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ISSUE NO 1 3 NEWS & REVIEWS INTRODUCTION A Vicious Circle Pharmacological treatment is often limited by the occurrence of intolerable side effects before optimal analgesia is achieved. This is especially true for strong opioids, where physicians and patients are struggling to find a balance between adequate pain relief and acceptable tolerability. The resulting Vicious Circle often leads to reduced quality of life and treatment discontinuation.The consequences are often underestimated by physicians. Therefore, increasing the awareness of this Vicious Circle of pharmacological treatment of severe chronic pain and its impact on patients among the medical community could improve treatment efficiency. Due to the multifacto- rial nature of chronic pain, many conditions, such as low back pain, may have both a noci- ceptive and a neuro- pathic pain component which often requires the use of combination therapy with the associ- ated possibility of in- creased side effects. Neuropathic pain, when present, is acknow- ledged to be more se- vere and difficult to treat and poses a partic- ular challenge for physicians. It is frequently undetected by physicians and thus not adequately treated, which causes considerable distress to sufferers. At present there is limited awareness within the medical commu- nity of the physiological differences between neuro- pathic and nociceptive pain, and the specific pharmacological options which are available. Improving this knowledge with the help of educational tools that are universal and user-friendly could lead to better treat- ment decisions. Pain is the most common reason why patients seek medical advice and represents a serious problem for a large proportion of the population worldwide. Chronic pain, which has lost its direct relationship to the trigger- ing event and has become a disease in its own right, presents a special therapeutic challenge. Many chronic pain sufferers will have experienced debilitating pain for extended periods of time and may have undergone many years of ineffective therapy. A pan-European sur- vey carried out in a wide range of countries found that 21% of the responders with chronic pain had suffered for more than 20 years and that 40% were dissatisfied with their treatment (Breivik, 2006)1 . Chronic pain is multifactorial in nature and manifests with both physical and psychological symptoms, often resulting in a significant reduction of patients’ quality of life. Furthermore, it imposes a strain on healthcare resources and results in a substantial socioeconomic burden. Inadequate training One of the reasons for the lack of effective pain treat- ment is insufficient training of physicians. Many of those treating chronic pain patients are not pain spe- cialists and may not fully appreciate the multifactorial nature of severe chronic pain. As a consequence, much of their treatment relies on tradition and per- sonal experience. The mechanism, prevention and treatment of chronic pain are all topics which should become mandatory in medical schools and specialist training situations in order to avoid an increase in the number of patients suffering from chronic pain. Lack of communication between physicians and pa- tients is often another reason why pain treatment is likely to be less effective unless individual targets are set. The experience of pain is very individual as is the degree of pain relief obtained from a given therapy. Therefore individual treatment goals are crucial if the therapy is to be effective. Reference 1. Breivik H, Collett B,Ventafridda V, Cohen R, Gallacher D. Survey of chronic pain in Europe: prevalence, impact on daily life, and treatment. Eur J Pain, 2006; 10: 287–333. CONCLUSION Thus, there are a number of issues responsible for inadequate treatment of severe chronic pain that need to be addressed in order to make progress in providing severe chronic pain patients with the level of treatment they deserve.