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ISSUE NO 1 5 NEWS & REVIEWS Most physicians tend to either over- or underestimate the pain-related improvement of their patients. Expectations of treatment Clinicians and patients often have very different expectations of treat- ment. The main objectives of pain management include the prevention or reversal of pain chronification, ac- tivation of endogenous pain control, improvement in physical functioning, and phychosocial rehabilitation. Standardised treatment targets fre- quently consider a 50% reduction of pain score to be a clinically rele- vant outcome, however, the degree of pain relief necessary to regain a substantial level of quality of life varies according to the individual. For many chronic pain patients even a 30% reduction of pain intensity can be a meaningful pain relief. As individual patients may have differ- ing treatment goals and expecta- tions, those need to be clearly identified. Setting individual treat- ment targets is likely to make pain management more efficient. For this purpose, simple, user-friendly tools that support physician-patient communication are needed. Opiophobia Pharmacological reasons for the current inefficiency of pain relief often arise through poor or outdated education of physicians and under- treatment of pain. The use of opi- oids in chronic pain varies widely in European countries with opiophobia being more relevant in Southern Eu- rope. Many physicians resist opioid use due to fears of side effects, ad- dictive potential, analgesic tolerance and safety concerns over long term COMMENTARY Dr med Gerhard H.H. Müller-Schwefe, President of the German Association for Pain Therapy (DGS) points out that poor communication between patient and physi- cian often leads to inadequate treatment CHANGE PAIN intends to resolve several problems in chronic pain treatment. One is identification of the many patients who lose several years be- fore they receive appropriate treatment. The development of chronic pain and its prevention is not taught to medical students or when physicians specialise, so that they are not trained in the issues they face when they meet patients. Optimally, pain needs to be treated im- mediately before it has the chance to become chronic. In order to do this we have to ask the patient “how intense is your pain”, “how does it impact your quality of life” and “how much pain would be tolerable for you” so that we know more about the individual patient’s goals be- fore deciding on the optimal treatment. In Europe we have many different approaches to diagnose and treat pain. CHANGE PAIN is a chance to understand what is happening in different countries and from that standpoint to develop a consensus on how to continue, how to improve diagnosis and treatment, and how to increase public awareness of chronic pain and its consequences. References 1. Freynhagen R et al. 2006. (See abstract on p.11). use. The cultural beliefs of both physicians and patients are also known to play a part. Due to their common use in cancer pain, opioid treatment might be understood to be an indicator of “terminal illness” leading patients to refuse opioid therapy in order to appease them- selves and avoid being categorised as a “doomed” person. Physicians need to be able to communicate with their patients to allay such fears. Conclusion Pain is individual and subjective and unless there is good commu- nication between physicians and patients and individual treatment targets are set, pain treatment is less likely to be effective.