CONTENT The President’s Corner A Word from the Editor SIP Focus Groups Fellowship Report Book Reviews by EFIC News from our Chapters:

Denmark Italy

Meetings: Past and Future

CONTACT newsletter@efic.org

IMPRESSUM Editor: Bart Morlion Contributors: Hans G. Kress, Mirka Lukić-Šarkanović, Parisa Gazerani, Stefano Coaccioli, Chris Wells

The President’s Corner

Dear friends of EFIC!

The European Pain Federation EFIC® and our national chapters are on the move. Having recently been at the national pain congresses in two countries that have been plagued much more than others by what is used to be

called the “€uro crisis”, I was deeply impressed by the considerable progress made there. In Granada, at the southern edge of Europe, the Spanish Pain Society (Sociedad Española del Dolor, SED) held its 10th National Congress together with the Portuguese Pain Association (APED) and the Federation of Latin-American IASP Chapters (FEDELAT), who joined them for their 11th FEDELAT Pain Meeting. After many inspiring talks with the congress president, Rafael Galvez, and our colleagues from most parts of the Spanish and Portuguese-speaking world, I was surprised by the remarkable political progress made in Spain for the recognition of chronic pain as a societal challenge. In particular at a local and regional level, and despite the ongoing austerity program, the Spanish health care professionals have set initiatives that can and should be used as positive examples for other European regions and countries. Up in the Celtic northwest of Europe, in Ireland, pain medicine has also made impressive progress since the launch of the “Diploma of Pain Medicine” in 2001, which was among the first post-graduate examinations in Europe. Thanks to the close political and personal collaboration of the Irish Pain Society, the Faculty of Pain Medicine of the College of Anaesthetists of Ireland (FPMCAI), and the patient group Chronic Pain Ireland, our Irish friends were remarkably successful in establishing post-graduate education on pain medicine. And they are now close to make Pain Medicine a specialty in Ireland.

NEWSLETTER 02/2013

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On the occasion of the 5th Annual Scientific Meeting in Ireland´s capital Dublin, it was therefore my pleasure to share with Professor Michael Cousins the privilege of being awarded the Honorary Fellowship of the Faculty of Pain Medicine (FFPMCAI). The photo - taken after the conferring ceremony – shows the two of us amongst the major “driving forces” of pain medicine in Ireland, Liam Conroy (Past President of the Irish EFIC Chapter and EFIC Councilor), Faculty Dean, Josh Keaveny, and Immediate Past Dean, Camillus Power.

Faculty of Pain Medicine of Ireland conferring ceremony Dr. Paul Murphy, Professor Michael Cousins, Dr. Josh Keaveny,

Dean of the Faculty of Pain Medicine of Ireland, Professor Hans G. Kress, Dr. Liam Conroy & Dr. Camillus Power

So, let us keep fingers crossed for the success of the important initiatives in Ireland and Spain, and let them be an incentive to other EFIC chapters that are far less suffering from severe national austerity programs.

With best wishes,

Hans G. Kress

President of EFIC

A Word from the Editor

Dear readership, Putting pain and pain relief on the political agenda is one of the priorities of our federation.

As reported by our president Prof. Hans Kress things are moving stepwise in several

European countries. In this edition you will find more information on the upcoming Societal

Impact of Pain meeting, to be held in Brussels in May 2013. It would give me great pleasure

to also publish the initiatives of your country in our newsletter in the future. In Belgium, for

example, the ministry of health very recently decided to invest in a multidisciplinary pain

team in every single Belgian hospital. Additionally, the number of publicly financed

multidisciplinary pain centers will be increased from 9 to 36 centers. Moreover, twelve of those centers will be

financially supported for the treatment of chronic pain in children. The measurements are going to be

implemented starting from July 1, 2013. To enforce your national and international political actions, knowledge

of the ongoing projects in other countries can be extremely helpful. Therefore, I repeat my call to contribute in

the EFIC newsletter.

Have a good read! Bart Morlion Editor EFIC Newsletter

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Societal Impact of Pain - Focus Groups 2013

In contrast to the last three years of symposia, this year the SIP Programme Committee decided to organize the so-called SIP 2013 Focus Groups. The Focus Groups are taking place on 14 - 15 May in the European Economic & Social Committee and the European Parliament in Brussels. Experts in the field of using and implementing pain indicators, politicians, policy-makers, health care professionals etc. will discuss about the two different topics: "Pain as Quality Outcomes Indicator" and "Chronic Pain in the Working Population".

