CARNETS D'UN VETERINAIRE DU CHEVAL CARNET 3 : MALADIE NAVICULAIRE DEFONSECA M DMV La maladie naviculaire est une arthrose dégénérative fréquente affectant l'os naviculaire et les structures s'y rapportant. La médecine évolue, les traitements aussi. Le vétérinaire traitant est responsable des traitements qu'il entreprend et ni l'auteur, ni son éditeur ne peut être tenu responsable d'accidents ou de dommages causés à des animaux suite à la lecture de cette publication.
Pain In Europe – A Report
Key European Findings
Findings – The shocking truth
A widespread problem
Who is suffering?
Where does it hurt?
Quality of life
How people rate treatments
Pain In Europe – A Report
Dr Tim Hunt
Emeritus Consultant Palliative Medicine, Cambridge University
EU Advisor on Palliative Medicine
Immense knowledge has been acquired since the 17th Century when the Dutch philosopherBaruch Spinoza considered pain to be evil. Philosophers continued to expound countlesstheories on the cause and purpose of pain, but these efforts were eventually superceded by thework of anatomists and physiologists such as Marshall Hall, Wilhem Erb and Carl Westphal, whodemonstrated the physiological structure of the nervous system. This knowledge was added toin the early 20th Century by Johannes Muller's work on stimulating nervous pathways andprogressed even further by Lord Adrian's studies on electrical conduction along nerve fibres.
Additionally, in the 1960's Patrick Wall and Ronald Melzack changed our thinking with their'gate' or 'pain receptors' theory. Man though could not wait for scholarship to relieve pain. Over time a great number of strangetherapies have been applied in the name of pain relief; hemlock and a mixture of yeast, juniperand beer, to name a but a few. Perhaps most insightful, though, was the use of the opium poppy to relieve pain – this practice has been recorded since the earliest time of writing, about5000 years ago. Later on, additional records from the mid-18th Century outline the interest inchemical extraction from the willow as an analgesic. This extract was called salicylic acid – whichin its better known guise, aspirin, is a familiar pain remedy reached for by millions. In the early 1950's John Bonica published one of the first texts on pain treatment techniques,resulting in a surge of interest in cancer pain with the first significant meeting on this subjectbeing held in 1977. Cancer provided the thrust and cancer pain dominated our interest in pain ingeneral. The number of cancer pain articles in the principal medical journals has increased byten fold in the last thirty years, compared with a meagre one to two-fold increase in the numberof articles on non-cancer pain. In contrast, our interest and knowledge on non-cancer painpathologies – joint and skeletal problems, neuropathic pain states, phantom limb syndrome andsickle cell – together with the particular problems of pain in the elderly, present a relative desertof knowledge. This is a real issue when you consider that these non-malignant conditions effectmany more than the number experiencing pain from malignancy. We have all experienced the sensation of pain, and most of us have known someone who hasbeen, or is still, in pain. Yet despite medical advances we know little as to how many peopleacross Europe are suffering from long term pain. Why do we need this information? For several decades national statistics in Europe haveprovided information on the incidence of many diseases such as cancer and diabetes, but wehave almost no information on the incidence of pain. This is because pain is frequently asymptom or legacy of a disease or illness, but pain itself is generally not recorded in nationalstatistics. With an industrial injury, pain is frequently what prevents return to work, but it is theindustrial injury that enters the statistics and not the pain. The Pain in Europe survey opens a new chapter in our understanding of pain. This pan-European study embraced over 46,000 people across 16 countries. Essentially the study was to consider the prevalence of chronic, non-malignant pain - but with a special effort being made to understand how pain impairs the lives of those who live with it and how they viewedthe help they were receiving. Pain In Europe – A Report
The incidence of significant pain does not only effect one person – the patient – but often thefamily. Pain is a symptom that may assume enormous ramifications when we consider itsdemands on health and supportive care structures, employers and the economy. Despite this,there is a clear poverty in our knowledge of chronic and non-malignant pain, because of aprevious feeble interest and almost a blindness in our understanding of this distressing andcostly problem. The Pain in Europe survey does much to try and fill this void and presents very considerable new information. And, as with any good study it stimulates many questions – it will promptfurther work on many of the points it has raised. It provides empirical information on much thatwas previously unknown; in part it confirms general clinical experience but elsewhere questionsconventional clinical thinking. It suggests where the medical profession could enhance theircontribution and where patients may benefit from appropriate increased knowledge. No study in a subject as nebulous as pain can be considered definitive, but this study is a truly auspiciousmilestone in an important subject that embraces all of us.
