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SIP 2017 - Key Statement

Prof. Tony O’Brien – Cork University Hospital, Ireland

"Uncontrolled pain is a global public health issue. Most of the world’s population cannot access necessary pain expertise or vital therapy. Opioids must only be initiated by competent clinicians as part of a multi-faceted treatment programme in circumstances where more simple measures have failed."


Prof. Tony O’Brien
Consultant Physician in Palliative Medicine
Cork University Hospital

Uncontrolled pain is a major public health concern. The Declaration of Montreal (IASP, 2012) states that pain management is inadequate across most of the world. The personal and socio-economic impact of uncontrolled pain is incalculable. Patients experiencing pain that is not responding quickly to standard therapies must have ready access to skilled specialist clinicians who are capable of performing a comprehensive pain assessment and who will devise an appropriate multi-faceted treatment programme.

Opioids are indispensable in the management of pain. They are not a panacea for all pains and are only introduced when strictly necessary and as part of a multi-faceted strategy that includes all necessary adjuvant analgesics, non-drug interventions, psychological support and rehabilitation.

Worldwide, lack of access to opioid medication due to inappropriate restrictions on their availability and accessibility is considered to be one of the most significant barriers to optimal pain management. Opioids are clearly not a panacea for all pains and the EFIC position Paper is solely concerned with the scientific use of opioid medications in selected and supervised chronic pain patients as part of a comprehensive, multi-modality, multi-disciplinary approach to treatment. There are enormous variations in opioid use across the globe and even within regions, similar variations are observed. This is particularly the case in Europe with staggering variations in opioid use between Western Europe and Easter Europe. With due regard to the facts that chronic pain affects 20% of European citizens and disrupts the lives of millions of people with its negative impact on quality of life and physical / psychological well-being, the EFIC position paper seeks to provide a fair, balanced and evidence-based guide to the non-specialist prescriber regarding the role of opioid therapy in pain management.

Prof Tony O’Brien is a consultant physician in palliative medicine at Marymount University Hospital & Hospice / Cork University Hospital and clinical professor of palliative medicine at the College of Medicine & Health, University College Cork, Ireland. Prof O’Brien undertook his post graduate training at St Christopher’s Hospice, London in the mid-1980s and has held his current position since 1991. He chaired the Irish Government’s National Advisory Committee on Palliative Care and subsequently was appointed as Chairperson of the National Council for Specialist Palliative Care. He also served as chairperson of the Council of Europe Expert Committee on Palliative Care. Prof O’Brien has published and lectured extensively on various aspects of pain and palliative care.