title: Make a CHANGE: optimising communication and pain management decisions.
abstract: 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.
authors.affiliation: Schmerz- und Palliativzentrum, Göppingen, Germany.
authors.forename: Gerhard
authors.initials: G
authors.lastname: Müller-Schwefe
authors.forename: Wolfgang
authors.initials: W
authors.lastname: Jaksch
authors.forename: Bart
authors.initials: B
authors.lastname: Morlion
authors.forename: Eija
authors.initials: E
authors.lastname: Kalso
authors.forename: Michael
authors.initials: M
authors.lastname: Schäfer
authors.forename: Flaminia
authors.initials: F
authors.lastname: Coluzzi
authors.forename: Frank
authors.initials: F
authors.lastname: Huygen
authors.forename: Magdalena
authors.initials: M
authors.lastname: Kocot-Kepska
authors.forename: Ana Cristina
authors.initials: AC
authors.lastname: Mangas
authors.forename: Cesar
authors.initials: C
authors.lastname: Margarit
authors.forename: Karsten
authors.initials: K
authors.lastname: Ahlbeck
authors.forename: Philippe
authors.initials: P
authors.lastname: Mavrocordatos
authors.forename: Eli
authors.initials: E
authors.lastname: Alon
authors.forename: Beverly
authors.initials: B
authors.lastname: Collett
authors.forename: Dominic
authors.initials: D
authors.lastname: Aldington
authors.forename: Andrew
authors.initials: A
authors.lastname: Nicolaou
authors.forename: Joseph
authors.initials: J
authors.lastname: Pergolizzi
authors.forename: Giustino
authors.initials: G
authors.lastname: Varrassi
mesh_terms: D000328:Adult; D002138:Calibration; D002755:Choice Behavior / Q000502:physiology; D003142:Communication; D003657:Decision Making / Q000502:physiology*; D006801:Humans; D008954:Models, Biological; D010146:Pain / Q000453:epidemiology; D059408:Pain Management; D010147:Pain Measurement / Q000379:methods; D010353:Patient Education as Topic / Q000592:standards*; D010817:Physician-Patient Relations; D017410:Practice Guidelines as Topic; D012107:Research Design