Workshop 1: Chronic diseases: Chronic Pain as a disease in its own right

Stefano Coaccioli Sean McDougall

ObjectivesObjectives

• The European Commission intends to support The European Commission intends to support member states in a reflection process on member states in a reflection process on chronic diseases to optimise the responsechronic diseases to optimise the response

• So the objectives of the workshop were to:So the objectives of the workshop were to:• Investigate the position of pain in relation to Investigate the position of pain in relation to

chronic diseaseschronic diseases

• Identify risk factors for a large number of Identify risk factors for a large number of chronic diseases which have pain as a chronic diseases which have pain as a concomitant diseaseconcomitant disease

Is chronic pain really a disease?Is chronic pain really a disease?

• ““It can’t be treated just as an It can’t be treated just as an unfortunate by-product of unfortunate by-product of some other condition; it is a some other condition; it is a disease like any other”disease like any other”

• ““If we use the term ‘disease’ If we use the term ‘disease’ then we make pain a ‘doctors-then we make pain a ‘doctors-only’ issue – can’t architects only’ issue – can’t architects and technology firms play and technology firms play their part too?”their part too?”

What one thing would you like toWhat one thing would you like tosee coming out of the workshop?see coming out of the workshop?

• ““Education – if only we could Education – if only we could persuade healthcare persuade healthcare professionals to consider the professionals to consider the wider aspects of pain”wider aspects of pain”

• ““Governments won’t act Governments won’t act until they see that chronic until they see that chronic pain is a trillion dollar pain is a trillion dollar economic opportunity that economic opportunity that will also improve total quality will also improve total quality of life for citizens”of life for citizens”

Chresten Mandal, plastic surgeon and pain specialist

from: Pain as a Disease …

… of silence… of silence

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towards: Pain as a Disease in its own right

Pain

DepressionDepression

PhysiopathologyPhysiopathology

Economic BurdenEconomic Burden

Therapeutic OptionsTherapeutic Options

QoL / ADLQoL / ADLSocial deprivationSocial deprivation

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Main clinical topicsMain clinical topics

• pain in relation of chronic diseasespain in relation of chronic diseases• ICD_11ICD_11• pain as the 5th vital signpain as the 5th vital sign

Chronic Pain is a Chronic Disease Chronic Pain is a Chronic Disease with a definite nosographywith a definite nosography

• Chronic Pain is one of the major reason for seeking Chronic Pain is one of the major reason for seeking medical help, for early retirement, for discontinuation medical help, for early retirement, for discontinuation of labourof labour

• Chronic Pain directly affects sufferers (as well as their Chronic Pain directly affects sufferers (as well as their caregivers) towards a reduction of quality of life and caregivers) towards a reduction of quality of life and worsening of activities of daily life – especially in the worsening of activities of daily life – especially in the elderlyelderly

• Chronic Pain represents a huge economic burden Chronic Pain represents a huge economic burden worldwideworldwide

• Chronic Pain requires a strict cooperation between Chronic Pain requires a strict cooperation between physicians, researchers, authorities, stakeholders, physicians, researchers, authorities, stakeholders, companiescompanies

Classification as a disease with its Classification as a disease with its own nosographic relevanceown nosographic relevance

• The previous ICD does not distinguish acute from The previous ICD does not distinguish acute from chronic pain: so that pain has been considered simply chronic pain: so that pain has been considered simply as a symptom of other disordersas a symptom of other disorders

• If acute pain is really a symptom, chronic pain is a If acute pain is really a symptom, chronic pain is a disease, and it must be considered as a chronic disease, and it must be considered as a chronic diseasedisease

• The development of ICD_11 should be site chronic The development of ICD_11 should be site chronic pain in a specific as well as dedicated position pain in a specific as well as dedicated position

Evaluate pain, and report it in the Evaluate pain, and report it in the clinical schedulesclinical schedules

• There is wide evidence that only a careful, continuous, There is wide evidence that only a careful, continuous, and strict evaluation of pain is able to put a light over and strict evaluation of pain is able to put a light over one of the most important sign of lifeone of the most important sign of life

• Only the measuring of pain can realize a skillful and Only the measuring of pain can realize a skillful and careful observation of a patients with chronic pain: this careful observation of a patients with chronic pain: this may transform the medical/nursing work from “cure” to may transform the medical/nursing work from “cure” to “taking care” of the sufferers“taking care” of the sufferers

• The measuring of pain is an ethics must for both The measuring of pain is an ethics must for both physicians and nursesphysicians and nurses

The patient’s perspectiveThe patient’s perspective

• For patients, pain is the first vital For patients, pain is the first vital sign – not the fifthsign – not the fifth

• Treating pain as a stand-alone issue Treating pain as a stand-alone issue can lead to stigmatism and over-can lead to stigmatism and over-exaggerationexaggeration

• Yet ignoring it condemns people to Yet ignoring it condemns people to divorce, depression, loneliness and divorce, depression, loneliness and loss of incomeloss of income

• Ultimately, the road-map offers Ultimately, the road-map offers people a chance of dignitypeople a chance of dignity

If you can’t count it, it doesn’t If you can’t count it, it doesn’t countcount

• It’s hard to sell chronic pain as an It’s hard to sell chronic pain as an issue because it is fragmented and issue because it is fragmented and hard to quantifyhard to quantify

• Pain management projects are often Pain management projects are often criticised because the participants criticised because the participants are chosen based on willingness to are chosen based on willingness to deliver the desired outcomedeliver the desired outcome

• Insurance policies seldom cover non-Insurance policies seldom cover non-specific chronic pain specific chronic pain

Pain is a social issuePain is a social issue