Strong opioids suitable for elderly patients – Weight loss reduces joint pain

Elderly patients with chronic musculoskeletal pain often receive inadequate medical treatment. A recent Polish study suggests that this situation does not change until patients are referred to specialised pain clinics. “Prior to referral, the patients receive systemic non-steroidal anti-inflammatory drugs (NSAIDs) all too often and opioids all too rarely. Yet the opioid buprenorphine, for instance, is a highly effective drug for combatting pronounced pain and is just as safe used on elderly patients as on younger ones,” said study author Dr Magdalena Kocot-Kepska from the Collegium Medicum of Jagiellonian University in Krakow (Poland) at a symposium staged in Dubrovnik by the European Pain Federation EFIC. The event is focused on the subject acute and chronic joint pain.

In this study, researchers evaluated data from 165 patients over the age of 80 who were referred to a pain clinic due to chronic complaints. 70 per cent of this group consisted of patients suffering from chronic musculoskeletal pain. Six out of seven patients were women. Prior to admission to the clinics, 71 per cent of the patients were treated with non-steroidal anti-inflammatory drugs (NSAIDs). That was the case even though nearly all of them (95 per cent) suffered from cardiovascular diseases and these analgesics are not indicated in the case of cardiovascular problems. After being admitted to the pain clinic, 35 per cent were given strong opioids, but only a good one in five of these patients displayed slight side-effects. Dr Kocot-Kepska: “A good deal of clarification and clear-cut treatment guidelines are still needed. The concerns about opioids and the excessive use of NSAIDs definitely have to be reconsidered, especially in elderly, most vulnerable patients.”

Weight loss reduces joint pain for osteoarthritic patients

Reduction of body weight reduces the pain level of patients suffering from advanced osteoarthritis. This is shown by a Scottish study that was also presented at the EFIC symposium in Dubrovnik. After losing weight, patients had to take steroidal anti-inflammatory drugs only three times a week instead of four times to combat breakthrough pain, according to the study authors.

In this study 30 people (twelve men, 18 women) were examined to determine how programmed weight reduction would affect their pain level. For 14 weeks, the study participants followed a diet and swam 30 minutes a day under the supervision of a physiotherapist. The participants weighed an average of 95 kilograms initially and the majority of them succeeded in losing about 6.7 per cent of their body weight. At the same time the pain level on the 10-point VAS pain scale fell from 6 to 4 points among the men and from 7 to 6 points among the women.

EFIC has declared 2016 to be the European Year against Joint Pain. The goal of this information campaign is to focus on a health problem from which more than half of the worldwide population over age 50 suffers. Against this background, pain experts attending the symposium in Dubrovnik are discussing the many current trends for understanding and treating pain caused by joint diseases.

New therapeutic strategies to combat joint pain: EFIC symposium in Dubrovnik

Joint pain continues to be one of the main reasons for persisting disablement. One explanation, among others, is that pain therapies available today do not always have the desired effect. David Walsh, a professor from the University of Nottingham (UK), discussed new developments in this area at a symposium focusing on severe and chronic joint pain being staged in Dubrovnik by the European Pain Federation EFIC. “Researchers are currently investigating a number of interesting possibilities. The development of new drugs is an arduous process, however, we can most likely expect that NGF blockers, a completely new class of painkillers, will be available for therapeutic practice in the foreseeable future,” Prof Walsh notes. NGF stands for “nerve growth factor”.

In the meantime, many clinical studies have shown that blocking nerve growth factor can have a positive effect on arthritis pain, back pain and likely also other types of pain. A recent study (Xu L, 2016), in which Dr Walsh was involved, shows in the animal model, for instance, that treatment with the anti-NFG antibody muMab911 mitigates pain responses in connection with arthritis, doing so without preventing cartilage damage and synovitis. This study also indicates that indirect effects on subchondral bone remodelling could also contribute to the analgesic effect of the NGF blockade. Other drugs in development that prevent NGF signalling might equally reduce arthritis pain (Nwosu L, 2015, Ashraf S, 2016).

Targeted therapy

One research approach attempts to identify the mechanisms of pain and of pain transmission and then deactivate them – but only at the right places. Prof Walsh: “Without pain as a warning signal, people would be at constant risk of injury. That is why the experience of pain as a whole cannot be prevented.” A team around Prof Walsh, Prof Wood and colleagues in London is identifying proteins that work as pressure sensors on nerves in the joint, and play an instrumental role in the arthritis pain when joints move or on standing.

