The individual and societal burden of chronic pain in Europe: the case for strategic prioritisation and action to improve knowledge and availability of appropriate care

BMC Public Health

Tony O’Brien¹  Elon Eisenberg³  Harald Breivik² 

[1] Marymount University Hospice & Cork University Hospital, Cork, Ireland;Department of Pain Management and Research, University Hospital and University of Oslo, Oslo, Norway;Institute of Pain Medicine, Rambam Health Care Campus, Technion-Israel, Institute of Technology, Haifa, Israel

关键词: Drug toxicity;    Pain burden;    Opioids;    Pain management;    Cost of illness;    Quality of life;    Chronic pain;   

Others  :  1161395
DOI  :  10.1186/1471-2458-13-1229

 received in 2013-04-05, accepted in 2013-12-11,  发布年份 2013

【 摘 要 】

Background

Chronic pain is common in Europe and elsewhere and its under treatment confers a substantial burden on individuals, employers, healthcare systems and society in general. Indeed, the personal and socioeconomic impact of chronic pain is as great as, or greater, than that of other established healthcare priorities. In light of review of recently published data confirming its clinical and socioeconomic impact, this paper argues that chronic pain should be ranked alongside other conditions of established priority in Europe. We outline strategies to help overcome barriers to effective pain care resulting in particular from deficiencies in education and access to interdisciplinary pain management services. We also address the confusion that exists between proper clinical and scientific uses of opioid medications and their potential for misuse and diversion, as reflected in international variations in the access to, and availability of, these agents.

Discussion

As the economic costs are driven in part by the costs of lost productivity, absenteeism and early retirement, pain management should aim to fully rehabilitate patients, rather than merely to relieve pain. Accredited education of physicians and allied health professionals regarding state-of-the-art pain management is crucial. Some progress has been made in this area, but further provision and incentivization is required. We support a tiered approach to pain management, whereby patients with pain uncontrolled by non-specialists are able to consult a physician with a pain competency or a specialist in pain medicine, who in turn can recruit the services of other professionals on a case-by-case basis. A fully integrated interdisciplinary pain service should ideally be available to patients with refractory pain. Governments and healthcare systems should ensure that their policies on controlled medications are balanced, safeguarding public health without undue restrictions that compromise patient care, and that physician education programmes support these aims.

Summary

Strategic prioritization and co-ordinated actions are required nationally and internationally to address the unacceptable and unnecessary burden of uncontrolled chronic pain that plagues European communities and economies. An appreciation of the ‘return on investment’ in pain management services will require policymakers to adopt a long-term, cross-budgetary approach.

【 授权许可】

   
2013 Breivik et al.; licensee BioMed Central Ltd.

【 图 表 】

Figure 1.