Pain In Europe – A Report
With over 46,000 people interviewed, Pain in Europe represents the largest and most in-depthlong term (chronic) pain survey ever conducted in Europe. The survey aims to reveal for the firsttime the real impact of chronic pain, and illuminate a pathway for the future management ofchronic pain for millions of sufferers. A thorough investigation into chronic pain across 16 countries, Pain in Europe investigates theissue of pain…nearly one in five Europeans suffering…individuals living with chronic pain for anaverage of seven years…one in six chronic pain sufferers feel the pain is sometimes so bad theywanted to die. Pain in Europe gives a glimpse into the isolated world of chronic pain sufferers. A place wherepain devastates everyday activities, leaving individuals depressed, unable to function properly indaily life, and frequently held back in their work. Worryingly, given the terrible toll exacted by chronic pain, one in four patients feel their doctordoesn't know how to control their pain, and across Europe the management of chronic pain isperceived as inadequate. Over two thirds of sufferers believe their medication is not sufficient tocontrol their pain at times, and three quarters of pain patients have to raise the topic of painsymptoms in the consultation, rather than being proactively assessed by their doctor.
Ultimately then, Pain in Europe is a map of chronic pain, a source of suffering for many peopleacross Europe, seriously impacting on their quality of life. Chronic pain does not appear to begiven the priority it should and specialist pain services in particular are not being accessed.
Patients feel cut off from information about new methods of managing their pain more effectively.
True partnership between doctors and chronic pain patients is the only way to improve this lackof information and under treatment of pain. Sufferers need to consider what questions they needto ask, and physicians should recognise, as declared by EFIC, that pain is a disease in its ownright and should be treated with the same urgency as the condition that causes it.
NFO WorldGroup carried out the survey which was sponsored by Mundipharma InternationalLtd., Cambridge, England.
Pain In Europe – A Report
Key European Findings
A Widespread Problem
Chronic pain is a devastating and widespread problem in Europe: • Chronic pain strikes one in five (19%) adults across Europe - Prevalence is highest in Norway, Poland and Italy, where over one-fourth of adults report suffering from chronic pain - Prevalence is lowest in Spain, even so more than one in ten (11%) suffers from chronic • Over one third of European households have at least one pain sufferer (chronic or otherwise) Real Pain
• Two-thirds of chronic pain sufferers experience moderate pain, while one-third experience severe pain (as rated on a 1–10 scale) • The most common source of pain reported by chronic pain sufferers is the back (24%), and the most common cause is arthritis/osteoarthritis (35%) A long term problem
• People with chronic pain have been suffering on average for 7 years, some for 20 years or • One third of patients suffer chronic pain at all times – 24 hours a day, 365 days a year• Time taken to achieve adequate pain control in over 50% of sufferers can take more than • A third of sufferers were so weighed down with pain that they felt they could not "tolerate Quality of life impacted
Untreated chronic pain can leave sufferers' lives in ruins – impacting on their work and familiesand often causing depression: • One in five chronic pain sufferers have lost a job as a result of their pain.
• Those employed were forced to take more than 15 days off work every year because of pain (estimate based on 6 month data) • One in five chronic pain sufferers have been diagnosed with depression as a result of their pain - Spain has the highest rate of depression (29%) as a result of pain, followed by Norway (28%). The lowest rate is in Denmark.
