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News&Review No.3

September 2010 l ISSUE NO 3 3 NEWS & REVIEWS COMMENTARY Professor Giustino Varrassi, President of the European Federation of ISAP Chapters (EFIC), Italy There are still huge differences throughout Europe in the approach to the pharmacological manage- ment of severe chronic pain. Improving healthcare professionals’ knowledge should lead to a greater appreciation of the prevalence of chronic pain and a better understanding of the needs of the patient. There is also a need to raise the awareness of pain on the political agenda, with a beneficial effect on regulation. I therefore urge my colleagues involved in treating pain to support our efforts in order to improve pain management across Europe. Professor Giustino Varrassi SEVERE CHRONIC PAIN – TREATMENT REALITY IN EUROPE Severe chronic pain is a consider- able burden to the individual and profoundly affects his or her quality of life1. It should therefore not just be regarded as an indicator of an un- derlying disease, but as a problem in its own right2. At present, approximately 1 in 4 of the European population experi- ences pain that affects the muscles, joints, neck or back, and which has lasted for more than 3 months3. However, 40% of patients consid- ered their pain was not well man- aged and 64% of those taking prescription medication reported that their pain was not always ade- quately controlled1. In addition, al- most 70% of participants at the Expert Summit indicated that se- vere chronic pain is oftentimes un- dertreated in their countries (see Figure 1). A consistent approach to chronic pain treatment is lacking across Europe which can be shown by an enormous variation in analgesic consumption, particularly with respect to opioids4. Treatment barriers and challenges Barriers to the use of strong opioids include healthcare professionals’ lack of knowledge, patients’ fear of stigma- tisation and regulatory restrictions5. Often, current pain treatment seems to be mainly driven by tradition and personal experience4. In addition, the WHO Ladder4 determines pharmaco- logical treatment solely on pain inten- sity rather than taking into account that chronic pain is multifactorial in nature2. Optimal pharmacological treatment needs to consider the underlying mechanisms of pain. Besides, a multi- modal approach is required, incorpo- rating i.e. physiotherapy, psychological therapy and patient education6. References 1. Breivik H et al. Survey of chronic pain in Europe: prevalence, impact on daily life, and treatment. Eur J Pain, 2006, 10: 287–333. 2. World Health Organisation. Cancer pain relief with a guide to opioid availability. 2nd ed. Geneva: World Health Organisation, 1996. 3. European Commission. Health in the European Union Report: Special EUROBAROMETER 272. September 2007. Available at: http://ec.europa. eu/health/ph_publication/eurobarometers_en.htm 4. Varrassi G et al. Pharmacological treatment of chronic pain – the need for CHANGE. Curr Med Res Opin, 2010, 26(5):1231-1245. 5. Vallerand A, Novak L. Chronic Opioid Therapy for Nonmalignant Pain: The Patient’s Perspective. Part II – Barriers to Chronic Opioid Therapy Pain Management. Nursing, June 2010, 126-131. 6. Argoff CE et al. Multimodal analgesia for chronic pain: rationale and future directions. Pain Med, 2009, 10(Suppl 2): 53–66. RESULTS OF DIGITAL VOTING QUESTION AT EXPERT SUMMIT To what extent do you agree that there is a problem with undertreatment of severe chronic non-cancer pain in your country? No problem n=167 Big problem 1 2 3 4 5 2.4 % 6.6 % 21.6 % 37.7 % 31.7 % Figure 1