【 参考文献 】

• [1]Breivik H, Collett B, Ventafridda V, Cohen R, Gallacher D: Survey of chronic pain in Europe: prevalence, impact on daily life, and treatment. Eur J Pain 2006, 10:287-333.
• [2]Tsang A, Von Korff M, Lee S, Alonso J, Karam E, Angermeyer MC, Borges GL, Bromet EJ, Demytteneare K, de Girolamo G, de Graaf R, Gureje O, Lepine JP, Haro JM, Levinson D, Oakley Browne MA, Posada-Villa J, Seedat S, Watanabe M: Common chronic pain conditions in developed and developing countries: gender and age differences and comorbidity with depression-anxiety disorders. J Pain 2008, 9:883-891.
• [3]Reid KJ, Harker J, Bala MM, Truyers C, Kellen E, Bekkering GE, Kleijnen J: Epidemiology of chronic non-cancer pain in Europe: narrative review of prevalence, pain treatments and pain impact. Curr Med Res Opin 2011, 27:449-462.
• [4]Patel AS, Farquharson R, Carroll D, Moore A, Phillips CJ, Taylor RS, Barden J: The impact and burden of chronic pain in the workplace: a qualitative systematic review. Pain Pract 2012, 12:578-589.
• [5]International Association for the Study of Pain and delegates of International Pain Summit 2010: Declaration that Access to Pain Management Is a Fundamental Human Right. 2010. [http://www.iasp-pain.org/Content/NavigationMenu/Advocacy/DeclarationofMontr233al/default.htm; webcite accessed 27 December 2013]
• [6]World Medical Association: WMA Resolution on the Access to Adequate Pain Treatment. [Adopted by the 62nd WMA General Assembly, Montevideo, Uruguay, October 2011] [http://www.wma.net/en/30publications/10policies/p2/index.html; webcite accessed 27 December 2013]
• [7]Radbruch L, de Lima L, Lohmann D, Gwyther E, Payne S: The Prague Charter: urging governments to relieve suffering and ensure the right to palliative care. Palliat Med 2013, 27:101-102.
• [8]Christopher MJ: It's time for bioethics to see chronic pain as an ethical issue. Am J Bioeth 2011, 11:3-4.
• [9]OPENMinds: Pain in Europe – a public health priority. A strategy to better diagnose and manage chronic pain and the responsible use of opioids. Cambridge: Mundipharma; 2011.
• [10]Fernández-de-las-Peñas C, Hernández-Barrera V, Alonso-Blanco C, Palacios-Ceña D, Carrasco-Garrido P, Jiménez-Sánchez S, Jiménez-García R: Prevalence of neck and low back pain in community-dwelling adults in Spain: a population-based national study. Spine (Phila Pa 1976) 2011, 36:E213-E219.
• [11]Azevedo LF, Costa-Pereira A, Mendonça L, Dias CC, Castro-Lopes JM: Epidemiology of chronic pain: a population-based nationwide study on its prevalence, characteristics and associated disability in Portugal. J Pain 2012, 13:773-783.
• [12]Raftery MN, Sarma K, Murphy AW, De la Harpe D, Normand C, McGuire BE: Chronic pain in the Republic of Ireland–community prevalence, psychosocial profile and predictors of pain-related disability: results from the Prevalence, Impact and Cost of Chronic Pain (PRIME) study, part 1. Pain 2011, 152:1096-1103.
• [13]Kurita GP, Sjøgren P, Juel K, Højsted J, Ekholm O: The burden of chronic pain: a cross-sectional survey focussing on diseases, immigration, and opioid use. Pain 2012, 153:2332-2338.
• [14]Landmark T, Romundstad P, Dale O, Borchgrevink PC, Vatten L, Kaasa S: Chronic pain: one-year prevalence and associated characteristics the HUNT pain study). Scand J Pain 2013, 4:182-187.
• [15]Gunnarsdottir S, Ward SE, Serlin RC: A population based study of the prevalence of pain in Iceland. Scandinavian Journal of Pain 2010, 1:151-157.
• [16]Taxonomy Working Group: Classification of Chronic Pain. 2nd edition. Seattle: IASP-Press; 1994.
• [17]Løyland B, Miaskowski C, Wahl AK, Rustøen T: Prevalence and characteristics of chronic pain among long-term social assistance recipients compared to the general population in Norway. Clin J Pain 2010, 26:624-630.
• [18]Gianni W, Madaio RA, Di Cioccio L, D'Amico F, Policicchio D, Postacchini D, Franchi F, Ceci M, Benincasa E, Gentili M, Zuccaro SM: Prevalence of pain in elderly hospitalized patients. Arch Gerontol Geriatr 2010, 51:273-276.
