National Initiatives Spain

In this section, national initiatives which have been set up in Spain can be found.

A review of chronic pain impact on patients, their social environment and the health care system

María Dueñas (1), Begoña Ojeda (2), Alejandro Salazar (2), Juan Antonio Mico (3), Inmaculada Failde (2)

(1) Nursing Faculty “Salus Infirmorum”, The Observatory of Pain, University of Cádiz, Cádiz, Spain; (2) Preventive Medicine and Public Health Area, The Observatory of Pain, University of Cádiz, Cádiz, Spain; (3) Department of Neuroscience, Pharmacology, and Psychiatry, CIBER of Mental Health, CIBERSAM, Institute of Health Carlos III, University of Cádiz, Cádiz, Spain

Abstract: Chronic pain (CP) seriously affects the patient’s daily activities and quality of life, but few studies on CP have considered its effects on the patient’s social and family environment. In this work, through a review of the literature, we assessed several aspects of how CP influences the patient’s daily activities and quality of life, as well as its repercussions in the workplace, and on the family and social environment. Finally, the consequences of pain on the health care system are discussed. On the basis of the results, we concluded that in addition to the serious consequences on the patient’s life, CP has a severe detrimental effect on their social and family environment, as well as on health care services. Thus, we want to emphasize on the need to adopt a multidisciplinary approach to treatment so as to obtain more comprehensive improvements for patients in familial and social contexts. Accordingly, it would be beneficial to promote more social- and family-oriented research initiatives.

Read here the full article.

Well-known professionals supported the inclusion of the improvement of pain in the National Chronic Diseases Strategy
  • Plataforma SinDOLOR organizes its IV Interautonomic Meeting in collaboration with the Spanish Ministry of Health, under the title “Pain in the Chronicity Strategies”
  • Well-known professionals from all health areas in Spain have supported the inclusion of the improvement of pain in the National Chronic Diseases Strategy

Plataforma SinDOLOR (NoPAIN Platform) organized its IV Interautonomic Meeting in collaboration with the Spanish Ministry of Health on November 23th under the title “Pain in the Chronicity Strategies”. During the meeting health managers, clinicians and pharmacists have shared both the analysis of the needs and their suggestions for improvements to the patients care with pain in the regional health services.

Read the full report below "23 Nov: Pain in National Chronic Disease Strategy".

tl_files/redakteur-bereich/National Initiatives/Spain/IV Encuentro Interautonomico_2012.jpg

tl_files/redakteur-bereich/National Initiatives/Spain/IV Encuentro Interautonomico_2_2012.jpg

tl_files/redakteur-bereich/National Initiatives/Spain/IV Encuentro Interautonomico_3_2012.jpg

23 Nov: Pain in National Chronic Disease Strategy

Well-known professionals supported the inclusion of the improvement of pain in the National Chronic Diseases Strategy

  • Plataforma SinDOLOR organizes its IV Interautonomic Meeting in collaboration with the Spanish Ministry of Health, under the title “Pain in the Chronicity Strategies”
  • Well-known professionals from all health areas in Spain have supported the inclusion of the improvement of pain in the National Chronic Diseases Strategy

Plataforma SinDOLOR (NoPAIN Platform) organized its IV Interautonomic Meeting in collaboration with the Spanish Ministry of Health on November 23th under the title “Pain in the Chronicity Strategies”. During the meeting health managers, clinicians and pharmacists have shared both the analysis of the needs and their suggestions for improvements to the patients care with pain in the regional health services.

Following the publication of the Management of Chronic Diseases Strategy of the Spanish Ministry of Health in October, the meeting “Pain in the Chronicity Strategies” was held. This has been a starting point to make pain become a priority for the Spanish Health Authorities, both national and regional.

During this meeting, the Spanish Agency of Medicines and Health Products, presented the upcoming Royal Decree which updates the narcotic drugs prescription and dispensation, for both human and veterinary use. This measure will reduce the difficulties in prescribing of these kinds of drugs (such as Palexia), making access to these treatments easier for patients.

