Pharmacological treatment of chronic pain the need for CHANGE

G. Varrassi, G. Müller-Schwefe, J. Pergolizzi, A. Ornska, B. Morlion, P. Mavrocordatos, C. Margarit, C. Mangas, W. Jaksch, F. Huygen, B. Collett, M. Berti, D. Aldington, K. Ahlbeck

Research output: Contribution to journalArticlepeer-review


Background: Although chronic pain affects around 20 of adults in Europe and the USA, there is substantial evidence that it is inadequately treated. In June 2009, an international group of pain specialists met in Brussels to identify the reasons for this and to achieve consensus on strategies for improving pain management. Scope: Literature on chronic pain management was reviewed, and information presented to and discussed by a panel of experts. Findings: It was agreed that guidelines are not universally accepted by those involved in pain management, and pain treatment seems to be driven mainly by tradition and personal experience. Other factors include poor communication between patients and physicians, the side effects of analgesic drugs, and limited individualisation of therapy. Difficulty in maintaining the balance between adequate pain relief and acceptable tolerability, particularly with strong opioids, can lead to the establishment of a vicious circle that alternates between lack of efficacy and unpleasant side effects, prompting discontinuation of treatment. The medical communitys understanding of the physiological differences between nociceptive pain and neuropathic pain, which is often more severe and difficult to treat, could be improved. Increasing physicians knowledge of the pharmacological options available to manage these different pain mechanisms offers the promise of better treatment decisions and more widespread adoption of a multi-mechanistic approach; this could involve loosely combining two substances from different drug classes, or administering an analgesic with two different mechanisms of action. In some circumstances, a single compound capable of addressing both nociceptive and neuropathic pain is desirable. Conclusions: To improve patient outcomes, a thorough understanding of pain mechanisms, sensitisation and multi-mechanistic management is required. Universal, user-friendly educational tools are therefore required to familiarise physicians with these topics, and also to improve communication between physicians and their pain patients, so that realistic expectations of treatment can be established.

Original languageEnglish (US)
Pages (from-to)1231-1245
Number of pages15
JournalCurrent Medical Research and Opinion
Issue number5
StatePublished - May 2010
Externally publishedYes


  • Chronic pain
  • Communication
  • Educational tools
  • Multi-mechanistic treatment
  • Neuropathic pain
  • Vicious circle

ASJC Scopus subject areas

  • Medicine(all)


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