Subgrouping people with arthritis pain

Prof Walsh: “To help people with joint pain more effectively, we need to recognise that not everyone is the same – for any one treatment people might either be responders for whom the analgesic works well or non-responders who might benefit more from other drugs.” A lot of research is now underway to determine how patients can best be clustered according to type of pain and to the mechanism behind that pain.

“The advantage of this approach is this: You are able to offer the patient a targeted therapy that brings about important relief that outweighs any likely side-effects. I am firmly convinced that many of the drugs attested to be ineffective in the past might well have worked for some people, but those people were hidden in the clinical trials among the large group of persons for whom the drug didn’t work, or whose pain even got worse. If we could identify the group of people for whom a treatment will work, new effective treatment possibilities could be found for them quickly,” Prof Walsh emphasises.

Reliable treatments, new possibilities for using them

Prof Walsh sees another future field of investigation in the identification of therapies from other indication areas whose analgesic benefits were heretofore unknown or not sufficiently known. For example, arthritis typically involves nociceptive pain triggered by mechanical stimuli. If common analgesics do not work, drugs for combatting neuropathic pain can help in many cases – quite unexpectedly.

Other examples might be beta blockers, which have been prescribed for decades to combat high blood pressure. In the meantime, there is growing evidence that they can also affect the transmission of pain in certain people. Non-drug treatment approaches should also be revisited and tested. Prof Walsh: “In some circumstances, physical exercise or psychological interventions can be employed differently than before and efficiently for specific groups of people with arthritis pain. Here, too, we must filter out those patients who can benefit from certain psychological techniques or defined exercise programs.”

For instance, patients who will continue to suffer severe pain after receiving a knee joint replacement can be predicted to a certain degree. Untreated depression is one of the predictors for postoperative problems. One reason, among others, may be that in some people the brain mechanisms active in connection with depression overlap with those that process pain. Prof Walsh: “It is therefore worthwhile looking into the question of whether antidepressants and cognitive behavioural therapy might also improve outcomes for some people needing joint surgery.”

EFIC has declared 2016 to be the European Year against Joint Pain. The goal of this information campaign is to focus on a health problem from which more than half of the worldwide population over age 50 suffers. Against this background, experts attending the symposium in Dubrovnik are discussing the many current trends for understanding and treating joint pain.

EFIC Symposium: Myths and facts about joint pain

A lot of incorrect assumptions about joint pain are in circulation. “The sometimes overly pessimistic misconceptions can prevent patients from getting into therapy even though it could improve their condition and reduce their pain,” pain expert Serge Perrot criticized. Perrot, a professor from Descartes University and Cochin Hospital, Paris, France, made these remarks at a symposium focusing on severe and chronic joint pain being staged in Dubrovnik by the European Pain Federation EFIC. The expert talked about some of the most common myths concerning joint pain.

Myth #1: The more extensive the joint damage, the more severe the pain.

The misconception that the intensity of pain correlates with the extent of anatomical joint damage is especially persistent. Prof Perrot: “This statement is true at most in connection with very severe lesions.” Data shows that half of the individuals with radiologically verifiable joint damage live free of pain whereas, conversely, one in every two patients with knee pain has an intact joint. Prof Perrot: “So the question has to be this: Are there joint changes that induce pain?” Various cohort studies (MOST, Framingham) prove, for example, that a constriction of the intra-articular space is more likely to result in knee pain than osteophytes are, i.e. degenerative, structural changes in the bone. According to MRT studies (Torres, Osteoarthritis Cartilage 2006), intense pain is strongly correlated with synovialitis (inflammation of the synovial membrane) or bone marrow injuries but not with osteophytes, changes in cartilage, bone cysts, subluxations of the meniscus or lacerated ligaments.

Myth #2: Joint pain is synonymous with inflammation.

Anyone who automatically assumes that inflammation is the reason for joint pain is equally off track. Prof Perrot provided more precise information: “Inflammations play a role mainly in acute pain but not in chronic and mechanical pain.” Viewed pathophysiologically, joint pain is both, namely, an inflammation of the synovial membrane and bone pain caused by a constriction of the intra-articular space that increases the local pressure. According to one study (Laslett, EULAR 2011, London), treatment with a 5mg IV of zoldedronic acid can reduce bone pain by 15 points on the 100-point VAS scale. Injuries to bone marrow are reduced by 37 percent. For pain caused by an inflammation of the synovial membrane, treatment with non-steroidal anti-inflammatory drugs (NSAIDs) can help. Treatment of bone marrow oedemas also helps mitigate the pain.