• [19]Onder G, Carpenter I, Finne-Soveri H, Gindin J, Frijters D, Henrard JC, Nikolaus T, Topinkova E, Tosato M, Liperoti R, Landi F, Bernabei R, SHELTER project: Assessment of nursing home residents in Europe: the Services and Health for Elderly in Long TERm care (SHELTER) study. BMC Health Serv Res 2012, 12:5. BioMed Central Full Text
• [20]Bos JT, Frijters DH, Wagner C, Carpenter GI, Finne-Soveri H, Topinkova E, Garms-Homolová V, Henrard JC, Jónsson PV, Sørbye L, Ljunggren G, Schroll M, Gambassi G, Bernabei R: Variations in quality of home care between sites across Europe, as measured by Home Care Quality Indicators. Aging Clin Exp Res 2007, 19:323-329.
• [21]Gerbershagen HJ, Ozgür E, Straub K, Dagtekin O, Gerbershagen K, Petzke F, Heidenreich A, Lehmann KA, Sabatowski R: Prevalence, severity, and chronicity of pain and general health-related quality of life in patients with localized prostate cancer. Eur J Pain 2008, 12:339-350.
• [22]van den Beuken-van Everdingen MH, de Rijke JM, Kessels AG, Schouten HC, van Kleef M, Patijn J: High prevalence of pain in patients with cancer in a large population-based study in The Netherlands. Pain 2007, 132:312-320.
• [23]van den Beuken-van Everdingen MH, de Rijke JM, Kessels AG, Schouten HC, van Kleef M, Patijn J: Prevalence of pain in patients with cancer: a systematic review of the past 40 years. Ann Oncol 2007, 18:1437-1449.
• [24]Scholten W, Nygren-Krug H, Zucker HA: The World Health Organization paves the way for action to free people from the shackles of pain. Anesth Analg 2007, 105:1-4.
• [25]Deandrea S, Montanari M, Moja L, Apolone G: Prevalence of undertreatment in cancer pain. A review of published literature. Ann Oncol 2008, 19:1985-1991.
• [26]Breivik H, Cherny N, Collett B, de Conno F, Filbet M, Foubert AJ, Cohen R, Dow L: Cancer-related pain: a pan-European survey of prevalence, treatment, and patient attitudes. Ann Oncol 2009, 20:1420-1433.
• [27]Lowney AC, Lowney EL, Murphy M, O'Brien T, Cassetly L, Plant WD: Self-reported symptom burden in prevalent haemodialysis patients in south-west of Ireland. Palliat Med 2012, 26:576.
• [28]Fredheim OM, Kaasa S, Fayers P, Saltnes T, Jordhøy M, Borchgrevink PC: Chronic non-malignant pain patients report as poor health-related quality of life as palliative cancer patients. Acta Anaesthesiol Scand 2008, 52:143-148.
• [29]Løyland B, Miaskowski C, Paul SM, Dahl E, Rustøen T: The relationship between chronic pain and health-related quality of life in long-term social assistance recipients in Norway. Qual Life Res 2010, 19:1457-1465.
• [30]Raftery MN, Ryan P, Normand C, Murphy AW, de la Harpe D, McGuire BE: The economic cost of chronic noncancer pain in Ireland: results from the PRIME study, part 2. J Pain 2012, 13:139-145.
• [31]Boonstra AM, Reneman MF, Stewart RE, Post MW, Schiphorst Preuper HR: Life satisfaction in patients with chronic musculoskeletal pain and its predictors. Qual Life Res 2013, 22:93-101.
• [32]West C, Usher K, Foster K, Stewart L: Chronic pain and the family: the experience of the partners of people living with chronic pain. J Clin Nurs 2012, 21:3352-3360.
• [33]Elliott TE, Renier CM, Palcher JA: Chronic pain, depression, and quality of life: correlations and predictive value of the SF-36. Pain Med 2003, 4:331-339.
• [34]Linton SJ, Bergbom S: Understanding the link between depression and pain. Scand J Pain 2011, 2:47-54.
• [35]Nicholas MK: Depression in people with pain: There is still work to do: Commentary on ‘Understanding the link between depression and pain’. Scand J Pain 2011, 2:45-46.
• [36]Langley PC, Van Litsenburg C, Cappelleri JC, Carroll D: The burden associated with neuropathic pain in Western Europe. J Med Econ 2013, 16:85-95.
• [37]Itz CJ, Geurts JW, van Kleef M, Nelemans P: Clinical course of non-specific low back pain: a systematic review of prospective cohort studies set in primary care. Eur J Pain 2013, 17:5-15.
• [38]Saastamoinen P, Laaksonen M, Lahelma E, Leino-Arjas P: The effect of pain on sickness absence among middle-aged municipal employees. Occup Environ Med 2009, 66:131-136.
• [39]Saastamoinen P, Laaksonen M, Kääriä SM, Lallukka T, Leino-Arjas P, Rahkonen O, Lahelma E: Pain and disability retirement: a prospective cohort study. Pain 2012, 153:526-531.
• [40]Nielsen CS: Pain in Norway. Chronic Pain is strongly associated with work disability. Scand J Pain 2013, 4:180-181.