All speakers were well known experts from different health areas, what has allowed to have a deep vision and the widest possible knowledge of the situation, as well as different points of view. On the other hand all of them agreed that these changes are a great improvement in the management of patients who suffer from pain in Spain.

As an example, Dr. Víctor Mayoral, Secretary of the Spanish Pain Society, Secretary of the Spanish Pain Society, considered pain management as a key in addressing the pain chronicity strategy and stressed the need for simplifying the prescription “in order to give physicians more time to inform their patients about the characteristics, side effects and advantages of the treatment with narcotics”.

Dr. Manuel Ollero, Director of the Andalusia Attention to Chronicity Plan, stressed that before the great challenge posed by demographic changes in Spain for being one of the most aged countries in the world, is key "intervention in multiple systems to achieve relevant clinical and functional results. In this regard, said that the National Strategy for Chronicity focusses on people and not on diseases. It also assures the leadership of Primary Care.
Here you can read Dr. Ollero's PPT-Presentation.

Mercedes Carreras, Subdirector of the Development and Security Assistance of the Galician Health Service, explained that all the models that are being considered at the regional and national levels "have two common objectives: to get informed patients capable co-responsibility for their health and to establish programs that promote self-care. She also pointed out that this strategy is helping develop a National Network of School of Patients and Citizens in which Galicia is collaborating actively.
Here you can find M. Carreras PPT-Presentation.

This meeting has been, without a doubt, one of the most important actions held by the Plataforma SinDOLOR, as it has signified the collaboration and commitment of the Ministry of Health to place chronic pain in a privileged position within the Spanish Strategy for Chronicity. 
Please find here the PPT-Presentation of Xavier Gomezbatiste.

About Platform SinDOLOR

SinDOLOR Platform is an initiative launched in October 2008 by FUINSA (Foundation for Health Research) and Grünenthal Foundation, with the goal of improving patient care with pain and their relatives. The Platform aims to raise awareness throughout  health structures and society about the importance of pain to the sufferer, coordinating actions of support and encouragement to carry out initiatives to improve the current situation. 
Website Plataforma SinDOLOR

15 Nov 2012: III. Jornadas Autonómicas Dolor Y Sociedad

tl_files/redakteur-bereich/National Initiatives/Spain/3.jornadas_autonomicas_.JPGOn the 15th November 2012 the "3rd Jornadas Autonómicas Dolor Y Sociedad" took place in the "Consellería de Sanidade". The event was hosted by Plataforma SinDOLOR, Grünenthal, FUINSA (Fundación para la Investigación en Salud), Servizo Galego de Saúde and Xunta de Galicia. Main topic of this meeting was "The Pain in the healthcare system of Galicia".

Galician progress of pain treatment

The platform SinDOLOR organized this conference in order to highlight the progress of the "Strategy for improving pain care in Galicia" and to stress that Galicia is the only autonomous region that values ​ pain as the 5th constant.

The Acting Minister of Health, Rocio Alvarez Mosquera, thanked the Grünenthal Foundation for their cooperation and continuous support for the various Galician projects that are being developed under the aforementioned Strategy.

The “Third Conference on Autonomous Pain and Society” outlined that Galicia is the only autonomous region that already implemented all procedures of pain assessment as 5th constant and has a proper monitoring with consistent indicators common to all hospitals.

Great support from diverse Galician institutions

The third conference of this initiative, brought together over 130 managers in Santiago de Compostela, health professionals and representatives of patient associations. Galician Health authorities, along with representatives of each group, stated their perspectives concerning the problems and the actions needed to improve the quality of life for patients suffering from severe pain. All these proposals elaborated by multidisciplinary working groups will be reflected in the new health-care regulations regarding chronic pain, cancer and noncancer-pain for the SERGAS (Regional Health Service provider).

