The European Federation of the International Association for the Study of Pain (IASP) Chapters (EFIC), a multidisciplinary professional organisation in the field of pain research and medicine, launched its European week against pain (EWAP) on 10 October. The campaign is dedicated to raising awareness on chronic back pain, including the design of a new and appropriate classification of this condition, the promotion of better research, and the development of more effective treatments.
According to Hans Georg Kress, EFIC president, chronic back pain is “a silent epidemic affecting tens of millions of Europeans and heavily underestimated by health professionals as well as decision makers in research and health care politics.” Maarten van Kleef, EWAP coordinator, considered that it was necessary to raise awareness about the “wholly unsatisfactory, unserious, and unscientific,” categorisation of 95% of back pain as “non-specific.” The pain specialists stressed that a new classification is needed if there was to be intensified research into customised therapies for the many different types of chronic back pain.
Kress, who heads the Department for Special Anaesthesia and Pain Therapy at Vienna Medical University, Austria, said a sustained campaign would be backed up by a broad variety of initiatives in all of the 35 countries covered by EFIC. Detailed material and information leaflets on diagnosis and treatment recommendations of chronic back pain may be found on EFIC’s website www.efic.org. The intention is to spread a “critical mass” of information: “Only then will we see real change in public consciousness and an appropriate refocusing of priorities in health policy,” he commented.
According to EFIC’s figures, about one fifth of the European population is suffering from various syndromes of chronic pain, 63% of them from chronic back pain. The lifetime prevalence is 30 to 50% for cervical pain, 16 to 20% for thoracic pain and over 70% for lower back pain.
EFIC also states that about 80% of patients on sick leave with non-specific back pain are back at work within a few weeks. “So it is wrongly assumed, even by health professionals that they have recovered. But for well over half of them, about 65%, the pain does not disappear at all. It becomes chronic,” explained van Kleef, Head of the Department of Anaesthesiology and Pain Medicine at Maastricht University Medical Centre, The Netherlands. “Back pain will then persist in almost half of all patients for more than five years. Many of them will suffer moderate or severe pain despite the treatments they received according to current medical knowledge. Yet even most primary care providers and health care decision-makers are unaware of this, with the result that this haunting condition is generally under-estimated.”
Both Kress and van Kleef argue that use of the term “non-specific”, which is assigned to the 95% of varieties of back pain not diagnosed as caused by infection, osteoporosis, cancer, or vertebral fracture, has in fact blocked the research that is needed to develop customised preventive and therapy programmes.
“The lack of terminological subdivisions has led to an astonishing deficiency of understanding non-specific back pain and of adequate options for managing it,” said van Kleef, who pointed to the considerable diversity of possible locations and underlying pain mechanisms – such as pain originating from disc disorders, pain originating from the degeneration of the small joints directing the movements of the spine, or pain originating from a degeneration of the sacroiliac joint.
“We urgently need to formulate reliable diagnostic criteria for each of these subgroups,” said van Kleef. “The specific mechanisms of each need to be explored if we are to offer adequate differential patient management strategies.”
EFIC’s plan of action to fight chronic back pain is ambitious indeed, as van Kleef insists, and it is “not just another plan of action but a dense and thoroughly planned sequence of multimodal initiatives at all social levels involved in health care.”
EFIC expects to extend this week’s campaign to a year’s initiative to be called the European year against back pain.