NUTRITIONAL COMPLEXITY IN MULTIMORBID CHRONIC PAIN: A CROSS-SECTIONAL ASSESSMENT OF POLYPHARMACY-NUTRITION INTERACTIONS AND PERSONALISED DIET PROTOCOL IMPLEMENTATION

G. Fedelfranco¹, N. Misceo², M. Di Masi³, F. Germini⁴ | ¹Social Health Local District, ASL Bari, U.O. Door of Unique Access(PUA)/Multidimensional Evaluetion Unit(UVM), University of Studies Bari "Aldo Moro", Bari, Italy; ²Ministry of Health, SASN Bari, Italy; ³Educational Director of Professional Training Activities for the Nursing Course in IRCCS Castellana Grotte, University of Studies Bari "Aldo Moro", Italy; ⁴Director Health Profession, Social Health Local District N.10 ASL Bari, Italy

Background & Aims. Multimorbid patients with chronic pain present the highest nutritional complexity: concurrent conditions(diabetes, renal failure, heart failure, malignancy) generate conflicting dietary restrictions, while analgesic polypharmacy introduces multiple food-drug interactions and appetite-suppressing side effects. This nutritional complexity is rarely systematically assessed in Italian community care, leading to suboptimal dietary prescriptions and iatrogenic malnutrition. This study aims to: (1) characterise nutritional complexity (Nutritional Risk Screening 2002, Mini Nutritional Assessment, and polypharmacy-nutrition interaction burden)in multimorbid patients with mixed chronic pain; (2) develop and pilot a Personalised Multimorbidity Nutrition Protocol (PMNP) addressing simultaneous dietary constraints; (3) evaluate PMNP implementation barriers using the CFIR framework and PDSA cycles.
Methods. Design: Sequential mixed-methods. QUAN: Cross-sectional nutritional complexity assessment (N=120 multimorbid patients, ≥3 chronic conditions, NRS ≥4). QUAL: Semi-structured interviews with 2 nurses and 2 nutritionists(IPA, implementation barriers). PMNP components: MNA-SF + NRS-2002, polypharmacy-nutrition interaction checklist (≥5 drugs), personalised diet prescription balancing renal/hepatic/cardiac/diabetic constraints, oral nutritional supplement (protein-enriched). Process instruments: NCP SIAP module, PMNP flowchart, CFIR domain mapping. Change management: CFIR + PDSA + interprofessional case conference (monthly). Statistics: Spearman (MNA-SF vs polypharmacy burden), Wilcoxon (BPI-SF, MNA-SF change at 8 weeks).
Results. (Prelim.) Cross-sectional data (N=78): MNA-SF ≤11 (malnutrition risk) in 64.1% (N=50). Mean drug count 7.3 (SD 2.4). Polypharmacy-nutrition interaction burden ≥3 interactions in 58.9% (N=46). Appetite loss secondary to analgesics in 51.3% (N=40). PMNP 8-week pilot (N=28): MNA-SF improved in 67.9% (p<0.001). BPI-SF pain interference reduced 1.7 points (p=0.003). CFIR dominant facilitator: interprofessional monthly case conference (100% endorsement).
Conclusions. Nutritional complexity and polypharmacy-nutrition interactions are highly prevalent in Italian multimorbid pain patients and are associated with malnutrition and pain interference. The PMNP protocol, guided by CFIR and PDSA methodology, shows early efficacy and feasibility, with monthly interprofessional case conferences emerging as the key change management driver for sustainable implementation.