The President’s Corner

Dear Friends of EFIC®! Approaching now the end of my 3-year term as President of EFIC, I would like to thank all Executive Board Members, our two Executive Secretaries

Mrs. Christel Geevels and Mrs. Sarah Darley, my personal assistants Mrs. Christa Huber and Mrs. Julia Huber for their great help and support during these 3 years. I also include my thanks to the Councilors and to the chairpersons of the EFIC Committees, who did so actively support me and the Executive Board. So let me briefly look back on my term and mention a few milestones: In this term, the former triennial rhythm switched to a biennial interval between our flagship EFIC Pain in Europe congresses. With the 7th EFIC Congress 2011 in Hamburg, the new era of biennial EFIC congresses has started off, but a true highlight was the 8th Pain in Europe Congress 2014 in Florence, which was the Anniversary Congress celebrating the first 20 years of EFIC. Our former President and Honorary Member Professor Serdar Erdine and I edited a booklet on the History of EFIC reflecting these first “20 years of Building Bridges”. EFIC has built bridges to close the gap between bench and bedside, between basic science and clinical practice, and EFIC has also built bridges between different pain societies, different European Countries, different traditions and cultures. This is what EFIC stands for and why EFIC has become the major driving force of pain medicine in Europe. Another milestone was the replacement of our European Week against Pain (EWAP) by the European Year against Pain (EYAP), and the synchronization of the topics for the European Year with the Global Year of IASP. This was achieved by very positive and constructive talks with IASP. EFIC will continue the awareness campaign under a brand-new EYAP logo, and I would like to encourage all national EFIC Chapters to use the logos of EFIC and EYAP for campaigning in their countries throughout the whole year. In the now ending term, we have built bridges to other Organizations active in or linked to pain medicine. EFIC has joined forces with the World Institute of Pain (WIP), the WIP Foundation, and WSPC in our efforts for a better access to high quality pain medicine worldwide, and I have signed on behalf of EFIC the “Declaration of Miami” (for more information please visit www.efic.org). Thanks to the initiative of our former councilor Roberto Casale from Italy, EFIC officially cooperates with the European Society for Physical and Rehabilitation Medicine (ESPRM), and we organized joint Topical Seminar sessions with the ESPRM President, Prof. Xanthi Michail, both in the program of the EFIC congress 2013 and the recent ESPREM Congress 2014 in Marseille. Another important collaboration with the European Headache Federation, the Lifting-the-Burden (LTB) global campaign against headache, and the Italian Society for the Study of Headache (SISC) has resulted in the new EFIC Taskforce on Headache chaired by Prof. Paolo Martelletti from Rome.

CONTENT The President’s Corner A Word from the Editor A Word from Chris Wells, Incoming President EFIC – Fondazione IBSA Award 2014 Chronic Pain Presented in the EP EFIC on Facebook EFIC Gruenenthal Grant 2014 EJP – News & Editor’s Choice Articles News from our Chapters: Serbia Ireland Bosnia and Herzegovina Ukraine Italy Meetings: Past and Future

CONTACT newsletter@efic.org

IMPRESSUM

Editor: Bart Morlion Contributors: Hans G. Kress, Chris Wells, Giustino Varrassi, Bettina Haake-Weber, Emilija Dubljanin Raspopović, Brona Fullen, Amira Karkin Tais, Vladimir Romanenko, Stefano Coaccioli, Arun Bashkar

NEWSLETTER 02/2014

http://www.efic.org/

2

EFIC has also endorsed the International Enrico Greppi Award for the best unpublished paper on headache, and thanks to a generous initiative of the IBSA Foundation in Switzerland, the new annual EFIC – Fondazione IBSA - Award on the best paper on pain published by a young European researcher under the age of 40 has just been handed over for the first time. EFIC has continued to cooperate with our Inner Circle members from industry on the further improvement of pain medicine in Europe. The SIP (Societal Impact of Pain) symposium series organized in close collaboration with Grünenthal has been successfully continued in 2011 in Brussels, 2012 in Copenhagen, and 2013 again in the European Parliament in Brussels. Another joint project with an Inner Circle member was the EFIC Taskforce on “Placing pain on undergraduate medical curricula in Europe”, which is a joint initiative with Mundipharma International under the acronym APPEAL (Advancing the Provision of Pain Education And Learning). The European expert taskforce, chaired by me, included Prof. Margarita Puig from Spain, Dr. Daniele Battelli from San Marino, and Prof. Andreas Kopf from Germany as additional EFIC members of the group. The taskforce completed the first ever Europe-wide study on pain teaching in undergraduate curricula including all Medical Schools of 15 representative European countries. The results have been preliminarily presented during the 2013 EFIC Congress in Florence and are going to be published as a full paper very soon. Besides the APPEAL taskforce, EFIC has successfully installed 4 other new EFIC Taskforces, one in 2012 on the “Implementation of chronic pain into ICD11”, another taskforce on “Drug reimbursement policies in European Countries”, the EFIC Taskforce on “Quality outcome indicators”, and – most recently – the Taskforce on “Proper use of opioids”. The EFIC ICD11 Taskforce has meanwhile become a global IASP/EFIC Taskforce under the lead of the former chairman of the EFIC Taskforce, Rolf-Detlef Treede, collaborating with WHO at a global level on the revision of ICD11. The EFIC Taskforce on “Drug reimbursement policies in European countries” under the lead of Prof. Lona Christrup from Denmark is close to finalizing the survey and analysis. Each year of my term, I personally opened the annual EFIC Pain Schools in Klagenfurt, Austria and Montescano, Italy. From this winter on, there will be a third EFIC Pain School on Cancer Pain organized by turns in Liverpool /UK and Maribor /Slovenia, and we are going to have a fourth one on more basic research topics. I tried my best to visit many, but unfortunately I was not able to attend all annual meetings of our member societies. I take this opportunity to thank them all for their great hospitality. Finally, I would like to mention that in November 2012 the EFIC Headquarters office moved from Vilvoorde to a new and convenient location in Diegem, closer to the Brussels Airport. I want to thank again our EFIC Office team for the very fast, professionally and smoothly managed relocation. I would like to close this short review of my term with the official change of EFIC´s name from “European Federation of IASP Chapters EFIC” into the new name “The European Pain Federation EFIC”. For me this has been the major landmark on the agenda of my term as president of EFIC, and I am proud to be able to leave the European Pain Federation EFIC in good shape to my successor Chris Wells, whom I wish all the best for his coming term! With best wishes, Hans G. Kress

