Symposium on the Societal Impact of Pain (SIP) 2011: European Commissioner John Dalli Calls for a Better Understanding of ‘Pain’ in Europe

Abstract

Pain is a topic that affects every one of us – either directly or via a person close to us. Since the beginning of May, the issue of pain and its impact to society has become a new topic on the agenda of the EU institutions in Brussels. On the 3rd and 4th May 2011 a very unique symposium on the ‘Societal Impact of Pain‘ (SIP 2011) took place in the European parliament, bringing together more than 300 European healthcare stakeholders from over 30 countries. This exciting meeting concluded with a call for action for all countries involved to actively participate in the new ‘Road Map for Action‘ in pain. The symposium ‘Societal Impact of Pain‘ was supported by all three European institutions, the EU parliament, the EU commission and the EU council. The European Federation of International Association for the Study of Pain (IASP^®) Chapters (EFIC^®) was responsible for the scientific framework of the meeting. EFIC is a multidisciplinary professional organization in the field of pain science and medicine, made up of the 35 European Chapters of National Pain Societies of IASP. Due to the urgency of this matter with pain affecting a significant number of the European population the scientific program of the symposium was endorsed by more than 85 national and international organizations and institutions that support pain care in Europe. Therefore, it provided a multistakeholder platform for healthcare professionals and specialists, as well as representatives of health authorities, pain advocacy groups, politicians, regulators and budget holders for discussion and to share examples of best practice in pain care. The pharmaceutical company Grünenthal GmbH was responsible for organization, logistics and support.

Figure 1. The Societal Impact of Pain Symposium took place during 3–4 May 2011 in the European Parliament in Brussels.

Figure 2. More than 300 stakeholders from over 30 countries participated in the 2-day event on the Societal Impact of Pain.

Figure 3. Patricia Reilly, Member of the Cabinet of Máire Geoghegan-Quinn, EU Commissioner for Research, Innovation and Science.

Patricia Reilly referred to pain as “undoubtedly one of the most debilitating conditions affecting people of all ages and it‘s a major healthcare challenge for Europe” and confirming that “research into pain and its many forms, its causes, management and indeed possible cures are very much part of the European Research agenda and are supported by the framework program”.

Figure 4. Isabel de la Mata, Principal Advisor from the EU Commission with special interest in public health.

Isabel de la Mata commented on the current Commission‘s Public Consultation on Active and Healthy Ageing, giving the three indicative action areas in this innovative partnership: “The first one is innovation and support of the health and the well-being of the older people. The second one is the innovation and support of the healthcare systems that could respond to the needs of the older people and the third one will be the action area for innovation in products and services that could support this Active and Healthy Ageing.”

Understanding & managing pain

Highlighting the importance of pain to society, John Dalli, European Commissioner, commented: “Each one of us has lived with pain at some point or another in our lives. This symposium, in fact, is showing the impact that pain has on us as individuals, on our working environment and on society at large.” Being responsible for Health and Consumer Policy, Dalli added “We should also realize that as the demographic profile of Europe changes and as the population becomes older, pain will become an increasingly important issue in the future. Therefore, we must understand it better and manage it correctly.”

‘Pain‘ influences quality of life

According to the National Health and Wellness Survey 2010 [1], presented by César Margarit, Member of the International Advisory Board of Change Pain, during the plenary session of the first day, the prevalence of pain in the five EU countries UK, Italy, France, Germany and Spain varies between 11.4 and 30.2% of the population. The prevalence of pain thereby negatively increases with age and has a tremendous impact on a patient‘s quality of life.

Professor Hans G Kress, President of EFIC, referred to pain as “an under-recognized ‘epidemic‘”: 19% of adult Europeans suffers from chronic moderate-to-severe pain, which has a tremendous effect on their quality of life, in particular their social and working lives; 19% had lost their jobs, 13% had changed jobs due to their pain, and 60% had visited their doctor two to nine times during the past 6 months, while only 2% had been treated recently by a pain management specialists [2].