Implementation of the Strategy

This meeting showed that SERGAS health professionals began to fulfill the registration of pain in hospitals in December 2010 and that currently all of them are implemented. Of the nearly 147,000 patients hospitalized in 2011, more than 97,000 have 5th pain recorded as constant.

Another measure developed by SERGAS is the constitution of the Galician Pain Care Commission, involving doctors, nurses, psychologists, pharmacists and patients. In addition, since last June a multidisciplinary group, which also includes patients, is working to develop the procedures for chronic pain care in primary care.

For further information visit the SinDOLOR Homepage.

08 Nov 2012: Symposium SECA

tl_files/redakteur-bereich/National Initiatives/Spain/Symposio2_SECA.JPGBest practice indicators for pain management

On the 8th November 2012 the Symposium SECA took place in the "Palacia Euskalduna" from 11:30 to 12:20. The Symposium was hosted by Plataforma SinDOLOR, Grünenthal and FUINSA (Fundación para la Investigación en Salud).

Main topic of this meeting was to find indicators of good practice in pain management.

The project’s objective was to assess and agree in the first set of indicators of good practice on Pain Management in the Spanish NHS.

The post-operative pain is most received and best handled but the treatment of chronic pain, cancer and noncancer-pain can be improved in most pathologies. This has been one of the main conclusions drawn by the project "Indicators of Good Practice on the Management of Pain in the Spanish NHS", a pioneering initiative in Europe that was sponsored by the Platform SinDOLOR. The first results were presented on November 8 in Bilbao, under the XXX. Congress of the Spanish Society for Quality Healthcare.

Progress of the Project

After two years of hard work, the project has entered its final phase: the collection and evaluation of health services involved, over a dozen, have valued the inclusion of some indicators of Good Practice in different management contracts. The drawn results were additionally compared and supplemented with those from a survey by the SinDOLOR Platform and will be published on this platform and also being sent to all regional and national health services.

Uniform indicators for improved pain management

During the presentation of these results, the project leader, Dr. Pedro J. Saturno, Professor of Public Health at the University of Murcia, stated the main objective of this project "to have a set of indicators that can be used in all levels of care of our health system to improve pain management. It is the first attempt to provide a full menu of indicators for all types of pain and all situations where it is important to address this circumstance to ensure a quality health service.”

So far 47 indicators have been highlighted as maximum interest indicators in acute pain, chronic cancer and non-cancer chronic pain. Early next year references with the findings of the project as well as various publications will be available, which will reflect the commitment of health services.

Progress according to exprets’ opinion

The symposium where these results were presented also included the participation of Dr. Enrique Barez, medical director of the Hospital Universitario de Álava, in the Basque Country, and Dr. Juan J. Cajaraville, head of the Pain Management Unit at the University Hospital of Navarra, and EFIC representative in Spain. Dr. Barez stressed the need to "create a culture of quality and safety among professionals working in the field of pain." This project, he said, "is a first step, as it allows us to have some basic parameters that may be provided by all pain units in our country."

On his part, Dr. John J. Cajaraville said this initiative "is an indispensable tool to try to lower the economic and social costs of chronic pain by improving the quality of life of these patients." EFIC's idea is "to take this project as a pilot study to later extended to other European countries in case of success."

For further information visit the SinDOLOR Homepage.

September 2012: Interview on Enfermería TV

On 12th of September, the interview given by Manuela Monleón from FAECAP (Federación de Asociaciones de Enfermería Comunitaria y Atención Primaria), was broadcast on "Enfermería TV" (Nursing TV); the original interview was recorded on 22nd of June, in which Monleón explaines the relevance of the Societal Impact of Pain and its focus to develop and identify the uncovered needs in pain managament and the specific role of nurses in pain treatment.

Please click here to watch the complete Spanish TV interview with Manuela Monleón.