President of the European Pain Federation EFIC

3

A Word from the Editor

Euroscepticism?

Dear readership, On Sunday 25th of May, the only directly elected institution in the European Union, the European Parliament, was elected. Despite the Eurosceptic poll gains, the EU will play a more prominent role in our daily life in the future, particularly in relation to the goals and challenges of our European Pain Federation EFIC. A lot of initiatives have been taken already to unite forces towards the improvement of pain management in Europe. On some of them you will find more information in this issue of our newsletter. Despite the waves of

euroscepticism, our Pain Federation will need to enforce and strengthen all interactions with the EU to move things forward. Multidisciplinary education in pain management, both pre- and postgraduate, creation of a professional identity of pain medicine, raising the awareness of the individual and societal impact of pain remain high on the agenda. On Monday 26th of May, the council members, representing their national IASP chapters, had a long and fruitful council meeting in Brussels and elected a new Executive Board. You will find a short report and some photographs in this issue. This is also reflected in the last word of the president’s corner by Hans Kress. His merits for the Pain Federation speak for themselves and he will continue hi s excellent work for the Federation in the function of Past President. Starting from the next edition, you will find our new president, Chris Wells, addressing you on the front page for the next years. Last but not least Giustino Varrassi was awarded honorary membership of our Federation for his dedicated work over many years, and Eli Alon was honored with a memento plaque in recognition of his excellent service as Honorary Treasurer during two terms. You find more in this issue. New boards bring new decisions and responsibilities. At this moment your humble editor does not know yet if he will be able to continue the editorship of this newsletter due to new responsibilities in our Federation as President Elect. In the meantime, I wish you a good read. Bart Morlion Editor European Pain Federation EFIC Newsletter

A Word from Chris Wells, Incoming President

Dear Reader, I am delighted to have the opportunity to address you as the incoming European Pain Federation EFIC President from June onwards. My first pleasant duty is to thank and praise the outgoing President, Hans Kress, who has done an outstanding job as President for the past three years. A great speaker, an excellent meeting Chair, and an insightful and innovative planner and moderator, he has started and completed many important tasks during his Presidency. Thank

4

you Hans, from all of us for the huge amount of important work and time you have committed to the European Pain Federation EFIC®. It is a great honor and a privilege for me to be the first UK President of the European Pain Federation EFIC, and I am looking forward to a very busy time for the next three years. I am also delighted to welcome on to the executive board both Professor Bart Morlion from Belgium as President Elect and Professor Elon Eisenberg, as Treasurer. Bart works at the University of Leuven as the director of the Multidisciplinary Pain Center and teaches pain medicine and pharmacology. He is well known as our Newsletter Editor. Elon is a Neurologist and Director of the Pain Research Unit at the Rambam Hospital in Haifa, Israel. They join Nevenka Krcevski-Skvarc, Hans Kress and myself to manage, with our able secretariat in Brussels, the day to day tasks of the European Pain Federation EFIC, and to steer its policies and activities. The immediate tasks are to work on our forthcoming SIP meeting and on our biannual Pain in Europe Congress. This 9th Congress taking place, as you know, in the beautiful city of Vienna, from 2nd to 5th of September. The theme for the congress is “Translating evidence into practice”, and it will be a very scientific and clinical meeting under the able chairmanship of Chris Eccleston from Bath, UK. Confirmation of the Plenary Speakers is expected soon. However, even before this, we are planning an important “Societal Impact of Pain” meeting (SIP). Following the tremendous success from SIP 2013, the mission of the European platform (www.sip-platform.eu) for improving pain care in Europe is continuing. This year we depart from our usual style of didactic slide presentations to a pacier debating style of meeting, led by Nick Ross. Nick is a top global moderator of scientific and other events with a long history and involvement in healthcare policy. Further information will appear on the website from now on. I look forward to keeping you up to date with our important work, and ask that all of you feel free to contact me, the European Pain Federation EFIC secretariat and the Newsletter team concerning all your activities. Especially, let the secretariat know about your annual meetings for inclusion on the website, we have over 40,000 individual members a year to the site, and this is excellent exposure for your important initiatives. With best wishes, 


