There was good and bad news for analgesia-focused pharmaceutical companies at the European Pain Federation (EFIC) Congress, which was held in Florence.
EFIC president Hans Kress of the Medical University of Vienna said that for many patients, life without pain is only possible with use of prescription opioids, however access to these drugs varies enormously. In many countries they are practically unobtainable, whilst in others they are overprescribed and he called for more rational use of opioids.
“Opioid drugs are most effective as analgesics; they are now prescribed 7.5 times more often than they were in 1990. Annual consumption worldwide has climbed from 7.67mg to 58.11mg per capita,” said Prof Kress but within the WHO European Region, there were major treatment gaps, he added. Although between 1990 and 2010 there was an almost 15-fold increase in the use of opioids, from 9.2mg to 135.11mg per capita, this statistical average masks some striking variations.
Whilst in the three European countries with the highest consumption – Denmark, Austria and Germany – the average per capita prescriptions were 469mg, 413mg and 375mg respectively (2010 data), in other countries not even the most common drugs used against cancer pain were available. In countries such as Kazakhstan (0.05mg per capita) and Tajikistan (0.04mg per capita) the frequency of use of opioids remains "vanishingly low".
Inside the EU, Poland, Lithuania and Latvia have the lowest rates of opioid prescription. “There are obviously unmet medical needs, and healthcare policy makers can no longer be allowed to ignore them while millions of people are condemned to lives of agonising pain. This is medically and ethically unacceptable,” said Prof Kress.
Lack of teaching about pain in med schools
Despite one in five EU citizens suffering chronic pain, doctors across Europe are woefully under-educated about pain management, according to results from a new EU survey presented at EFIC.
The findings from APPEAL (Advancing the Provision of Pain Education And Learning), the first Europe-wide study on pain education, show an "alarming" lack of dedicated teaching about pain in undergraduate medical schools in Europe, say researchers.
The APPEAL study, which was funded by Mundipharma, involved 242 undergraduate medical schools in 15 EU countries and found that 82% of these schools have no dedicated courses on pain that are compulsory for all students.
"With the exception of France and a handful of schools in other countries, which have made headway in the provision of pain teaching, there is a striking lack of dedicated teaching on pain across Europe," said the British Pain Society's Emma Briggs. "This raises the question as to whether the provision of pain education in undergraduate medical studies is fit for purpose to address the current and growing unmet public health need."
Based on the findings, the APPEAL researchers recommend the introduction of compulsory pain teaching for all EU undergraduate medical students and the establishment of a European framework for pain education.