Report Chronic Pain Dutch Council for the Quality of Health Care

Prof.dr. Frank Huygen

Department Anesthesiology Painmedicine Erasmusmc

Rotterdam The Netherlands

Disclosure

European Scientific and educational advisoryboard "Change Pain"

Global Scientific advisorboard Spinal Modulation (Spinal Modulation)

Editorial board "Painpractice" (Wiley Blackwell)

Editorial board "Praktische richtlijnen anesthesiologische pijnbestrijding"

(Tijdstroom)

Editorial board "Evidence based interventional painmedicine" (Wiley Blackwell)

Teacher "educational programs neuropathic pain" (Pfizer)

Chairman multidisciplinary guideline committee mechanical low back (orde van

medisch specialisten)

Chairman workgroup chronic pain Dutch council for the quality of health care

Member workgroup development indicators "failed back surgery syndrome"

(Zichtbare Zorg ziekenhuizen)

Member program committee NeuroSIPE (Stichting Technische

Wetenschappen)

Prevalence chronic pain in Europa

• Mean percentage chronic pain: 19% (n= 8815)

Breivik et al 2006

Chronic pain-> 6 months-piain in the previous months-≥ 2 x a week- ≥ 5 on a 10 point NRS

Prevalence chronic pain compared to other chronic diseases in the Netherlands

Bala et al 2011

Chronic pain – mostly a known cause

Breivik et al 2006

Involved healthcare professionals

Breivik et al 2006

Dutch Council for the Quality of Health Care

Established in 2009 by the Minister of Health to promote high-quality

care in the Netherlands. The working area of the Council covers

prevention, cure and long-term care. The Council sets tasks for

advisory and research activities and gives recommendations. The

activities are mainly aimed at increasing safety, enhancing the

patient/client perspective and stimulating the efficacy of care.

Examples of topics of the Council for the quality of health care

Guideline on Guidelines

Prioritised list of guideline topics

Expensive drugs in guidelines and off label use of drugs

Restructuring 2nd line obstetric care – an exploration on the effects of concentration

Deducting valid and trustworthy patient information from authorised guidelines

www.regieraad.nl

Council –Chronic pain

November 2010

Presentation data epidemiology of chronic pain in the Netherlands

January 2011

Initiation workgroup chronic pain council

April 2011

Pressure cooker session

September 2011

Presentation report workgroup to council

Presentation data epidemiology of chronic pain in the Netherlands

Prevalence chronic pain > other

chronic diseases, however it gets less

attention

Diagnosis and treatment have a great

variety and are often inadequate

Chronic pain has a big impact on

quality of life and functionality and has

high direct and indirect costs

Bala et al 2011

Workgroup chronic pain council

Name Discipline

Dr. Dolf Boerman Neurologist

Dr. Jannes J.E. van Everding Secretary council

Drs. Ruud Gardenbroek Medical adviser

Marion Giesberts Pain nurse

Prof.dr. Frank Huygen Anesthesiologist

Prof.dr. Bart Koes Epidemiologist, general practice

Dr. Ingeborg Meijer, Independent advisor

Dr. Roberto S.G.M Perez Physiotherapist/movement scientist

Prof.dr. Rob J.E.M. Smeets Rehabilitation doctor

Ilona Thomassen Patient

Dr. Gerbrig Verstegen, Psychologist

Prof.dr. Pieter A.M. Vierhout Chairman council

Prof.dr. Kris Vissers Anesthesiologist

Workgroup chronic pain council

Members of the workgroup are invited based on:

Individual title

Longterm approved involvement in chronic pain

Representative for different stakeholders

Pressure cooker session

Discussion based on “statements” brought in by participants

Statements

Chronic pain is a disease in its own right

A national guideline on chronic pain could improve diagnosis and

treatment

A mechanism based treatment is preferred

Besides attention for the cause and treatment of pain, there should be

more attention for perception and behaviour

Statements

(un)justified fear for opioid dependency results in undertreatment

There is not enough attention for pain medicine in the educational

programs for healthcare professionals

Insurance/social doctors are not well enough equipped to estimate

chronic pain

Statements

There are huge health care and socio-economic costs in chronic pain

Chronic pain is so prevalent that disease management/chain care is

necessary to come to a solution. The first line plays a key role in

prevention and treatment

A discipline oriented care system is an obstruction for a solution of the

pain problem. Pain medicine will benefit from a patient oriented

approach

Profits can be gained with prevention and early recognition and

treatment of chronic pain

Discussion

Broadening and deepening of pain medicine is necessary

But

On short term the biggest profit is gained by simple interventions in

non-pain specialists

Conclusion and recommendations

Put chronic pain on the agenda of the council in 2012

Use the workgroup chronic pain as a platform which together with

partners in the field searches for solutions to improve care of patients

with chronic pain

Conclusions and recommendations

Develop together with the scientific associations and other

stakeholders a national guideline on chronic pain

Starting questions for such a guideline would be:

- Definition and classification system

- Prescription of analgesics, therapy compliance, prevention of

addiction

- Algorithm for diagnosis and treatment

- Use of psychometric instruments in diagnosis

- Prevention

- Impairment in chronic @@@

Conclusions and recommendations

Stimulate education and training in pain medicine

Stimulate the development of research programs for chronic pain

Comment round

Asked for attention for specific groups, e.g. chronic pain in the eldery

Asked about the responsibilities of different scientific associations

1st step

Publication report chronic pain by council

Consultation General practitioners association about development

guideline chronic pain

1st Step

Handover report to chairman of permanent parliamentary commission

Thank you for your attention

Discussion?