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News&Review No.3

September 2010 l ISSUE NO 3 7 NEWS & REVIEWS Dr Andrew Nicolaou SURVEY OF CHRONIC PAIN MANAGEMENT The CHANGE PAIN Physician Sur- vey to explore physicians’ views on chronic non-cancer pain and its treatment was initiated at the 2009 EFIC Congress. The survey is still ongoing but first results from 1,761 responders are now available on the CHANGE PAIN website ( These in- dicate that there are still a number of unmet medical needs when treating severe chronic non-cancer pain patients. The results also showed that healthcare profession- als have no common understanding of what constitutes severe pain on a numerical rating scale; most re- spondents consider severe pain to begin somewhere between scores of 5 and 8. The main groups of responders were primary care physicians and pain specialists, whose views differed as follows: Primary care physicians consider efficacy the main criterion when choosing an analgesic, whereas pain specialists favour a balance between efficacy and side effects. Two-thirds of primary care physi- cians never or only sometimes use classical strong opioids for severe chronic non-cancer pain, whereas half the pain specialists use them often or very often and only 9% never do so. They all agreed that the main limiting factor is gastrointestinal side effects. 65% of pain specialists use specific opioids for long-term treatment (>3 months) whereas treatment duration by the pri- mary care physicians is generally lower. Most of the respondents thought there was a lack of knowledge of the pharmacology of analgesics in the medical community which included not fully appreciating the differences between nociceptive and neuro- pathic pain, the latter being widely regarded as the more difficult to treat. Severe chronic low back pain is generally treated with combination COMMENTARY Dr Andrew Nicolaou, St Georges Hospital, London, UK The results of the CHANGE PAIN Survey confirm that there are still many unmet medical needs in managing severe chronic non-cancer pain. The CHANGE PAIN Expert Summit was an ex- tremely important meeting as it brought together a large group of experts in managing pain who had the wealth of knowl- edge to address these urgent needs. The sessions inspired the discus- sion which I believe is what we need to ensure an agreed joint approach to efficient pain management. therapy, but no fewer than 161 differ- ent combinations have been men- tioned by the 1,761 respondents. Asked about their own treatment approach for severe chronic low back pain the participants of the Expert Summit emphasized the importance of combining different drug classes to address the underlying mecha- nisms. Roughly 53% usually com- bine two agents from different drug classes and 41% physicians use even more than two agents from dif- ferent drug classes. The initial results of the CHANGE PAIN Physician Survey are currently being prepared for publication. You are welcome to participate in the survey at