Chris Wells, Incoming President European Pain Federation EFIC

http://www.sip-platform.eu/

5

EFIC – Fondazione IBSA Award 2014 The winner of the EFIC - Fondazione IBSA Publication Award 2014 is Serena Materazzi, Ph.D. from the University of Florence with her paper on "Parthenolide inhibits nociception and neurogenic vasodilatation in the trigeminovascular system by targeting the TRPA1 channel". The picture shows from left to right: Prof. Luis Villanueva, Chair of the EFIC Research Committee, Dr. Giuliana Villa IBSA Institut Biochimique SA, Switzerland, and Dr. Silvia Misiti Director of the Fondazione IBSA for scientific research, Dr. Rominia Nassini (co-author of the paper, standing in for the award winner Dr. Materazzi who was not able to attend) and Prof. Hans Georg Kress. Please read the abstract of the paper here: Although feverfew has been used for centuries to treat pain and headaches and is recommended for migraine treatment, the mechanism for its protective action remains unknown. Migraine is triggered by calcitonin gene-related peptide (CGRP) release from trigeminal neurons. Peptidergic sensory neurons express a series of transient receptor potential (TRP) channels, including the ankyrin 1 (TRPA1) channel. Recent findings have identified agents either inhaled from the environment or produced endogenously that are known to trigger

migraine or cluster headache attacks, such as TRPA1 simulants. A major constituent of feverfew, parthenolide, may interact with TRPA1 nucleophilic sites, suggesting that feverfew’s antimigraine effect derives from its ability to target TRPA1. We found that parthenolide stimulates recombinant (transfected cells) or natively expressed (rat/mouse trigeminal neurons) TRPA1, where it, however, behaves as a partial agonist. Furthermore, in rodents, after initial stimulation, parthenolide desensitizes the TRPA1 channel and renders peptidergic TRPA1-expressing nerve terminals unresponsive to any stimulus. This effect of parthenolide abrogates nociceptive responses evoked by stimulation of peripheral trigeminal endings. TRPA1

targeting and neuronal desensitization by parthenolide inhibits CGRP release from trigeminal neurons and CGRP-mediated meningeal vasodilatation, evoked by either TRPA1 agonists or other unspecific stimuli. TRPA1 partial agonism, together with desensitization and nociceptor defunctionalization, ultimately resulting in inhibition of CGRP release within the trigeminovascular system, may contribute to the antimigraine effect of parthenolide.

http://efic.org/moxiemanager/data/files/IBSA_paper.PDFhttp://efic.org/moxiemanager/data/files/IBSA_paper.PDFhttp://efic.org/moxiemanager/data/files/IBSA_paper.PDFhttp://efic.org/moxiemanager/data/files/IBSA_paper.PDF

6

Chronic Pain Presented in the European Parliament by Multi-Stakeholders

By Giustino Varrassi

On the occasion of an exhibition and cocktail reception hosted on April 10, 2014 by Petru Luhan, Member of the European Parliament and winner of the MEP award for Health 2013, a multi-stakeholder platform of scientists, patient organizations, academia and industry, called on EU institutions and national authorities to recognize the societal and individual burden of chronic pain. The aim was to introduce adequate measures against it. During the exhibition in the European Parliament, the Pain Patient Pathway Recommendations, a result of a pan-European survey spanning 18 countries, were presented

to policy makers for the first time. Also, the “My pain feels like” box – a psychophysical experiment developed by the Montescano Rehabilitation Centre in Italy – attracted a large number of people and showed, through a combination of electronic stimulus and heat, how localized neuropathic pain feels like and helped empathize with patients suffering from this disease and their challenge to express what they feel. Representatives of national pain associations from UK, Italy, Romania, Belgium, The Netherlands, Spain, Poland, Germany, and Finland were there to share their experience and work in the field of chronic pain. The exhibition in the European Parliament was closed by a reception including presentations of different perspectives on chronic pain expressed by the policy makers (MEP Petru Luhan), the patients (Joop van Griensven, Pain Alliance Europe), the European Pain Federation EFIC Representative (Prof. Giustino Varrassi), and the industry (Jeanette Hübsch, Grünenthal). “We have to join forces in the battle against the devastating social and economic effects of chronic pain in Europe”, states MEP Petru Luhan. He also promised his constant commitment to be close to all stakeholders in case of his re-election.

EFIC on Facebook Are you a fan of the European Pain Federation EFIC on Facebook? Join our community online and stay up-to-date on recent developments, grants and all other news related to the European Pain Federation EFIC as well as the pain research and pain medicine sector. Is there anything else you would like to see on our Facebook page? Then please feel free to let us know!

EFIC Gruenenthal Grant 2014 – Encouraging Innovative Pain Research Projects The European Pain Federation EFIC is pleased to announce research grants for clinical and human experimental pain research. These biennial grants totalling € 200,000 from Grünenthal GmbH are supporting young scientists early in their career to carry out innovative clinical pain research in any member country of EFIC. Individual research grants are valued at up to € 40,000 per project for a duration of up to two years. Research Grants are intended for clinical and human experimental pain research. Research proposals on animals, computer simulations, cell lines etc. will

https://www.facebook.com/EFICorghttps://www.facebook.com/EFICorg

7

not be considered. The decision of the awards is made independently by the EFIC Committee on Scientific Research. Applicants should be citizens of an EFIC chapter country with a position at a recognized hospital, university or other institution that provides the infrastructure and other support necessary for carrying out the proposed research. They should have obtained a PhD, M.D. or equivalent postgraduate degree and should not be born before January 1st, 1974. The quality criteria for research proposals are:

Strength of the applicant - Including training, research publication record (relevance, quality of journals) and recommendations.