- Up to a half of chronic pain sufferers report feelings of helplessness, or inability to think or function normally Pain In Europe – A Report
• Over 40% of chronic pain sufferers say their pain impacts on everyday activities, from lifting and carrying to taking exercise and sleeping • Nearly one in six chronic pain sufferers feel their pain is sometimes so bad they want to die• The problem of social isolation seems most acute in France where the greatest number of sufferers (39%) felt unable to discuss their pain with other people Satisfaction with doctors
• Nearly two-thirds said they felt "very or extremely satisfied" with the doctor who treats their pain. Satisfaction was highest in Belgium (78%) and lowest in Poland, where only 20% ofpeople were "extremely" or "very satisfied" • Seventy percent are treated by their primary care doctor• The median length of time with their current doctor was 4.5 years Doctors not "proactive" enough
Despite patients reporting high satisfaction with doctors, more detailed questioning revealed: • Only 23% have ever been seen by a specific pain management specialist and only one in ten have been evaluated using pain scales • One third of patients believe their doctor doesn't know how to control their pain• Over one-quarter claim their doctor only rarely evaluates their pain symptoms Treatment of Pain
Chronic pain sufferers report that there is considerable room for improvement in theeffectiveness of pain treatments.
• Almost two-thirds of chronic pain sufferers report that their pain control is inadequate at times• Over two fifths have switched to more powerful medications• Over two-thirds are prepared to try out new medications• On average NSAIDs are by far the most frequently used non-prescription pain medication (55%), together with paracetamol (43%) and weak opioids (13%) • Strong opiods (the strongest of all painkillers) are hardly used at all in Italy and Spain, whereas in Ireland, UK and Denmark they are used more frequently • Finland made the greatest use of alternative treatments with 91% of chronic pain sufferers using one or more treatment, while Spain had the lowest with just 56% making use of suchtreatments Poorly informed patients
Nearly a third of patients claim they haven't been informed about new methods to bettermanage their pain. The survey revealed two possible explanations: • 65% of patients only see one to two doctors, with 70% of these doctors being GPs who are generalists who haven't specialised in pain management • 72% of patients receive their information about pain treatments from TV, magazines and newspapers, compared to only 5% who actively sought it out from the internet Pain In Europe – A Report It is thought that chronic pain is a widespread problem, but its prevalence in the European adultgeneral population has not been previously investigated. Little is also known about individual'sperceptions of their pain and its treatment. The Pain in Europe survey is the most in-depth andlargest ever survey of chronic pain sufferers in Europe, designed to explore these issues. Specifically it aimed to: • estimate the prevalence of chronic pain conditions across Europe;• understand and quantify the sources and causes of chronic pain;• explore the demographics of sufferers;• explore the impact of pain on sufferers' quality of life (QoL) and activities of daily living;• understand current treatment practices, levels of satisfaction with and barriers to appropriate • explore the attitudes of sufferers toward and experiences with pain, as well as those of their families, friends, co-workers and healthcare providers (through the eyes of the sufferers).
NFO WorldGroup carried out the survey which was sponsored by Mundipharma InternationalLtd., Cambridge, England.
Pain In Europe – A Report With over 46,000 people interviewed, Pain in Europe represents the largest and most in-depthlong term (chronic) pain survey ever conducted in Europe. Using Computer Assisted Telephone Interview (CATI), screening interviews were conductedamongst approximately 3,000 respondents in each country, totalling 46,394 across Europe toget the baseline prevalence data.
The attitudinal analysis of chronic pain sufferers was based on a sample of 4,839 chronic painsufferers across Europe who satisfied the criteria outlined in the methodology. This section ofthe survey was capped to include approximately 300 chronic pain sufferers in each country.
The country-level data is weighted based on gender and age, and bias due to telephonebehaviour, to be fully representative of the population surveyed.