Myth #3: Joint pain emanates from the joint.

The assumption that joint pain has to emanate from the joint would seem obvious but is in fact incorrect. Prof Perrot: “Joint pain is a complex experience in which social factors, pain behaviour, feelings, thoughts, the perception of pain and damage to nociceptive tissue come into play.” He cited arthritis as an example that demonstrates just how much a matter of the mind pain ultimately is: Spontaneous arthritic pain is exhibited in the brain in the medial prefrontal cortex and affects the person’s emotional state. Pain induced by a stimulus exhibits itself in brain regions that process somatosensorily nociceptive processes. In the central nervous system, joint pain sensitizes the brain, thereby creating excess local sensitivity.

Myth #4: Joint pain comes with age.

Prof Perrot: “80 percent of arthritis patients are 50 or older but age alone does not determine whether a person suffers from joint pain and how severe that pain is.” Besides age, two other cofactors for the intensity of arthritis pain are obesity and local injuries. People with the genotype Ile585Val TRPV1 are less sensitive to pain in the lower part of their body and therefore have a significantly lower risk of suffering from painful arthritis in their knees. With inflammatory joint diseases, gender can determine the level of pain: Women suffer more from these diseases than men do. Hormones can also be involved in joint pain: A blockage of oestrogen, for instance in connection with breast cancer treatment, can quickly result in inflammatory changes to wrists and ankles.

Myth #5: Joint pain is not treatable.

Even if freedom from pain is not a realistic goal of therapy in some cases: Joint pain does not have to be accepted without any hope of relief. Even intense pain is not synonymous with serious damage to the joint. “Joint pain is highly heterogeneous. The pain phenotypes therefore have to be precisely analysed to be able to initiate a suitable treatment,” the expert emphasised. He recommended that pain management should in any case consist of a combination of pharmacological and non-drug therapies.

EFIC has declared 2016 to be the European Year against Joint Pain. The goal of this information campaign is to focus on a health problem from which more than half of the worldwide population over age 50 suffers. Against this background, experts attending the symposium in Dubrovnik are discussing the many current trends for understanding and treating joint pain.

European Pain Federation EFIC® launches new information campaign: "European Year Against Pain"

 Today, the European Pain Federation EFIC® launched its “European Year Against Pain (EYAP)” campaign in Brussels. In doing so, EFIC is putting a health problem on centre stage, from which more than half the total population over age 50 suffers. “Joint pain is among the most frequent health complaints of all and a leading reason for disability,” EFIC President Dr Chris Wells noted. “Joint pain will become an even more urgent problem in future given the prevalence of a sedentary lifestyle, ever more widespread obesity, and the increase in life expectancy. Like chronic pain in general, joint pain causes not only individual suffering but also has an enormous social cost in the form of health care expenses, sick days off work, loss of productivity or occupational disability.” Figures from the US show the economic dimension involved: Between 1996 and 2011, expenses for the treatment of joint complaints increased more than in any other category, namely by 192 per cent. Throughout the EU, musculoskeletal problems constitute the most important diagnosis category in terms of health care spending and the indirect costs of decreased productivity.

Despite major efforts, currently available therapies are not yielding the desired effects and in some cases fall short of the patients’ expectations. The EFIC President: “Care must be improved substantially. Joint pain sufferers must receive adequate, reliable treatment more quickly, treatment that not only fights pain but also enables the joints to retain their functionality. We want to show what is needed to achieve this objective and raise awareness about how worthwhile it can be to invest in the treatment of joint pain.”

The intent of the European Year Against Joint Pain is to inform the public about the diverse symptoms of joint pain and the possible treatments. That way, pain sufferers could also “seek appropriate help on time,” as EFIC President Dr Wells emphasised.  The website www.efic.org makes available collected facts and patient information on the various forms of joint pain. There is a variety of initiatives, PR efforts, and conferences in the 37 countries in which EFIC is represented with national chapters. In September, EFIC will stage a topical seminar on this subject in Dubrovnik, Croatia.

