title: A holistic approach to chronic pain management that involves all stakeholders: change is needed.
abstract: Chronic pain affects a large proportion of the population, imposing significant individual distress and a considerable burden on society, yet treatment is not always instituted and/or adequate. Comprehensive multidisciplinary management based on the biopsychosocial model of pain has been shown to be clinically effective and cost-efficient, but is not widely available. A literature review of stakeholder groups revealed many reasons for this, including: i) many patients believe healthcare professionals lack relevant knowledge, and consultations are rushed, ii) general practitioners consider that pain management has a low priority and is under-resourced, iii) pain specialists cite non-adherence to evidence-based treatment, sub-optimal prescribing, and chronic pain not being regarded as a disease in its own right, iv) nurses', pharmacists' and physiotherapists' skills are not fully utilized, and v) psychological therapy is employed infrequently and often too late. Many of the issues relating to physicians could be addressed by improving medical training, both at undergraduate and postgraduate levels - for example, by making pain medicine a compulsory core subject of the undergraduate medical curriculum. This would improve physician/patient communication, increase the use of standardized pain assessment tools, and allow more patients to participate in treatment decisions. Patient care would also benefit from improved training for other multidisciplinary team members; for example, nurses could provide counseling and follow-up support, psychologists offer coping skills training, and physiotherapists have a greater role in rehabilitation. Equally important measures include the widespread adoption of a patient-centered approach, chronic pain being recognized as a disease in its own right, and the development of universal guidelines for managing chronic non-cancer pain. Perhaps the greatest barrier to improvement is lack of political will at both national and international level. Some powerful initiatives and collaborations are currently lobbying policy-making bodies to raise standards and reduce unnecessary pain - it is vital they continue.
authors.affiliation: a a Department of Special Anaesthesia and Pain Therapy , Medizinische Universität/AKH Wien , Vienna , Austria.
authors.forename: Hans-Georg
authors.initials: HG
authors.lastname: Kress
authors.affiliation: b b Hampshire Hospitals NHS Trust , Winchester , Hants , UK.
authors.forename: Dominic
authors.initials: D
authors.lastname: Aldington
authors.affiliation: c c Universitätsspital Zurich , Zurich , Switzerland.
authors.forename: Eli
authors.initials: E
authors.lastname: Alon
authors.affiliation: d d Santa Maria General Hospital , Terni , Italy.
authors.forename: Stefano
authors.initials: S
authors.lastname: Coaccioli
authors.affiliation: e e University Hospitals of Leicester NHS Trust , Leicester , UK.
authors.forename: Beverly
authors.initials: B
authors.lastname: Collett
authors.affiliation: f f Department of Medical and Surgical Sciences and Biotechnologies , Sapienza University of Rome , Italy.
authors.forename: Flaminia
authors.initials: F
authors.lastname: Coluzzi
authors.affiliation: g g University Hospital , Rotterdam , The Netherlands.
authors.forename: Frank
authors.initials: F
authors.lastname: Huygen
authors.affiliation: h h Wilhelminenspital der Stadt Wien , Austria.
authors.forename: Wolfgang
authors.initials: W
authors.lastname: Jaksch
authors.affiliation: i i Pain Clinic, Department of Anaesthesiology, Intensive Care and Pain Medicine, University of Helsinki, and Helsinki University Hospital , Finland.
authors.forename: Eija
authors.initials: E
authors.lastname: Kalso
authors.affiliation: j j Department of Pain Research and Treatment , Collegium Medicum Jagiellonian University , Kraków , Poland.
authors.forename: Magdalena
authors.initials: M
authors.lastname: Kocot-Kępska
authors.affiliation: k k UNIDOR, Centro Hospitalar de Leiria , Leiria , Portugal.
authors.forename: Ana Cristina
authors.initials: AC
authors.lastname: Mangas
authors.affiliation: l l Hospital General Universitario de Alicante , Spain.
authors.forename: Cesar Margarit
authors.initials: CM
authors.lastname: Ferri
authors.affiliation: m m Clinique Cecil , Lausanne , Switzerland.
authors.forename: Philippe
authors.initials: P
authors.lastname: Mavrocordatos
authors.affiliation: n n University Hospitals Leuven , Belgium.
authors.forename: Bart
authors.initials: B
authors.lastname: Morlion
authors.affiliation: o o Schmerz- und Palliativzentrum , Göppingen , Germany.
authors.forename: Gerhard
authors.initials: G
authors.lastname: Müller-Schwefe
authors.affiliation: p p St. Georges Hospital , London , UK.
authors.forename: Andrew
authors.initials: A
authors.lastname: Nicolaou
authors.affiliation: q q Hospital Universitario de la Princesa , Madrid , Spain.
authors.forename: Concepción Pérez
authors.initials: CP
authors.lastname: Hernández
authors.affiliation: r r Hôpitaux de Saint-Denis , Paris , France.
authors.forename: Patrick
authors.initials: P
authors.lastname: Sichère
mesh_terms: D059350:Chronic Pain / Q000175:diagnosis / Q000628:therapy; D006694:Holistic Health / Q000592:standards*; D006801:Humans; D020380:Needs Assessment; D059408:Pain Management / Q000379:methods; D010147:Pain Measurement / Q000379:methods; D010346:Patient Care Management / Q000592:standards; D011580:Psychological Techniques
keywords: Biopsychosocial model; Chronic pain; Improved training; Multidisciplinary management; Patient-centered approach; Political will; Standardized pain assessment tools