CHRONIC PAIN PREVALENCE IN ITALY: GEOGRAPHICAL DISTRIBUTION, COMORBIDITIES AND PSYCHOSOCIAL BURDEN FROM THE MULTIPURPOSE NATIONAL SURVEYS “ASPETTI DELLA VITA QUOTIDIANA” 2022-2023

A. Maraschini¹, M. Tenti², W. Raffaeli², G. Minelli¹, E. Bologna³, L. Gargiulo³, L. Iannucci³, A. Burgio³, I. Cascavilla¹, A. Maione¹, M. Ferri¹, V. Toccaceli¹ | ¹Istituto Superiore di Sanità, Roma, Italy; ²Fondazione ISAL, Rimini, Italy; ³ISTAT, Roma, Italy

Introduction. Chronic pain (CP) (1) represents a major public health issue, impacting individual well-being, functional status, and healthcare systems (2-4). In Italy, the 2019 European Health Interview Survey (EHIS) data reported a CP prevalence of 24% in adults (5), showing strong associations with depressive symptoms, reduced social participation, and functional limitations (6). This study provides updated national estimates using the 2022–2023 ISTAT data, focusing on prevalence, severity, and dose-response associations between CP intensity and health and psychosocial outcomes.
Methods. Data from the 2022-2023 National Multipurpose ISTAT surveys “Aspetti della vita quotidiana”, including a validated 5-item Chronic Pain Questionnaire (7), were analyzed. The samples (2022: n=35,954; 2023: n=35,695) were representative of the Italian population aged ≥18 years. Descriptive analyses evaluated CP prevalence, standardized geographical differences, and comorbidities. Multivariate logistic regression models assessed the dose-response gradient between CP intensity and (i) obesity, (ii) physical inactivity, (iii) psychosocial well-being, (iv) self-reported health, and (v) activity limitations, adjusting for socio-demographic characteristics.
Results. The surveys estimated that nearly 13 million adults in Italy suffer from CP, representing 25.7% of the adult population (22.0% in males, 29.0% in females). Regarding intensity, among sufferers, 19.5% reported mild, 57.6% moderate, and 22.9% severe pain. Age-standardized prevalence was higher in Northern Italy (24.5%) than in the Center (22.8%) and South (22.7%), reversing after age 65. Among sufferers, 18.0% attributed pain to an undiagnosed condition, 19.0% received no therapy, and 16.1% under treatment reported it as entirely ineffective. Osteoarthritis/arthrosis (43.7%) was the most prevalent comorbidity. Depressive symptoms affected 11.4% of CP sufferers vs 2.8% of CP-free subjects. Significant dose-response associations emerged between CP intensity and obesity (OR: 1.25 mild, 1.28 moderate, 1.52 severe). Physical inactivity showed an inverse association with mild pain (OR: 0.84; 95%CI: 0.78–0.91) but a strong positive association with severe pain (OR: 1.64; 95%CI: 1.52–1.76). Psychosocial well-being was severely compromised: life dissatisfaction (OR: 1.21, 1.56, 2.83) and psychological distress (OR: 1.47, 2.14, 5.03) escalated with pain intensity. Finally, severe pain was robustly associated with major activity limitations (OR: 9.53; 95%CI: 8.65–10.49).
Conclusion. CP affects approximately one-quarter of the Italian adult population, confirming its substantial public health burden. Compared with 2019 estimates, overall prevalence appeared slightly increased, particularly in Northern and Central Italy. Beyond prevalence, care access and management indicators appeared to worsen: undiagnosed CP-related conditions increased (18.0% vs 13.6% in 2019), as did those receiving no treatment (19.0% vs 14.8%) and perceiving treatments as ineffective (16.1% vs 7.6%). These findings highlight growing unmet healthcare needs, reinforcing the need for strengthened diagnostic pathways, improved treatment effectiveness, and integrated care strategies. Continuous monitoring remains essential to inform public health strategies.