Chronic pain affects around 20% of the adult population in Europe, yet it remains poorly managed and under-treated, affecting not only the patients, but society as a whole. It is time for EU and national authorities to recognise chronic pain as a priority and to ensure better diagnosis, fund research, adapt health insurance and guarantee that Europe’s 80 million sufferers get the treatment they need.

A Few Facts

  • Chronic pain directly effects sufferers and their quality of life and is a common characteristic of chronic diseases.
  • The estimated healthcare costs and loss in productivity associated with chronic pain equal 3-10% of European economic growth or GDP.
  • Chronic pain sufferers in Europe are denied many of the recognised patient rights notably access to treatment, information and new technologies, according to the Pain Patient Pathways Recommendations.
  • The low level of understanding among medical professionals of chronic pain is not proportional to the prevalence and impact of the disease.
  • Chronic pain provokes varying amounts of disability and may cause anxiety and depression including a heightened risk of suicide.
  • Low awareness of chronic pain as a healthcare problem and the consequences for sufferers and society at large undermine efforts to find solutions.
  • However, in some countries policy makers started working on innovative ways of tackling chronic pain from a legislative perspective. In particular, the Italian Law 38 of March 15th, 2010, entitled "Measures to ensure access to palliative care and pain therapy", represents a unique example of legislation in the European panorama, because it protects "the right of citizens to have access to palliative care and pain therapy" and detects three networks of care dedicated to palliative care, pain therapy and paediatric patients.

Call to Action
With the aim of addressing this situation, a multi-stakeholder platform including ministries of health’s representatives and delegates from patient and civic organisations, healthcare professional associations, the industry and EU institutions gathered to discuss the main challenges posed by chronic pain and possible solutions, identifying key Recommendations.

These Recommendations call for urgent action at national and EU level urging policy makers to:

  • Prioritise
    • The European Commission and member states should identify chronic pain as a health priority
    • Member states should develop and implement effective policies on the prevention, diagnosis, treatment and monitoring of chronic pain
    • The European Commission should support the creation of networks among national institutions responsible for chronic pain and interested stakeholders, to facilitate the sharing of good practices on pain therapy and palliative care-related policies, as well as on pain management pathways
  • Raise awareness
    • The European Commission and member states should increase public awareness of chronic pain, by supporting information campaigns towards the general public
    • They should also promote initiatives to empower patient and civic organisations so that patients can understand their rights and make informed choices
  • Educate
    • Member states should place higher emphasis on chronic pain in undergraduate and postgraduate education for healthcare professionals
  • Stimulate research and data collection
    • The European Commission and member states should continue including chronic pain in research and health-related programmes and activities
    • The European Commission and member states should support the creation of a database of social and economic indicators to track and better understand the impact of chronic pain on society

The project and the methodology
The Recommendations are based on the results of a pan-European survey spanning 18 European countries and carried out by national patients' and civic associations active in the fight against unnecessary pain. The project, entitled Pain Patient Pathway Recommendations, was initiated in November 2012 by a three-member coalition representing patients, citizens and industry, to create greater awareness of chronic pain, to promote a European policy on chronic pain and to improve its management. Working together the Pain Alliance Europe (PAE), the Active Citizenship Network (ACN), and the pharmaceutical company Grünenthal have set as the Recommendations’ ultimate goal to reduce the impact of chronic pain in Europe. The data, collected through interviews with representatives of national Ministries of Health, patients and citizens’ associations and healthcare professionals, fed into a project report which set the scene for the development of EU Pain Patient Pathways Recommendations. The Recommendations were developed during a workshop held on 22-23 October 2013 in Brussels, which involved 45 representatives of ministries of health, EU institutions, patient’s and civic associations, European healthcare professional associations and the industry.

Next Steps

  • The project partners will continue to reach out at national level to build momentum for an EU initiative on chronic pain.
  • They also welcome the interest expressed by the Italian government to prioritise pain therapy and palliative care during its Presidency of the EU Council from July to December 2014. 

While PAE and ACN are responsible for the political framework, scientific design, methodology and contents of the Pain Patient Pathways Recommendation project, Grünenthal provides financial and non-financial support.

For more information about the Recommendations:
Daniela Quaggia, ACN Project Manager
Tel: +39 06 36718315 E-mail: This email address is being protected from spambots. You need JavaScript enabled to view it.
Georgiana Huiban, PAE Communications and Public Affairs Officer
Tel: +32 2 7250151 E-mail: This email address is being protected from spambots. You need JavaScript enabled to view it.

The Recommendations’ endorsers (download the list of endorsers)

  • Pain Alliance Europe, Belgium
  • Active Citizenship Network, Italy
  • European Pain Federation EFIC
  • Alliance of Transplanted and Operated (ATO), Bulgaria
  • Association of Patients with Cardiovascular Diseases, Bulgaria
  • Association of Reproductive Health, Pregnancy and Childcare "Smile“, Bulgaria
  • Pijn Platform Nederland, The Netherlands
  • Index Foundation, Bulgaria
  • Together With you, Bulgaria
  • ISAL Foundation, Italy
  • Rede Integrada de Associações de Doença Crónica dos Açores (RIADCA), Portugal
  • Générations Mouvement, France
  • Medicine and Ecology Research Center (MERC), Macedonia
  • S. Miguel and S.ta Maria Islands Diabetes Association, Portugal
  • Vlaamse Pijnliga, Belgium
  • Myeloma Euronet Romania, Romania
  • Suomen Kipu ry, Finland
  • Fibromyalgia Association of Sweden, Sweden
  • European Federation of Neurological Associations, Belgium
  • Malta Health Network, Malta
  • Collectif Interassociatif Sur la Santé, France
  • Grunenthal

Breivik H, et al. Survey of chronic pain in Europe: Prevalence, impact on daily life, and treatment. Eur J Pain 2012;16:289-99
European Parliament Resolution of 15 September 2011 on European Union position and commitment in advance to the UN high-level meeting on the prevention and control of non-communicable diseases
Gustavsson A, et al. Socio-economic burden of patients with a diagnosis related to chronic pain - Register data of 840,000 Swedish patients. Eur J Pain 2012;16:289–99
Pain Patients Pathway Recommendations project report, October 2013
A blueprint for Pain Education, October 2013
Poole H, White S, Blake C et al. Depression in chronic pain patients: prevalence and measurement. Pain Pract 2009;9:173-180
Legge 15 marzo 2010, n. 38, "Disposizioni per garantire l'accesso alle cure palliative e alla terapia del dolore"


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