• [41]Christensen J, Bilde L, Gustavsson A: Socio-economic consequences of pain-intensive diseases in Denmark. Danish Institute for Health Services Research: Copenhagen; 2011.
• [42]Gaskin DJ, Richard P: The economic costs of pain in the United States. J Pain 2012, 13:715-724.
• [43]Gustavsson A, Bjorkman J, Ljungcrantz C, Rhodin A, Rivano-Fischer M, Sjolund KF, Mannheimer C: Socio-economic burden of patients with a diagnosis related to chronic pain - Register data of 840,000 Swedish patients. Eur J Pain 2012, 16:289-299.
• [44]Dagenais S, Caro J, Haldeman S: A systematic review of low back pain cost of illness studies in the United States and internationally. Spine J 2008, 8:8-20.
• [45]Juniper M, Le TK, Mladsi D: The epidemiology, economic burden, and pharmacological treatment of chronic low back pain in France, Germany, Italy, Spain and the UK: a literature-based review. Expert Opin Pharmacother 2009, 10:2581-2592.
• [46]Phillips CJ, Harper C: The economics associated with persistent pain. Curr Opin Support Palliat Care 2011, 5:127-130.
• [47]Phillips C, Main C, Buck R, Aylward M, Wynne-Jones G, Farr A: Prioritising pain in policy making: the need for a whole systems perspective. Health Policy 2008, 88:166-175.
• [48]World Bank GDP (current US$). [http://data.worldbank.org/indicator/NY.GDP.MKTP.CD webcite] (accessed 27 December 2013)
• [49]Clar C, Lerch C, Wolf R, Kleijnen J: Epidemiology of chronic non-malignant pain in Germany. Grünenthal GmbH; [City and date unknown]
• [50]Gouveia M, Augusto M: Indirect costs of chronic pain in Portugal. Copenhagen, Denmark; 2012. [Presentation at Societal Impact of Pain Conference] [http://www.sip-platform.eu webcite]
• [51]Rief W, Zenz M, Schweiger U, Rüddel H, Henningsen P, Nilges : Redefining (somatoform) pain disorder in ICD-10: a compromise of different interest groups in Germany. Curr Opin Psychiatry 2008, 21:178-181.
• [52]World Health Organization: Ensuring balance in national policies on controlled substances: guidance for availability and accessibility of controlled medicines. Geneva: WHO; 2011.
• [53]Johnson M, Collett B, Castro-Lopes JM: The challenges of pain management in primary care: a pan-European study. J Pain Research 2013, 6:393-401.
• [54]World Health Organization: Cancer pain relief, with a guide to opioid availability. 2nd edition. Geneva: WHO; 1996.
• [55]Maltoni M, Scarpi E, Modonesi C, Passardi A, Calpona S, Turriziani A, Speranza R, Tassinari D, Magnani P, Saccani D, Montanari L, Roudnas B, Amadori D, Fabbri L, Nanni O, Raulli P, Poggi B, Fochessati F, Giannunzio D, Barbagallo ML, Minnotti V, Betti M, Giordani S, Piazza E, Scapaticci R, Ferrario S: A validation study of the WHO analgesic ladder: a two-step vs three-step strategy. Support Care Cancer 2005, 13:888-894.
• [56]World Health Organization: WHO guidelines on the pharmacological treatment of persisting pain in children with medical illnesses. Geneva: WHO; 2012.
• [57]World Health Organization: Scoping document for WHO Guidelines for the pharmacological treatment of persisting pain in adults with medical illnesses (document GRC-08-04-0052A). Geneva: WHO; 2012.
• [58]Chou R, Fanciullo GJ, Fine PG, Adler JA, Ballantyne JC, Davies P, Donovan MI, Fishbain DA, Foley KM, Fudin J, Gilson AM, Kelter A, Mauskop A, O'Connor PG, Passik SD, Pasternak GW, Portenoy RK, Rich BA, Roberts RG, Todd KH, Miaskowski C, American Pain Society-American Academy of Pain Medicine Opioids Guidelines Panel: Clinical guidelines for the use of chronic opioid therapy in chronic noncancer pain. J Pain 2009, 10:113-130.
• [59]Attal N, Cruccu G, Baron R, Haanpää M, Hansson P, Jensen TS, Nurmikko T, European Federation of Neurological Societies: EFNS guidelines on the pharmacological treatment of neuropathic pain: 2010 revision. Eur J Neurol 2010, 17:1113-e88.
• [60]British Pain Society: Opioids for persistent pain: Good practice. A consensus statement prepared on behalf of the British Pain Society, the Faculty of Pain Medicine of the Royal College of Anaesthetists, the Royal College of General Practitioners and the Faculty of Addictions of the Royal College of Psychiatrists. London: British Pain Society; 2010.