Using a short questionnaire, screening interviews were conducted amongst approximately 3,000adult men and women in each country. The screening questionnaire served two purposes: • to determine the prevalence of chronic pain by country and across Europe; and• to identify at least 300 chronic pain sufferers per country to participate in a more detailed questionnaire to learn more about chronic pain sufferers and their experiences/attitudes withtheir pain Pain In Europe – A Report The working definition of a chronic pain sufferer was defined as: • adult (18 years old or older)• has suffered from pain due to illness or medical condition for at least six months• has experienced pain within the past month• has experienced pain at least several times a week• rates intensity of pain as 5 or higher on a 1-10 scale where 1 = "No pain at all" and 10 = "The worst pain imaginable" Attitudes to Pain As part of the research the attitudes of pain sufferers were examined by evaluating their level ofagreement with various "attitude, interest, and opinion (AIO)" statements. The AIO statementsincluded topics such as: • life in general as a result of pain• attitudes toward pain medication• attitudes toward doctors; and• perceptions of themselves and others as a result of the pain they experienced The broad representation of European countries yielded a sample that is representative of theattitudes of pain sufferers across Europe.
The interviews were carried out between October 2002 – June 2003.
Pain In Europe – A Report Findings – The shocking truth
A widespread problem
When considering only moderate to severe chronic pain, the overall prevalence across Europe is just under one-fifth, with the highest prevalence in Norway, Poland and Italy, thelowest in Spain.
Prevalence of Chronic Pain by Country – European Summary Based onComplete Screener Data Belgium (n=2,45 Austria (n=2,00 Finland (n=2,00 S Netherlands (n=3,19 land (n=3,812) aly (n=3,8 Overall Prevalence Germany (n=3,832)Israel (n=2,24 Denmark (n=2,16 Sw Ireland (n=2,722) UK itzerland (n=2,0 ance (n=3,8 • Just under one in five adults in Europe (19%) suffers from chronic pain.
• Just over one third of European households interviewed in the first questionnaire were found to have at least one member aged 18 or over who suffers from pain (chronic or otherwise).
• Over 19% of households who reported having pain sufferers contain more than one sufferer.
• When asked about their most recent pain experience 67% or respondents said they had "moderate pain" (rated as levels of 5, 6, and 7 on a pain scale) and 33% severe pain (rated aslevels of 8,9,10 on a pain scale).
Pain In Europe – A Report Comparison highlightsThe prevalence of chronic pain in the population was highest in Norway (30%) andlowest in Spain (11%).
• Norway, Poland and Italy have the highest proportion of moderate and severe chronic pain sufferers relative to total country populations.
• Highest country prevalence for moderate sufferers: Norway, Poland and Austria• Highest country prevalence for severe sufferers: Italy, Israel and Norway Who is suffering?
A typical chronic pain sufferer would be a middle aged, married woman who has no children stillliving at home.
• Across Europe the average age of pain sufferers is 50 years of age.
• In most European countries slightly more women than men suffer pain - 56% of chronic pain sufferers are female and 44% male. • Pain sufferers are most likely to live with other people (79%), be married (59%) and have no children living in the household (71%).
• Gender and age are consistent between moderate and severe pain sufferers, as is the likelihood of children being present in the household.
• It appears that severe pain sufferers may be somewhat more likely than moderate sufferers to be divorced or separated.
Where does it hurt?
The back represents by far the most common location for pain, with unspecified back paineffecting nearly a quarter of all respondents, lower back pain 18% and upper back pain 5%.
Other significant body areas afflicted with pain were: knees, legs, heads, joints, shoulders,necks, hips, upper back and hands.
The most frequent cause of chronic pain was arthritis/osteoarthritis, which effected over onethird of respondents, followed by herniated or deteriorating discs and traumatic injury. Lesscommon causes were rheumatoid arthritis, migraine headaches, fracture/deterioration of thespine, nerve damage, cartilage damage, whiplash and surgery.
