Report Chronic Pain Dutch Council for the Quality of Health Care

1. Report Chronic Pain Dutch Council for the Quality of Health Care Prof.dr. Frank Huygen Department Anesthesiology Painmedicine Erasmusmc Rotterdam The Netherlands

2. Disclosure European Scientific and educational advisoryboard "Change Pain" Global Scientific advisorboard Spinal Modulation (Spinal Modulation) Editorial board "Painpractice" (Wiley Blackwell) Editorial board "Praktische richtlijnen anesthesiologische pijnbestrijding" (Tijdstroom) Editorial board "Evidence based interventional painmedicine" (Wiley Blackwell) Teacher "educational programs neuropathic pain" (Pfizer) Chairman multidisciplinary guideline committee mechanical low back (orde van medisch specialisten) Chairman workgroup chronic pain Dutch council for the quality of health care Member workgroup development indicators "failed back surgery syndrome" (Zichtbare Zorg ziekenhuizen) Member program committee NeuroSIPE (Stichting Technische Wetenschappen)

3. Prevalence chronic pain in Europa Chronic pain -> 6 months -piain in the previous months -≥ 2 x a week - ≥ 5 on a 10 point NRS Breivik et al 2006 • Mean percentage chronic pain: 19% (n= 8815)

4. Prevalence chronic pain compared to other chronic diseases in the Netherlands Bala et al 2011

5. Chronic pain – mostly a known cause Breivik et al 2006

6. Involved healthcare professionals Breivik et al 2006

7. Dutch Council for the Quality of Health Care www.regieraad.nl Established in 2009 by the Minister of Health to promote high-quality care in the Netherlands. The working area of the Council covers prevention, cure and long-term care. The Council sets tasks for advisory and research activities and gives recommendations. The activities are mainly aimed at increasing safety, enhancing the patient/client perspective and stimulating the efficacy of care.

8. Council –Chronic pain November 2010 Presentation data epidemiology of chronic pain in the Netherlands January 2011 Initiation workgroup chronic pain council April 2011 Pressure cooker session September 2011 Presentation report workgroup to council

9. Presentation data epidemiology of chronic pain in the Netherlands Bala et al 2011 Prevalence chronic pain > other chronic diseases, however it gets less attention Diagnosis and treatment have a great variety and are often inadequate Chronic pain has a big impact on quality of life and functionality and has high direct and indirect costs

10. Workgroup chronic pain council

11. Workgroup chronic pain council Members of the workgroup are invited based on: Individual title Longterm approved involvement in chronic pain Representative for different stakeholders

12. Pressure cooker session Discussion based on “statements” brought in by participants

13. Statements Chronic pain is a disease in its own right A national guideline on chronic pain could improve diagnosis and treatment A mechanism based treatment is preferred Besides attention for the cause and treatment of pain, there should be more attention for perception and behaviour

14. Statements (un)justified fear for opioid dependency results in undertreatment There is not enough attention for pain medicine in the educational programs for healthcare professionals Insurance/social doctors are not well enough equipped to estimate chronic pain

15. Statements There are huge health care and socio-economic costs in chronic pain Chronic pain is so prevalent that disease management/chain care is necessary to come to a solution. The first line plays a key role in prevention and treatment A discipline oriented care system is an obstruction for a solution of the pain problem. Pain medicine will benefit from a patient oriented approach Profits can be gained with prevention and early recognition and treatment of chronic pain

16. Discussion Broadening and deepening of pain medicine is necessary But On short term the biggest profit is gained by simple interventions in non-pain specialists

17. Conclusion and recommendations Put chronic pain on the agenda of the council in 2012 Use the workgroup chronic pain as a platform which together with partners in the field searches for solutions to improve care of patients with chronic pain

18. Conclusions and recommendations • Develop together with the scientific associations and other stakeholders a national guideline on chronic pain • Starting questions for such a guideline would be: • - Definition and classification system • - Prescription of analgesics, therapy compliance, prevention of • addiction • - Algorithm for diagnosis and treatment • - Use of psychometric instruments in diagnosis • - Prevention • - Impairment in chronic @@@

19. Conclusions and recommendations Stimulate education and training in pain medicine Stimulate the development of research programs for chronic pain

20. Comment round Asked for attention for specific groups, e.g. chronic pain in the eldery Asked about the responsibilities of different scientific associations

21. 1st step Publication report chronic pain by council Consultation General practitioners association about development guideline chronic pain

22. 1st Step Handover report to chairman of permanent parliamentary commission

23. Thank you for your attention Discussion?