino,

Great question! And it's not limited to an Italian issue. I view this from two separate positions: 1) as an anesthesia provider, and 2) as a family member of a dying patient(s).

As a family member, it was difficult to obtain appropriate pain relief (in a timely manner). As an anesthesia provider, I know there are techniques utilized within acute and chronic pain services that would alleviate suffering in the terminal population. The frustration comes with the lack of adoption (payment) for such services. I would coin the term "hospice anesthesia". This service could provide nerve blocks, "pain" catheter insertion and infusions to comfort patients in their waning days of life. Perhaps pain free or at least at bearable levels so patients can have meaning engagement with family and friends. 

IMO.

Regards,

Christopher

Hello!

I am not familiar with healthcare services in Italy. In the USA, all persons with health insurance (Medicare, Medicaid, or private) can have hospice care in their homes (including in skilled nursing facilities, also called nursing homes). Hospice care includes expert nurses, physicians, medical social workers and chaplains (along with other interdisciplinary team members) who provide assessment of pain at end of life and then write appropriate pain medication prescriptions and help families obtain them. 

Because of our commercial health insurance system, hospice care is not available to persons who are not considered to have a terminal diagnosis of 6 months of life. However, in many communities now, especially in hospitals, there are palliative pain (and other symptom) consultation services available to people who do not have such a short prognosis (terminal or otherwise). 

One place to search for resources and begin to network if you are fluent in English is: http://www.nhpco.org/

Tony, 

Having worked as both a hospice and palliative care nurse, the surprise question, as it has been labelled, has turned out to be quite important. However, for palliative care, which is different from hospice or end of life care, a person does not have to be within 6 months or a year of dying. A palliative care consultation is appropriate for any person with a serious illness whose symptoms cannot be well-managed by the regular treatment team. Our biggest problem in the USA is a lack of qualified (educated) practitioners to meet the demand. Also, the insurance billing system makes it difficult for palliative (not hospice) providers to charge for their services. 

Estimado Giustino Varrassi.

Celebro la aprovacion de la ley comentada, en mi opinion ademas de la promulgacion de leyes, se requieren leyes secundarias y presupuestos que garanticen su aplicacion, el tema es complejo y una manera de avanzar es separar los presupuestos y programas para el alivio del dolor y el de cuidados paliativos.

Deseo pronto se logre la cobertura en tu país de los numeros pacientes que requieren  esta impresindible atencion. Saludos

In my view, what has led the U.S. astray is its lack of understanding of addiction and drug use more generally, which in turn fuels opiophobic attitudes, as people can externalize the blame for the occurrence of addiction onto drugs, ignoring its roots that exist in the way children are parented, genetic influences, early life traumas, lack coping skills, and resultant attachment disorders that drive individuals to seek social bonding from drugs instead of from people. With this in mind, I believe that the most compelling argument for drawing attention to why people should treat pain is to outline the following: the economic costs in terms of lost productivity, the loss of great minds who are unable to attend school because of severe pain, the social isolation and poverty that often results from severe chronic pain, and finally, the most compelling point, the natural physiological consequences of pain from which the "disease in itself" line of thought comes, that entails immunosuppression, slowed wound healing (preventing recovery in acute and chronic conditions, and increasing the risk of the development and worsening of chronic pain), potentially deadly heart complications, stroke, suicide, and the entirety of the physiological consequences of allostatic load. I hope that the government in Italy proves more logical and reasonable than that of the U.S. I figure the best way to bill the condition is as a deadly one, where death typically just takes a very long time, particularly since Grol-Prokopczyk, 2016 noted that severe chronic pain predicted death within 10-12 years, and served as a long term mortality risk for reasons such as those mentioned above, and the increased blood pressure, as well as the immense suicide risk. Frame the relief of pain in people with chronic pain as lifesaving interventions, because in effect, that is what one is doing when one is alleviating severe, intractable pain.