Pain relief has now been recognised as a fundamental human right1, yet the results of many studies reveal that patients across the world still experience unacceptable levels of chronic pain2, despite a wide range of treatments with the potential to relieve them.

Whilst there are increasing steps being taken to improve patient access to effective pain treatments, considerable barriers still remain3, resulting in many patients across the world suffering needlessly.

Today\'s paineurope newswire reports on two studies being presented at the IASP meeting - World in Pain2 (a review of the impact and prevalence of pain across the world), and the Legal and Regulatory Frameworks Governing Opioid Prescribing Across Europe3, a review of the social, economic and governmental barriers to pain management across Europe.

In order to provide an insight into the global prevalence of chronic pain, a systematic review of studies into the prevalence and impact of chronic pain was conducted by a team led by Professor Harald Breivik, professor of anaesthesiology at Rikshospitalet University Hospital in Oslo, Norway, and president of the European Federation of IASP Chapters2.

A wide range of medical studies were assessed and analysed in order to compare the prevalence and impact of chronic pain from across the world

\"Chronic pain is known to have considerable impact on the patient, affecting their quality of life and their ability to work. Not only does this result in continued, unnecessary suffering for the patient, but untreated chronic pain can cause a significant economic cost. For example, in Europe it is estimated that chronic pain results in nearly 500 million lost working days, costing the European economy at least 34 billion Euros5\" explained Professor Breivik.

The review found that, shockingly, on average as many as one in five adults and up to a third of the elderly population still suffer from chronic pain despite proven, effective medication being available.

The experience of pain is a universal phenomenon and relief from pain ranks among the most fundamental bases for the practice of medicine. Despite this, there has been a lack of information about the global prevalence, impact and consequences of chronic, long-term pain. This is partly because pain is frequently a symptom or a legacy of an underlying disease or injury, but also because pain itself is generally not recorded in national statistics.

The review2 found that chronic pain has a huge impact on not only the patient\'s life but also that of their friends and families. It was demonstrated that living with chronic pain dramatically affected a person\'s ability to work - across Europe, 60 per cent of people with chronic pain said they were less able or unable to work outside home and around a fifth had lost their job due to pain. In Australia, significantly fewer people with chronic pain were in full-time employment compared to those people who did not suffer from pain.

In Canada, half the people who had chronic pain were unable to attend social or family events due to their chronic pain and almost 60 per cent were unable to go about their usual activities at home.

It was also shown that half the people suffering from chronic pain were not satisfied with the treatments available to them, with 77 per cent of people in Japan saying that their pain was not adequately controlled. 28 per cent of people across Europe saying that they believe their doctor does not know how to control their pain. Patient groups have called for better education of medical professionals, saying that instead of helping their patients they can actually be a barrier to obtaining adequate pain relief.

The study also found that in the countries surveyed, consistent under-treatment of pain was rife. In Japan, over 60 per cent of patients with chronic pain receive no treatment whatsoever, whilst in New Zealand that figure is 32 per cent and in Europe it is 31 per cent In Europe, only five per cent were being treated with strong opioid medication, which is licensed for severe pain and in Japan this figure was just three per cent.

These figures clearly demonstrate that whilst effective pain medication is available, there are many barriers which prevent patients from receiving it due to misconceptions and stigmatisation of both pain as a disease and strong pain medications by doctors, patients and the public.

Why are patients not receiving the pain medication that they need?

In a separate study, carried out in 17 European countries and conducted on behalf of Opioids and Pain European Network of Minds (OPEN Minds), a group of pain management experts, the regulations governing opioid prescription and reimbursement policies were examined and it was found that many barriers currently exist in the prescribing of strong pain medications3.

Strong opioids have always been stigmatised by an association with the treatment of the seriously ill, addiction and abuse, despite an overwhelming medical agreement as to their efficacy, when utilised appropriately, in managing long term pain.

\"One of the primary healthcare goals for all countries should be the provision of appropriate treatment for people suffering from chronic pain. This means ensuring adequate access to opioid medicines, a situation which this research demonstrates is not universal across Europe\", explained Professor Eckhard Beubler, Institut fur experimentelle und klinische Pharmakolgie, Universitat Graz, Austria and current Chair of the OPEN Minds group.