Locations and causes of pain Back (unspecified) deteriorating discs Rheumatoid arthritis Joints (unspecified) Migraine headaches Pain In Europe – A Report Nearly equal numbers of people described their pain as "constant", as opposed to "intermittent"(46% versus 54%). When asked to describe their pain, the most frequently used adjective by over a quarterquestioned was "aching". Other common adjectives were "annoying", "intense" and "constant"The least common descriptions were "dull", "tingling" and "nauseating". This only highlights thedifficulty patients have in communicating their pain to their physicians and their families.
To be categorised as a chronic pain sufferer, people needed to have experienced pain within thelast month. Amongst sufferers: - Two thirds (65%) had experienced pain on the day of the questionnaire- 28% in the past week - 7% within the past month Overall one third (35%) reported experiencing pain every minute of their lives "at all times", asopposed to 31% who experienced it daily and 34% who experienced it several times a week. Using the 10 point pain scale abut two thirds of respondents rated their pain as "moderate" (ascore of 5-7) as opposed to "severe" (a score of 8-10).
The median time people reported having suffered chronic pain was 7 years. When subdividedsevere pain sufferers were found to have experienced pain for one third longer than moderatepain sufferers. Overall one fifth of respondents said they had been in pain for 20 years or more.
On average sufferers report having experienced pain for the past 7 years. Pain In Europe – A Report Duration of Pain Reported by Chronic Pain Sufferers – European Summary(n=4,839) Despite such suffering chronic pain patients in Europe appear a uncomplaining group withnearly a half saying that they felt that they could "tolerate" at least, a little more pain but some31% said their pain was so severe they could not "tolerate any more".
Comparison highlights• The Finnish had suffered from chronic pain longer than any other country group – a median time of 9.6 years. • A higher proportion of severe pain sufferers report suffering from pain "today," whereas a higher proportion of moderate pain sufferers report suffering from pain"within the past week." • More people in Netherlands (62%) reported suffering constant pain than any other country, followed by Spain (61%) and Denmark (55%). Poland had the smallestproportion of people complaining of constant pain.
Quality of life
Suffering chronic pain has an undoubted impact on people's daily lives, effecting their ability toundertake a wide variety of physical tasks.
People report that chronic pain effects their ability to undertake certain activities, having animpact on their independence and interpersonal relationships. One quarter of people felt thatthey couldn't take as much care of themselves or others as they would have liked.
• 27% said that they were less able or unable to maintain relationships with friends and family• 30% are less able to maintain an independent lifestyle• 19% are no longer able to have sexual relations Pain undoubtedly effects people's employment; however, 44% of respondents were stillmanaging to work full or part time despite their pain. Taking into account those who have retiredthis still left however a group of sufferers (22%) who are unemployed, which is still significantlyhigher than the background European unemployment rate.
• 26% reported that suffering chronic pain had impacted on their jobs• 19% said that they had lost a job due to their pain Pain In Europe – A Report • 16% had changed job responsibilities• Overall, the mean time lost by chronic pain sufferers from work in the last six months was Suffering from chronic pain has an undoubted impact on people's emotional health: • 50% report feeling tired all the time• 43% said feeling in pain made them feel helpless• 44% said that their pain kept them from thinking or concentrating clearly• One in five (21%) chronic pain sufferers had been diagnosed with depression as a result of • A staggering 16% said that some days the pain was so bad they wanted to die One third of people felt their chronic pain had effected relationships with family, friends andwork colleagues. Many had negative feelings surrounding pain that had created social isolation.
• 29% said no one believed how much pain they were in• 28% said that they felt alone with their pain• 23% felt their employers and colleagues were unsympathetic• 18% that their families didn't understand how pain effected their lives• 17% that they were treated differently because of their pain Most people appear to have fairly positive relationships with doctors, but a sizeable proportion(43%) felt their doctors to be more focused on their illness than controlling their pain. A smallproportion were sceptical about their doctor's ability or even their commitment to treating pain.