• [61]British Pain Society: Cancer pain management: A perspective from the British Pain Society, supported by the Association for Palliative Medicine and the Royal College of General Practitioners. London: British Pain Society; 2010.
• [62]Koes BW, van Tulder M, Lin CW, Macedo LG, McAuley J, Maher C: An updated overview of clinical guidelines for the management of non-specific low back pain in primary care. Eur Spine J 2010, 19:2075-2094.
• [63]Ripamonti CI, Bandieri E, Roila F, ESMO Guidelines Working Group: Management of cancer pain: ESMO Clinical Practice Guidelines. Ann Oncol 2011, 22(Suppl 6):vi69-vi77.
• [64]Caraceni A, Hanks G, Kaasa S, Bennett MI, Brunelli C, Cherny N, Dale O, De Conno F, Fallon M, Hanna M, Haugen DF, Juhl G, King S, Klepstad P, Laugsand EA, Maltoni M, Mercadante S, Nabal M, Pigni A, Radbruch L, Reid C, Sjogren P, Stone PC, Tassinari D, Zeppetella G, for the European Palliative Care Research Collaborative (EPCRC); on behalf of the European Association for Palliative Care (EAPC): Use of opioid analgesics in the treatment of cancer pain: evidence-based recommendations from the EAPC. Lancet Oncol 2012, 13:e58-e68.
• [65]Manchikanti L, Abdi S, Atluri S, Balog CC, Benyamin RM, Boswell MV, Brown KR, Bruel BM, Bryce DA, Burks PA, Burton AW, Calodney AK, Caraway DL, Cash KA, Christo PJ, Damron KS, Datta S, Deer TR, Diwan S, Eriator I, Falco FJ, Fellows B, Geffert S, Gharibo CG, Glaser SE, Grider JS, Hameed H, Hameed M, Hansen H, Harned ME, American Society of Interventional Pain Physicians: American Society of Interventional Pain Physicians (ASIPP) guidelines for responsible opioid prescribing in chronic non-cancer pain: Part 2--guidance. Pain Physician 2012, 15(3 Suppl):S67-116.
• [66]Mellbye A, Svendsen K, Borchgrevink PC, Skurtveit S, Fredheim OM: Concomitant medication among persistent opioid users with chronic non-malignant pain. Acta Anaesthesiol Scand 2012, 56:1267-1276.
• [67]Werner EL, Ihlebæk C: Primary care doctors’ management of low back pain patients – ten years after. Tidsskr Nor Legeforen 2012, 132:2388-2390.
• [68]Webster BS, Courtney TK, Huang YH, Matz S, Christiani DC: Physicians' initial management of acute low back pain versus evidence-based guidelines. Influence of sciatica. J Gen Intern Med 2005, 20:1132-1135.
• [69]Piccoliori G, Engl A, Gatterer D, Sessa E, In der Schmitten J, Abholz HH: Management of low back pain in general practice -- is it of acceptable quality: an observational study among 25 general practices in South Tyrol (Italy). BMC Fam Pract 2013, 14:148. BioMed Central Full Text
• [70]Zech DF, Grond S, Lynch J, Hertel D, Lehmann KA: Validation of World Health Organization Guidelines for cancer pain relief: a 10-year prospective study. Pain 1995, 63:65-76.
• [71]Meuser T, Pietruck C, Radbruch L, Stute P, Lehmann KA, Grond S: Symptoms during cancer pain treatment following WHO-guidelines: a longitudinal follow-up study of symptom prevalence, severity and etiology. Pain 2001, 93:247-257.
• [72]Becker A, Leonhardt C, Kochen MM, Keller S, Wegscheider K, Baum E, Donner-Banzhoff N, Pfingsten M, Hildebrandt J, Basler HD, Chenot JF: Effects of two guideline implementation strategies on patient outcomes in primary care: a cluster randomized controlled trial. Spine (Phila Pa 1976) 2008, 33:473-480.
• [73]Becker A, Held H, Redaelli M, Chenot JF, Leonhardt C, Keller S, Baum E, Pfingsten M, Hildebrandt J, Basler HD, Kochen MM, Donner-Banzhoff N, Strauch K: Implementation of a guideline for low back pain management in primary care: a cost-effectiveness analysis. Spine (Phila Pa 1976) 2012, 37:701-710.
• [74]Committee on Education of the EFIC® (European Federation of IASP® Chapters): The Pain Management Core Curriculum for European Medical Schools. Diegen, Belgium: EFIC®; 2013.
• [75]Kress HG, Battelli D, Briggs E, Gordon D, Kopf A, Ribeiro S, Puig M: The provision of pain education within undergraduate medical schools across Europe. Florence, Italy; 2013. [Poster presented at the 8th Congress of the European Federation of IASP Chapters (EFIC®)] October 9-12,2013, Abstract no. 1128