Joint pain can take many forms: at least 150 known types

Until now, some 150 different forms of joint pain have been identified, with very diverse causes. For instance, they can be traced to bone fractures or to previous joint surgeries. The most frequent causes of chronic joint problems, however, are wear-related osteoarthritis, crystal deposits (gout) and inflammatory processes. Prof Bart Morlion, President elect of EFIC and coordinator for the European Year Against Pain: “Today we do not yet sufficiently understand the various causes and mechanisms relating to the broad range of forms that joint pain can take. Until now, researchers have concentrated primarily on the most frequent forms.  A number of important new findings have been made recently but still have to find their way into actual practice. They pertain to common mechanisms of incurrence or manifestations of whole different forms of joint pain. Policymakers are called on to create the necessary basic framework for tailor-made programmes geared to different patient groups.” Whereas changes in bones should be treated with corresponding active ingredients, for example, highly obese individuals could be offered weight-reduction programmes. It is still paramount that researchers find answers to the many unanswered questions regarding diagnosis and treatment. Prof Morlion: “We are counting on the European Year Against Joint Pain to provide fresh impetus to these efforts.”

Osteoarthritis and gout as widespread ailments

Gout is the most frequent of the painful inflammatory joint diseases. It is characterised by episodes of acute pain that can also develop into a chronic inflammatory condition. Between one and four per cent of the population suffers from gout. The most frequent inflammatory joint disease with an autoimmune cause is rheumatoid arthritis. Less than one per cent of the global population suffers from this disease, which customarily affects multiple joints.

Osteoarthritis is the most frequent form of painful joint problems. This complex disease is characterised by excess wear to the joints, where mechanical pain can be coupled with inflammatory and/or neuropathic pain. Osteoarthritis accounts for a substantial 20 per cent of all chronic pain worldwide. Ten to fifteen per cent of the global population is affected by this disease and its prevalence clearly rises with age. Among all 60 to 70-year-olds, osteoarthritis is diagnosed in 40 per cent of women and 25 per cent of men. It is the most frequent disease of the musculoskeletal system in older people and is the cause of disability in this group more often than any other condition. Symptoms such as joint pain or stiffness do not occur in all patients for which the disease can be proven on an x-ray. This is the case in ten to fifteen per cent of the population, however. Knee, hand and hip joints are the joints most frequently involved.

Osteoarthritis is more than just a joint disease

For a long time, osteoarthritic pain was neglected and the mechanisms behind it and possible therapies for it were incorrectly assessed. Prof Morlion: “In the meantime, we know that osteoarthritis is more than a joint disease. There is a complex interplay between it on the one hand and obesity, metabolic syndrome and cardiovascular diseases on the other.” Hormone-like messengers such as adipokines, myokines and cytokines were found to be the common denominator of these diseases. They are secreted into the blood by joint tissue, muscles and fat and promote inflammatory processes and cartilage degeneration. Prof Morlion: “The challenge continues to be to treat osteoarthritis in a joint-preserving manner. Recently a decisive step was taken when the various manifestations of osteoarthritis were described. The Osteoarthritis Research Society International (OARSI) also published guidelines for non-surgical treatment. What is new about these guidelines is that they contain varying recommendations depending on the clinical subcategory, for instance, whether comorbidities exist in the case of knee osteoarthritis.” The key treatments suitable for all patients comprise gymnastics and water gymnastics, weight control, strength workouts, and trainings.

Using drugs on a mechanism basis

The goal for joint pain of the most varied kinds has to be to prevent this pain from becoming chronic. On that all experts agree. The risk of this happening is high, however. With osteoarthritis, for instance, many patients do not seek out medical help until a considerable period of time has elapsed. 66 per cent try to improve the situation with non-prescription food additives and drugs while 41 per cent of the patients experience joint pain at least one year prior to the diagnosis.

The range of available therapies is as broad as the causes and manifestations of joint pain are varied. Application of heat and cold, electrotherapies, exercise strategies, strength workouts or weight loss are among the important non-drug treatment approaches. In terms of drug therapy for joint pain, a new approach is becoming increasingly established – namely a selection of substances geared to the mechanisms of the given manifestation of pain. Conventionally, the therapy for joint pain had been geared to the pain severity as modelled on the WHO pain ladder – with non-opioid analgesics and non-steroidal anti-inflammatory drugs (NSAIDs) used for mild severity, “weak” opioids for moderate pain and “strong” opioids for severe pain.

Prof Morlion: “A new approach has now become increasingly established, namely to select the therapy by the mechanism underlying the given pain and by the target of the given drug.”  For joint pain, this means that nociceptive inflammatory pain should be treated as a rule by reducing inflammation with steroids or NSAIDs, non-inflammatory nociceptive pain by opioid and non-opioid analgesics, and neuropathic pain by antidepressants or anticonvulsants, or various types of rheumatic disorders with monoclonal antibodies. Prof Morlion: “That is progress because it means the therapies more closely match the patient’s needs than with the conventional escalation strategies from weaker to stronger drugs.” 

