Pharmacological treatment of chronic pain—The need for CHANGE

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

doi:10.1185/03007991003689175

Cited by 170Pain Management and Opioid UsePain Mechanisms and TreatmentsAnesthesia and Pain Management

Pharmacological treatment of chronic pain—The need for CHANGE

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Varrassi, G., Müller-Schwefe, G., Pergolizzi, J., Orónska, A., Morlion, B., Mavrocordatos, P., Margarit, C., Mangas, C. +6 more·2010·Current Medical Research and Opinion

DOI 10.1185/03007991003689175

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Abstract

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 community's 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.

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The long-term success of pharmacological pain therapy is limited due to high number needed to treat (NNT) and frequent adverse side effects.
“the long-term success of pharmacological pain therapy is limited due to the high number needed to treat (NNT) and frequent adverse side effects [3]”
From Changes in pain, daily occupations, lifestyle, and health following an occupational therapy lifestyle intervention: a secondary analysis from a feasibility study in patients with chronic high-impact pain (2024) · cites this paper as [3]
The Introduction says that side effects and other disadvantages limit the long-term success of opioid treatment, and the Conclusions say that adverse effects compromise chronic-pain management. The cited passages do not establish a high number needed to treat (NNT) as a reason for that limitation; a search for NNT and “number needed to treat” found no supporting passage. Page numbers were unavailable in our copy. (LLM, conf=0.87)
Experimental — accuracy not yet measured
The list of adverse symptoms included the most frequent side effects of treatments for pain.
“The list of adverse symptoms included the most frequent side effects of treatments for pain [52,57,58].”
From Telemonitoring in Chronic Pain Management Using Smartphone Apps: A Randomized Controlled Trial Comparing Usual Assessment against App-Based Monitoring with and without Clinical Alarms (2020) · cites this paper as [58]

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Authors: Varrassi, G., Müller-Schwefe, G., Pergolizzi, J., Orónska, A., Morlion, B., Mavrocordatos, P., Margarit, C., Mangas, C., Jaksch, W., Huygen, F., Collett, B., Berti, M., Aldington, D., & Ahlbeck, K.
Affiliations: University of L'Aquila (IT)
Schmerz- und Palliativzentrum, Göppingen, Germany
Naples Anesthesia & Physician Associates (US)
Hospicjum Domowe, Wrocław, Poland
Universitair Ziekenhuis Leuven (BE)
Hirslanden Clinique Cecil (CH)
Hospital General Universitario de Alicante Doctor Balmis (ES)
Hospital de Santo André (PT)
Wilhelminen Hospital (AT)
Erasmus MC (NL)
Leicester Royal Infirmary (GB)
Ospedale di Parma (IT)
Churchill Hospital (GB)
Karolinska University Hospital (SE)
Corresponding author: Pergolizzi, J.
ORCID: Varrassi, G.
Pergolizzi, J.
Morlion, B.
Margarit, C.
Jaksch, W.
Huygen, F.
Berti, M.
Aldington, D.
Venue: Current Medical Research and Opinion
Publisher: Informa UK Limited
Published: 2010-03-25
Volume: 26
Issue: 5
Pages: 1231-1245
ISSN: 0300-7995 (ISSN-L)
1473-4877
DOI: 10.1185/03007991003689175
OpenAlex: W2003872067
Cited by: 167
References: 88
Citations by year: 2026: 5 · 2025: 8 · 2024: 7 · 2023: 14 · 2022: 3 · 2021: 15 · 2020: 12 · 2019: 13 · 2018: 10 · 2017: 6 · 2016: 2 · 2015: 12 · 2014: 8 · 2013: 12 · 2012: 12
FWCI: 3.27
Type: journal article
Language: en
Open access: bronze
doi.org
Locations: Current Medical Research and Opinion (publishedVersion)
PubMed (publishedVersion)
EUR Research Repository (Erasmus University Rotterdam) (submittedVersion)
Topics: Health Sciences › Medicine › Anesthesiology and Pain Medicine › Pain Management and Opioid Use
Health Sciences › Medicine › Physiology › Pain Mechanisms and Treatments
Health Sciences › Medicine › Surgery › Anesthesia and Pain Management
Keywords: chronic pain, pharmacotherapy, pain management, analgesic side effects, strong opioids, opioid tolerability, neuropathic pain, nociceptive pain, analgesic combination therapy, pain mechanisms, sensitization, physician-patient communication, treatment guidelines, physician training
MeSH terms: Analgesics, Chronic Disease, Humans, Pain, Practice Guidelines as Topic

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Pharmacological treatment of chronic pain—The need for CHANGE

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