August 2012: Five years of Plataforma SinDOLOR

5 years of experience with a multi-stakeholder platform in Spain

Plataforma SinDOLOR is a multi-stakeholder platform in Spain, setup 5 years ago with the aim to raise awareness and to make people conscious of the importance of Pain and to draw together all the stakeholders involved in pain.

The association has developed several initiatives, including Awareness Raising Campaings, organizing forums and developing publications.

Please find here an informative presentation by Plataforma SinDOLOR.

Activities of the Galician Rheumatologic League

Liga Reumatolóxica Galega

The Galician Rheumatologic League is a patients organisation set up in 1996 in Spain with the objective to help improve the quality of life of people with rheumatologic diseases. Currently the GRL currently has 550 members. The institution is included in the Commission of Pain of the Department of Health and also is a member of the Advisory Committee of the patients of the same Department.

tl_files/redakteur-bereich/National Initiatives/ES/Activities of the GRL/foto dia artritis.jpg

The organisation conducts campaigns to increase awareness about the impact and influence chronic pain has on the individual. Please find here a powerpoint presentation which has been developed to support this purpose. A recent succes was the celebration of the first Worldday of Autoimmune Arthritis on May 20th 2012.

Please also find here a detailed calender of 2012 that aims to raise awareness of the impact of rheumatic diseases.

Official website Liga Reumatolóxica Galega

9 February 2012: Gestion del Dolor en el Sistema Sanitario

Salón de Actos del Hospital General Univ. de Guadalajara
Jueves 9 de Febrero de 2012

Programma Guadalajara

El dolor compromete la calidad de vida de los pacientes y su elevada prevalencia pone en entredicho la calidad asistencial. 

A diferencia de otros servicios clínicos, que se podrían estructurar más fácilmente alrededor de funciones o de áreas de actividad más convencionales, el tratamiento del dolor constituye un auténtico desafío de gestión por tratarse de un conjunto de actividades de naturaleza transversal que deben integrarse en la dinámica general de los hospitales facilitando, no interfiriendo, la labor de otros servicios con una estructura más tradicional.

January 2012: Spanish Publication on Future Medicine

"Is morphine still the best reference opioid?"

In the report “Is morphine still the best reference opioid?” in “Pain Management” (January 2012, Vol. 2, No. 1, Pagse 33-45) by Rafael Galvéz & Concepción Pérez, the suitability of morphine as the gold standard in the treatment of chronic pain is questioned. More information can be found on Future Medicine in the summary.

Dec 2011: Second Galician Pain Conference (Jornada de Dolor)

On December 15th 2011 the second Conference Pain & Society “Pain in Galician Health System” was held in Santiago de Compostela. The meeting was organized by the Galician Health Service, SERGAS, in partnership with Plataforma SinDolor, combined initiative of Grunenthal Foundation y FUINSA.

Involving more than 160 health managers, professionals and representatives of patient associations, health authorities emphasized their commitment to achieve the goal that was set a year ago, when they promoted the “Galician strategy for improving care of pain”, in order to get all Galician citizens access to pain care as a fundamental human right.

Dr. Jose De Andrés, EFIC representative in Spain, explained the “Road map for action”, an initiative by the SIP, and presented the first recommendations that EFIC has just set out for health authorities. With these recommendations they want to provide guidance for the different European governments, national and regional, to prepare their plans of action against pain.

Dr. Jose Mª Muñoz shared his experiences as project leader within La Paz Madrid hospital “Pain free hospital” as a best-practice. For their part, several SERGAS professionals shared their experiences during this first year of work and the important results they are obtaining.

In the different contributions, the speakers showed their appreciation and recognition to the support and collaboration that Plataforma SinDolor, and Grunenthal Foundation, has provided for the development of the whole strategy in Galicia.

