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SIP 2017 - Panel Plenary Session I

Liisa Jutila, Miroslav Mikolasik MEP, Richard Muscat, Rolf Detlef Treede, Thomas Tölle – Malta

Evolving concepts in the definition of chronic pain: a dynamic process

Problem definition

For policy makers, the different views on the definition of chronic pain held by health care professionals can be confusing. In particular, the issue of whether chronic pain can be considered a diagnostic entity, or even a condition in its own right, can lead to consternation. In some cases, the lack of certainty over this issue appears to cause reluctance to address pain in policy measures.

Session objectives

• To define a consensus statement for policy purposes on the definition of chronic pain.

• To address a fundamental issue related to the societal impact of pain: to what extent, and in which circumstances, should chronic pain be considered a disease in its own right, rather than a ‘symptom’?

• To gain insights on how to overcome the reluctance of policy makers to address pain in policy initiatives addressing chronic diseases.

• To offer policy makers guidance on how to address the problem.

• To invite participants to draw attention to policy initiatives of relevance in this area.


Proposed consensus statement

Chronic pain can either co-exist with other conditions, or be the only diagnosis (Chronic primary pain). When it coexists with other conditions initially, it may frequently outlast those other conditions (e.g. Cancer, rheumatoid arthritis, herpes zoster, etc.) Impact for policy makers

With the introduction of chronic primary pain as a ‘diagnostic entity’, a broad group of patients with pain may now receive appropriate care, where previously they may have been neglected, if they stay in their primary disease entities (e.g. osteoarthritis or neuropathic pain) We hope that this description strengthens the representation of chronic pain conditions in clinical practice, research and policies, addressing the societal impact of pain.


Pain is a common element of numerous chronic health conditions, such as cancer and musculoskeletal diseases, and often persists past normal healing time (Bonica, 1953). Usually pain is regarded as chronic when it lasts or recurs for more than 3 to 6 months (Merskey & Bogduk, 1994). Although acute pain may reasonably be considered a symptom of disease or injury, chronic and recurrent pain is a specific healthcare problem, leading to typical co-morbidities such as sleep disturbances, anxiety, depression and low self-esteem among others. Thus, chronic pain develops into a typical syndrome and could even be considered a disease in its own right. While acute pain by definition is a brief and self-limiting process, chronic pain Comes to dominate the life of the people concerned and often also family, friends and caregivers.