TY - JOUR
T1 - Pharmacological treatment of chronic pain the need for CHANGE
AU - Varrassi, G.
AU - Müller-Schwefe, G.
AU - Pergolizzi, J.
AU - Ornska, A.
AU - Morlion, B.
AU - Mavrocordatos, P.
AU - Margarit, C.
AU - Mangas, C.
AU - Jaksch, W.
AU - Huygen, F.
AU - Collett, B.
AU - Berti, M.
AU - Aldington, D.
AU - Ahlbeck, K.
N1 - Funding Information:
This article was supported by an unrestricted educational grant from Grünenthal GmbH, Aachen, Germany.
PY - 2010/5
Y1 - 2010/5
N2 - Background: Although chronic pain affects around 20 of adults in Europe and the USA, there is substantial evidence that it is inadequately treated. In June 2009, an international group of pain specialists met in Brussels to identify the reasons for this and to achieve consensus on strategies for improving pain management. Scope: Literature on chronic pain management was reviewed, and information presented to and discussed by a panel of experts. Findings: It was agreed that guidelines are not universally accepted by those involved in pain management, and pain treatment seems to be driven mainly by tradition and personal experience. Other factors include poor communication between patients and physicians, the side effects of analgesic drugs, and limited individualisation of therapy. Difficulty in maintaining the balance between adequate pain relief and acceptable tolerability, particularly with strong opioids, can lead to the establishment of a vicious circle that alternates between lack of efficacy and unpleasant side effects, prompting discontinuation of treatment. The medical communitys understanding of the physiological differences between nociceptive pain and neuropathic pain, which is often more severe and difficult to treat, could be improved. Increasing physicians knowledge of the pharmacological options available to manage these different pain mechanisms offers the promise of better treatment decisions and more widespread adoption of a multi-mechanistic approach; this could involve loosely combining two substances from different drug classes, or administering an analgesic with two different mechanisms of action. In some circumstances, a single compound capable of addressing both nociceptive and neuropathic pain is desirable. Conclusions: To improve patient outcomes, a thorough understanding of pain mechanisms, sensitisation and multi-mechanistic management is required. Universal, user-friendly educational tools are therefore required to familiarise physicians with these topics, and also to improve communication between physicians and their pain patients, so that realistic expectations of treatment can be established.
AB - Background: Although chronic pain affects around 20 of adults in Europe and the USA, there is substantial evidence that it is inadequately treated. In June 2009, an international group of pain specialists met in Brussels to identify the reasons for this and to achieve consensus on strategies for improving pain management. Scope: Literature on chronic pain management was reviewed, and information presented to and discussed by a panel of experts. Findings: It was agreed that guidelines are not universally accepted by those involved in pain management, and pain treatment seems to be driven mainly by tradition and personal experience. Other factors include poor communication between patients and physicians, the side effects of analgesic drugs, and limited individualisation of therapy. Difficulty in maintaining the balance between adequate pain relief and acceptable tolerability, particularly with strong opioids, can lead to the establishment of a vicious circle that alternates between lack of efficacy and unpleasant side effects, prompting discontinuation of treatment. The medical communitys understanding of the physiological differences between nociceptive pain and neuropathic pain, which is often more severe and difficult to treat, could be improved. Increasing physicians knowledge of the pharmacological options available to manage these different pain mechanisms offers the promise of better treatment decisions and more widespread adoption of a multi-mechanistic approach; this could involve loosely combining two substances from different drug classes, or administering an analgesic with two different mechanisms of action. In some circumstances, a single compound capable of addressing both nociceptive and neuropathic pain is desirable. Conclusions: To improve patient outcomes, a thorough understanding of pain mechanisms, sensitisation and multi-mechanistic management is required. Universal, user-friendly educational tools are therefore required to familiarise physicians with these topics, and also to improve communication between physicians and their pain patients, so that realistic expectations of treatment can be established.
UR - http://www.scopus.com/inward/record.url?scp=77951065733&partnerID=8YFLogxK
U2 - 10.1185/03007991003689175
DO - 10.1185/03007991003689175
M3 - Comment/Letter to the editor
C2 - 20337502
AN - SCOPUS:77951065733
SN - 0300-7995
VL - 26
SP - 1231
EP - 1245
JO - Current Medical Research and Opinion
JF - Current Medical Research and Opinion
IS - 5
ER -