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SIP 2017, WG1: Pain as a quality indicator for health care systems

SIP 2017, WG1: Pain as a quality indicator for health care systems
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Co-chairs and Speaker of this Working Group

Andreas Kopf, Audun Stubhaug, Axel Drews, Elsa Frazão Mateus, Johannes Wacker, José Romão, Marisol Garcia Penalta, Monique Steegers, Narinder Rawal, Nélia Gouveia, Nicola Bedlington, Oliver Scicluna, Paul A Cameron, Per Kjærsgaard-Andersen, Rianne van Boekel, Tony O’Brien, Tony Woolf, Winfried Meissner

Pain lasting more than three months is defined as chronic pain. Pain is a personal, subjective experience that arises in the conscious brain, typically associated with actual or potential tissue damage, or described in terms of such damage. As it is a subjective emotional sensation, reliable tools are required to facilitate the diagnosis and treatment of pain in clinical practice. Evaluation of whether pain therapy is effective should account for patients’ experience and Sensation. Equally, because pain is a central element of the patients’ experience within many healthcare settings (chronic primary pain, postoperative pain, oncological pain, neuropathic pain, headache and visceral pain), the level of pain can be considered as an indicator of the general quality of a country’s healthcare System.

Policy opportunity
As a part of a renewed collaboration between the OECD and the European Commission, the initiative of the “State of Health in the EU” was launched. Designed to support EU member states in their evidence-based policy making and to further align with the 2014 European Commission Communication on effective, accessible and resilient health systems, Health at a Glance: Europe, in its fourth edition, presents key indicators of health and health systems in the 28 EU countries, 5 candidate countries to the EU and 3 EFTA countries. Two main areas of influence: the links between population health and labour market outcomes and the challenge of resilience, efficiency and sustainability of health systems in Europe. Experts and stakeholders have been invited to participate in the ICD revision by making comments or proposals on ICD Units. Through the ICD-11 online platform interested parties may become appointed reviewers, participate in field testing or contribute to language translations. Structured input provided by these participants will be peer reviewed by experts in the field. WHO has welcomed the active participation of researchers, health information managers, health care providers and others interested in the classification. All Member States are expected to use the most current version (ICD -11) for reporting disease statistics, thereby facilitating the collection and storage of data for analysis and evidence-based decision making. At the informal Council of EU Health Ministers in Milan, 22 September 2014, national governments committed to the use of quality indicators on pain management. The European Commission should follow up on this to facilitate the sharing of best practice.

Institutional timeline

  • EU Health at a Glance Report – pain included as an indicator in the OECD and European Commission work
  • Revision of ICD – inclusion of pain in the ICD 11
  • Maltese Presidency of the European Union – The implementation of the Cross-Border Healthcare Directive is currently among the Presidency priorities


  • An English explanation of the Italian law 38/2010 on measures to ensure access to palliative care and pain therapy is available here.
  • The cross-border healthcare Directive is available here.
  • The Expert Panel on effective ways of investing in health’s opinion on Cross-border Cooperation is available here (...)
  • The Commission opinion on the implementation of the Cross-Border Healthcare Directive is available here.
  • The discussion paper for the 24-25 September 2015 Informal meeting of Health Ministers in Luxembourg concerning “The Cross-Border Healthcare Directive: Stocktaking two years after transposition” is available here.
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