The societal impact of pain: a ‘Road Map for Action‘

The major outcome of the meeting was to draw up and present a decisive ‘Road Map for Action‘. The Road Map is the outcome of the second of the six parallel workshops that took place on the second day. The workshop, entitled “Pain policy; Ensuring access to pain treatment”, outlines the key issues on how the EU institutions and member states can effectively address the societal impact of pain at EU level. Specifically, the Road Map for Action calls on European governments and the EU Institutions to work on seven concrete policy dimensions on the “societal impact of pain”:

• ▪ Acknowledgement of pain as an important factor limiting the quality of life;

• ▪ Availability of information and access to pain diagnosis and management;

• ▪ Increased awareness of the medical, financial and social impact that pain and its management have;

• ▪ Increased awareness of the importance of prevention, diagnosis and management of pain;

• ▪ Encouragement of pain research;

• ▪ Establishment of a EU platform for the exchange, comparison and benchmarking of best practice;

• ▪ Trend monitoring in pain management by using the EU platform.

The detailed Road Map can be found online [101].

Pain on the European policy agenda

Jim Higgins, Member of the European Parliament, who chaired the workshop session on the Road Map for Action commented: “Pain affects us all, whether personally or through someone dear to us: it truly affects everyone across all EU member states. The Road Map for Action highlights the key policy dimensions for all EU governments and member states and illustrates the urgency for Europe to act by putting the societal impact of pain on the healthcare policy agenda”.

Furthermore, he added “The success of the Road Map is that it takes into account all angles that should be tackled, from access to pain diagnosis, to raising awareness up to sharing best practice and monitoring through an EU platform.”

An example of local policy making in pain care was given by Guido Fanelli, President of the Ministerial Commission on pain management, Italy: “The access to opiods is so important, not only in palliative care, but also in pain medicine. In Italy our situation before 2010 was very dramatic, because in order to prescribe opioids, oral or transdermal opoids, one needed a special prescription.” The new law 38/2010 has been outlined on “Measures to ensure access to palliative care and pain therapy” and guarantees each citizen access to pain therapy and palliative care, the simplification of opioid prescriptions and better accessibility of opioids, and the acknowledgement of pain as a disease and not only as a symptom.

Multi-stakeholder discussions in the European parliament

During the 2-day event participants could join in 12 sessions and workshops in total focusing on the different topics of pain care and its improvement in Europe.

Giustino Varrassi, SIP conference President, opened the plenary session along with the two co-hosts and Czech Members of European Parliament Dr Jiri Maštálka and Dr Milan Carbnoch. EU Commissioner John Dalli, responsible for Health and Consumer Policy, welcomed everyone to the meeting and spoke of pain as a considerable public health challenge, but also of its significant economic importance: “The societal costs on member states exert the heavy burden on social security budgets across the board. Given the personal, societal and economic implications of pain, I applaud the fact that a broad coalition of individuals working on pain has been built over the years and this is represented at this event. This is Europe working to its strength … I am pleased to support such events. The EU Commission puts pain on the agenda by providing data and by supporting projects targeting pain.”

Setting the stage by raising the question of pain care as an unmet societal need, Mary Baker, President of the European Federation of Neurological Associations moderated the following plenary session illustrating the relevance of pain and its recognition as a disease in its own right (Professor Hans G Kress, President EFIC), the economic influence of pain on society (Ceri Phillips, College of Human and Health Sciences, Swansea University, UK) and the impact of pain from a national statutory perspective (Guido Fanelli, President of the Ministerial Commission on pain management).

In the afternoon, MEP Anna Rosbach from Denmark chaired the second plenary session on the society‘s perspective taking into account the multiple interests of the different stakeholders involved when dealing with pain on a daily basis. Various patient group representatives, health economists, officials from reimbursement authorities, from academia and the Catholic Church (Archdiocese of L‘Aquila) shared their recent findings, perspectives and ideas on the topic with the audience.

