The major objectives of the CHANGE PAIN International Advisory Board are to enhance understanding of chronic pain and to develop strategies for improving pain management. At its second meeting, in November 2009, evidence was presented that around one person in five in Europe and the USA experiences chronic pain, and the delay before referral to a pain specialist is often several years. Moreover, physicians' pharmacological approach to chronic pain is inconsistent, as evidenced by the huge variation in treatment between different European countries. It was 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. Pharmacological therapy must be matched to the causative mechanisms responsible, or it is likely to prove ineffective and risk the development of a 'vicious circle'; doses are increased because of inadequate pain relief, but this increases side-effects so doses are reduced, pain relief is then inadequate, so doses are increased, and so on. Pain management decisions should not therefore be based solely on the severity of pain. Based on the concept of individual treatment targets (ITT), the CHANGE PAIN Scale was adopted a simple, user-friendly assessment tool to improve communication between physician and patient. The 11-point NRS enables the patient to rate the current pain intensity and to set a realistic individual target level. On the reverse are six key parameters affecting the patient's quality of life; clinicians simply need to agree with patients whether improvement is needed in each one. Regular use can establish the efficacy and tolerability of pain management, and the rate of progress towards individual treatment targets.

Brief Pain Inventory, CHANGE PAIN Scale, Chronic pain, Communication, Individual treatment targets, Multifactorial, Short Form 12, Short Form 36, User-friendly assessment tool, Vicious circle, Western Ontario and McMaster Universities Osteoarthritis Index, acupuncture, analgesia, analgesic agent, anticonvulsive agent, antidepressant agent, cancer pain, chronic pain, clinical assessment, clinical practice, consensus development, continuing education, decision making, doctor patient relation, drug choice, drug efficacy, drug safety, drug tolerability, e-mail, evidence based practice, frail elderly, gabapentin, health care cost, health personnel attitude, human, hyperalgesia, interpersonal communication, lidocaine, low back pain, mass medium, monotherapy, multidisciplinary team, n methyl dextro aspartic acid receptor blocking agent, narcotic analgesic agent, neuromodulation, neuropathic pain, nociception, non prescription drug, nonsteroid antiinflammatory agent, nurse, opiate, pain, pain assessment, paracetamol, patient care, patient referral, pharmacist, physiotherapy, polypharmacy, practice guideline, pregabalin, prescription, prevalence, professional practice, quality of life, questionnaire, rating scale, review, self care, serotonin noradrenalin reuptake inhibitor, teamwork, transcutaneous nerve stimulation, treatment planning, tricyclic antidepressant agent, visual analog scale, world health organization,
Current Medical Research and Opinion
Erasmus MC: University Medical Center Rotterdam

Müller-Schwefe, G, Jaksch, W, Morlion, B, Kalso, E, Schäfer, M, Coluzzi, F, … Varrassi, G. (2011). Make a CHANGE: Optimising communication and pain management decisions. Current Medical Research and Opinion (Vol. 27, pp. 481–488). doi:10.1185/03007995.2010.545377