MIXED-MECHANISM CHRONIC PAIN ASSESSMENT IN ITALIAN MULTIMORBID COMMUNITY PATIENTS: IMPLEMENTING THE PAINDETECT-PLUS PROTOCOL IN COMMUNITY SETTINGS

G. Fedelfranco¹, M. Di Masi², N. Misceo³, F. Germini⁴, G. Muggeo⁵ | ¹Social Health Local District, ASL Bari, U.O. Door of Unique Access(PUA)/Multidimensional Evaluetion Unit(UVM), University of Bari "Aldo Moro", Bari, Italy; ²Educational Director of Professional Training Activities for the Nursing Course in IRCCS Castellana Grotte, University of Studies Bari "Aldo Moro", Italy; ³Ministry of Health, SASN Bari, Italy; ⁴Director Health Profession, Social Health Local District N.10 ASL, University of Studies Bari, Italy; ⁵Fragility and Complexity Unit - Palliative care, Social Health Local District, ASL Bari, Italy

Background & Aims. Mixed-mechanism pain — combining nociceptive, neuropathic, and nociplastic components — is the dominant pain phenotype in patients with multimorbidity (≥3 chronic conditions), representing over 60% of complex chronic pain presentations in Italian community care (Marengoni et al. Ageing Res Rev 2011). Accurate phenotyping of mixed pain mechanisms is essential to guide appropriate analgesic selection, yet Italian community nursing assessment protocols rely almost exclusively on unidimensional NRS scores. The painDETECT questionnaire enables rapid mixed-mechanism phenotyping; its integration into community nursing workflow has not been studied in Italy. This study aims to: (1) characterise pain mechanism phenotypes using painDETECT in multimorbid communty patients; (2) assess the association between pain phenotype and current analgesic appropriateness (PMI); (3) implement a nurse-led mixed pain assessment protocol (MMAP) via PDSA methodology.
Methods. Design: Cross-sectional audit + PDSA quality improvement. Setting: Social Health Local District Bari , 2025–2026 (N=150 multimorbid patients ≥3 chronic conditions; cross-sectional N=100, PDSA pilot N=50). MMAP components: painDETECT (Freynhagen et al. Pain 2006, PMID:16716920), PMI calculation, polypharmacy flag (≥5 medications), Charlson Comorbidity Index (CCI). Process instruments: MMAP SIAP module, PDSA run chart, analgesic phenotype-matching algorithm. Change management: Kotter 8-step + 3h ECM mixed pain phenotyping workshop. Statistics: κ agreement (painDETECT vs clinical impression), χ² (analgesic appropriateness by phenotype).
Results. (Prelim.) Preliminary cross-sectional data (N=84): Neuropathic component likely/unclear (painDETECT ≥13) in 52.4% (N=44). Pure nociceptive phenotype in 31.0% (N=26). Nociplastic indicators present in 16.7% (N=14). PMI ≥1 significantly higher in neuropathic phenotype vs nociceptive (68.2% vs 38.5%, OR 3.38, 95%CI 1.28–8.93, p=0.013). CCI mean 4.2 (SD 1.8). PDSA pilot (N=32): MMAP completion rate 90.6%; analgesic regimen adjustmenttriggered in 40.6% of patients.
Conclusions. Mixed pain phenotypes, particularly those with neuropathic components, are associated with significantly higher analgesic undertreatment in Italian multimorbid community patients. The MMAP protocol using painDETECT, implemented through Kotter-guided change management, enables mechanistic pain characterisation at community level and triggers appropriate analgesic adjustment in a substantial proportion of patients.