Six parallel workshops

The first of the six parallel workshops in the morning of the second day on 4th May dealt with the topic of “Consumers, costs or patients: dealing with pain on a daily basis” and was chaired by Antigoni Papadopoulou, MEP from Cyprus. It investigated the requirements and health inequalities in pain care especially from the consumer and patient perspective with regard to the demographic change that our society has to face in the forthcoming decades.

The second workshop focused entirely on the policy making for the improvement of pain care and brought forth a consensus document entitled “A Road Map for Action” (see above), listing seven aspects that EU institutions and member states would have to address and work on at both EU and national level in order to substantially improve future pain care for our European citizens. The final Road Map can be found online [101].

Concentrating on “Pain – numbers, facts and figures”, workshop three had invited speakers demonstrating evidence-based initiatives in pain care and first evaluations and conclusions from the implementation of these. Romanian Cristian Silivu Buşoi chaired the session; Jürgen Scheftlein from the EU Commission (DG SANCO C4-Health Determinants) introduced the series of keynote presentations with insights on the Commission‘s approach on health determinants.

The Irish MEP Gay Mitchell chaired and Irish MEP Marian Harkin introduced the fourth workshop on “Healthy aging; pain, ethics and society” and emphasised the topic of palliative care, care for elderly and healthy aging from the different angles across all stakeholder groups, including patients, their families, as well as professional and nonprofessional care-givers.

“What best practices in pain management could look like” was the theme for participants of workshop five and fuelled the discussion on the requirements from society, consumers and patients, reflecting how the evidence base on effective ways to tackle pain-related issues could be used for benchmarking pain care in the EU.

Workshop six dealt with “Pain care in the future” and its societal requirements, possibilities and promises of evidence-based medicine in pain care and questions around the issue of personalized or stratified medicine in pain research. MEP Mary Honeyball from the UK chaired the workshop, Philippe Cupers from the EU Commission (Directorate General for Research and Innovation) moderated and guided through the different representatives from European, as well as national, authorities, organizations and ministries. Willem Scholten from the WHO bridged the gap to the following afternoon session on “Future access to pain treatment” by commenting on the topic of access to pain medicines for patients: “From the perspective of the WHO, this symposium is very important, because in my work I try to improve access for patients to pain medicines and pain treatment in general. In the larger part of the world patients don‘t have any access because the medicines are so heavily regulated under the international drug control regulations.”

Future access to pain treatment

In the afternoon of the second day on May 4th Timothy Steiner, representing “Lifting the Burden” presented the WHO Atlas of Headache Disorders, leading to two further high-ranked speeches by Patricia Reilly, Member of the Cabinet of Máire Geoghegan-Quinn, EU Commissioner for Research, Innovation and Science (Figure 3), and Isabel de la Mata, Principal Advisor from the EU Commission with special interest in Public Health (Figure 4).

SIP Conference President Giustino Varrassi, co-hosts Dr Jiri Maštálka and Dr Cabrnoch wrapped-up the key learnings from the 2-day event and closed the final session. All information on the program of SIP 2011, its outcomes, as well as videos, statements, presentations and pictures can be found online [102].

Acknowledgements

The Societal Impact of Pain (SIP 2011) event was kindly co-hosted at the European parliament by Jirí Mastálka and Milan Cabrnoch. The author would like to thank Kristina Barinka of Grünenthal GmbH for the practical assistance in the writing process of this article.

Financial & competing interests disclosure

G Varrassi is past-President of the European Federation of IASP^® Chapters (EFIC^®). The scientific framework of Societal Impact of Pain 2011 was designed under the responsibility of the European Federation of IASP Chapters (EFIC) and endorsed by 85 international patient advocacy and scientific organizations. The pharmaceutical company Grünenthal GmbH was responsible for logistic support, preparation and organization. The author has no other relevant affiliations or financial involvement with any organization or entity with a financial interest in or financial conflict with the subject matter or materials discussed in the manuscript apart from those disclosed.

No writing assistance was utilized in the production of this manuscript.