• 28% said that they didn't think their doctor knew how to control their pain• 23% didn't think they were given enough time to discuss their pain• 22% said that their doctor never asked about their pain Nearly two thirds of chronic pain sufferers were willing to try new treatments, but the sameproportion expressed concerns over side effects, and over one third were afraid of becomingaddicted to pain medications. The majority said that they'd prefer to use medications thatresolved their illness rather than treat their pain.
Comparison highlights• Chronic pain appeared to have the most adverse impact on job retention in the Denmark and the Netherlands, where 29% of people questioned said they'd lost theirjobs due to pain. • Swedish and Norwegian employers offered greatest flexibility, with nearly one third of people being allowed to change job responsibilities to accommodate their pain. • The problem of social isolation seems most acute in Denmark where the greatest number of sufferers (50%) felt unable to discuss their pain with other people.
Overall the survey paints an interesting picture of good doctor/patient relationships with 62% ofpeople saying they felt "very or extremely" satisfied with the doctor treating their pain and anoverwhelming 94% feeling comfortable discussing pain with their doctor. More people discussedpain with doctors than with their partners, other family members or friends and co workers.
Pain In Europe – A Report Consultations were most frequently with general and family practitioners (70%). Otherspecialities most commonly involved were: • Orthopaedist / orthopaedic surgeons –27%.
• Neurologists/neurosurgeons -10%.
• Rheumatologists - 9%.
Worryingly, only 23% of people had been referred to pain management specialists. The surveyhighlighted a disturbing under use of pain scales. Nearly two thirds of people said that theirdoctors evaluated their pain at every visit, but this was most commonly through discussion orphysical evaluation. 90% said they'd never been evaluated with a pain scale.
In the overall survey, of the 10% of respondents who were "not very satisfied" or "not at allsatisfied" with their doctors, the most common reasons given were that treatments hadn'thelped relieve their pain or that the doctor wasn't showing enough interest or understanding.
Chronic pain sufferers visit doctors fairly frequently, with over half reporting having gone threetimes in the past six months. They also establish long term relationships with the same doctors,with 75% of respondents having seen no more than two doctors for their pain and the medianlength of time with their current doctor being 4.5 years.
Comparison highlights• Satisfaction with doctors was highest in Germany and lowest in Poland and Israel, where only 20% and 39% of people were "extremely or very satisfied" respectively In the survey 69% of people reported treating their chronic pain – whether by prescriptionmedications, over the counter drugs or alternative treatments. Of the different types of treatment,prescription medications represented by far the most popular choice, with 78% saying they'dtried prescriptions at some time and 52% reporting they currently used them.
People who avoided drugs completely felt they could live with the pain, that the pain wasn't badenough to warrant medication or had been put off by concerns over side effects. Of the 26%who'd decided against currently taking prescription medications the most common reasonsgiven were: - Lack of need 64%.
- Lack of effectiveness 9%.
- Concerns over side effects 14%.
The most commonly used prescriptions were: - NSAIDs (44%).
- Weak opioids (23%).
- Paracetamol (18%).
Pain In Europe – A Report Source: Q18. Which prescription pain medicines are you currently taking for the specific pain wehave been discussing? Less commonly used prescriptions were COX-2 inhibitors, barbiturates, ergotamine,tricyclic/SSRI/SNRI, triptan, DMARD/steroid, anti-epileptics, muscle relaxants and beta/CCblockers.
Switching prescriptions was relatively common, with 44% of sufferers changing theirmedications, and the most frequent reason given being the need for stronger medication. Butpain sufferers appear relatively conservative, with two thirds of those questioned only everhaving taken one or two different types of prescription pain medications.
Pain In Europe – A Report Non prescription medication use was perhaps lower than might have been expected, currentlywith over half of respondents (53%) reporting having used no non prescription medications inthe past six months. Of those who used over the counter pain medications, the most popular class of drugs wereNSAIDs, (55%), followed by paracetamol (43%) and weak opioids (13%).
Taking both prescription and non prescription medications together, the majority (61%) reporttaking one pill a day, while one in five take at least four pills a day.
