Proceedings of the CHANGE PAIN Expert Summit in Rome, June 2010

Abstract

Chronic non-cancer pain – unlike acute pain, which can be regarded as a symptom of disease or injury – is gaining recognition as a disease in its own right. It is a burden for the individual sufferer that has a severe impact on physical and social functioning. Chronic back pain, in particular, is a highly prevalent condition that has a considerable economic impact on society. However, treatment approaches for severe chronic non-cancer pain differ widely. The CHANGE PAIN initiative aims to enhance the understanding of patients who suffer from severe chronic pain and to improve pain management. The following special supplement, consisting of 10 commentaries, describes the proceedings from the first international Expert Meeting of the CHANGE PAIN initiative, which was held in Rome on June 20th and 21st, 2010.

Keywords::

• Chronic pain
• Neuropathic pain
• Pain management
• Pain mechanisms
• Physician/patient communication
• Vicious Circle

Introduction

As we approach the second decade of the 21st century, chronic pain still represents a considerable burden to both the individual and society. Many drugs are available which can effectively treat severe chronic pain but its management needs to be made more efficient. Reasons for the current situation of unmet need include the following: the struggle to balance efficacy and tolerability often leads to low patient compliance and discontinuation of treatment; pain with a neuropathic component presents a particular challenge to management; and physician/patient communication is often ineffective1.

Improving the pharmacological management of severe chronic pain requires better education of physicians about the adequate use of existing therapies, and the development of a more mechanism-orientated approach to pharmacological treatment.

The CHANGE PAIN initiative

In 2009, an International CHANGE PAIN Advisory Board of pain specialists was established to address the issues surrounding inadequate pain management. It is supported by Grünenthal GmbH, and endorsed by the European Federation of International Association for the Study of Pain Chapters (EFIC). The Advisory Board’s 21 members were drawn from various European countries, as well as the USA, and were identified as being key opinion leaders with considerable clinical experience in pain management.

The Advisory Board began meeting twice a year under the joint chairmanship of Professor Giustino Varrassi of L’Aquila University and Dr Gerhard H.H. Müller-Schwefe of the Centre for Interdisciplinary Pain Therapy and Palliative Care in Göppingen, Germany. At these meetings, members work jointly to achieve consensus on the challenges that physicians face in managing chronic pain, and to develop guidance that will increase healthcare professionals’ understanding of the patient’s experience and simultaneously raise awareness of best practice.

Key factors for improvement in pain management that have so far been identified by the Board include effective physician/patient communication, greater knowledge of the multifactorial nature of chronic pain, increased awareness of the Vicious Circle1 in pharmacological therapy, and the need for treatment decisions to be guided by an understanding of pain mechanisms2.

Changing practice, improving care

The Board aims to achieve its objective in three main ways. Firstly, it supports research that will provide a greater appreciation of both physicians’ and patients’ perspectives of chronic pain. Examples include studies which investigate the incidence of chronic, non-cancer pain and its impact on patients’ lives; the economic cost of this pain; patients’ trade-offs between efficacy and side effects; and both physicians’ and patients’ preferences regarding treatment. Secondly, it encourages publication of the results of these studies in peer-reviewed professional journals, and promotes the dissemination of the results throughout the medical community as widely as possible, via both electronic and print media. Thirdly, the CHANGE PAIN Advisory Board is sponsoring the development of modular Continuing Medical Education (CME) materials, using a proven, blended-learning, evidence-based strategy to combine face-to-face and online learning elements. These can be adapted to meet the requirements of different national frameworks for treatment and CME, as well as the individual needs of healthcare professionals.

In the commentaries that follow, the authors describe the proceedings of the first international Expert Meeting of the CHANGE PAIN initiative, held in Rome on June 20th and 21st, 2010. These papers pinpoint deficits in the current management of chronic pain, and propose some strategies for improving pain management and patient satisfaction. Almost 200 pain specialists came from all over the world to hear presentations on many different aspects of chronic pain and its treatment from key opinion leaders. Germany, the United Kingdom and France were the best represented countries, with 29, 25 and 21 delegates respectively. A total of 103 delegates came from other European countries, while 11 came from Latin America and the USA. Delegates were able to share their views through an electronic voting system, which enabled the audience to respond to questions and the answers to be collated and displayed immediately. Almost without exception, these answers corroborated the evidence in the speakers’ presentations; for example, that pain is a highly individual and subjective experience, that the treatment of chronic pain should not depend solely on its intensity, and that the focus of pain management should move from symptom control to mechanism-based treatment. Widespread appreciation of these messages could be a critical first step towards improving the care of those who suffer from chronic pain.

Transparency

Declaration of funding

This in-journal supplement was based on a meeting held in Rome, Italy, on June 20th and 21st, 2010, which was supported by Grünenthal GmbH, Aachen, Germany.

Declaration of financial/other interests

G.V., B.C., B.M., E.K., A.N., A.D., J.P., M.S. and G.M.-S. have disclosed that they have received honoraria from Grünenthal GmbH to attend the meeting in Rome. G.V. and G.M.-S. have also disclosed that they have been chairmen of Grünenthal’s International CHANGE PAIN Advisory Board since June 2009, and receive honoraria in this context.

CMRO peer reviewers may have received honoraria for their review work. The peer reviewers on this manuscript have disclosed that they have no relevant financial relationships.

Acknowledgements

The authors thank Derrick Garwood Ltd, Cambridge, UK, for editorial support, which was sponsored by Grünenthal GmbH, Aachen, Germany.