Novelty of the research question - Including societal and scientific importance. This may include plans to obtain data in support of a future application to a major granting institution. Hypothesis testing is preferred over empirical data collection. Exploratory research on particularly interesting ideas is encouraged, even if there is a risk of failure.

Quality of the research plan - The plan should lead to a clear answer to the question(s) posed, within the time and budget available. Projects that are overly ambitious have to be avoided.

Applications for an EFIC-Grünenthal Grant 2014 can be submitted online until 31 December 2014, 12:00 am. More information on the EFIC Gruenenthal Grant 2014 can be found here.

European Journal of Pain – News & Editor’s Choice Articles

By Bettina Haake-Weber

EJP Strategy Meeting in Vienna In April, a strategy meeting of the EJP editorial office with Wiley Blackwell took place in Vienna, Austria. From left to right, the picture below shows Prof. Hermann Handwerker, Editor-in-Chief of the European Journal of Pain, Dr. Bettina Haake-Weber, Managing Editor, Amanda McLean-Inglis, and her successor Sarah Tatum, Wiley Blackwell, and Prof. Hans G. Kress, Deputy Editor and President of the European Pain Federation EFIC.

http://www.e-g-g.info/

8

OnlineOpen – Wiley’s Open Access Option The EJP offers “Open Access” as required by important funding agencies, e.g. NIH, MRC and Welcome Foundation. Choosing OnlineOpen makes your article open access and freely available to all on Wiley Online Library, including those who don’t subscribe to the journal. OnlineOpen fulfills funding agency mandates that require grantees to archive the final version of their articles. Wiley will also immediately deposit your OnlineOpen article in PubMed Central and PMC mirror sites. Authors choosing OnlineOpen will retain copyright in their articles and will be offered a choice of creative commons licenses. The cost for OnlineOpen is US$3,000, which can be paid by the author, the author's funding agency, or the author's institution. The „Anywhere Article“– launch of the new „Enhanced HTML Article“ What is the „Anywhere Article“?

Mobility - the responsive HTML article will adapt to any device - desktop, tablet, or mobile - to give the optimal reading experience

Readability - superfluous information and clutter has been removed so that readers can focus on the article.

Functionality - the new layout and sidebar trays allows readers easy access to important information, such as references, at any point in the reading experience, without losing their place on the page.

Figure browser - as well as viewing a figure in context, readers can browse through all other figures in the article at the same time, and quickly navigate to each figure's context in the article

How to start using the „Anywhere Article“:

- Beside the regular links to the PDF- and the HTML-version of an article, you'll see at the bottom of each article the new link:

Following that link, you can bring up the new 'Anywhere Article' version of that content, allowing you to view it easily on the device of your choice, at your convenience.

Virtual Issues (free access) In February 2014 we started a new series of so called „virtual issues“. A virtual issue collects several articles on a certain topioc published recently in the European Journal of Pain. Until today we released the following virtual issues: Complex Regional Pain Syndrome, Cancer Pain. You can get access to these issues easily via the EJP website. The European Journal of Pain seeks new Editor-in-Chief The European Pain Federation EFIC is currently looking for a new Editor-in-Chief for the European Journal of Pain. Please find more information here. EJP Editor’s Choice articles May 2014 Are you a subscriber of the European Journal of Pain? If not, you can still download the Editor's Choice articles for free on the EJP website. Please read on to find out which articles are featured in this section in May 2014:

“Review: Extended-release opioids in the management of cancer pain: A systematic review of efficacy and safety”

B. Mesgarpour et al.; doi: 10.1002/j.1532-2149.2013.004

Database • Included were five randomized controlled trials and four observational studies, with follow-up of

at least 1 week, which compared effects of extended-release opioids in cancer pain.

http://onlinelibrary.wiley.com/journal/10.1002/(ISSN)1532-2149/homepage/custom_copy.htmhttp://onlinelibrary.wiley.com/journal/10.1002/(ISSN)1532-2149/homepage/custom_copy.htmhttp://efic.org/moxiemanager/data/files/EFIC%20seeks%20EJP%20EiC.pdfhttp://onlinelibrary.wiley.com/journal/10.1002/(ISSN)1532-2149/homepage/custom_copy.htmhttp://onlinelibrary.wiley.com/doi/10.1002/j.1532-2149.2013.00401.x/pdf

9

What does this review add? • There is lack of sufficient and high-quality comparative studies on extended-release opioids in

cancer pain management. • We can neither confirm nor rule out differences in the comparative efficacy and risk of harms for

the majority of comparisons.

"Neuronal differences between chronic low back pain and depression regarding long-term habituation to pain"

R. Rodriguez-Raecke et al.; doi:10.1002/j.1532-2149.2013.004

Database

• Eligible studies were identified from the included studies of two recent systematic reviews. • These systematic reviews searched Medline, EMBASE, CENTRAL, CINAHL, PsycINFO, PEDro,

International Pharmaceutical Abstracts and LILACS, and performed citation tracking of the included studies and relevant reviews.

