Treatment limitations in the field of chronic pain


Patients with severe chronic pain are often insufficiently treated resulting in a high burden for society. Especially in non-cancer pain indications there is still limited access to potent substances. Despite not being intended for long term use, the majority of chronic pain patients are treated with non-opioid analgesics for lengthy periods and NSAIDs are used most frequently.1

In a pan-European survey, 40% were not satisfied with the management of their pain, and 12% said their physicians never determined how much pain they were experiencing.1

Pharmacological treatment is often limited by side effects. This is especially true for strong opioids where side effects limit the effective analgesic dose that can be achieved. Hence, patients and physicians struggle to find the balance between sufficient pain relief and acceptable tolerability – and therefore are trapped in a Vicious Circle often leading to treatment discontinuations.2

This becomes even more important for indications like chronic low back pain or cancer pain where a neuropathic component is often involved. In this case the combination of a classical opioid with co-analgesics is commonly used but there is evidence for an increased risk of side effects under combination therapy.3

Especially, for patients with severe chronic low back pain or cancer pain, a combination of pain types is rather the rule than the exception. Physicians usually need to control both pain types, nociceptive and neuropathic.4

Therefore, improving physicians' knowledge about the physiological difference between neuropathic and nociceptive pain and the specific pharmacological options as well as the individualisation of treatment is crucial to make better treatment decisions and to offer patients throughout Europe a more effective pain treatment at an early stage.2


References

1 Breivik H et al. Survey of chronic pain in Europe: prevalence, impact on daily life, and treatment. Eur J Pain. 2006; 10:287-333.
2 Varrassi G et al. Pharmacological treatment of chronic pain – the need for CHANGE. Curr Med Res Opin. 2010; 26(5):1231-1245.
3 Hanna M et al. Prolonged-release oxycodone enhances the effects of existing gabapentin therapy in painful diabetic neuropathy patients. Eur J Pain, 2008; Vol 12: 804-813.
4 Freynhagen R et al. painDETECT: a new screening questionnaire to identify neuropathic components in patients with back pain. Curr Med Res Opin. 2006; 22(10):1911-20.