• [76]Deutsche Schmerzgesellschaft e.V. Endlich: Schmerzmedizin wird Pflichtfach. 2012. [Press release available at http://idw-online.de/de/news477678 webcite. Last accessed 29 Dec 2013]
• [77]Cunningham AJ, Knape JT, Adriaensen H, Blunnie WP, Buchser E, Goldik Z, Ilias W, Paver-Erzen V, Board of Anaesthesiology of the European Union of Medical Specialists: Guidelines for anaesthesiologist specialist training in pain medicine. Eur J Anaesthesiol 2007, 24:568-570.
• [78]Bond M: Pain education issues in developing countries and responses to them by the International Association for the Study of Pain. Pain Res Manag 2011, 16:404-406.
• [79]European Federation of IASP Chapters: Educational support grant for Eastern European countries - guidelines. EFIC; 2012. [http://www.efic.org/index.asp?sub=1502d13E4PiYt1 webcite] (Accessed 27 December 2013)
• [80]Goebel A, Barker CH, Turner-Stokes L, et al.: Complex regional pain syndrome in adults: UK guidelines for diagnosis, referral and management in primary and secondary care. London: Royal College of Physicians; 2012.
• [81]Jacobsen R, Samsanaviciene J, Liuabarskiene Z, Sciupokas A: Barriers to pain management among Lithuanian cancer patients. Pain Pract 2010, 10:145-157.
• [82]Jacobsen R, Møldrup C, Christrup L, Sjøgren P: Patient-related barriers to cancer pain management: a systematic exploratory review. Scand J Caring Sci 2009, 23:190-208.
• [83]Schofield P: Pain education and current curricula for older adults. Pain Med 2012, 13(Suppl 2):S51-S56.
• [84]Albaladejo C, Kovacs FM, Royuela A, del Pino R, Zamora J, Spanish Back Pain Research Network: The efficacy of a short education program and a short physiotherapy program for treating low back pain in primary care: a cluster randomized trial. Spine (Phila Pa 1976) 2010, 35:483-496.
• [85]Kovacs F, Abraira V, Santos S, Díaz E, Gestoso M, Muriel A, del Real MT G, Mufraggi N, Noguera J, Zamora J, Spanish Back Pain Research Network: A comparison of two short education programs for improving low back pain-related disability in the elderly: a cluster randomized controlled trial. Spine (Phila Pa 1976) 2007, 32:1053-1059.
• [86]van der Peet EH, van den Beuken-van Everdingen MH, Patijn J, Schouten HC, van Kleef M, Courtens AM: Randomized clinical trial of an intensive nursing-based pain education program for cancer outpatients suffering from pain. Support Care Cancer 2009, 17:1089-1099.
• [87]Oldenmenger WH, Sillevis Smitt PA, van Montfort CA, de Raaf PJ, van der Rijt CC: A combined pain consultation and pain education program decreases average and current pain and decreases interference in daily life by pain in oncology outpatients: a randomized controlled trial. Pain 2011, 152:2632-2639.
• [88]Thomas ML, Elliott JE, Rao SM, Fahey KF, Paul SM, Miaskowski C: A randomized, clinical trial of education or motivational-interviewing-based coaching compared to usual care to improve cancer pain management. Oncol Nurs Forum 2012, 39:39-49.
• [89]van Middelkoop M, Rubinstein SM, Kuijpers T, Verhagen AP, Ostelo R, Koes BW, van Tulder MW: A systematic review on the effectiveness of physical and rehabilitation interventions for chronic non-specific low back pain. Eur Spine J 2011, 20:19-39.
• [90]Gross DP, Deshpande S, Werner EL, Reneman MF, Miciak MA, Buchbinder R: Fostering change in back pain beliefs and behaviors: when public education is not enough. Spine J 2012, 12:979-988.
• [91]Werner EL, Ihlebaek C, Laerum E, Wormgoor ME, Indahl A: Low back pain media campaign: no effect on sickness behaviour. Patient Educ Couns 2008, 71:198-203.
• [92]Werner EL, Gross DP, Lie SA, Ihlebaek C: Healthcare provider back pain beliefs unaffected by a media campaign. Scand J Prim Health Care 2008, 26:50-56.
• [93]Hara KW, Borchgrevink P: National guidelines for evaluating pain—Patients’ legal right to prioritised health care at multidisciplinary pain clinics in Norway implemented 2009. Scand J Pain 2010, 1:60-63.
• [94]Cevoli S, Cortelli P: Italian Law "measures to guarantee the access to palliative and pain treatments": rebound on headaches' management. Neurol Sci 2011, 32(Suppl 1):S77-S79.
• [95]Gensini GF: New disposition for pain therapy in Italy, center for headache should be integrated in the network. Neurol Sci 2011, 32(Suppl 1):S67-S70.
