The major objectives of the CHANGE
PAIN International Advisory Board are to enhance understanding of
chronic pain and to develop strategies for improving
pain management. At its second meeting, in November 2009, evidence was presented that around one person in five in Europe and the USA experiences
chronic pain, and the delay before referral to a
pain specialist is often several years. Moreover, physicians' pharmacological approach to
chronic pain is inconsistent, as evidenced by the huge variation in treatment between different European countries. It was agreed that efficient communication between physician and patient is essential for effective
pain management, and that efficacy/side-effect balance is a key factor in choosing an
analgesic agent. The multifactorial nature of
chronic pain produces various physical and psychological symptoms, so the management of chronic
pain should be tailored to the individual. Pharmacological
therapy must be matched to the causative mechanisms responsible, or it is likely to prove ineffective and risk the development of a 'vicious circle'; doses are increased because of inadequate
pain relief, but this increases side-effects so doses are reduced,
pain relief is then inadequate, so doses are increased, and so on.
Pain management decisions should not therefore be based solely on the severity of
pain. Based on the concept of individual treatment targets (ITT), the CHANGE
PAIN Scale was adopted - a simple, user-friendly assessment tool to improve communication between physician and patient. The 11-point NRS enables the patient to rate the current
pain intensity and to set a realistic individual target level. On the reverse are six key parameters affecting the patient's quality of life; clinicians simply need to agree with patients whether improvement is needed in each one. Regular use can establish the efficacy and tolerability of
pain management, and the rate of progress towards individual treatment targets.