• In April 2013, we re-ran the searches of the two reviews to capture any new studies. What does this review add?

• Over one-third of the 77 included studies used multiple terms to describe radiating leg pain; the most commonly used was sciatica.

• There were inconsistencies in the terms used to describe (e.g., sciatica), and eligibility criteria used to define, radiating leg pain and symptoms.

• Across the studies, there was a lack of consistent association between the terms used to describe and the eligibility criteria used to define radiating leg pain, and between the eligibility criteria used by studies and definition of terms provided in an international taxonomy of pain.

• There is a need to reach clear and consistent definitions to facilitate communication in clinical practice and research, e.g., when making treatment recommendations and for comparison between studies.

“Mirror therapy for phantom limb pain: Brain changes and the role of body representation” J. Foell et al.; doi:10.1002/j.1532-2149.2013.004

What is already known about this topic?

• It is known that mirror therapy provides relief for some patients with chronic phantom limb pain. • We also know that the intensity of this pain is correlated with the extent of cortical reorganization

in primary somatosensory cortex. What does this study add?

• This study shows that the pain relief induced by mirror therapy is accompanied by a reversion of cortical reorganization, and that the treatment effect is dependent on properties of the phantom limb.

You can access all Editors’ Choice articles from past issues for free via the journal’s website.

file:///C:/Users/Miu/Desktop/EFIC/Meeting%20Reports,%20Presentations%20etc/Newsletter/2014/2/%22http:/www.europeanjournalpain.com

10

News from our Chapters

Basic Principles of Pathogenesis, Diagnosis and Therapy of Musculosceletal Pain

By Emilija Dubljanin Raspopović

As an EFIC grant recipient I organized an educational course named” BASIC PRINCIPLES OF PATHOGENESIS, DIAGNOSIS AND THERAPY OF MUSCULOSCELETAL PAIN" at the Medical School, University of Belgrad on 11.4.2014 under the endorsement of EFIC, DGSS, and EFIC. 120 participants working in the field of physical medicine and rehabilitation, orthopaedic surgery and traumatology and rheumatology took part in the course. General aims of the project were to improve knowledge of pain aetiology, pathophysiology, diagnosis and management of musculosceletal pain conditions of professionals working in rehabilitation medicine, rheumatology and orthopaedics/traumatologists, who are confronted with pain patients in their daily practice enabling them with “general pain management” skills. In order to raise awareness for the importance of adequate pain management I was able to officially invite representatives from the legal office of the Ministry of Health, who opened the ceremony. The Pro-Dean of the Medical School, School of Medicine also greeted the audience .Dr Chris Wells, as the elected EFIC president also held an opening speech explaining the mission and vision of the EFIC to the audience. The course was divided in three parts covering general topics (epidemiology, pathophysiology and pain assessment, pharmacological pain treatment, and non-pharmacological pain treatment. We distributed questionnaires to the audience to assess pre and post course knowledge, and course satisfaction of the attendees. The teaching faculty consisted of Dr. Chris Wells, Dr. Andreas Kopf, Prof. Dr. W. Meissner, Prof. Dr. Michael Schaefer and local faculty (Prof. Pjevic, Prof Lj. Konstantinovic and Doc. Dr. E. Dubljanin Raspopovic). We encountered no problems in the organization of the course, and are very satisfied with its outcome. In addition to the educational course a “train-the-trainer” workshop was carried out to educate local trainers who will carry out teaching activities as Continuous Medical Education or at local conferences, and thus foster local teaching activities of high quality in the future. There were 8 local trainers – 2 physical medicine and rehabilitation specialist, 2 orthopaedic specialists, 1 rheumatologists, 1 anaesthesiologist and 1 psychiatrist. The workshop was a great success. There is an idea to continue with the teaching activities of the local stuff by forming a “pain mobile group”, which will organize pain conferences in different cities in Serbia and Montenegro.

Need for a National Pain Management Strategy in Ireland

By Brona Fullen On April 10th 2014 a delegation from the Irish Pain Society (IPS) appeared before the Joint Committee on Health and Children in the Houses of the Oireachtas (Irish Parliament) to discuss the need for a national pain management strategy in Ireland. Professor Laserina O’Connor (President IPS) outlined the conceptualization of

11

chronic pain as a public health challenge and the need for co-ordinated and adequately resourced health services for pain management in Primary and Secondary Care. Dr. Josh Keaveney (Chair of Faculty of Pain Medicine) spoke on the need for pain medicine to be awarded specialty status within the Irish Health Service, and for a clinical lead director with responsibility for pain management be appointed in the Health Service Executive to ensure that appropriate multidisciplinary resources be established. Miss Cathy Sexton (Irish Pain Nurses and Midwives Society) discussed the need to increase numbers of advanced nurse practitioners in pain management. Dr Brona Fullen (IPS representative to European Federation of the International Association for the Study of Pain) summarized research undertaken regarding the prevalence, cost and management of chronic pain being undertaken in the Centre for Pain Research in the National University of Ireland Galway, and in the School of Public Health, Physiotherapy and Population Science, University College Dublin. Mr John Lindsay (Chair, Chronic Pain Ireland, patient support group) spoke about chronic pain from the patient’s perspective. The Joint Committee on Health and Children agreed a set of recommendations to be forwarded to the Minister for Health and Children: (i) That a national strategy for pain management in Ireland be developed (ii) That a clinical lead director for pain management be appointed in the Department of Health and Children (iii) That pain medicine be designated as a specialty in its own right. Photograph: L-R front: Ms C. Conway, TD, Mr J Buttmer, TD (Chair Joint Committee on Health and Children), Ms Niamh Molloy (President-elect IPNMS), Prof. L. O’Connor (IPS President), Mr J. Lindsay (Chair CPI), Dr B. Fullen (IPS rep. to EFIC), Ms C. Sexton (IPNMS), Mr C. O’Caolain, TD L-R Back: Dr H.Gallagher (Treasurer, IPS), Ms M Mitchell-O’Connor, TD, Dr J. Keaveney (Chair of Faculty of Pain Medicine)