• [96]Norrefalk JR, Ekholm K, Linder J, Borg K, Ekholm J: Evaluation of a multiprofessional rehabilitation programme for persistent musculoskeletal-related pain: economic benefits of return to work. J Rehabil Med 2008, 40:15-22.
• [97]Lin CW, Haas M, Maher CG, Machado LA, van Tulder MW: Cost-effectiveness of general practice care for low back pain: a systematic review. Eur Spine J 2011, 20:1012-1023.
• [98]Lin CW, Haas M, Maher CG, Machado LA, van Tulder MW: Cost-effectiveness of guideline-endorsed treatments for low back pain: a systematic review. Eur Spine J 2011, 20:1024-1038.
• [99]Becker N, Sjøgren P, Bech P, Olsen AK, Eriksen J: Treatment outcome of chronic non-malignant pain patients managed in a Danish multidisciplinary pain centre compared to general practice: a randomised controlled trial. Pain 2000, 84:203-211.
• [100]Becker A: Health economics of interdisciplinary rehabilitation for chronic pain: does it support or invalidate the outcomes research of these programs? Curr Pain Headache Rep 2012, 16:127-132.
• [101]Thomsen AB, Sørensen J, Sjøgren P, Eriksen J: Chronic non-malignant pain patients and health economic consequences. Eur J Pain 2002, 6:341-352.
• [102]Eriksen J: Long-term/chronic non-cancer pain. Epidemiology, health-care utilization, socioeconomy and aspects of treatment. Copenhagen, Denmark: DMedSci thesis monograph, Copenhagen University; 2004.
• [103]Überall MA, Müller-Schwefe G, Nolte T, Kletzko H: Das Projekt zur integrierten Versorgung Rückenschmerz – IVR. Schmerztherapie 2009, 25:1-7.
• [104]Überall MA: Wenn aus einer Vision Wirklichkeit wird. Schmerzmedizin 2012, 28:2.
• [105]Heiskanen T, Roineb RP, Kalso E: Multidisciplinary pain treatment – which patients do benefit? Scand J Pain 2012, 3:201-207.
• [106]Heiskanen T, Roine RP, Kalso E: Which patients benefit from treatment?Answer to Letter to the Editor. Scand J Pain 2013, 4:54.
• [107]Martín J, Torre F, Padierna A, Aguirre U, González N, García S, Matellanes B, Quintana JM: Six-and 12-month follow-up of an interdisciplinary fibromyalgia treatment programme: results of a randomised trial. Clin Exp Rheumatol 2012, 30(6 Suppl 74):103-111.
• [108]International Association for the Study of Pain: Recommendations for pain treatment services. IASP; 2009. [http://www.iasp.org webcite]
• [109]Azevedo LF, Costa-Pereira A, Mendonça L, Dias CC, Castro-Lopes JM: A population-based study on chronic pain and the use of opioids in Portugal. Pain 2013, 154:2844-2852.
• [110]Cherny NI, Baselga J, de Conno F, Radbruch L: Formulary availability and regulatory barriers to accessibility of opioids for cancer pain in Europe: a report from the ESMO/EAPC Opioid Policy Initiative. Ann Oncol 2010, 21:615-626.
• [111]Krakauer EL, Wenk R, Buitrago R, Jenkins P, Scholten W: Opioid inaccessibility and its human consequences: reports from the field. J Pain Palliat Care Pharmacother 2010, 24:239-243.
• [112]Seya MJ, Gelders SF, Achara OU, Milani B, Scholten WK: A first comparison between the consumption of and the need for opioid analgesics at country, regional, and global levels. J Pain Palliat Care Pharmacother 2011, 25:6-18.
• [113]Cherny N, on behalf of the International Collaborative Project to Evaluate the Availability and Accessibility of Opioids for the Management of Cancer Pain: The international collaborative project to evaluate the availability and accessibility of opioids for the management of cancer pain: survey result [abs 1707]. Ann Oncol 2012, 23(9):ix456.
• [114]Roth SH, Fleischmann RM, Burch FX, Dietz F, Bockow B, Rapoport RJ, Rutstein J, Lacouture PG: Around-the-clock, controlled-release oxycodone therapy for osteoarthritis-related pain: placebo-controlled trial and long-term evaluation. Arch Intern Med 2000, 160:853-860.
• [115]Breivik H, Ljosaa TM, Stengaard-Pedersen K, Persson J, Aro H, Villumsen J, Tvinnemose D: A 6-months, randomised, placebo-controlled evaluation of efficacy and tolerability of a low-dose 7-day buprenorphine transdermal patch in osteoarthritis patients naïve to potent opioids. Scand J Pain 2010, 1:122-141.
