A holistic approach to chronic pain management that involves all stakeholders: change is needed.

Curr Med Res Opin. 2015;31(9):1743-54. doi: 10.1185/03007995.2015.1072088. Epub 2015 Aug 20. Kress HG1, Aldington D2, Alon E3, Coaccioli S4, Collett B5, Coluzzi F6, Huygen F7, Jaksch W8, Kalso E9, Kocot-Kępska M10, Mangas AC11, Ferri CM12, Mavrocordatos P13, Morlion B14, Müller-Schwefe G15, Nicolaou A16, Hernández CP17, Sichère P18. Author information 1 a a Department of Special Anaesthesia and Pain Therapy , Medizinische Universität/AKH Wien , Vienna , Austria. 2 b b Hampshire Hospitals NHS Trust , Winchester , Hants , UK. 3 c c Universitätsspital Zurich , Zurich , Switzerland. 4 d d Santa Maria General Hospital , Terni , Italy. 5 e e University Hospitals of Leicester NHS Trust , Leicester , UK. 6 f f Department of Medical and Surgical Sciences and Biotechnologies , Sapienza University of Rome , Italy. 7 g g University Hospital , Rotterdam , The Netherlands. 8 h h Wilhelminenspital der Stadt Wien , Austria. 9 i i Pain Clinic, Department of Anaesthesiology, Intensive Care and Pain Medicine, University of Helsinki, and Helsinki University Hospital , Finland. 10 j j Department of Pain Research and Treatment , Collegium Medicum Jagiellonian University , Kraków , Poland. 11 k k UNIDOR, Centro Hospitalar de Leiria , Leiria , Portugal. 12 l l Hospital General Universitario de Alicante , Spain. 13 m m Clinique Cecil , Lausanne , Switzerland. 14 n n University Hospitals Leuven , Belgium. 15 o o Schmerz- und Palliativzentrum , Göppingen , Germany. 16 p p St. Georges Hospital , London , UK. 17 q q Hospital Universitario de la Princesa , Madrid , Spain. 18 r r Hôpitaux de Saint-Denis , Paris , France. Abstract Chronic pain affects a large proportion of the population, imposing significant individual distress and a considerable burden on society, yet treatment is not always instituted and/or adequate. Comprehensive multidisciplinary management based on the biopsychosocial model of pain has been shown to be clinically effective and cost-efficient, but is not widely available. A literature review of stakeholder groups revealed many reasons for this, including: i) many patients believe healthcare professionals lack relevant knowledge, and consultations are rushed, ii) general practitioners consider that pain management has a low priority and is under-resourced, iii) pain specialists cite non-adherence to evidence-based treatment, sub-optimal prescribing, and chronic pain not being regarded as a disease in its own right, iv) nurses', pharmacists' and physiotherapists' skills are not fully utilized, and v) psychological therapy is employed infrequently and often too late. Many of the issues relating to physicians could be addressed by improving medical training, both at undergraduate and postgraduate levels - for example, by making pain medicine a compulsory core subject of the undergraduate medical curriculum. This would improve physician/patient communication, increase the use of standardized pain assessment tools, and allow more patients to participate in treatment decisions. Patient care would also benefit from improved training for other multidisciplinary team members; for example, nurses could provide counseling and follow-up support, psychologists offer coping skills training, and physiotherapists have a greater role in rehabilitation. Equally important measures include the widespread adoption of a patient-centered approach, chronic pain being recognized as a disease in its own right, and the development of universal guidelines for managing chronic non-cancer pain. Perhaps the greatest barrier to improvement is lack of political will at both national and international level. Some powerful initiatives and collaborations are currently lobbying policy-making bodies to raise standards and reduce unnecessary pain - it is vital they continue. KEYWORDS: Biopsychosocial model; Chronic pain; Improved training; Multidisciplinary management; Patient-centered approach; Political will; Standardized pain assessment tools