The Spanish Society of Family and Community Medicine (semFYC) maintains that, in the case of chronic pain without active lesions of tumoral, infectious, or inflammatory origin, the use of medications should not be placed as a first line. Instead, it proposes a biopsychosocial and multidisciplinary approach that combines therapeutic exercise, pain education, and psychological support.
During the XLVI Congress of semFYC, specialists in Family and Community Medicine have reviewed the current care model which, in their view, continues to focus above all on the painful area and on relieving the symptom. At the same time, they denounce that the recovery of functionality, the prescription of therapeutic exercise, and psychological support are not systematically integrated into everyday clinical practice.
The coordinator of the semFYC Patient Safety working group, Lourdes Luzón, emphasizes the urgency of adapting care strategies to move toward a safer, more equitable model focused on the concrete needs of each person.
Among the key transformations, the experts highlight a paradigm shift in the understanding of chronic pain that requires redefining therapeutic objectives. With this change, the management of chronic pain must go beyond mere symptom relief and be oriented toward restoring the patient’s functionality and autonomy, with a more comprehensive and less iatrogenic vision.
Along the same lines, María Muñoa, coordinator of the Working Group on the Approach to Chronic Pain, stresses that "in cases of chronic pain without active lesions of tumoral, infectious, or inflammatory origin, among others, drug treatment should not constitute the starting point".
Regarding opioids, María Eloísa Rogero, from the Working Group on the Use of Medicines of semFYC, warns that "opioids have not demonstrated sufficient effectiveness to justify their generalized use in this context" and recalls the associated dangers, such as dependence, tolerance, and increased mortality.
Professionals insist that, when these drugs have already been prescribed, it is essential to reassess their indication and consider a progressive, planned, and supervised withdrawal, providing information and continued support to the affected person. The rest of the medications, when justified, should remain as adjunctive treatments and not as the basis or main axis of pain management.
Social and gender inequalities are also evident in the management of chronic pain. According to the 2022 Chronic Pain Barometer, the prevalence among women in Spain reaches 30.5 percent, compared with 21.2 percent among men. In addition, various scientific studies point to differences in the appropriateness of treatments even in comparable painful conditions.
"This is not only that certain groups have a higher prevalence of chronic pain, but that they can also receive less appropriate care, with greater exposure to pharmacological treatments, higher doses, and less access to interdisciplinary approaches," says Muñoa.
These gaps are reproduced in access to diagnostic tests and in the therapeutic alternatives available, affecting especially women, the migrant population, and people with a lower socioeconomic level.
"We need a more equitable, accessible, and coordinated range of services, as well as to train professionals to identify and reduce the gender, origin, and social class risks that can condition the care and treatment of pain," María Varela, coordinator of the Working Group on Palliative Care of semFYC, has concluded.