Chronic Pain as a Disease in its Own Right: Reflections and Solutions

1. Workshop 1: Chronic diseases: Chronic Pain as a disease in its own right Stefano Coaccioli Sean McDougall

2. Objectives • The European Commission intends to support member states in a reflection process on chronic diseases to optimise the response • So the objectives of the workshop were to: • Investigate the position of pain in relation to chronic diseases • Identify risk factors for a large number of chronic diseases which have pain as a concomitant disease

3. Is chronic pain really a disease? • “It can’t be treated just as an unfortunate by-product of some other condition; it is a disease like any other” • “If we use the term ‘disease’ then we make pain a ‘doctors-only’ issue – can’t architects and technology firms play their part too?”

4. What one thing would you like tosee coming out of the workshop? • “Education – if only we could persuade healthcare professionals to consider the wider aspects of pain” • “Governments won’t act until they see that chronic pain is a trillion dollar economic opportunity that will also improve total quality of life for citizens” Chresten Mandal, plastic surgeon and pain specialist

5. from: Pain as a Disease … _________________________________________________________________ … of silence

7. Pain towards: Pain as a Disease in its own right _________________________________________________________________ QoL / ADL Depression Social deprivation Therapeutic Options Physiopathology Economic Burden

8. Main clinical topics • pain in relation of chronic diseases • ICD_11 • pain as the 5th vital sign

9. Chronic Pain is a Chronic Disease with a definite nosography • Chronic Pain is one of the major reason for seeking medical help, for early retirement, for discontinuation of labour • Chronic Pain directly affects sufferers (as well as their caregivers) towards a reduction of quality of life and worsening of activities of daily life – especially in the elderly • Chronic Pain represents a huge economic burden worldwide • Chronic Pain requires a strict cooperation between physicians, researchers, authorities, stakeholders, companies

10. Classification as a disease with its own nosographic relevance • The previous ICD does not distinguish acute from chronic pain: so that pain has been considered simply as a symptom of other disorders • If acute pain is really a symptom, chronic pain is a disease, and it must be considered as a chronic disease • The development of ICD_11 should be site chronic pain in a specific as well as dedicated position

11. Evaluate pain, and report it in the clinical schedules • There is wide evidence that only a careful, continuous, and strict evaluation of pain is able to put a light over one of the most important sign of life • Only the measuring of pain can realize a skillful and careful observation of a patients with chronic pain: this may transform the medical/nursing work from “cure” to “taking care” of the sufferers • The measuring of pain is an ethics must for both physicians and nurses

12. The patient’s perspective • For patients, pain is the first vital sign – not the fifth • Treating pain as a stand-alone issue can lead to stigmatism and over-exaggeration • Yet ignoring it condemns people to divorce, depression, loneliness and loss of income • Ultimately, the road-map offers people a chance of dignity

13. If you can’t count it, it doesn’t count • It’s hard to sell chronic pain as an issue because it is fragmented and hard to quantify • Pain management projects are often criticised because the participants are chosen based on willingness to deliver the desired outcome • Insurance policies seldom cover non-specific chronic pain

14. Pain is a social issue