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CPPC Co-Chair reflects of the 1st EFIC Topical Symposium

CPPC Co-Chair reflects of the 1st EFIC Topical Symposium

3rd October 2016

Reflections on the 1st EFIC Topical Symposium: Acute and Chronic Joint Pain, held in Dubrovnik, Croatia, 21-23 September 2016

Apart from being the first Topical Symposium held by EFIC, the European Pain Federation, the event also marked the first formal collaboration between EFIC and EULAR.  I participated in my capacity as International Liaison Officer for EULAR, presenting on Patient Empowerment; and Prof Maurizio Cutolo, EULAR Past President, gave the opening lecture.

Prof Cutolo's presentation stimulated great interest, dealing with Circadian pain management in chronic rheumatic inflammatory disease. The evidence presented illustrated how the human body performs a 'reboot' during the night, the immune system sending its 'police officers and firefighters' to attack unhealthy cells in well people, and healthy cells in people with rheumatic disease. This was clearly of great interest to an audience comprising predominantly pain doctors, together with some orthopaedic surgeons and representatives of other disciplines.

Other highlights included workshops on surgical pain, led by 2 of the most renowned leaders in the field, Henrik Kehlet and Winfried Meissner.

Dr Kehlet has been working in Copenhagen for many years and is perhaps the most well-known surgeon among anesthesiologists around the world due to his substantial contributions toward the understanding of surgical pathophysiology. In the UK and many other countries he is recognised as the founder of the Enhanced Recovery pathway, which has provided 'win-wins' to patients and healthcare systems in many countries now by accelerating the pace of the patient pathway, reducing admission periods (and therefore costs) whilst delivering patient experience and outcome measures which are as good or better than traditional surgical pathways.

He continues to perform groundbreaking work and, at this meeting, presented new, procedure-specific evidence for optimal analgesia in joint surgery. This included the PROSPECT studies and the use of prospective patient databases. He looked specifically at hip and knee replacement, and his summary of the evidence concluded that there was little or no evidence for the routine use of opioids in these interventions, especially without clear evidence of side effects.

In the UK, we at the Chronic Pain Policy Coalition are addressing the need for chronic pain patients to have an annual review of their management regime, including use of opioids, and in policy terms this is part of a wider movement to greater opioid sparing' where appropriate.

There are other potential policy implications here, as there is clearly an evidence based need to develop an approach to surgery which proactively tackles post surgical pain before the surgery has taken place, the way this is done being variable according to the nature of the specific intervention in each case.

Professor Meisner, from the Jena University Hospital, Germany, is well know for the Pain Out initiative: see Here he illustrated how to optimise the organisation of peri operative pain management.

My own presentation had the objectives of challenging some common perceptions of 'Patient Empowerment'. This is a term sometimes more used in the breach than the observance, I find, as commitments to Shared Decision Making rub shoulders with more traditional approaches to care, based on clinician led direction.  So my aim was to better define our terms: for example, is 'patient' really the right word for someone with a long term condition such as chronic pain, who manages that condition 24/7 but is only in a clinic a tiny amount of their life?

But more than that I wanted to offer concrete examples of what patient empowerment means in practice. To this end, I drew on examples from my work with NHS England, developing a patient booklet on Enhanced Recovery in close consultation with patients and carers; from EULAR's work in building a strong patient network via PARE (Patients with Arthritis and Rheumatism Europe), to collaborate with clinicians and health professionals, as well as provide an authoritative patient voice in its own right; and from public affairs / political work carried out by the Chronic Pain Policy Coalition in the UK, and EULAR at EU level.

I hope these initiatives and achievements generated by these projects and organisations demonstrate that when patient empowerment is done well, it delivers better patient experience, better patient outcomes and better public policy for both patients and healthcare professionals.

I would be very happy to share my slides and / or hear from anyone interested in discussing this matter further.

As EULAR PARE reminds people who are discussing issues that affect the lives of patients, 'Nothing about us without us!'

It's a demand, but a very reasonable one.

Personal conclusions:

  • High attendance and mixed audience reflects strong interest in Joint Pain, with many expressing interest in a meeting on this topic to be held regularly
  • Fast developing interest in seeking to change practice, doing more pre-operatively to optimise / minimise post-operative pain
  • Ongoing interest in use of opioids: better targeting of their use, to avoid over-prescribing (a major policy issue) and the personal consequences which can follow
  • Growing recognition that an MTD approach is the only way to handle the surgical pathway effectively
  • The patient is the most important member of the MDT, and needs to be appropriately empowered to play an active part in that pathway.

Neil Betteridge


26 September 2016


Neil Betteridge, Co-Chair, Chronic Pain Policy Coalition