Alternative treatments are often attempted, with two thirds of sufferers reporting using at leastone non drug treatment for their pain – the most popular being massage, physical therapy andacupuncture.
Comparison highlights• The highest use of NSAIDs was in Poland (71%); and the highest use of opioids in the UK, where 50% of the chronic pain population use weak opioids and 12% use strongopioids.
How people rate treatments
40% of people have not achieved adequate pain control and for those that have it has been along road to reach this state. Of the people who reported their pain is under control, 61% tookmore than a year to achieve this and for one-fifth it took a staggering 20 years or longer.
Generally, prescription medications were perceived as more effective than either nonprescription medications or non drug treatments. 45% found them "completely or very effective"versus 31% for non prescription medications and 38% for non drug treatments.
Many chronic pain sufferers report that their pain "sometimes breaks through"– 79% say theyexperience pain from activity and 64% of those currently taking prescription medications reportthat their pain is inadequately controlled at times. The highest levels of inadequate control werefound in the UK and France. Such responses suggest there's still considerable room forimproving the effectiveness of chronic pain treatments.
Comparison highlights• The highest numbers of people reporting adequate pain control are found in Finland (73%), followed by Ireland (71%) and Germany (71%). On average it took longest forpeople to get their pain under control in Spain, followed by Finland and theNetherlands. Of all the countries Germans achieved pain control fastest.
• The highest level of satisfaction with prescription medications were found in Germany.
Pain In Europe – A Report Magazines and newspapers provided the most widely used source of information about paintreatments.
• Overall 39% of people derived their information from magazines and newspapers• 33% got it from television• 24% from their doctor's surgery• 14% from family, friends and work colleagues• 5% from the internet• 4% from pharmacies Such findings suggest that pain sufferers are most likely to be passive recipients of informationwho come across articles by chance when reading magazines and newspapers or watchingtelevision, rather than actively going and seeking it out using the internet. Such approaches toinformation go some way to explain why one third of sufferers feel they're poorly informed aboutnew methods of managing pain.
Pain In Europe – A Report Long term pain is a widespread problem in Europe with the survey revealing that one in fiveadults suffers from chronic pain and one in three households have at least one member whoexperiences pain. One-third of the individuals with chronic pain are suffering severe pain on aregular basis. Most have suffered with pain for at least two years and one-fifth have been in painfor 20 years or more. The study shows that despite most respondents claiming to be copingwith normal activities and reporting levels of satisfaction with the medical profession, many aren'tgetting their pain under adequate control.
Chronic pain is leaving sufferers' lives in ruins - being less able to undertake daily activities suchas lifting, exercising, sleeping and working outside the home. Over a quarter feel their ability tomaintain independence or family relationships is impaired. This lowers self esteem and has clearimplications for their careers and creates a negative impact on healthcare resources: • Unemployment in this group is more than double the background rate• One in five chronic pain sufferers have lost a job as a result of their pain• Those in jobs report losing an average of 7.8 working days due to pain in the last six months• Tellingly, one in five respondents had been diagnosed with depression as a direct result of The use of prescription medication is high among moderate to severe pain sufferers, with thevast majority (78%) having tried prescription medications and 52% continuing to take them.
Over the counter medications are less popular, with only 47% of respondents reporting usingthem in the last six months. Of all classes of pain medication NSAIDs are the most popular, bothin prescription and non-prescription categories.
But people don't appear to be getting the best possible care as evidenced by the time taken toachieve pain relief/control (which in half of cases took more than two years) and the fact that79% still report experiencing pain from activity and two-thirds report their medication isinadequate at times.
Although two thirds of people say they're willing to try out new pain treatments, concern withside effects often stops them from actually doing so. Most would rather take treatments thataddress the underlying medical cause of the problem than treating their pain. People arecautious about taking new treatments and the possibility of adverse effects, forgetting thatcommonly used drugs, such as NSAIDS, also have well documented side effects.
