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ISSUE NO 2 5 NEWS & REVIEWS tion. The National Health and Well- ness Survey also demonstrated the effect of pain in the workplace, with a significant decrease in work pro- ductivity being reported. It has been estimated that nearly 500 mil- lion working days are lost every year as the result of chronic pain, costing the European economy at least 34 billion Euros (Pain in Eu- rope Report). Treatment differences in Europe With regard to pharmacological therapy currently there is no com- mon approach to treat chronic pain patients. In general, physicians in Northern Europe are much more willing to prescribe opioids than their colleagues in the South (Var- rassia, 2010). First results of the CHANGE PAIN Physician Survey confirmed the very large differences in the daily practice of severe chronic pain management: The ma- jority of physicians agree that there is little knowledge of the pharmaco- logical characteristics of different pharmacological treatment options within the broad medical commu- nity, and almost a fifth state that they never prescribe strong anal- gesics for severe chronic non-can- cer pain conditions, such as low back pain (Varrassib, 2010). Furthermore, there is no common understanding of what constitutes severe pain. When questioned on where they perceive severe pain to start on an 11-point Numerical Professor Giustino Varrassi Epidemiological evidence indicates that a substantial proportion of adults in Europe suffer from chronic pain, which seriously affects the quality of their social and working lives. The 2008 National Health and Wellness Survey (Kantar Health, Inc., 2008), which collected data from over 53,000 participants in five major European countries (DE, F, IT, ES, UK), showed that about one in five people had experienced pain in the last month, with moderate and then severe pain being most common. Back pain was found to be the main cause of moderate to severe pain. Women were more likely to be affected by severe pain than males. Chronic pain – a burden to patients and society Chronic pain has a considerable ef- fect on patients’ quality of life with the majority of sufferers reporting that it severely affects sleep pat- terns, the ability to exercise, walk, perform household chores, attend social activities, and maintain an in- dependent lifestyle (Breivik, 2006). The prevalence of co-morbidities such as anxiety, migraine and de- pression was shown to be higher in pain sufferers than in the general population and increases with pain severity (Kantar Health, Inc., 2008). As a result, pain patients place an increased burden on healthcare re- sources through increased num- bers of visits to family doctors, emergency rooms and hospitaliza- Rating Scale (NRS), most participants put this in the range from 4 to 8. Further results illustrate the unmet medical needs and challenges in the treatment of severe chronic pain. For the majority of physicians reduc- tion of pain is the main treatment goal, followed by improved quality of life and better physical functioning. Physicians' major determinant for choice of analgesic is the balance between efficacy and side effects. Gastrointestinal side effects are mentioned as the main reason for treatment failure of classical strong opioids in severe chronic non-cancer pain patients, with analgesic toler- ance development and lack of effi- cacy also being important factors. The survey also disclosed a limited awareness of the physiological dif- ference between nociceptive and neuropathic pain in the broad med- ical community. Most of the physi- cians agreed with the statement that in severe chronic low back pain patients a neuropathic component is often not clearly diagnosed. How- ever, studies have indicated that up to 77% of severe chronic back pain patients have a suspected neuro- pathic component (Freynhagen, 2006). 80% of the participants of the CHANGE PAIN Physician Sur- vey regarded pain with a neuro- pathic component as more severe and difficult to treat. Pharmacologi- cal treatment of severe chronic low back pain varies widely: Of the 403 respondents, 7% choose mono- therapy while among the 93% choosing combination therapy there are 104 different combinations of substance classes mentioned (see Figure 2). COMMON UNDERSTANDING OF PAIN IMPACT IS THE BASIS FOR ADEQUATE PAIN MANAGEMENT