At the end of the meeting Dña. Mercedes Carrera, Director of Development and Security Care, reaffirmed the SERGAS commitment to follow the recommendations of SIP and EFIC and announced the forthcoming publication of the decree for the constitution of the “Galician Pain Commission”.

tl_files/redakteur-bereich/National Initiatives/ES/II Jornada Dolor-Galicia(1).jpg tl_files/redakteur-bereich/National Initiatives/ES/II Jornada Dolor-Galicia(2).jpg

May 2010: "Epidemiology of chronic non-malignant pain in Spain"

In May 2010, the report "Epidemiology of chronic non-malignant pain in Spain" was written by Karla Soares Weiser, Ivan Sola, Ed Aromataris, Jesús Tornero, Concepción Pérez, César Margarit and Jos Kleijnen. Chronic pain is a widespread problem. However, the information about this problem is scarce. This report therefore aims to provide epidemiological data about chronic pain in Spain. The report itself and a slide show on the report can be found below.

"Epidemiology of chronic non-malignant pain in Spain"
Slide Show on Report 

The website of Change Pain España also contains other interesting information concerning pain. Please follow the link below.

Change Pain España

Chronic Pain becomes Priority in Spain

Spanish Ministry of Health acknowledges Chronic Pain as one out of 4 main topics for its national strategy for addressing chronic diseases

On 16th October the Spanish Ministry of Health has published its Strategy for addressing Chronic Diseases (“Estrategia para el Abordaje de la Cronicidad en el Sistema Nacional de Salud”).

The concept had been previously approved by the Interterritorial Council of the National Health System (“Consejo Interterritorial del Sistema Nacional de Salud”) on 27 June 2012.

Aim of the new strategy is to set goals and recommendations that will effectively manage health service deliveries to improve population’s health and its determinants, strengthen prevention of health conditions and reduce limitations in chronic and comprehensive care. The concept describes four main pillars on which the strategy for chronicity is based on:

  • Stratification of Patients
  • Quality indicators in Health Care
  • National network of schools for patients
  • Improvement of the chronic pain approach

The Strategy was presented at the Ministry of Health in a event opened by Ms. Pilar Farjas (General Secretary for Health), and moderated by Ms. Mercedes Vinuesa (General Director of Public Health and Quality at the MoH) and Ms. Sonia García San José (Deputy Director of Quality and Cohesion at the MoH).

Please read here the full Estrategia para el Abordaje de la Cronicidad

Andalusia

Strategies for the improvement of pain care in Andalusia

In Andalusia, in response to national laws and the actual andalusian autonomic law, which includes the right of patients to receive adequate pain treatment and within the Andalusian Quality Plan, integrated care processes (ICP) were developed, like Non- Cancer Chronic Pain ICP, Fibromyalgia ICP and Palliative Care ICP, all of them published in 2005.

These processes are directly related to addressing pain, and in late 2007 a working group was formed to develop a comprehensive strategic plan aimed at pain prevention, care and rehabilitation of patients with pain, which was published in May 2010 with the title "Andalusian Caring Plan for People in Pain" (ACPPP).

The ACPPP was developed by a multidisciplinary group composed of 24 professionals (anesthesiologists, surgeons, nurses, sport experts, pharmacists, A&E  physicians, pediatricians, psychologists, psychiatrists, rehabilitation physicians, interventional radiologists, orthopedic surgeons, epidemiologists, technical and administrative personnel led by Reyes Sanz, phD,MD and Juan Antonio Guerra phD,MD.

Once established, the group proceeded to define the scope of the plan and to analyse the situation from a quantitative and qualitative perspective. The state of the existing care situation and needs in our community were established, the objectives were formulated and improvement and implementation actions were designed in relation to training, resources, evaluation and communication; these actions are grouped into 6 major lines consistent with the strategic objectives.

The draft was subsequently sent to external review to both scientific societies and professional experts, the necessary changes were incorporated and the final ACPPP document was published.