12

Monitoring the Development of Pain Management at 3 SPAMU Pain Units in Bosnia and Herzegovina

By Amira Karkin Tais

In 2007, HOPE’87 in cooperation with the Association for Pain Therapy-Bosnia Herzegovina (APT-BiH), started to realize a project called “Comprehensive Pain Management in BH”. The projects are based on community and institutional support of the Ministries of Health as part of the national health strategy. Activities and measurements include the establishment of seven pain units in clinics and for children at the paediatric clinic as well as seminars on pain therapy, rehabilitation (CBR) and continuous pain education courses. Representatives of the Association for Pain Therapy in B&H (APTBH) served as an umbrella body for pain therapy in B&H, and together with the HOPE’87 monitoring team conduct field visits to all the SPAMU. The report produced as a result of the monitoring visits needs to pinpoint the obstacles SPAMUs and further

advancement of pain therapy in B&H are facing. The 3 SPAMUs (established 2007- 2009) in three cities are still operational and functional and have treated 1.610 patients in 2013. Overview of the pain therapy in all three SPAMUs (Sarajevo, Mostar, Foča)

Diagnostic-pain estimation; treatment of pain: pharmacological and non-pharmacological, psychological (relaxation training, exercises, massage); consultation with multidisciplinary team of specialists in same hospital.

Therapy is being conducted using a multidisciplinary approach with other specialists in Hospital. Data base (Protocol patients, therapy, efficiency of individually therapy are provide).

As a result of the implementation of this project, the skills of medical staff that provide pain treatment in SPAMU and B&H have improved drastically. Additionally, key trainers are now capable of providing technical instructions in pain therapy. Doctors are available to control pain, recognize pain as an important part of health care. To pain patients, the pain was eliminated or reduced measured through the VAS (Visual Analog Scale). They have established pain treatment in the practice with a comprehensive aim to decrease complications, improve rehabilitation, and optimize costs. It has great psychological, social and economic effects. The education through seminars and continue pain education showed the participants' motivation and strong interest for this kind of training and lecturers and also improved are information and exchange of experience among the medical staff in SPAMU and B&H in the field of pain therapy. The existing "SPAMU-Pain Units" become centres for transfer of knowledge in pain management through the following activities:

Presentation of special cases in the treatment of pain in routine praxis in SPAMU during National meetings and World Congresses (IASP Congress Milan 2012, EFIC Congress Florence, 2013).

Participation in the EFIC continuous pain education, research Projects, Community Based Rehabilitation (CBR) projects, and EFIC Pain School Education

13

The development of the pain therapy network and JICA FOLLOW-UP COOPERATION (SPAMU) improved the continuing regular activities in the implementation of good practice in the treatment of pain for people suffering from pain. Pain patients were treated adequately by medical staff in every SPAMU. As a result of the implementation of this project, the treatment of pain improved. The network for pain treatment (SPAMU) has improved the quality of life and the quality of health services for patients with pain. It also achieved the main goals of the project and justified the importance of additional establishments of SPAMU and pain therapy in general in B&H. SPAMU units are supported and accepted by the hospital administration and the ministries of health, but not financially supported by the Insurance Fund. A major obstacle in conducting pain therapy in a SPAMU is the fact that the payment by the Insurance Fund is only provided to hospitalized patients. Secondly, some of the procedures in the treatment of pain unfortunately are not funded by the Insurance Fund. Another significant problem is the lack of pain drugs. The legislative framework for the accessibility of pain medication is not regulated. The need for institutional solutions, capacity development and awareness raising is still present.

East-European Congress on Pain in Ukraine

By Vladimir Romanenko Yalta in the Crimea is a very well-known town, linked to illustrious names as Stalin, Churchill and Roosevelt. 62 years after the famous Yalta conference, the city once more became a center of innovation. From September 18-20 pain experts from all over the world shared their knowledge at the IASP-East European congress on Pain. A balanced mix of preclinical scientists and pain clinicians discussed at this congress new ideas related to pain management. The scene for the congress was magnificent: the hotel complex Belorussia, located on the hills near Yalta, surrounded by pine trees with a grand view on the black sea. A perfect place to meet old friends, make new friends, and exchange thoughts on pain management and research. And last but not least, to experiencing together splendid hospitality and laughter. Fundamental aspects of pain, most topical methods of diagnostics of nociceptive, neuropathic and dysfunctional pain, pharmacological and non-pharmacological methods of pain treatment and legal issues of pain management in Ukraine were discussed during 3 days of work of the congress. More than 150 delegates from 23 countries and 28 speakers from 10 countries took part in the congress. The congress program featured plenary sessions and topical seminars, satellite symposia, hands-on workshops and video sessions. The congress was truly multidisciplinary and gathered together neurologists, anesthesiologists, general practitioners, neurosurgeons, orthopedic surgeons, gynecologists and medical lawyers. A congress special event featured the final round of an All-Ukrainian Contest on the Best Scientific Paper on Pain

