Removing the veil of silence from chronic pain

By Sílvia Garcia Farreny,
freelance science journalist, member of ACCC (Spain, Catalan)

EUSJA has been invited to attend the 8-th biennial congress “Pain in Europe” in Florence (October 9-12, 13 science journalists from Belgium, Germany, Hungary, Netherlands, Poland, Russia, Spain and Switzerland could take part in that very interesting multidisciplinary forum, meet top scientists and learn about the latest developments in the study and treatment of acute or chronic and recurrent pain. Silvia Garcia Farreny, science journalist from Spain (Catalan) shares with her colleagues the interview with the President of European Pain Federation, professor Hans Georg Kress.

“Pain is the major healthcare problem in Europe. Although acute pain may reasonably be considered a symptom of disease or injury, it is a specific disease”, Prof. Hans G. Kress

Approximately 20% of the European adult population –more than 80 million people- suffer from chronic pain, meaning pain which occurs repeatedly over a period of three months or longer. In other words, one in five Europeans suffer from chronic pain, and the direct and indirect costs resulting from the condition amount to between 1,5 and 3% of total European GDP (Gross Domestic Product).

These alarming figures were the subject of discussion last 9-12 October at Pain in Europe VIII, the 8th Congress of the European Pain Federation EFIC, in Florence, Italy. More than 4.000 experts from all over the world attended Europe’s largest pain medicine event.

Hans Georg Kress, the President of European Pain Federation EFIC, is Professor of Anaesthesiology, Intensive Care and Pain Medicine and Head of the Department of Special Anaesthesia and Pain Therapy at the Medical University of Vienna. He is fascinated leading an organisation as EFIC; which has grown to 36 national chapters and a staggering 20.000-plus physicians, researchers and other healthcare professionals.
Hans Georg has a calm voice, deliberate and clear, with a slight German accent. He speaks with confidence and never takes his blue eyes from yours, keeping an intense and warm eye contact most of the time. He gestures to emphasize his words and every small gesture of his body seems to reinforce the conviction in his words.

Why is your organisation so important in our society?
It is vital that we raise awareness of chronic pain as a medical, economic and social problem. Chronic pain affects quality of life more than other illnesses and it is the number one reason why people visit their doctor. Chronic pain has a major impact on everyday routines, on work and family life. It not only causes personal suffering for millions; it has greater effects on society than is usually assumed.
This is a big step forward towards public recognition of chronic pain as a true challenge, not only to our patients and their physicians, but to our healthcare systems in Europe, the budget holders, decision-makers and, of course, politicians.
As the current President of EFIC I am very proud of these achievements and look forward to further contributing, to supporting and to playing an active role in our campaign for the recognition of chronic pain as a disease in its own right.

Thereby, chronic pain is still difficult to diagnose nowadays, isn’t it?
Yes, more or less. One reason why we have chronic pain as a challenge is that chronic pain is sometimes hidden behind other different diagnoses. There is for example no single category in the ICD (International Classification of Diseases) tend, which is our international code for diseases that is used at the hospitals and everywhere. There is no single category for chronic pain; so chronic pain is hidden behind diagnoses.

Really? In which kind of diagnoses is most usually hidden?
I am talking about, for instance, neurological diagnoses. Or we can find other good example in diabetes; no one will count a diabetic patient as a chronic pain patient. Although the only thing is suffering from is the polyneuropathy with the pain. The diabetes is treated; the patient is under the insulin treatment and, theoretically, there aren’t more problems. But he is suffering from a permanent chronic neuropathic pain. Nevertheless this patient is always counted as a diabetic patient not as a chronic pain patient.

But how is possible that doctors do not distinguish chronic pain yet?
Listen, even physicians don’t know that chronic pain is a disease. In fact, many of our colleagues from other specialities think just chronic pain is not a problem, as long as they treat the underline disease chronic pain is a symptom that will disappear during the physiological dealing process, but this is not true. So what we need is more awareness about chronic pain. Because chronic pain is more frequent and it is more money spent on chronic pain than on cancer and diabetes for example.

From your point of view, how is possible to change the marginal situation of pain in our countries?
We have to change it with medical approaches from different perspectives; we have to improve the medical education about pain from medical schools, we have to improve and we have to talk about chronic pain to post-graduated physicians that are already in their practice and, specially, we have to educate family physicians. We have to educate also physicians that are more or less involved on treatment of chronic pain. And, very important, listen the patients that suffered from chronic pain because of an operation.

One moment… Are you talking about surgeons?
Yes, I am. Because many surgeons have no idea how frequent and persistent pain is after an operation. Really considerable percentages of chronic pain patients have a chronic pain because of an operation. And our surgeons are not aware about this problem so we have to make them to be aware, to recognise, this type of pain. And therefore, to treat this pain as a chronic pain, not as a complication as a result on the operation.

However, it is possible to treat chronic pain to improve the patients’ quality of life, isn’t it?
Yes, it is. But more than a half of chronic pain patients suffer from the condition for two years or more before they receive adequate treatment. One third of patients get no treatment at all, and around 38% say that the treatment received was not sufficient. All of this is a result of inadequate treatment of pain, at last. Despite major advances in chronic pain therapies, far too many patients do not benefit from the opportunities opened up by modern pain medicine.

Maybe, another problem is how to measure pain. It seems very difficult because the same pain is different in each person, isn’t it?
Yes, it is. That is a double good point. You can’t see the pain. I mean, you can’t see an image of pain. So that is a big obstacle, because many physicians think: ‘What I can not see, what I can not measure, that doesn’t exist’. And this is a big problem. However, the well educated and expert pain physicians could know what kind of patients are suffering from chronic pain or other kind of pain. There is a second problem that’s that perception of pain changes in each patient; in one patient the pain is insufferable and, the same pain with the same intensity, in another one is supportable. So, the training of physicians for recognising the pain and his intensity its essential; we have questionnaires, we have instruments, we have specifically test, there are a lot of things for well recognition of chronic pain.

Nowadays, in some countries, like Spain, the economic crisis has a direct impact on health services. I imagine that’s an important point that spoils the fight about aware society of chronic pain….
With health and social services under pressure due to cost-cutting measures it is more important to draw attention to the economic impact of chronic pain. We need investments in pain research, in education and training in this field, and most of all in specialised facilities for chronic pain prevention, treatment and rehabilitation. Less chronic pain, less suffering, greater productivity. We can achieve it, but doesn’t come free.

Then, it’s very important to tell about chronic pain around the world…
Absolutely. Pain is the major healthcare problem in Europe. Although acute pain may reasonably be considered a symptom of disease or injury, chronic pain is a specific healthcare problem, a disease in its own right. For this reason, we have to tell to the media that chronic pain is an important topic we should think about and we should change something; we must approach the politicians, because they decided were money have to be invested.

This is maybe the most difficult thing. In some countries, like Spain, nowadays the difficult economic situation spoils the investment in good treatments.
Yes, that’s true. However, Spanish Pain Society approaches the concern to politicians to convince them about the importance of it.
In Spain (most particulary in Galicia, Andalusia or Catalonia) these kinds of projects are very successful. We need many many of small steps to have big steps and finally improve this situation.

Then, where is exactly Spain in the ranking of good treatments of pain?
I think Spain is in the middle. You aren’t in the top, because you have also very much to improve. It could be still better, yes. However, Spain is not one of there countries that we have many worries about. I said this because there are some countries where the patient has no opportunity of treatment or prescriptions. I think Spain is in the good way.



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