The ACPPP was launched in June 2010 and until 2011 it has developed the foundations for the subsequent implementation of other elements, the most important ones developed to date are:

1. The review and update of ICPs: non-cancer chronic pain, fibromyalgia, Palliative Care, and ICP “surgical block” (deals with care to postoperative pain from any mayor surgery procedure) and the development of an evidence based clinical practice guideline about the safe use of opioids for terminal care.

2. The training program, which covers general training on chronic pain and specific training on psycho-education, exercise prescription and physical activity and the safe use of opioid prescriptions.

3. The development of general competencies for all health service professionals, shared skills for groups of professionals in areas related to the scope of the plan and specific skills in relation to the ICPs developed.

4. The development of a sign of quality called: "Centres Against Pain " aimed at GP Centers, hospitals and pain management units.

5. The development of a safety program for the Pain Management Units of hospitals.

The next challenges that will be addressed during the remaining term of the plan (2010-2013), are to incorporate intermediate and final indicators of health outcomes to the digital history to assess changes in healthcare and citizens health, to incorporate aspects of attention to pain in the portfolio of health facilities and improvement goals for these centres, to continue with the training activities and the final evaluation of the ACPPP itself.

More information available at (click on logo): 

tl_files/redakteur-bereich/Pain Policy/Spain/Consejeria de Salud.jpg       or     tl_files/redakteur-bereich/Pain Policy/Spain/SAS2.jpg

Galicia

Strategy for the improvement of attention to pain in Galicia

Galicia is a Spanish region with nearly 3 million people, which has complete autonomy in setting health policies to meet the needs of an ageing and largely dispersed population.

In May 2010, Galician Health Minister began working on developing a "comprehensive strategy for patient care in pain". This project is being led by Mercedes Carrera and Dolores Martin, from the General Directorate of patient safety and quality care, and supported both by the General Manager of the Galician Health Service, SERGAS, and the Health Minister herself.

Health staff, professionals and patients have to implement actions to develop the strategy and achieve its main objective, which is "optimal pain management for all Galician citizens and their families."

The actions undertaken during 2011 include: institutional declaration of attention to pain as a fundamental human right, awareness campaigns for professionals and patients, introduction of indicators of pain within the goals of professionals and health managers, including pain as the 5th vital sign on the patient's electronic medical records, creation of committees of pain management in all Galician hospitals and an Advisory Council on Pain Management for the Galician Health Service.

With all these activities, the implementation of the strategy in all Galician hospitals has been achieved, with a significant increase in both, the knowledge of the real intensity of patient pain, the registration in their electronic medical records and the relief of pain among inpatients.

The actions planned for 2012 are focused on the following objectives:

- The development of the strategy and procedures for chronic pain in primary care.
- The implementation of training programs in pain for nurses, GPs and training doctors.
- Analysis, evaluation and definition of the processes for the attention to chronic pain in the Galician Pain Care Units.

Diario Oficial de Galicia

O Servizo Galego de Saúde crea a Comisión Galega da dor

O sergas presenta a súa estratexia de atención integral á dor no Parlamento Europeo

A primeira fase do plan integral de eficiencia enerxética do sergas permitirá un aforro de máis de 6 millóns de euros ao ano

tl_files/redakteur-bereich/Pain Policy/Spain/Servizo Galego de Saude.jpg  tl_files/redakteur-bereich/Pain Policy/Spain/Xunta de Galicia.jpg

Spanish Epidemiological Review & Results of the NHWS 2010

Revisión de Estudios Epidemiològica del Dolor España.

El dolor es la principal causa de las consultas médicas, con una importante repercusión a nivel asistencial, individual y grupal. Por ello, se ha desarrollado la presente revisión sobre la epidemiología del dolor específicamente para España.

Su estructura por temas analizados, con tablas de resumen al final del documento, y su exhaustiva revisión de la literatura, valorándola en función de la calidad de los estudios, hacen de este documento un manual de fácil consulta y de referencia en materia de epidemiología del dolor.

 "Epidemiology of Chronic Non-Malignant Pain in Spain"