Physician unmet needs 

Chronic pain is considered to be one of the main causes of disability,³ affecting around 20–50% of all adults in the United States.^4,5 Any chronic pain is shown to have important deleterious effects on health, employment and daily life, and the burden of chronic pain is increasing globally.^5,6

The gap in patient–physician communication

Choosing the appropriate treatment and assessing achievement of a treatment goal are dependent on clear communication between patient and physician.¹ However, data indicate that patients and physicians may have a different understanding of the degree of pain and pain relief.¹ Indeed, an analysis of patient–physician communication in chronic pain management found that only 31% of patient requests around pain medications were agreed to by the physician.⁷ A positive patient perception of physician communication has been linked with lower levels of pain intensity and interference, with a less positive perception relating to higher levels.⁸ More widespread use of standardised assessment tools, such as scales and questionnaires, may facilitate this exchange and lead to more individualised care.¹

The balancing act of pain relief and side effects

One major concern that surrounds the management of pain is balancing the pain relief provided by the medication against the occurrence of possible associated side effects.¹ If a patient’s medication does not control their pain appropriately, the dose may need to be increased. In a survey of 511 patients with chronic pain, 77% reported inadequate pain management.⁹ In addition, medication effects may wear off before the patient’s next dose.¹⁰ However, increasing the medication dose can also increase the risk of side effects to a point where tolerability can become unacceptable.¹ It is possible to manage more severe side effects with additional medications, but this can lead to drug–drug interactions or additional side effects.^1,11 Alternatively, the patient may be switched to a different medication or a combined regimen to maintain efficacy.^1,11

The importance of urgency in diagnosis and treatment

Patients with chronic pain in particular may experience considerable delays in receiving a diagnosis and receiving treatment for their condition and are often treated inadequately.¹ This situation may be driven by a general unawareness about the appropriate management of chronic pain and of local treatment guidelines.¹ For instance, in a survey of chronic pain management practices among 48 primary care practitioners, one-third responded that they do not refer to pain management guidelines for therapy.¹² In addition, treatments for conditions with diverse symptoms, such as fibromyalgia, may not be approved in certain countries, preventing physicians from treating their patients appropriately.¹³ This means that education about the adequate management of chronic pain needs to be emphasised.¹

Addressing these physician unmet needs and developing medications to reduce pain will serve to address the unmet needs faced by patients. By improving pain treatment algorithms, listening to the patient voice and sharing knowledge, it is hoped that disability and patient suffering can be reduced, quality of life improved and that the communication gap between patients and healthcare professionals can be closed.