Under-treatment widespread

For many joint pain sufferers, exhaustive use is not made of the available drug options for pain therapy. One reason is a concern about undesirable effects – especially in elderly patients. Prof Morlion elaborated: “There have been a number of improvements lately, however. New opioids for example have attained sustainable success when used on slight gastrointestinal or cognitive impairments and the risk of dependency is small.” The local administration of pain killers has also been shown to reduce side-effects. Recently published methods involving antibodies that block nerve growth factors show the potential of biological therapies for osteoarthritis, too. They are aimed at peripheral pain mechanisms and hardly penetrate the central nervous system. Thus, side-effects such as sleepiness or nausea are problems of the past. Prof. Morlion urged the following: “Pain should in any case be treated at an early stage, because we can now also determine the cause of it more quickly.”

European Year Against Pain

“Each year we turn attention on a special form of pain or a special health care problem with our regular EYAP information offensive staged in coordination with the International Association for the Study of Pain (IASP)”, said EFIC President Dr Chris Wells Our intent is to point out the health problem of pain in all its facets and consequences, to support pain patients and to sensitize the broader public. In addition, we consider it essential to make policymakers aware of the challenges that chronic pain poses for the health care system and to set a priority in this area.”

Expertos y autoridades sanitarias de más de veinte países debaten sobre el impacto socio-económico del abordaje del dolor

“El dolor es actualmente el mayor problema de salud en Europa”, según ha puesto de manifiesto el profesor Giustino Varrasi, presidente de la EFIC (European Federation of IASP –International Association for the Study of Pain- Chapters), durante el I Simposium europeo de la EFIC “Impacto Social del Dolor”, celebrado en Bruselas. Cerca de 200 profesionales europeos de 28 países, procedentes de distintos ámbitos asistenciales, económicos y de la gestión sanitaria, han fijado los retos y principales avances en la prevención y manejo del dolor en esta reunión.
Durante el evento, auspiciado y organizado por la EFIC, con el apoyo de Grünenthal, se han dado a conocer nuevos datos epidemiológicos sobre el dolor crónico, su impacto social y repercusión económica, así como proyectos innovadores que se están desarrollando en distintos países europeos y que, en opinión del Prof. Varrasi, “deben ser la base sobre la que generar iniciativas globales europeas”.
Y es que, según ha afirmado en este reputado foro el presidente de la EFIC, “la falta de organización, planificación y sensibilidad frente a las consecuencias individuales, sociales, sanitarias y económicas del dolor, están ralentizando la generalización de estrategias eficaces para contrarrestar este problema de salud pública”.
Entre las principales conclusiones extraídas de este encuentro, como resume el Prof. Varrasi, cabe destacar que “aunque el dolor agudo puede ser considerado como un síntoma de una enfermedad o de una lesión, el dolor crónico es algo más y debe considerarse como una enfermedad por sí misma”.

--Esfuerzo conjunto
Como se ha puesto de relieve en este Simposium, un creciente número de pacientes que sufren dolor crónico no está tratado de forma adecuada; en opinión del presidente de EFIC, “esto se debe fundamentalmente a que el dolor sigue sin ser reconocido como un importante problema sanitario por parte de muchos sistemas nacionales de salud”.
Sin embargo, esta tendencia se está invirtiendo, especialmente por el impulso mostrado por algunos países en la lucha contra el dolor, organizando proyectos encaminados a determinar el impacto de este trastorno en los pacientes y en la sociedad. “Son experiencias muy positivas”, reconoce José de Andrés, de la Facultad de Medicina de la Universidad de Valencia, “pero su efecto puede ser muy limitado si no se hace un esfuerzo conjunto; todos los países europeos debemos trabajar en sintonía y de forma coordinada”.
En este sentido, Isabel de la Mata, Asesora Principal en Salud Púbica de la Comisión Europea, ha destacado en este foro la sensibilidad que está mostrando la Comisión Europea ante el impacto personal y social que supone el dolor crónico. “Aunque el tratamiento, reembolso y la financiación de las terapias dirigidas a paliar el dolor depende de los estados miembros de la Unión Europea, desde la Comisión estamos decididos a mejorar la coordinación, cooperación y difusión de las buenas prácticas clínicas en el manejo del dolor”, señala. A su juicio, “la próxima aprobación de la Directiva de Atención Sanitaria Transfronteriza va a permitir que los pacientes y los profesionales sanitarios tengan una mayor movilidad en el entorno europeo, lo que multiplicará la necesidad de optimizar recursos y fomentar la mejora de las prácticas clínicas”.

