A website specializing in Lifestyle Modification of Chronic Non-Cancer Pain

Although 20% of the adult population in Europe has CNCP, the “treatment of chronic non-malignant pain remains a controversial issue” as it does in the U.S. However, a group of pain specialists from 15 European countries – the Opioids and Pain European Network of Minds (OPENMinds – available at www.openmindsonline.org) – has started addressing the issue by investigating barriers to more effective opioid prescribing. Data is being gathered via questionnaires, which are sent to group members, patient networks and local pharmaceutical companies.  Some of the preliminary findings of their effort are:

• Writing prescriptions for opioids in Europe is a major problem. Prescription pads vary by country, rather than being standardized. Some countries require that Rx’s be written in triplicate, others make the doctors get them personally from the authorities, and still others require they get them from the national bank! The consequences of the situation is: it discourages doctors from writing Rx’s for opioid Rx’s; it’s a clear stigma for Pts; and, it adds so much additional paperwork that it further discourages doctors from prescribing opioids;
• The amounts that can be prescribed also vary: in some countries there are no limits, in most others, doctors can only prescribe a 1 week supply of opioids;
• Reimbursement varies: some countries reimburse the total cost of opioids, others not at all. So, generics or inappropriate strength meds are used, often with inappropriate clinical effect;
• Doctors’ fear of costly litigation, prosecution or loss of their license are the same as in the US;
• Low physician awareness of CNCP and the appropriate use of opioids is the same as it is in the US: most physicians are well intentioned, but lack the training or experience in CNCP, familiarity with the different opioids and their modes of delivery, and how to integrate them into the comprehensive multidisciplinary programs that are the global standard of care for CNCP.

The consistency of the pattern worldwide has clear implications for CNCP patients: Do not wait for government, medical associations or individual doctors to give any different a message than the inaction they’ve provided for the past half century (1953) when JJ Bonica published The management of pain. The message: “We’re not going to do anything about your chronic pain.” The alternative is for CNCP patients to take personal action: to become highly aware about CNCP; to screen and locate pain specialists in your own home town; to become familiar with the type of multidisciplinary program that works and to do it, if needed, on your own; and, finally, get over the expectation that there is an easy “fix” for CNCP and move on with creating the multiple conditions that will increase your functionality as much as possible.