Pain Medicine Specialization

Pain Medicine Specialization

In recent years we have witnessed beginnings of the emergence of "Pain Medicine" as a distinct academic discipline with delineated borders and aims. This trend has been accompanied by a shift away from the treatment of complex pain problems within the framework of classical medical disciplines, using a restricted toolbox of therapeutic agents in a purely symptomatic mode (for instance orthopedist treating back-pain, oncologists treating cancer pain). The emerging trend has been towards the development of Pain Centers and Pain Clinics within which pain, per se, is the central focus. Pain Centers specialize in the management of pain associated with a variety of medical conditions, typically using a multidisciplinary approach.

 As a part of this trend, the European Pain Federation EFIC® has recently issued its "Declaration" which states that, whereas acute pain may reasonably be considered a symptom of disease or injury, chronic and recurrent pain is a specific healthcare problem, a disease in its own right. This position has been supported and endorsed by a wide variety of leading pain specialists around the world, including the International Association for the Study of Pain (IASP). European Pain Federation EFIC®'s declaration distinguishes between acute pain, which is properly treated symptomatically within the framework of classical medical specialties whose central focus is curing the precipitating medical disorder, and chronic pain which requires more specialized pain treatment knowledge and a more comprehensive kit of pain management strategies. Most medical specialists lack specialized training on chronic pain.

 Chronic, unrelieved pain is a major unsolved healthcare problem worldwide. It is universal, with no age, race, social class, national or geographic boundaries. It has enormous associated costs, financial (treatment compensation, and lost productivity) as well as a tremendous burden in terms of degraded quality of life for the sufferer and his/her family and immediate society. Rough estimates place the costs of chronic pain, as a disease state, in the very substantial category of cardiovascular disease and of cancer. The incidence of chronic pain tends to increase with age. With the success of curative and preventative medicine, and the consequent increase in average life-spans, the problem of chronic pain is likely to increase for the foreseeable future.

 Given the enormous need, the time has come to focus greater awareness on the problem of chronic pain as a disease, and to recruit the human, financial and organizational resources required to face it. In the past decade, healthcare authorities of several countries in Europe and elsewhere have recognize this need, and have begun to establish programs for specialist training and certification in the field of Pain Medicine. The time has come to broaden the scope of pain specialization to cover all of Europe, using uniform, agreed upon standards of training and certification for pain specialists. Pan-European standards of training and certification, once in place, will ensure higher professional quality, uniformity and mobility among pain specialists, and ultimately better patient care. Such standards will also promote recognition among specialist and non-specialists alike, of the boundaries at which patients with complex chronic pain ought to be referred to a pain specialist for treatment. Finally, they will create a body of trained professionals qualified to provide guidance and leadership in the areas of therapeutic modalities, resource allocation, research, ethical considerations and public policy concerning chronic pain and its management.

The European Pain Federation EFIC® calls for the establishment of a framework for realizing pan-European training and certification standards in Pain Medicine, which will include: 1) Creation of a core curriculum of basic and applied medical knowledge on pain. Some efforts have already been made toward this goal, including the core curricula developed by IASP. These constitute a good starting point for national chapters, but there is a need to coordinate and further develop the existing knowledge. 2) Definition of a recognized toolkit of practical pain management resources including essential drugs and procedures, and 3) Subspecialty training (in some countries an alternative term might be adopted, such as "competence" or "capacity'") will include acquisition by candidates of clinical experience under supervision, leading to recognized professional certification in "Pain Medicine". The typical duration of such a training program is two years, including the period of practical training, although this period may be adjusted. Candidates entering the program will be required to already have obtained accreditation in an appropriate medical specialty such as Anesthesiology, Neurology or Rehabilitation Medicine.  

Pain Medicine declared a Medical Specialty in Ireland

In 2014 The Minister for Health and Children, Dr James Reilly TD, under the provisions of the Medical practitioners Act 2007 and on the recommendation of the Irish Medical Council, declared Pain Medicine a Medical Specialty.

The EU council under the Italian Presidency to prioritize Pain and Palliative Care in 2014!

Four interactive panel discussions involving key stakeholders in Europe will define what needs to be done now to ensure that chronic pain and palliative care become long term EU and National Health priorities as well !

The SIP programme committee announced earlier this year that SIP symposium 2014 will be hosted on November 17th and 18th . The decision to move the annual SIP event to the second semester this year is due to the exciting news that the Italian department of European Affairs announced that it intends to list pain therapy and palliative care as priorities to be addressed during their presidency of the EU council . This means that for the first time ever during the Italian Presidency of the EU Council all EU Health Ministers will be discussing the societal burden of Chronic Pain and Palliative Care and will be debating how to address this priority in the years to come.

Here you can find the link to the official document where it is stated on page 100 ( translated from Italian) : During the Presidency semester the themes of pain therapy and palliative care will be tackled: topical issues thanks to the progresses in medicine and on which our country wants to share its own experience with other member states.

Considering the importance of this announcement it was also decided to celebrate the 5th SIP symposium by inviting Nick Ross, one of the most renowned European journalists and scientific moderators to lead four interactive panel discussions. Nick Ross has a long interest and involvement with healthcare policy and an interest in pain management ( you can find a brief CV below* and here a link to his website)

Therefore policy makers and those who influence EU Health Policy i.e. politicians , insurers , economists , patient advocates , industry , journalists and all other key stakeholders are invited to join an intense and exiting debate to define what needs to be done now to ensure that chronic pain and palliative care will become an EU and National Health Policy priority also in the long term.

* Nick Ross : Chairman Wales Cancer Bank, President of HealthWatch (UK charity promoting evidence-based medicine), trustee Sense About Science (promotes scientific literacy), Chairman Evidence Matters (promotes evidence-based public policy), trustee UK Stem Cell Foundation (funds stem cell research), Fellow Royal Society of Medicine, Visiting Professor and Honorary Fellow UCL, adviser London Health Review, patron various health charities, etc. Former member: UK Gene Therapy Advisory Committee, Nuffield Council on Bioethics, Royal College of Physicians Committee on Ethical Issues in Medicine, NHS Review Team, Academy of Medical Sciences Review of Non-Human Primate Use in Medical Research, etc

Please join the discussion on the  SIP Group on LinkedIn !