5 Dec 2014: Health Policy - Invest in training

Pain therapy and end-of-life care are rising in importance on the European agenda.

Stakeholders are requesting the EU to set up European networks for palliative care and pain therapy. The focus should definitely be on the training of specialists and exchange of best practices.

Better education on pain management and the need to promote the exchange on best practices in Europe were called for in November as part of the 5th symposium on the Societal Impact of Pain, SIP. SIP is an international multi-stakeholder platform with the aim of raising awareness of the relevance of the impact of pain on our society, health and economic systems.

Pain therapy and palliative care were listed as priorities by the Italian Presidency of the EU and, for the first time ever, all EU ministers of health discussed this topic at the recent informal meeting of the health ministers in September. Delegates of the SIP symposium, supported by the Italian Presidency, welcomed the EU health ministers’ decision to create a European network for training healthcare professionals and exchanging information.

They discussed what measures are urgently required to ensure that pain therapy and palliative care remain priorities on the agenda of both the EU institutions and national governments. European member states should be able to benefit from already existing best practices to avoid inequalities in access to pain therapy. Furthermore the EU Commission and member states should secure the necessary resources to ensure that a European network is put in place for the benefit of European patients. This applies particularly to the needs of the elderly and very young paediatric patients.

Access to pain therapies
Marco Spizzichino, Director of Office XI, Palliative Care and Pain Therapy in the Italian Ministry of Health, General Directorate for Health Planning, referred on behalf of the Italian Minister of Health Beatrice Lorenzin to law 38/2010, which ensures access to pain therapies in Italy: “Member states should consider developing public health strategies that include effective policies on pain therapy and palliative care, for which Italy is a good example.”
Spizzichino also emphasised the need to ensure access to all currently available treatments and to reduce the inequalities in access to treatment between regions and the European member states: “Upholding the right of the patients to avoid unnecessary suffering and pain should be a national and European priority.”

Willem Scholten, a former employee of the World Health Organisation WHO, reiterated the Italian Minster of Health's request and emphasised that “Opioid analgesics are considered to be essential medicines by the WHO and are necessary for the treatment of moderate to severe pain. However, there are no uniform guidelines allowing access to these medicines.”

The SIP participants recognised the need for EU member states to equally apply the 2011 WHO guidelines for controlled substances. The exchange of best practices could also contribute to improving the management of controlled substances and reducing the social consequences of misuse.

Approximately 100 million European citizens, and 50% of the older population in Europe, suffer from chronic pain. Overall chronic pain causes 500 million days of illness in Europe and costs the European economy more than €34 billion. Dr Chris Wells, President of the European Pain Federation EFIC® pointed out that “Early treatment of pain, particularly back pain, can achieve huge cost savings and a reduction in sick leave and inability to work.”

Improve training
Depression, anxiety disorders, reduced physical mobility and social isolation are frequently associated with chronic pain. Depression and back pain are two of the five main reasons that result in inability to work in all European countries. And yet, 82 percent of the universities provide no courses on pain therapy for undergraduate medical students in Europe – at any rate, there are no courses that are compulsory for all students.
The effects on European society are considerable as chronic pain is one of the major reasons why people exit the labour market prematurely.
“Therefore, we have to invest in training young professionals when it comes to pain and palliative care. The topic must be given more attention in the curricula of medical education in Europe and the world”, Professor Hans-Georg Kress, the former President of the EFIC® concluded.
The European Pain Society EFIC® (European Federation of IASP Chapters®) is responsible for the scientific contents of the SIP platform.

A German version of the article is available at: www.springermedizin.at

SIP, Ärzte Woche 50/2014
© 2014 Springer-Verlag GmbH, Impressum

18 Nov 2014: Parliament Magazine on SIP 2014

Grünenthal: Summary of SIP 2014 - December 15th

Brussels, 18th November 2014. Better education on pain management and the need to foster European best practice sharing was discussed at the 5th Symposium on the Societal Impact of Pain (SIP), an international multi stakeholder platform aimed at raising awareness for the impact that pain has on our societies, health and economic systems. Pain therapy and palliative care were listed as a priority by the Italian Presidency of the EU Council and, for the first time ever, all EU ministers of health discussed this topic at the recent informal Health Council meeting in September. Delegates of the SIP symposium, endorsed by the Italian Ministry of Health, welcomed the EU health ministers’ decision to create a European network for the training of healthcare professionals and the sharing of information and best practicesi. They discussed what measures are urgently required to ensure that pain therapy and palliative care remain priorities on the agenda of both the EU institutions and national governments. European countries should benefit from existing good practices to avoid inequalities in access to pain treatment and the Commission and member states should secure the necessary resources to ensure that such a network is put in place for the benefit of European patients, especially considering the needs of both the elderly and paediatric patients.

