Societal Impact of Pain

The Societal Impact of Pain (SIP) platform

The Societal Impact of Pain (SIP) is an international, multi-stakeholder platform created as a joint initiative of the European Pain Federation EFIC® and Grünenthal with the aim to:

  • raise awareness of the relevance of the impact that pain has on our societies, health and economic systems
  • exchange information and sharing best-practices across all Member States of the European Union
  • develop and foster European-wide policy strategies for an improved pain management in Europe (Pain Policy).

One of the key documents developed by the SIP platform is the “SIP Road Map for Action”. This instrument outlines seven steps for policy makers and health institutions to effectively address the societal impact of pain at EU and national level (SIP Roadmap, 2011).

“A long standing advocate for the Societal Impact of Pain initiative, pain self-help management expert Peter Moore independently made this video to help spread the message of SIP and further propel it into the public consciousness. It offers a clear overview and history of SIP in just over 1 minute, providing the viewer a concise introduction to European multi-stakeholder platform that has been in development for over 7 years.“

The Societal Impact of Pain (SIP) in 2017

The scientific framework of the “Societal Impact of Pain” (SIP) platform is under the responsibility of the European Pain Federation, EFIC®. Cooperation partners for SIP 2017 are Pain Alliance Europe (PAE) and Active Citizenship Network (ACN). The SIP 2017 symposium is co-hosted by the Malta Health Network and the No Pain Foundation. The pharmaceutical company Grünenthal GmbH is responsible for funding and non-financial support (e.g. logistical support).

This year’s 7th annual Societal Impact of Pain (SIP) symposium in Valletta, Malta resulted in actionable policy recommendations to change pain care in Europe for the better. Four working groups discussed and composed suggestions which were presented during the plenary session, closing the symposium

  • Establish an EU platform on the societal impact of pain
  • Develop instruments to assess the societal impact of pain
  • Initiate policies addressing the impact of pain on employment
  • Prioritize pain within education for health care professionals, patients and the general public
  •  Increase investment in research on the Societal Impact of Pain

Aside from these recommendations a highlights of SIP 2017 was the announcement from Martin Seychell, Deputy Director General in the Health and Food Safety’s Directorate. In his speech he disclosed that the European Commission has launched the EU Health Policy Platform to build bridges between policy makers and health systems, thereby following SIP’s lead. The societal impact of pain is included among other health policy areas and will have a dedicated expert group to enhance and facilitate sharing of best practices across EU member states in coordination with the Commission. As soon as the platform is fully launched representatives from across the health care system such as insurers, economists or employer organizations are to be involved.

Another particular highlight was presented by Dr. Robert Jakob, Medical Officer at the World Health Organization (WHO), who proposed a new definition of ‘chronic pain’ and outlined its implications. The WHO regularly updates its International Classification of Diseases (ICD) which is usually followed by governments when performing changes in their health systems and considering which services to fund. The ICD code is also utilized by researchers and clinicians for analysis of actual treatment practices and beyond. Including chronic pain in the updated version ICD11 would significantly improve pain care for patients worldwide.

The symposium brought together more than 300 participants representing pain advocacy groups, researchers, healthcare professionals and specialists in the field of pain as well as insurers and budget holders under the auspices of the 2017 Maltese Presidency of the Council of the EU. SIP is an international, multi-stakeholder platform created as a joint initiative of Grünenthal and the European Pain Federation EFIC®. Further partners are Pain Alliance Europe (PAE) and the Active Citizenship Network (ACN). This year the Malta Health Network and the No Pain Foundation co-hosted the symposium.

You find more information at www.SIP-Platform.eu

Background

Pain is a problem for individuals, but also has a significant impact on healthcare systems, economies and society. Acute and chronic pain cause untold damage for millions of people worldwide and tears at the very economic and social fabric of our culture. Pain is a common element of numerous chronic health conditions, such as cancer and musculoskeletal diseases, and often persists past normal healing time (Bonica, 1953) (Roberto, et al., 2016) (Majithia, et al., 2016) (IASP, 2009) (Mieritz, et al., 2016). Although acute pain may reasonably be considered a symptom of disease or injury, chronic and recurrent pain is a specific healthcare problem, leading to typical co-morbidity, such as sleep disturbances, anxiety, depression and low self-esteem among many others. Chronic pain can either co-exist with other conditions, or be the only diagnosis (Chronic primary pain). When chronic pain coexists with other conditions initially, it may frequently outlast those other conditions (e.g. cancer, rheumatoid arthritis, herpes zoster, etc.) (Treede, et al., 2015). Usually pain is regarded as chronic when it lasts or recurs for more than 3 to 6 months (Merskey & Bogduk, 1994).

The most widespread chronic pain conditions, low back pain, arthritis and recurrent headache (including migraine) are so common that they are often seen as a normal and unavoidable part of life. In addition to the erosion in quality of life and financial burdens caused, chronic pain often sets the stage for the emergence of a complex set of physical and psychosocial changes that are an integral part of the chronic pain problem, greatly adding to the individual burden.

While acute pain by definition is a brief and self-limiting process, chronic pain comes to dominate the life of the people concerned and often also family, friends and caregivers. Indeed, chronic pain is one of the most common co-morbidities of other long-term illnesses (Barnett, et al., 2012). Therefore it is of no surprise that a large proportion of physician visits are caused by pain complaints (Gureje, et al., 2001) (Mäntyselkä, et al., 2001) (Koleva, 2005). Additional to pain being a frequent complaint, people with chronic pain consult their general practitioner five times more frequently than those without chronic pain complaints (Von Korff, et al., 1990). Overall individuals reporting chronic pain have a significantly higher health care system utilisation than individuals without chronic pain complaints (Eriksen, et al., 2004).

