Mixed-mechanism chronic pain assessment in italian multimorbid community patients: Implementing the paindetect-plus protocol in community settings

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.