The CPPC perspective on SIP 2014

I asked Neil Betteridge, as both Vice Chair of the Chronic Pain Policy Coalition (CPPC) and as one of its patient representatives his thoughts on this year’s SIP meeting.

The CPPC is the UK umbrella body for chronic pain. Its members are organisations with an interest in pain representing patients, primary and secondary care, the private and public sectors, and academic institutions. For several years it has provided secretarial support to the All Party Parliamentary Group on Chronic Pain in the UK Parliament.

On this year's SIP meeting, Neil Betteridge says: 'It was a privilege to participate on behalf of the CPPC in two of the four panel discussions. All of these sessions were lively, with active audience engagement where you could feel the positive energy in the room. There are very few opportunities for the diverse perspectives, which the Coalition represents in the UK, to come together via a European platform. It allowed us to identify common challenges, but also some of the common solutions. As Chair of the panels, Nick Ross, not only brought independent expertise of the highest level, he also kept everyone focused on outcomes and next steps. The whole event therefore was both stimulating and purposeful.’

'For example, I see one of the CPPC's main functions being to draw up an agenda for change which we can then use constructively in discussions with policymakers. To strengthen this further via a pan‐European consensus can only help in these discussions. It means we come not just with challenges but with constructive and mandated recommendations for what can be done. Given that 1 in 5 people in the UK live with chronic pain it is essential we do this.’

Neil continued: ‘Two specific issues stood out for me. The first was a strong desire to agree what best practice in supporting people with chronic pain would look like. It was agreed this should include not only access to the safest and most effective treatments – irrespective of where the person with pain might be living – but also non‐pharmacological support such as structured self‐management and psychological support where needed.’

He noted, 'As meeting hosts, the European pain federation (EFIC) welcomed the suggestion of a multi‐stakeholder approach which might agree what these standards of care could look like, whilst recognising important variation at national level between health systems.This would help UK citizens with pain to feel more entitled to a high quality service (even if they moved countries in Europe); and would also be helpful to UK health professionals in terms of delivering care consistently no matter where they were working.

Alongside this, delegates also wanted to see further development of education modules on pain for trainee health professionals. Current provision is scant and, where it exists at all, differs widely between countries. This impacts on people living with pain in the UK because they will encounter a high proportion of health professionals at the community level who have not been even adequately trained in pain. It also means the profile of chronic pain is unnecessarily low within the medical community. We need more priority for pain services at the specialist level, to complement wider recognition of pain issues within primary and community care.’

Neil stated that: ‘Since the SIP meeting, myself and Martin Johnson, the Royal College of General Practitioners’ lead on chronic pain, have been elected as Co‐chairs of the CPPC. This reflects the importance of patient representatives and health professionals working as a team. We each look forward to providing updates on these exciting developments to parliamentarians over the coming period. We remain grateful for the support of Lord Luce, Linda RiordanMP and the many other active supporters we have in both Houses.’

Find more information at: www.theparliamentmagazine.eu

18 Nov 2014: 5th SIP Symposium

European advocates call for EU action in the creation of a European Network for palliative care and pain therapy focusing on training of professionals and sharing of best practice.