14

and the ceremony of the award presentation. An industry exhibition and medical publishing houses products exhibition took place aside from scientific sessions. The spirit of academism was felt throughout the congress, warm atmosphere facilitated establishment of new acquaintances and promoted productive communication. All presentations were highly interested from practical point of view and were accompanied by intensive discussions. More information about past and upcoming East-European Congress on Pain can be found here.

Recent activities of the Italian Association for the Study of Pain

By Stefano Coaccioli Epidemiology of Chronic Pain on General Population An epidemiological survey on chronic pain (CP) (the first one in Europe after the European survey of 2004) has been done analysing a community in central Italy. This survey has involved about 8,000 individuals inhabitants of a town nearby Terni (Umbria); over 1,200 questionnaires have been collected and they have confirmed the presence of CP in the 26% of the population, with a substantial prevalence within the feminine gender; those with major prevalence are rheumatologic pathologies, while patients reported inadequate control of pain; almost a third of the patients do not receive any analgesic therapy. The manuscript will soon be ready for publication. Epidemiology of Chronic Pain on Frequent Diseases Two epidemiological surveys have been carried out on the evaluation of CP prevalence in diabetes mellitus and obesity. Both studies have involved about 1,000 patients and both works will be published (for the time being, only in Italian with English abstract) for Recenti Progressi in Medicina, Rome – Italy. Efficacy of Meditation on Chronic Pain A survey for the evaluation of the efficacy of Buddhist Meditation (vipassana) has been done analysing a little community of Thai individuals residing in Italy. It has been demonstrated as some individuals, who are expert in Meditation (practice>40’/session), referred of a significant reduction of CP compared to subjects with poor or no experience in meditation (practice

15

Meetings: Past and Future By Arun Bashkar and Chris Wells

Past Meetings Neuromodulation is now an integral tool in the armamentaria of a multidisciplinary pain team and the mechanism of action of the various treatment options are still widely debated. The first ever meeting looking into the mechanism of action was organised by Dr. Elliot Krames and Dr. Eric Grigsby in Orlando, Florida. The meeting held on 28-30 March 2014 had more than 170 attendees including pain physicians, neurosurgeons, neurophysiologists, biomedical engineers, basic science researchers and industry members. This meeting brought together the world’s foremost experts and leaders in the field of neuromodulation and facilitated the collaboration of various specialties into looking at the various mechanisms and future applications in the field of neuromodulation. The first two sessions were on spinal cord stimulation and stimulation of the dorsal root ganglion and was chaired by Dr. Robert Levy, Editor-in-Chief of Neuromodulation and Dr. Bengt Linderoth of the Karolinska Institute, Stockholm. The evidence for the various mechanisms were looked at by Dr. Lisa Johanek and the effect on WDR neurons was highlighted by Dr. Yun Guan. The various modalities of SCS were also discussed in detail: Sub threshold stimulation (Dr. Thomas Yearwood), High Frequency stimulation (Dr. Richard North) and Burst Stimulation (Prof. Dirk de Ridder). Dr. Bert Joosten presented the effects of DRG stimulation with pulsed radiofrequency and Dr. Quinn Hogan discussed the effects of electrical stimulation of the DRG. Dr. Elliot Krames then proposed a hypothesis on the mode of action of neuromodulation at the DRG. Drs. Ali Rezai and Konstantin Slavin, key opinion leaders in the field of deep brain stimulation (DBS) led a session discussing DBS as an effective treatment option for various pain and functional disorders. Brain Computing Interfacing, functional neuromodulation for bowel and bladder dysfunction through sacral nerve stimulation as well as neuromodulation for cardiovascular disease and gastric dysfunction were also presented. Dr. Scott Lempka was awarded the new investigator award for his paper “Mechanisms of High-Frequency Spinal Cord Stimulation for Chronic Pain”. The 2014 Annual Scientific Meeting of the British Pain Society was held in Manchester under the stewardship of Dr. William Campbell, President of the BPS and the scientific committee under Prof. Gary Macfarlane. The first plenary lecture was given by Prof. Sir Michael Bond, former President of IASP, taking us through nearly 50 years of his distinguished career during which pain medicine developed as a specialty in its own right. Prof. Rolf-Detlef Treede, President-Elect of IASP, gave a plenary lecture on Gain control mechanisms of pain sensitivity. There were ten plenary sessions and speakers included Prof. Henrik Kehlet from Copenhagen (Post-operative pain – what are the future challenges), Prof. Paul Eldridge (The surgical treatment of facial pain) and Prof. David Wynick (At the translational interface of pain: new drug developments for neuropathic pain) amongst others. The theme of the meeting encompassed the multidisciplinary working in pain management and sessions were also devoted to pain education, use of technology in promoting better communication as well as breaking down barriers to effective pain management. The “Bend it Like the BPS” welcome party at the National Football Museum in Manchester gave the opportunity to meet up with colleagues, old and new, and it was a fun evening watching them try out their footballing skills at the various stations. Another successful meeting was the 7th World Congress of the World Institute of Pain, held in Maastricht, the Netherlands come out from May the 7th to the 10th. This meeting attracted 1600 delegates, and had an excellent scientific program prepared by Maarten van Kleef and Allan Basbaum, and their committee. A superb Opening Ceremony saw Ernst Smid speak with some passion about his late wife, and the fact she died from cancer with her pain unrelieved, in spite of modern technology. He pointed out the need for improvement of organisation skills. There was then an excellent display of the painting, The Night Watch, formed by over 20 actors marching in to the sound of drums, and taking in their places on the stage in the exact position of Rembrandt’s famous work. There were many great plenaries, and good interactive workshops, but I particularly enjoyed the first day when Craig Hartrick from the USA spoke about establishin treatment goals in chronic pain, Allan Basbaum talked about treating the disease of neuropathic pain, and Andrew Moore looked at the evidence of the various techniques that are used, in considering not only efficacy but also side effects and costs of treatment. From the 9th to the 11th of April, EFIC supported a train-the-trainer course in Belgrade, Serbia, and also a Symposium on the pain management of musculoskeletal disease organized by Emilija Dubljanin Raspopović. The