The topics of the SIP Focus Groups are closely related to one of the seven policy dimensions of the SIP Road

Map for Action. The Road Map was a key result from SIP 2011 symposium outlining seven policy dimensions

on how the EU institutions and member states can effectively address the societal impact of pain at EU level.

The Focus Groups will provide a forum for inspirational key note presentations and in-depth plenary

discussion.

Rationale for the SIP Programme Committee for selecting this topic for SIP Focus Group 1 has been the

commonly agreed need for developing and implementing instruments for monitoring and measuring the

quality of pain management in Europe. Adequate pain management has started to become a priority for health

care services and providers across Europe. The epidemiological data, the high prevalence and significant direct

and indirect costs for the health care systems have been noted and shared during previous SIP symposia.

However, health care providers and budget holders still struggle to measure the quality of pain management

and thus to defend the required allocation of appropriate resources. The objective of SIP Focus Group 1 is

therefore to develop and agree upon a set of indicators for chronic non-malignant pain management, which are

most-commonly shared among EU member states and which shall be adopted and sequentially validated

and/or implemented by EU Member States following SIP 2013.

During SIP 2013 Focus Group 2, the significance of the EU workforce and the impact of chronic pain on the

latter will be the central topic: “In times of austerity and economic crisis, employment and productivity of the

working population is a central topic discussed on national and European level”, explains Marian Harkin, Irish

Member of European Parliament, who will be chairing this SIP Focus Group 2. “We need to discuss the

importance of both preventive measures and rehabilitation programmes as part of an effort to ensure that our

working population is able to re-enter the workforce even if they have been affected by chronic pain.” Due to

the need for sharing best practices and exchanging models among EU Member States for keeping our workforce

healthy, SIP Focus Group 2 aims at developing a “Proposal for Action”, giving national examples of

rehabilitation and integrated care programs and proposals for concrete measures on EU and Member State

policy level.

EFIC Fellowship Reports The EFIC fellowship is an individual fellowship for medical doctors supporting a training at a European Pain

Centre with specific expertise in the diagnosis and treatment of all pain related problems. The selected pain

centres do have educational programs dedicated to the fellow. To find out more about where fellowships are

possible and how to apply for one, click here.

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Berlin, Germany By Mirka Lukic

The Benjamin Franklin Pain Management Center is one of the three campuses located at Berlin’s University

Hospital Charite. The Center for Treatment of Acute and Chronic Pain resides within the Clinic for Anesthesia

and Intensive Care. Their multidisciplinary approach is based on the treatment of both acute and chronic pain

management, a subject area of great professional interest to me.

During my fellowship in December 2012 I worked closely with the ambulance center team of the treatment of

chronic pain as well as with the services for the treatment of acute post-operative pain (called "acute pain

service" or APS). APS is made up by specialists, anaesthesiologists and nurses with specific training in the

diagnostics, treatment and management of acute pain. This well managed service provides a both comfortable

and quick recovery to the their patients.

On a daily basis, I worked in the fields of diagnostics and treatment of patients with chronic, cancer or non-

cancer pain, and was therefore able to expand my knowledge in new techniques and approaches in these areas.

I was especially impressed by the work performed by the multidisciplinary teams. Meeting every Wednesday,

after regular duty hours, they discussed and reported on specific emerging issues concerning their patients.

The group analyzed difficulties associated with treatment and patient care as well as discussed additional

diagnostic and treatment approaches in order to formulate improved patient treatment plans. These teams

consisted of anaesthesiologists, neurologists, psychiatrists, psychologists, orthopaedists, social workers and

sometimes also individual patients.

I especially wish to thank EFIC for their sponsorship of my visit to this renowned center for diagnostics and

treatment of chronic pain. This visit greatly assisted me in expanding my knowledge and improving my skills in

my daily clinical work. I also want to express my gratitude to Dr A. Kopf on the good will, great help, hard work

and desire to convey his knowledge.

Book Reviews by EFIC

Are you a publisher of a recent book in the field of pain research? Then

send us a copy of your publication for a chance of a review by EFIC. The

review will be printed in the EFIC Newsletter and will feature an honest

and objective opinion on the book, along with information on where it

can be acquired.

If you want your book to be reviewed by EFIC please contact us at

newsletter@efic.org with detailed information on your publication.

Please note: A book review in the EFIC Newsletter is 100% impartial and

does not imply endorsement of any kind by EFIC.