Brussels, 18th November 2014. Better education on pain management and the need to foster European best practice sharing was discussed at the 5th Symposium on the Societal Impact of Pain (SIP), endorsed an international multi stakeholder platform aimed at raising awareness for the impact that pain has on our societies, health and economic systems. Pain therapy and palliative care were listed as a priority by the Italian Presidency of the EU Council and, for the first time ever, all EU ministers of health discussed this topic at the recent informal Health Council meeting in September. Delegates of the SIP symposium, endorsed by the Italian Ministry of Health, welcomed the EU health ministers’ decision to create a European network for the training of healthcare professionals and the sharing of information and best practices. They discussed what measures are urgently required to ensure that pain therapy and palliative care remain priorities on the agenda of both the EU institutions and national governments. European countries should benefit from existing good practices to avoid inequalities in access to pain treatment and the Commission and member states should secure the necessary resources to ensure that such a network is put in place for the benefit of European patients, especially considering the needs of both the elderly and paediatric patients.

Italian Minister of Health Beatrice Lorenzin, commenting on the Symposium, referred to law 38/2010 which ensures access to pain therapies in Italy and said: “Member states should consider developing public health strategies that include effective policies on pain therapy and palliative care, for which Italy is a good example”. Minister Lorenzin also pointed out the need to ensure access to all currently available treatments and to reduce the existing inequalities between regions and EU member states. “Upholding the right of the patients to avoid unnecessary suffering and pain should be a national and European priority” she said.

Willem Scholten, former WHO officer echoed the call by the Italian Minister of Health. “Opioid analgesics are considered essential medicines by the WHO” – he reminded the audience – “and they are indispensable for the treatment of moderate to severe pain. However, policies ensuring access to this kind of treatment are not equally present throughout Europe”. Participants recognised the need for EU member states to equally apply the 2011 WHO Policy Guidelines for Controlled Substances, which help identify appropriate policies with regards to availability, accessibility, affordability and control of medicines, such as opioids. The exchange of best practice in this field could help countries improve management of controlled substances and avoid the social consequences of misuse.

Chronic pain affects almost 100 million European citizens and 50% of the older population in Europe. All in all, chronic pain causes 500 million days of illness per year in Europe, costing the European economy more than €34 billion. Dr. Chris Wells, President of the European Pain Federation EFIC® pointed out that "Better early management of pain, especially back pain, could produce a huge cost saving and a reduction in sick leave and disability".

Depression, anxiety, reduced physical mobility, and social isolation are frequently related to chronic pain conditions. Depression and back pain are two of the top five causes of disability in every region of Europe. And yet, 82% of undergraduate medical schools in Europe have no dedicated courses on pain that are compulsory for all students. The effects on European society are considerable, chronic pain being one of the major reasons why people exit the labour market prematurelyvi. “We therefore need to put much more emphasis on the education of young professionals when it comes to pain and palliative care. The topic must receive more attention in the curricula of medical education in Europe and the world”, concludes Prof. Dr. Hans-Georg Kress, past president of EFIC®

The scientific framework of the SIP platform is under the responsibility of the European Pain Federation (EFIC®). The pharmaceutical company Grünenthal GmbH is responsible for funding and non-financial support (e.g. logistical support).


References

Summary of the conclusions of EU Health Ministers meeting in Milan, 23 September 2014: http://italia2014.eu/en/news/post/conclusioni-informale-salute/

Law 38/2010 on provisions to ensure the access to palliative care and pain therapies: http://www.parlamento.it/parlam/leggi/10038l.htm(in Italian only)

World Health Organization (WHO), Ensuring Balance in National Policies on Controlled Substances, Guidance for availability and accessibility of controlled medicines, Geneva, 2011. ISBN 978 92 4 156417 5 (http://www.who.int/medicines/areas/quality_safety/guide_nocp_sanend/en/)

Breivik H, Survey of chronic pain in Europe: prevalence, impact on daily life, and treatment, Eur J Pain 2006; 10 (4): 287-333 (http://www.ncbi.nlm.nih.gov/pubmed/16095934)

Hill L. et al., Recent advances in the pharmaceutical management of pain, Expert Rev. Clin. Pharmacol. 2(5), 2009, 543-557

Phillips C, Main C, Buck R, Aylward M, Whynne-Jones G, Farr A., Prioritising pain in policy making: The need for a whole systems perspective, Health Policy 88, 2008, 166-175

Murray CJL et al. Lancet. 2012;380(9859) :2197-223

European Pain Federation (EFIC), Advancing the Provision of Pain Education and Learning (APPEAL), October 2013: http://www.efic.org/userfiles/APPEALmediareport.pdf

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