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Key points

  • Due to its widespread impact and high burden on quality of life, pain can be considered as one of the most important issues worldwide, yet its management is often inadequate.1,2
  • Improving patient–physician communication, balancing the pain relief that a medication may offer against its side-effect profile, and educating healthcare professionals on the urgency of referral to pain specialists are important challenges that can be addressed by physicians to reduce suffering.1
  • Addressing these unmet needs may lead to better treatment decisions and reduce patient suffering.1

Chronic pain affects approximately 20% of adults in Europe and the United States.1 The Global Burden of Disease Study 2013 highlights chronic pain as “the most important condition—globally, regionally, and in every individual country”, when considering years lived with disability.2 Despite this, there is substantial evidence that chronic pain management remains woefully inadequate, with many patients being impacted by psychological and social factors, leading to decreased quality of life and socio-economic consequences.1

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 In fact, one study showed that up to 80% of physicians may have an inaccurate picture of their patients’ pain symptoms1 and in another study, 95% of physicians agreed that patient expectations of pain management were not always consistent with their own expectations.3 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 fact, the symptoms of up to 75% of patients with acute and chronic pain may be insufficiently controlled.3 In addition, medication effects may wear off before the patient’s next dose.3 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.1,4 Alternatively, the patient may be switched to a different medication or a combined regimen to maintain efficacy.1,4

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 may be driven by a general unawareness about the appropriate management of chronic pain and of local treatment guidelines.1 For instance, studies have shown that chronic low back pain is often not managed in line with current treatment recommendations.5,6 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.7 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.

  • References

    1. Varrassi G et al. Curr Med Res Opin. 2010;26:1231–45.

    2. Rice ASC et al. Pain. 2016;157(4):791–6.

    3. McCarberg BH et al. Am J Ther. 2008;15:312–20.

    4. Kress HG. Eur J Pain Suppl. 2009;3:11–15.

    5. Ivanova JI et al. Spine J. 2011;11:622–32.

    6. Fullen BM et al. Eur J Pain. 2007;11:614–23.

    7. Häuser W. Dialogues Clin Neurosci. 2018;20:53–62.