16

Council member for Serbia, Miroslava Pjevic had requested and received EFIC support, and Andreas Kopf and his team from Germany had arranged two excellent train-the-trainer workshops which took place on the day before the main meeting and the day afterwards. The purpose of this is to train people about how to teach pain medicine and science in their own country, and to roll this out to neighbouring countries. So that rather than speakers needing to be shipped in from abroad, at great expense, local people can do an excellent job of education in their region. Candidates had been selected to receive training, which took place by internet and on the first day of the meeting. The expert speakers presented material themselves at the main symposium on the 11th of April, and then the individual new trainers presented back to the panellists on the 12th of April, for the critical appraisal. The new speakers will be followed up on a regular basis by Andreas Kopf and the rest of the team, including myself, to help them to become accomplished lecturers in the subjects they have developed. This is an excellent initiative and one which I hope EFIC can support throughout Europe in the future. Upcoming Meetings The 4th Biannual International Multidisciplinary Pain Congress is being held in Eindhoven, Netherlands from 01 October to 04 October 2014. The scientific committee comprising of Prof. Nikolai Bogduk, Prof. Serdar Erdine, Prof. Hans Kress, Prof. Frank Huygen and Dr. Tim Deer amongst others have put together a great scientific programme with renowned speakers covering a wide breadth of topics. The joint meeting of the Neuromodulation Society of UK & Ireland (NSUKI) and the Swiss Neuromodulation Society along with the Swiss Society for Interventional Pain Medicine (SSIPM) would be held at the Grand-Hotel Suisse Majestic in Montreux, Switzerland on 21-22 November 2014. The previous meetings had high profile speakers from across the globe presenting the latest developments in the field of pain medicine and neuromodulation. The IASP biennial scientific meeting is to be held in Buenos Aires, Argentina, from the 6th to the 10th of October 2014, with refresher courses the day before. Registrations available until June 6th, so if you want to go to the meeting, please do log on to the IASP website right now and register quickly to avoid additional expense. The program looks excellent, and we are sure that those who wish to travel to this exciting country, will have a really great educational and tourist experience.

17

How did you enjoy the EFIC Newsletter 02/2014? Let us know at newsletter@efic.org. We look forward to receiving your feedback on this issue. If you wish to unsubscribe from the EFIC Newsletter, you can do so here. The next EFIC Newsletter will be published in August 2014. The deadline for contributions is August 15, 2014. All contributions must be emailed to Bart Morlion at bart.morlion@uzleuven.be.

EFIC Newsletter 02/2014 Contributors

Prof. Hans G. Kress MD, PhD FFPMCAI (Hon.) Chair of Anaesthesiology and Pain Medicine Medical University of Vienna/AKH, Vienna, Austria Prof. Bart Morlion MD, PhD Director of the Leuven Center for Algology & Pain Management University Hospitals Leuven, Belgium Prof. Giustino Varrassi, M.D. Past EFIC President President of the Paolo Procacci Foundation, Rome, Italy Dr. Chris Wells, Consultant in Pain Relief Liverpool, United Kingdom Dr. Bettina Haake-Weber Managing Editor European Journal of Pain Dr. Emilija Dubljanin Raspopović Clinical Center Serbia Dr. Brona Fullen UCD School of Public Health, Physiotherapy and Population Science Dublin, Ireland Amira Karkin Tais, Prim, MD President of Association for Pain Therapy Bosnia and Herzegovina Vladimir Romanenko MD Ukrainian Institute of Pain Prof. Stefano Coaccioli Associate Professor of Internal Medicine Perugia University Medical School, Italy Arun Bhaskar Consultant in Pain Medicine, Anaesthesia & Critical Care Manchester, UK

Inner Circle Company Members of EFIC 2014:

mailto:newsletter@efic.orghttp://www.efic.org/index.asp?sub=02yQYF1B2LdUnZmailto:bart.morlion@uzleuven.be

18

19

20