Although many people are not achieving adequate pain control most are satisfied with theirdoctors. An overwhelming 94% felt comfortable talking to their doctor about their pain and 62% were "extremely or very satisfied" with their doctor. But there's evidence that doctors are not always sufficiently "proactive" with people sufferingpain.
• 71% of respondents said it was left up to them to raise the issue in consultations• One fifth report that their doctors only rarely evaluated pain symptoms• Nearly a quarter didn't feel they were given adequate time for discussing pain Pain In Europe – A Report While the majority of chronic pain sufferers report their doctor evaluates their pain at every visit, few doctors make use of pain scales. Pain scales provide a recognised and validated method for tracking changes in pain intensity and the effectiveness of treatments. Also, only 23% of pain patients are being referred to specialist pain clinics that have the greatest expertise in controlling pain. Over two thirds of patients have only seen one or two doctors for their pain, with 70% ofdoctors seen being general or family physicians who receive very little pain managementtraining. This has probably led to caution about the use of effective therapies that lie outside ofthe traditionally range of therapies that are employed, as seen through this study. Indeed, in aUK study of over 3000 doctors, 15% did not recall receiving any education on pain control, andthe situation across Europe is not much better. There appears to be a clear need for more formaltraining in the area of pain management and for ongoing education.
When it comes to being informed about new treatments, pain patients are most likely to be thepassive recipients of information rather than actively going to seek it out. Such attitudes areevidenced by newspapers and magazines being the most frequent ways people get informed,as opposed to using the internet. This may explain why one third of sufferers are poorlyinformed about new methods of managing pain. The survey revealed that many people suffering from chronic pain have a uncomplaining attitudewith a high tolerance to the under treatment of their pain and acceptance of the status quo.
There's an urgent need to establish a true partnership between physicians and patients basedon mutual understanding and information.
EFIC have declared that pain is a major healthcare problem in Europe. The EFIC ‘Europe AgainstPain' initiative states that chronic pain isn't just a symptom – it should be regarded as a diseasein its own right and should be treated with the same sense of urgency as the condition thatcauses it. Not enough is being done to evaluate, assess and monitor long-term pain. There is aneed for more and better education and a need for pain services to be provided in line with thehigh prevalence of chronic pain amongst the European population. The only effective way ofbeating chronic pain is for all parties; patients, doctors and policy makers to work together andmake it the priority it should be.
For further information, please contact:
Rob Cohen Email: [email protected] Tel: +44 (0) 1223 424444 Mob: +44 (0) 7734 159122 Nick Francis Email: [email protected] Tel: +44 (0) 20 7465 7776 Mob: +44 (0) 07789 650 306 Or visit www.painineurope.com Pain In Europe – A Report Barbiturate A sedative drug.
COX-2 inhibitors Newest class of NSAIDS, work by blocking COX-2 enzyme which is involved in the inflammationpathway.
DMARD Disease-modifying anti-rheumatic drugs.
Ergotamine A vasoconstrictor that is used early in the migraine attack.
NSAIDS Non Steroidal Anti Inflammatory Drugs.
SSRISelective Serotonin Reuptake Inhibitor.
SNRI Selective Serotonin Norepinephrine Reuptake Inhibitor.
Triptan Class of drug used to migraine attacks.
TricyclicsClass of drug used in the treatment of depression.
The Pain in Europe report is authored by Janet Fricker, a freelance medical writer,prepared in association with Mundipharma International Limited, Cambridge, England.
Pain In Europe – A Report
ASPETTI PSICOSOCIALI DELLE CORSO DI FORMAZIONE PER LA TUTELA DELLA SALUTE NELLE ATTIVITA' SPORTIVE E LA PREVENZIONE DEL DOPING Roma "La Sapienza" Ministero della Salute Istituto Superiore di Sanità La definizione di Doping proposta dal Comitato Olimpico Internazionale (CIO) è: "la somministrazione o l'uso di sostanze