Change Pain

Change Pain

Change pain logo

CHANGE PAIN® is an initiative aiming to enhance the understanding of the needs of patients with severe chronic pain and to develop solutions to improve pain management. Initiated by the German pain expert Grünenthal and endorsed by the European Pain Federation EFIC®, CHANGE PAIN® involves 21 pain experts from across Europe and the US.

The International Advisory Board is chaired by Professor Hans G. Kress, M.D., Ph.D., and Dr. Gerhard H. H. Müller-Schwefe, MD, President of the German Pain Association (DGS).

Recently published:


The consensus group is committed to support research projects that will provide a better understanding of physicians’ and patients’ perspectives, e.g. by conducting surveys and analysing published data.

The CHANGE PAIN® Physician Survey was started at the European Pain Federation EFIC® Congress 2009 and is still ongoing across Europe. The initial results underline the need for further education of healthcare professionals in the field of chronic pain management. According to the survey, a deeper knowledge on underlying pain mechanismsis crucial. To participate, please access the survey via the CHANGE PAIN® website (-> Physician Survey).

Results of the National Health and Wellness Survey, which evaluated data of more than 50,000 respondents show that approximately 20 % of the adult population in five European countries (UK, France, Italy, Germany and Spain) has experienced pain within the last months. The most frequently reported condition causing pain was back pain, cited by almost two-thirds of respondents, followed by joint and neck pain.

February 2017: Are you interested in participating in a pain-European project to improve perioperative pain management of your patients? If so please click here for more details.


In order to raise awareness of the perspectives of patients and physicians it is essential to publish the research results. The CHANGE PAIN® Initiative communicates findings in scientific publications on a regular basis.

A selection of the main publications is published in a special edition of the journal Current Medical Research and opinion which can be accessed via the Change pain website About CHANGE PAIN/publications.

The CHANGE PAIN® News & Reviews Journals inform about the ongoing discussion within the CHANGE PAIN® expert group by summarising the latest insights in the field of severe chronic pain management and reflecting the results of the CHANGE PAIN® Advisory Board meetings.

Available for download on the Change pain website -> About CHANGE PAIN/Publications/News&Reviews.


The CHANGE PAIN Initiative aims to contribute to the education of healthcare professionals and to increase knowledge of pain physiology and pain management to help physicians with their treatment decisions. Based on insights of the international Advisory Board, a comprehensive educational program is being developed.

The PAIN EDUCATION program so far includes four interactive CME modules which cover the following topics: assessing pain and physician-patient communication, multi-modal management of chronic pain, mechanism-orientated pharmacological pain therapy, and the treatment of chronic back pain. Further modules are under development. (-> How to CHANGE/PAIN EDUCATION).

Consensus of the CHANGE PAIN® Advisory Board:

The CHANGE PAIN® group 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.

Communication between physicians and patients

Efficient communication between physicians and patients is very important, as it is the only way to assess the level of pain and its consequences for the quality of life a patient is experiencing.

The CHANGE PAIN® Scale has been developed and translated into several European languages as a new, quick and user-friendly tool suitable for enhancing communication between healthcare professionals and patients.

Vicious Circle
Many chronic pain patients find themselves in a Vicious Circle of insufficient analgesia and debilitating side effects associated with their medication. The result of the Vicious Circle can either be side effects, lack of efficacy or analgesic tolerance which may all lead to therapy discontinuations and low compliance of patients. Successfully treating severe chronic pain requires balancing analgesia with acceptable tolerability. Increasing awareness of the Vicious Circle among the medical community could reduce treatment discontinuation.

Mechanism-orientated treatment approach
To select the most appropriate therapy physicians have to take into account that pain is often multifactorial in nature due to the fact that different mechanisms can be involved. An important goal for improving the management of severe chronic pain is to increase the awareness of the physiological difference between neuropathic and nociceptive pain and their specific pharmacological treatment options. Pain which has a neuropathic component is often more severe and more difficult to treat. A neuropathic component is present in many pain conditions; severe chronic low back pain is a typical example.

For a comprehensive overview of the consensus points of the CHANGE PAIN® group please see: Varrassi G et al. Pharmacological treatment of chronic pain – the need for CHANGE. Current Medical Research & Opinion. Vol. 26, No. 5, 2010, 1231-1245 (About CHANGE PAIN/Publications) and Müller-Schwefe G et al. Make a CHANGE: optimising communication and pain management decisions. Current Medical Research & Opinion. Vol. 27, No. 2, 2011, 481–488

Pain assessment scales

Various tools are available for identifying and measuring pain. For a rapid and simple assessment of pain severity, validated pain scales can be used. They are based on patient self-reports, thus giving physicians a good idea of patients’ pain perception. Very often used are the following scales in adults:

  • Visual Analogue Scale: Patients are asked to rate the intensity of their pain on a scale with one end indicating “no pain” and the opposite end indicating “maximum imaginable pain”.
  • Numeric rating scale: Patients are asked to identify how much pain they are having by choosing a number from 0 (“no pain”) to 10 (“worst pain”).

Change Pain scale

Here you can download some pain scales in various languages:

Croation version Czech version Danish version English version Flemish version
Dutch version French version German version Portugese version Slovakian version
Slovenian version Spanish version Swedish version Polish version