Mannaioni G, Fornasari D, Romualdi P, et al. (2020) 1:31-40 https://doi.org/10.36118/pharmadvances.01.2020.08 - 31 - © 2020 The Italian Society of Pharmacology (SIF) Published by EDRA SPA. All rights reserved Treatment of chronic pain in Italy: therapeutic appropriacy of opioids and fear of addiction: the situation in Italy vs. USA D. Fornasari 1 , G. Gerra 2 , S. Maione 3 , G. Mannaioni 4 , A. Mugelli 5 , D. Parolaro 6 , P. Romualdi 7 , P. Sacerdote 8 1 Department of Medical Biotechnology and Translational Medicine, Milan, Italy 2 Department of “Drug and Health Prevention”, Ufficio delle Nazioni Unite contro la Droga e il Crimine (UNODC), Rome, Italy 3 Department of Experimental Medicine, University of Campania, Naples, Italy 4 Department of Pharmacology, University of Florence, Florence, Italy 5 Faculty of Medicine and Surgery, University of Firenze, Florence, Italy 6 Faculty of Medicine and Surgery, University of Insubria, Varese, Italy 7 Department of Pharmacy and Biotechnology, Alma Master Studiorum University of Bologna, Italy 8 Department of di Pharmacy and Biomulecolr Sciences, University of Milan, Milan, Italy E-mail: guido.mannaioni@unifi.it, patrizia.romualdi@unibo.it Introduction Chronic pain is considered to be one of the most debilitating and expensive pathologies in Europe, North America and Australia. In Europe, 19% of adults suffer from moderate to severe chronic pain. Chronic pain has great impact on daily activities, work and social life, and represents an important problem for public health. That being said, most patients are not treated by a pain therapy specialist, and 40% are not provided adequate pain management (1). In terms of the prevalence of chronic pain, Italy ranks third in Europe; it is estimated that about 26% of the population has had to resort to drugs to treat chronic pain at least once in their lifetime (2). In 2010, Law 38/2010, aimed at ensuring adequate treatment of patients suffering from cancer-related pain or chronic non-cancer pain through an integrated network of services, was approved in Italy (3). There is widespread consensus and international approval for the use of opioids in the management of pain associated with advanced-stage cancer (4). In such cases, the benefit of pain relief obtained via opioids fully justifies the risks of long-term therapy with this class of drugs. From a clinical standpoint, opioid use rarely interferes negatively with the overall management of these patients. However, the use of opioids in chronic non-cancer pain is still controversial today (5). Indeed, when the prescription of opioids is aimed at the treatment of chronic non-cancer and/or neuropathic pain, there is evidence of poor efficacy and the onset of serious complications (6). A recent meta-analysis of randomized clinical trials has shown that there are no significant differences in efficacy between opioids and other pharmacological and non-pharmacological treatments in the treatment of chronic non-cancer pain, and has concluded that there is Open Access RESEARCH ARTICLE