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News from our Chapters

European Year against Pain in Denmark

By Parisa Gazerani The Global Year Against Pain has been launched by the International Association for the Study of Pain (IASP)

from October 2012 to October 2013 with this year’s focus on "Visceral Pain". Along with this global initiative,

the European Year Against Pain launched by EFIC has also started to give a special priority to visceral pain.

The overall aim of this annual campaign is to attract global attention on pain that originates in or near the

internal organs of the body to improve diagnosis and treatment of visceral pain among all specialist areas in

cardiology, pulmonology, gastroenterology, urology, gynaecology and internal medicine. In addition, visceral

pain has been subject to much less research than pain from tissue damage or nerve injuries and requires

dedicated pain researchers to focus on this type of pain. Visceral pain conditions in women should receive

higher attention as those are not only more prevalent and persistent, but also may be more insidious, complex,

and difficult to diagnose or treat. This places women at greater risk than men for prolonged episodes of pain

from internal organs associated with a low quality of life and more sick leaves. Chronic visceral pain can also

pose a significant burden to health care system and society and needs a general awareness for public.

The Center for Sensory-Motor Interaction in Aalborg, Denmark has therefore decided to organize a

Symposium on the "Gender Differences in Visceral Pain" on September 19-20 2013. The symposium

objective is to address main concepts in visceral pain with a focus on visceral pain conditions, diagnosis,

challenges and treatments. Many details in this context have not yet been clarified. For instance detailed

mechanism of sex related differences and the issue of why women are affected more frequently than men.

Clarification and addressing these issues will ultimately lead to better diagnosis and treatment strategies and

will definitely enhance patients' quality of life. More information on this symposium including a detailed

preliminary program can be found here.

Studies on Chronic Pain in Italy

By Stefano Coaccioli Chronic pain is usually measured by means of self-measuring, the sole methodology of how to build a comprehensive knowledge of prevalence of chronic pain as well as other clinical data. A simple questionnaire based on ten questions, has been conducted in order to study chronic pain as follows: Demographic data and associated diseases; prevalence, localization and type of pain; self-measurement of pain; drugs received and reduction of pain; knowledge of the Italian laws regarding chronic pain. The study has been carried out with patients affected by diabetes mellitus and/or obesity. The previous data of more than 1.000 patients shows a prevalence of chronic pain in females, in diabetic/obese patients with a

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preferential localization in the joints and low back; the level of chronic pain ranges from moderate to severe in more than 50% of subjects; the reduction of chronic pain is poor/moderate in more than 50% of treated patients, while 30% of subjects with chronic pain do not receive any therapy; the drugs used to treat chronic pain are the following: Paracetamol (35%), NSAIDs (60%), opioids (less than 3%) and pragabalin (less than 2%, even though 20% of patients affirms a type of chronic pain suggesting neuropathic pain). It is somewhat surprising and unexpected that 30% of diabetic patients with chronic pain receives NSAIDs. These preliminary results seem to confirm that chronic pain represents a major health problem, particularly in patients with chronic and dangerous conditions such as diabetes mellitus. Therefore, chronic pain needs to be taken more seriously by physicians as well as those responsible for health care policies.

Meetings: Past and Future

By Chris Wells Past Meetings Since the last newsletter I have been to one excellent meeting and heard about one or two others. I went to the Cleveland Clinic annual symposium held in Sarasota, Florida. The meeting was put on by Dr Nagy Mekhail, from Cleveland and is extremely well arranged. There were four days of meetings, but on each day there was an option for hands-on training at a local hospital, and at the end of the meeting there was a cadaver course to teach nerve blocks (on a separate fifth day). Over 300 doctors attended the meeting, including some from Europe. I have