• [116]Friedmann N, Klutzaritz V, Webster L: Long-term safety of Remoxy® (extended-release oxycodone) in patients with moderate to severe chronic osteoarthritis or low back pain. Pain Med 2011, 12:755-760.
• [117]Trescot AM, et al.: Effectiveness of opioids in the treatment of chronic non-cancer pain. Pain Physician 2008, 11(2 Suppl):S181-S200.
• [118]Chou R, Ballantyne JC, Fanciullo GJ, Fine PG, Miaskowski C: Research gaps on use of opioids for chronic noncancer pain: findings from a review of the evidence for an American Pain Society and American Academy of Pain Medicine clinical practice guideline. J Pain 2009, 10:147-159.
• [119]Manchikanti L, Ailinani H, Koyyalagunta D, Datta S, Singh V, Eriator I, Sehgal N, Shah R, Benyamin R, Vallejo R, Fellows B, Christo PJ: A systematic review of randomized trials of long-term opioid management for chronic non-cancer pain. Pain Physician 2011, 14:91-121.
• [120]Noble M, Treadwell JR, Tregear SJ, Coates VH, Wiffen PJ, Akafomo C, Schoelles KM: Long-term opioid management for chronic noncancer pain. Cochrane Database Syst Rev 2010., 1CD006605
• [121]Kuijpers T, van Middelkoop M, Rubinstein SM, Ostelo R, Verhagen A, Koes BW, van Tulder MW: A systematic review on the effectiveness of pharmacological interventions for chronic non-specific low-back pain. Eur Spine J 2011, 20:40-50.
• [122]Minozzi S, Amato L, Davoli M: Development of dependence following treatment with opioid analgesics for pain relief: a systematic review. Addiction 2013, 108:688-698.
• [123]Skurtveit S, Furu K, Borchgrevink P, Handal M, Fredheim O: To what extent does a cohort of new users of weak opioids develop persistent or probable problematic opioid use? Pain 2011, 152:1555-1561.
• [124]Svendsen K, Skurtveit S, Romundstad P, Borchgrevink PC, Fredheim OM: Differential patterns of opioid use: defining persistent opioid use in a prescription database. Eur J Pain 2012, 16:359-369.
• [125]Beubler E, Eisenberg E, Castro-Lopes J, Rhodin A: Prescribing policies of opioids for chronic pain. J Pain Palliat Care Pharmacother 2007, 21:53-55.
• [126]Manchikanti L, Helm S 2nd, Fellows B, Janata JW, Pampati V, Grider JS, Boswell MV: Opioid epidemic in the United States. Pain Physician 2012, 15(3 Suppl):ES9-ES38.
• [127]International Narcotics Control Board (INCB): Report of the International Narcotics Control Board on the availability of internationally controlled drugs: ensuring adequate access for medical and scientific purposes. Vienna: INCB; 2010.
• [128]Mosoiu D, Mungiu OC, Gigore B, Landon A: Romania: changing the regulatory environment. J Pain Symptom Manage 2007, 33:610-614.
• [129]Bosnjak S, Maurer MA, Ryan KM, Leon MX, Madiye G: Improving the availability and accessibility of opioids for the treatment of pain: the International Pain Policy Fellowship. Support Care Cancer 2011, 19:1239-1247.
• [130]Hutchinson K, Moreland AM, de C Williams AC, Weinman J, Horne R: Exploring beliefs and practice of opioid prescribing for persistent non-cancer pain by general practitioners. Eur J Pain 2007, 11:93-98.
• [131]Spitz A, Moore AA, Papaleontiou M, Granieri E, Turner BJ, Reid MC: Primary care providers' perspective on prescribing opioids to older adults with chronic non-cancer pain: a qualitative study. BMC Geriatr 2011, 11:35. BioMed Central Full Text
• [132]Srivastava A, Kahan M, Jiwa A: Prescription opioid use and misuse: piloting an educational strategy for rural primary care physicians. Can Fam Physician 2012, 58:e210-e216.
• [133]Corson K, Doak MN, Denneson L, Crutchfield M, Soleck G, Dickinson KC, Gerrity MS, Dobscha SK: Primary care clinician adherence to guidelines for the management of chronic musculoskeletal pain: results from the study of the effectiveness of a collaborative approach to pain. Pain Med 2011, 12:1490-1501.
• [134]McCracken LM, Boichat C, Eccleston C: Training for general practitioners in opioid prescribing for chronic pain based on practice guidelines: a randomized pilot and feasibility trial. J Pain 2012, 13:32-40.
• [135]Breivik H, Gordh T, Butler S: Keeping an open mind: Achieving balance between too liberal and too restrictive prescription of opioids for chronic non-cancer pain: Using a two-edged sword. Scand J Pain 2012, 3:1-4.