EU health policy should reflect realities
Chronic diseases get a lot of attention from EU policymakers, but chronic pain is just as big a problem, and practitioners should learn how to handle it, writes Professor Hans Kress.
Professor Hans G. Kress is the President of the European Pain Federation, EFIC.
Chronic conditions have been the focus of EU policy discussions for some time, whilst pain has been overlooked, despite being one of the most frequent chronic conditions doctors encounter in clinical practice. One in five adults in Europe is affected by chronic pain – or approximately 75 million people.
A recent Europe-wide study looking into pain education provision in undergraduate medical schools in Belgium, Bulgaria, Denmark, France, Germany, Ireland, Italy, the Netherlands, Poland, Portugal, Romania, Spain, Sweden, Switzerland and the UK shows an alarming lack of dedicated teaching on pain. Worryingly, the study showed that at best, we are educating our medical students for only 0.2 of their entire studies – or on average 12 hours – on how to deal with pain.
EU Health Ministers agree with the World Health Organisation (WHO) that 86% of mortality in the European Region is currently caused by chronic diseases that could – with the proper systems in place – be avoided, or at the very least better treated. However, agreement on the need for action has yet to lead to any significant efforts to stem the growth of these diseases.
Earlier this month, the Senior Level Working Party on Public Health met for a discussion to feed into the most recent meeting of EU Health Ministers. The Senior Level meeting addressed, amongst other things, the reflection process on innovative approaches for chronic diseases in public health. On the agenda since 2010, these discussions have made an attempt to further advance the debate by reviewing the work performed in the EU over the last year.
Discussions have been protracted because the Commission is reluctant to acknowledge one disease area over any other as priority. On top of this, Member States are likewise hesitant to identify a single health system’s approach to care that would suggest a silver bullet for addressing the myriad conditions that fall under the category of ‘chronic’. I fear such a focus of the debate will lead to recommendations that lack what doctors such as myself have been demanding for a while: policy that gives us better ways of caring for our patients, which in turn will require policy that ensures better ways of training our doctors.
As a healthcare professional and medical school professor, I have a vested interest in ensuring undergraduate medical education is reflective of health realities. As a Professor of Anaesthesiology, Intensive Care and Pain Medicine and President of the European Pain Federation, EFIC, I am deeply concerned by the fact that a specific condition such as chronic pain still affects one in five adults in Europe, yet remains poorly managed and under-treated. Lack of knowledge about pain among physicians is one of the key barriers to effective pain treatment and management; especially as it is widely acknowledged that many healthcare professionals are not educated and familiar with best practice medicine.
The APPEAL (Advancing the Provision of Pain Education And Learning) study, launched on 10 October at the annual congress of the European Pain Federation in Florence, makes a number of recommendations as to how we might be able to help our future doctors. In order to cope with the significant burden of chronic pain, a number of changes will need to be made, including establishing a European framework for pain education, introducing compulsory pain teaching to all undergraduate medical students and improving documentation of pain teaching.
As a doctor who treats patients suffering from the often debilitating effects of pain, and one who understands the intricacies of pain treatment and management for patients and medical professionals alike, I appeal to EU Health Ministers to take a more holistic approach to solving one of Europe’s most pressing public health challenges. By addressing not just the conditions included to-date under ‘chronic diseases’, but also chronic pain and future doctors’ education on pain, the Council could deliver real value to Europe’s pain sufferers, doctors and health systems.