to say that travelling to a warm and sunny Florida in February was delightful! Temperatures were in the low 20’s with sunshine nearly all of the day. In spite of this, delegates stayed inside the hall to hear the latest on the science and management of chronic pain. Speakers ranged from Alan Basbaum giving a review of the neuroscience of pain, through to Daniel Carr exploring problems the Americans had had with the use of opioids. Some of the latest interventions were highlighted, including Dr Meghail himself describing a new technique for minimally invasive surgery for spinal stenosis. This was a meeting that would have been enjoyed by all pain clinicians and also by nurses, general practitioners with an interest in pain, and some scientists. It is held every year, and next year’s meeting will be in California. I will post details of the meeting in the meetings column when these are available. During the meeting, we had a good interactive debate about Fibromyalgia, with a neurologist claiming it was a neuropathic pain syndrome, and myself arguing it was a generalized widespread pain syndrome with tender bits, similar in many ways to the widespread pain syndromes we see without tender bits. There was a lot of common ground and we all felt that one of the major problems with Fibromyalgia was the name! I also held an interesting tutorial about the management of pain in the elderly, and it soon became clear how readily American physicians initiate opioids. Their main interest was which particular opioid I used on the elderly; my reply was that I seldom put elderly patients on opioids. They could not understand how their pain could be managed. It is interesting to reflect that the USA uses 7x the overall amount of opioids (mg/capita) for pain than is used in the UK, and the UK ranks as fairly medium throughout Europe. There are some countries which use even less, and some in Europe that use more. This is an interesting topic for debate and will be discussed at the EFIC meeting in Florence. In the last issue I mentioned the upcoming NeuPSIG meeting in Toronto from 23 - 26 May 2013. Also remember the First World Congress on Abdominal and Pelvic Pain in Amsterdam from 30 May to 1 June 2013. Remember also the Third International Conference on Interventional Pain Medicine and Neuromodulation in Poland, from 14 - 16 June 2013. This is followed by a hands-on scanning workshop on ultrasound in pain medicine on 16 June 2013 itself.

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Upcoming Meetings A meeting not previously mentioned is one to be held in Friburg, Switzerland from 17 - 20 June 2013. This is a meeting on somatosensory rehabilitation, a four day comprehensive theoretical and hands-on course for therapists, physicians and others, about prevention and sensory re-education for patients suffering from pain due to peripheral sensory injury. This might well be of interest to EFIC members who deal with this type of problem, either scientifically or in a clinic. More information on this meeting can be found here. Two UK meetings of interest. A meeting on Cancer Pain at the Royal Marsden 27th June 2013 includes mechanisms, assessment, and treatment from medication to biopsychosocial. The Liverpool Course on Clinical Management of Chronic Pain is a 3-day meeting from 4-6th July 2013. This is an advanced practical and interactive course in clinical pain management for Pain Professionals and trainees who are aiming to develop their skills of assessing and treating complex chronic pain patients. The course will offer those who attend, the opportunity to develop an evidence based approach to assessment, examination and formulation of diagnosis, and how to design a comprehensive management plan. It is limited to 30 participants, and only 3 places are left! I also have news on a special symposium on visceral pain at Aarlberg University on 19 - 20 September 2013, arranged with the European Year against Visceral Pain in mind. An excellent program includes research and clinical aspects, and is well worthwhile attending. We are getting nearer to our own EFIC meeting in Florence from 9th to 12th October 2013. Entitled 8th Pain in Europe Congress, 20 Years of Building Bridges, it will bring together 4.000 delegates to the biggest meeting on pain in the world, this year. All the plenary speakers have now been identified and many of the excellent workshops will be shown on the website in the next few weeks. Remember to book this one off, register for the meeting, submit a poster, and I look forward to seeing you all there!

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How did you enjoy the EFIC Newsletter 02/2013? Let us know at newsletter@efic.org. We look forward to receiving your feedback on this issue. If you wish to unsubscribe from the EFIC Newsletter, you can do so here. The next EFIC Newsletter will be published in August 2013. The deadline for contributions is August 15, 2013. All contributions must be emailed to Bart Morlion at bart.morlion@uzleuven.be. If you are interested in contributing to one of our next issues, please have a look at the EFIC Newsletter Contribution Guidelines.

EFIC Newsletter 02/2013 Contributors

Prof. Hans G. Kress MD, PhD FFPMCAI (Hon.) Chair of Anaesthesiology and Pain Medicine Medical University of Vienna/AKH, Vienna, Austria Prof. Bart Morlion MD, PhD Director of the Leuven Center for Algology & Pain Management University Hospitals Leuven, Belgium Mirka Lukić-Šarkanović MD, PhD Clinic for Anaesthesiology and Intensive Care Novi Sad, Serbia Parisa Gazerani, Pharm D, PhD Center for Sensory-Motor Interaction Department of Health Science & Technology Aalborg University, Denmark Prof. Stefano Coaccioli Associate Professor of Internal Medicine Chief, Dept. of Internal Medicine, Rheumatology, Medical Pain Therapy Perugia University Medical School, Italy Dr. Chris Wells, Consultant in Pain Relief Liverpool, United Kingdom

Inner Circle Company Members

of EFIC 2013:

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