Pain, just a symptom or a disease on its right?


By Merce Piqueras

When I told a friend of mine, who is a nurse, that I was to attend a meeting on pain, she asked me: “Is it an anaesthesiology meeting?” My friend, like other professionals of health, assumes that pain is the province of anaesthesiologists, the specialists whose main task is to prevent pain during and after surgery. However, pain medicine is much more than anaesthesiology; it is a multi-disciplinary, complex branch of medicine. The meeting I attended through EUSJA was the 11th Congress of the European Pain Federation EFIC, which was held in Valencia, Spain on September 4-7 this year, which gathered around 3,500 healthcare professionals from different fields of pain medicine. Pain has been usually considered only a symptom. However, in many pathological conditions in which pain starts as a symptom, it turns into a disease on its right, with its own biology and own biological consequences.

Pain is a subjective experience and cannot be measured as temperature and blood pressure are. Gene studies have revealed that about half of our sensitivity to pain is coded in our genes. Luda Diatchenko, from the Allan Edwards Centre for Research on Pain in Montreal, Canada, investigates the molecular and cellular events that lead humans to develop chronic pain. In Valencia, he explained how the results of genetic studies have been used to develop new drugs to treat chronic pain. Understanding the mechanisms by which specific variations in genes affect the individuals pain perception and sensitivity will be a key issue to personalise pain diagnosis and treatments.

The fact that pain is invisible, an emotion, makes it difficult for the physicians to assess the severity of the patient’s condition and the effectivity of treatments. By now, providing evidence of chronic pain for insurance and legal purposes has been very difficult, if not impossible. Nevertheless, this could change in the near future. At the EFIC Congress, Rolf-Detlef Trede, from the Centre for Biomedicine and Medical Technology of Manheim, Germany, presented a project he leads that aims to identify biomarkers such as proteins and hormones with the capability of objectively measuring pain. These are just two of the many topics discussed at the EFIC Congress.

The International Association of the Study of Pain (IASP) declared 2019 “Global Year Against Pain in the Most Vulnerable” with the aim to improve the assessment and treatment of pain in the most vulnerable populations: infants and young children, the elderly (including old people suffering dementia), individuals with cognitive impairments (non-dementia related) or psychiatric disorders, and survivors of torture. The EFIC Congress took into account the 2019 celebration and various sessions focused on topics related to the most vulnerable populations. Miriam Kunz, co-chair of the 2019 Global Year Against Pain in the Most Vulnerable, has used her advanced understanding of patient’s facial expressions and other non-verbal cues to attract attention towards the usually inadequate treatments of pain in vulnerable patients Communication of pain by patients from these groups tends to be difficult and the health professionals must interpret body language and other non-verbal communication of patients.

The Societal Impact of Pain (SIP) platform, which was created as a joint initiative of the European Pain Federation EFIC and the pharmaceutical company Grünenthal GmbH, was also present at the Congress. Currently, SIP comprises eight SIP national platforms (Belgium, Finland, France, Ireland, Malta, Netherlands, Portugal Spain), whose representatives presented their experiences and achievements at different sessions.

In an informal talk with science journalists, Bart Morlion, EFIC past President, highlighted that, in the 2017 Congress, the foundations for a new EFIC direction were laid. They do not want ‘dinosaurs’ leading the organization, and young people can bring fresh ideas such as the increasing use of digital tools. This is why the motto of the 2019 Congress was “Bringing the Future to the Present”. Another change in EFIC, whose core work focuses on education, research and advocacy, is that the Federation has, for the first time, a female President: Brona Fullen, who is also the first non-physician President—she is Associate Professor in the School of Public Health, Physiotherapy and Sports Science of University College Dublin. Morlion described some novelties in the Congress including the active participation of patients and the introduction of new formats of workshops to give room to young talented researchers. Out of modesty, Morlion did not mention what was to be the highlight of the last day of the Congress: the innovative session on antinociceptive cooking led by Morlion himself, assisted by Víctor Mayoral, Secretary of the Spanish Pain Society (and by Miguel, a professional cook, just in case…).

Brona Fullen evoked David Niv (1950-2007), a former EFIC President (1999-2002) whose patients used to call him the “pain doctor”, and remembered a phrase he had liked: “Few die of pain, but many die of pain, even more live in pain”. In fact, in Europe, more than 150 million people suffer from chronic pain—persistent, episodic o variable—an amount higher than French and German populations together. The clinical and socio-economic impact of chronic pain, which often leads to distress and disability, is of great relevance and it costs the European Union more than 441 billion euros per year. However, in the current EU 8th Framework Programme (FP8/Horizon 2020), pain has been mentioned in one call for proposal on Novel patient-centred approaches for survivorship, palliation and/or end-of-life care, with a funding which does not reach 1% of health research funding in the Horizon 2020. SIP and other organizations involved in the management of pain, have requested to the European Commission, to its member states and to the Civil society that they unite to reduce the impact of pain in the European Union. The Congresses of the  European Pain Federation EFIC provide the right framework for stakeholders to gather and discuss all issues related to pain.

Photo: Merce Piqueras

Merce Piqueras is science journalist based in Bacelona. Freelance collaborator of ARA (Catalan newspaper, print and online) and various digital media in Catalan, Spanish and English. Science writer and science journalist mostly on biology and health topics. Author of “Walks around the Scientific World of Barcelona” (Catalan, Spanish and English eds.). Former President of ACCC.

About Viola Egikova

Viola Egikova - science journalist based in Moscow, president of Intellect, former Vice-President of the European Union of Science Journalists' Associations, Programme Coordinator of All Russia Science Festival