Even the language and terminology used to describe these medicines is negative in many European countries. For example, in Germany, the group of all narcotics including opioids are referred to as \"Bet?ubungmitteln\", literally \"the means to knock you out\", whilst in Austria, prescription forms are known as \"Suchgiftrezepte\", or \"addictive poison prescription forms\". This situation is compounded by a misperception amongst members of the public with regards to the effects and risks of these medicines, and a stigma around opioid medicines which existing regulations do little to alleviate.

The study found that due to unnecessarily restrictive regulations, insufficient resources and negative perceptions of opioid medication - caused mainly by lack of education of both doctors and patients - people with chronic pain in Europe are being prevented from obtaining adequate pain relief.

In response to this, and with the backing of patient groups and MEPs, OPEN Minds have developed a White Paper4, calling for improved access to effective pain medication, which is currently awaiting review by the European Parliament.

The White Paper calls to action governments across Europe, asking them to review existing policies affecting access to strong opioids for use in pain management and stating that policies should have as their primary aim the provision of appropriate treatment to people suffering from chronic pain. It is designed to help governments combat the inadequacy of access to pain treatment that currently exists across Europe, by addressing the barriers, stigma and the regulatory and economic factors that cause them. It states that all doctors should have free and easy access to the forms necessary for prescribing strong opioids. Prescription lengths for strong opioid treatments should reflect the needs of the individual patient and should recognise the importance of regular monitoring by the prescribing doctor.

Currently, strong opioids are reimbursed in varying amounts across Europe. The White paper states that financial factors should not prevent patients from gaining access to the pain treatments that they need and asks that all authorised treatments should be reimbursed to the same level, irrespective of the root cause of the pain.

\"Chronic pain is a major European healthcare issue\", explained Professor Margarita Puig, Dept of Anaesthesiology, Hospital Universitario del Mar, Barcelona, Spain, and member of The OPEN Minds group. \"The \'White Paper on Opioids and Pain: A Pan-European Challenge\' illustrates the extent to which legal, regulatory, cultural and economic factors impede upon the treatment of chronic pain across Europe. Most importantly, the research illustrates a fundamental misunderstanding if the impact of pain and the important role that strong opioids play in the management of chronic pain\", she continued.

Additional research6, surveying public opinion and attitudes around opioids and strong pain killers, alarmingly reveals one in five members of the European public have experienced a negative reaction when they have told someone they are taking a strong pain killer. 30 per cent of respondents reported having a different opinion of opioids compared to other strong pain killers, with 45 per cent explaining they would feel worried if a member of their family was prescribed an opioid. The research also hints at an additional factor impacting on the public\'s opinion - of those questioned, only 4 per cent felt the media painted a positive picture of opioids, with nearly half (44%) reporting that they felt the media reported opioids in a negative light.

The International Narcotics Control Board (INCB), the organisation responsible for reducing drug abuse, has declared that the global use of essential narcotic medicines to treat pain is inadequate7. The INCB concluded that, in looking to control the illicit consumption of opioid medicines, governments have gone too far, and that control has become impediment and denial.


1 WHO 2 Breivik, H; Hattori, S; Moulin, Dwight E. Prevalence and impact of chronic pain: a systematic review of epidemiological studies on chronic pain. Presented at the International Association for the Study of Pain (IASP) 11th World Congress on Pain, Sydney, Australia. (2005)
3 Castro-Lopes, J; Borgeat, A; Collett, B; Rhodin, A. Legal and regulatory frameworks governing opioid prescribing across Europe. Presented at the International Association for the Study of Pain (IASP) 11th World Congress on Pain, Sydney, Australia. (2005)
4 The OPEN Minds Group. White Paper on Opioids and Pain: A Pan-European Challenge. (2005)
5 Pain In Europe (
6 Public Perceptions of Opioids and Strong Pain Killers. Research by Light Speed Research on behalf of the OPEN Minds Group (2005)
7 INCB Press Release, Use of narcotic drugs to treat pain is inadequate, March 3 2004, (