Grünenthal advocates for an innovative approach to European pain management

Unfortunately throughout the EU, chronic pain patients report insufficient pain control and dissatisfaction with treatments (Breivik, et al., 2006). Chronic pain is often not only under-diagnosed but also under-, over- or just wrongly-treated (Dietl & Korczak, 2011). In some indications, elderly persons get less access to pain treatment than the general population as chronic pain is often overlooked by health professionals (Booker, et al., 2016) (WHO, 2015). Chronic pain is one of the most costly health issues for industrialized countries and the number one reason for health-related absence from labor and early retirement. Despite its socio-economic impact healthcare systems and policy-makers across Europe often times are challenged addressing pain in policies.

Grünenthal is convinced that the complex nature of pain calls for a holistic effort from prevention, through early diagnosis, to most effective treatment. This effort has to involve the patient from the beginning and has to embrace the multidisciplinary aspects of chronic pain management. In practice this means that policy makers, healthcare professionals, budget holders, and industry urgently need to work together in order to modernize the entire approach.

The need for innovation

Grünenthal is committed to foster innovation for the improvement of pain management in Europe. Grünenthal has increased its research and development investments and built an organizational framework that effectively drives innovation. Grünenthal invests a sustainable amount of its revenues for research and development, Grünenthal is actively involved in a number of public-private partnership initiatives and cooperates within the framework set by the Innovative Medicines Initiative (IMI) of the European Union and the European Federation of Pharmaceutical Industries and Associations (EFPIA). These projects will run for several years and aim to understand and improve treatment of pain.

References

1 Barnett, K., Mercer, S. W., Norbury, M., Watt, G., Wyke, S., & Guthrie, B. (2012, July 7). Epidemiology of multimorbidity and implications for health care, research, and medical education: a cross-sectional study. The Lancet, 380(9836), pp. 37-43.

2 Bonica, J. (1953). The management of pain. Philadelphia: Lea & Febiger.

3 Booker, S., Bartoszczyk, D., & Herr, K. (2016). Managing Pain in Frail Elders. American Nurse Today, 11(4).

4 Breivik, H., Collett, B., Ventafridda, V., Cohen, R., & Gallacher, D. (2006). Survey of chronic pain in Europe: prevalence, impact on daily life, and treatment. European Journal of Pain, 10, pp. 287–333.

5 Dietl, M., & Korczak, D. (2011, April 19). Over-, under- and misuse of pain treatment in Germany. (G. M. House, & Düsseldorf, Eds.) GMS Health Technology Assessment, 7.

6 Eriksen, J., Sjøgren, P., Ekholm, O., & Rasmussen, N. (2004, Dec). Health care utilisation among individuals reporting long-term pain: an epidemiological study based on Danish National Health Surveys. European Journal of Pain, 8(6), 517-523.

7 Gureje, O., Simon, G. E., & Von Korff, M. (2001, May). A cross-national study of the course of persistent pain in primary care. Pain, 92(1-2), pp. 195-200. IASP. (2009). Musculoskeletal Pain fact sheet.

8 IASP (International Association for the Study of Pain).

9 Koleva, D. (2005). Pain in primary care: an Italian survey. European Journal of Public Health, 15, pp. 475–479.

10 Majithia, N., Loprinzi, C., & Smith, T. (2016, Nov 15). New Practical Approaches to Chemotherapy-Induced Neuropathic Pain: Prevention, Assessment, and Treatment. Oncology (Williston Park), 30(11)(pii: 219814).

11 Mäntyselkä, P., Kumpusalo, E., Ahonen, R., Kumpusalo, A., Kauhanen, J., Viinamäki, H., et al. (2001). Pain as a reason to visit the doctor:a study in Finnish primary health care. Pain, 89, pp. 175–180.

12 Merskey, H., & Bogduk, N. (1994). Pain terms: classification of chronic pain (Second ed.). Seattle: International Association for the Study of Pain (IASP.

13 Mieritz, R. M., Forman, A., Mieritz, H. B., Hartvigsen, J., & Christensen, H. W. (2016, Nov 1). Musculoskeletal Dysfunctions in Patients With Chronic Pelvic Pain: A Preliminary Descriptive Survey. Retrieved Nov 18, 2016, from http://www.jmptonline.org/article/S0161-4754(16)30213-5/abstract

14 Roberto, A., Deandrea, S., Greco, M., Corli, O., Negri, E., Pizzuto, M., et al. (2016, June). Prevalence of Neuropathic Pain in Cancer Patients: Pooled Estimates From a Systematic Review of Published Literature and Results From a Survey Conducted in 50 Italian Palliative Care Centers. Journal of Pain and Symptom Management, 51(6), pp. 1091–1102.e4.

15 SIP Roadmap. (2011, May 4). The Societal Impact of Pain – A Road Map for Action, 1. (SIP, Editor) Retrieved July 26, 2016, from https://www.sip-platform.eu/events/sip-2011/materials.html

16 Treede, R.-D., Rief, W., Barke, A., Azizc, Q., Bennett, M. I., Benoliele, R., et al. (2015). A classification of chronic pain for ICD-11. (IASP, Ed.) Pain, 156(6), pp. 1003-1007.

17 Von Korff, M., Dworkin, S. F., & Le Resche, L. (1990). Graded chronic pain status: an epidemiologic evaluation. Pain, 40, pp. 279 – 291.

18 WHO. (2015, November). Draft global strategy and plan of action on ageing and health. (W. H. Organization, Ed.) Retrieved June 26, 2016, from http://www.who.int/ageing/ageing-global-strategy-revised-draft-for-who-eb.pdf