--Impacto sociosanitario
“El dolor es una de las causas más frecuentes de visita al médico” ha declarado el Prof. Varrassi. “Los datos más recientes muestran que muchos de los pacientes que sufren dolor, no reciben el tratamiento adecuado porque no está reconocido como un problema de salud importante por los sistemas sanitarios nacionales”.
La Organización Mundial de la Salud (OMS) estimó recientemente que aproximadamente un 80% de la población mundial no tiene acceso o éste es muy limitado a tratamientos para hacer frente al dolor moderado-severo. Asimismo, señaló que cada año unos 10 millones de personas en todo el mundo (incluidos los pacientes oncológicos y los enfermos con VIH/SIDA) al final de sus vidas sufren dolor sin recibir un tratamiento adecuado. Según se ha confirmado en esta reunión, hasta un 40% de los europeos con dolor crónico no reciben un correcto abordaje de esta enfermedad.
España, con todo, sigue gozando de un cierto privilegio en comparación con otros países europeos. En datos aportados por la Dra. Renata Villoro, especialista en Economía de la Salud y profesora en el Instituto Max Weber de Madrid, “mientras que la tasa media de dolor crónico se sitúa en el 19% en los países europeos (afectando a 75 millones de personas), España registra una prevalencia próxima al 12%”. Sin embargo, los costes sociales de la enfermedad siguen siendo enormes. A este respecto, la Dra. Villoro citó que de cerca de un 20% de los pacientes que experimentan un dolor crónico pierden su trabajo por ello y un 13% deben cambiar de empleo o de responsabilidad laboral por esta causa.

--Contribución de las iniciativas españolas
La iniciativa Hospital Sin Dolor, promovida por el Hospital Universitario La Paz de Madrid, ha sido una de las aportaciones españolas que más interés ha despertado en este foro. Dicho proyecto, ha permitido consolidar una Comisión de Dolor, que complementa a la Unidad del Dolor y que permite su abordaje multidisciplinar, integral y de calidad. Entre las actividades más significativas, como ha destacado el Dr. José María Muñoz y Ramón, miembro de la Comisión Hospital Sin Dolor de La Paz, “hemos distribuido unas 5.000 escalas de dolor estandarizadas entre todo el personal sanitario del centro. Esto posibilita una rápida y eficaz evaluación del dolor en todos nuestros enfermos, siendo un parámetro más de investigación y tratamiento en cualquiera de nuestras intervenciones”.
También ha suscitado un importante interés la experiencia promovida por la Fundación Josep Laporte y la Universidad Autónoma de Barcelona. La Universidad de Pacientes, en palabras de Sergi Blancafort, profesor en esta institución, “es una clara muestra del beneficio que se puede obtener con la instauración de programas de automanejo del dolor”. Con esta iniciativa se ha evidenciado el éxito del trabajo conjunto de administraciones sanitarias e instituciones, en colaboración con los pacientes, promocionando la responsabilidad de los enfermos en sus cuidados de salud, “lo cual optimiza la utilización de los servicios sanitarios y los recursos disponibles”.
La Plataforma SinDOLOR estuvo presente con la asistencia de los directores de las dos entidades que la constituyen, el Dr. Antón Herreros, director de FUINSA y el Dr. Guillermo Castillo, director de la Fundación Grünenthal. Esta iniciativa española ha llevado a cabo desde su fundación en 2008 diversas actividades encaminadas a concienciar, tanto a la Administración como a los profesionales sanitarios y a la sociedad en general, sobre la importancia de un correcto abordaje del dolor, tal y como ha hecho la EFIC con este Simposium en el ámbito europeo.

-La visión del paciente
También se ha tenido en cuenta la perspectiva del paciente en este foro. En este sentido, la directora del Foro Español de Pacientes, Joana Gabriele, ha puesto de relieve que “el dolor sigue siendo un problema relevante y no resuelto, que afecta a millones de personas en todo el mundo y que es por sí mismo un determinante de la salud global”.
Entre sus consecuencias, como ha indicado Emilia Altarriba, presidenta de la Fundación de Pacientes con Fibromialgia y Fatiga Crónica, destaca “la pérdida de autoestima, el impacto negativo en el ámbito laboral y social, así como sus repercusiones psicológicas. Con todo, añade, “una de las principales quejas de los pacientes con dolor crónico es que su trastorno no es reconocido como tal, siendo habitualmente incomprendidos, como sucede a las personas con fibromialgia”.