Doctor Lourdes Luzón, coordinator of the Patient Safety Working Group of the Spanish Society of Family and Community Medicine (SEMFYC), has stressed the importance of "adapting care strategies to move toward safer, more equitable care that is tailored to the needs of each person".
In her address, she has called for a "paradigm shift in the approach to chronic pain from an epistemic point of view," which "would consequently lead to modifying therapeutic objectives". As she has pointed out, "in this way, the approach to chronic pain must go beyond relieving the symptom and focus on recovering the patient’s functionality and autonomy in a more comprehensive and less iatrogenic manner".
These reflections were presented in the talk "Challenges in the management of chronic pain: correct approach, equity, polypharmacy, coordination", within the framework of the "XLVI Congress of the SEMFYC", which is being held until November 7 in Las Palmas de Gran Canaria. At this meeting, the weight of pharmacological treatment, the barriers to generalizing non-pharmacological interventions, and inequalities in care for people with persistent pain are analyzed.
According to Luzón, the current care model "continues to be, to a large extent, focused on treating the affected area and relieving the symptom, while aspects such as restoring functionality, therapeutic exercise, and psychological support are not always integrated into routine care". In addition, she has warned that "to this are added differences in diagnosis, in the prescribing of medications, and in access to non-pharmacological treatments depending on gender, origin, socioeconomic status, or place of residence".
Doctor María Muñoa Capron-Manieux, coordinator of the SEMFYC Working Group on Chronic Pain Approach, has emphasized that "in cases of chronic pain without active lesions of tumoral, infectious or inflammatory origin, among others, drug treatment should not be the starting point". For her part, Doctor María Eloísa Rogero, from the Working Group on Use of Medicines, has recalled that "opioids have not demonstrated sufficient effectiveness to justify their widespread use in this context", due to the risks of dependence, tolerance, and increased mortality.
In relation to social and gender gaps, the speakers have highlighted that these are also carried over into the clinical management of chronic pain. In Spain, women show a prevalence of 30.5 percent, compared with 21.2 percent for men, according to the "Chronic Pain Barometer" of 2022. Likewise, various scientific studies show differences in the suitability of treatments even when it comes to pain conditions with similar characteristics.
Differences by gender and social class in the treatment of pain
Muñoa Capron-Manieux has stated that "it 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." She added that "these differences are also observed in access to diagnostic tests and in the therapeutic options available, and they especially affect women, the migrant population, and people with a lower socioeconomic level."
Given this situation, the specialists advocate for a comprehensive assessment of people with chronic pain in order to design an individualized and agreed-upon therapeutic plan, which should take into account not only the physical component, but also emotional and social factors. Dr. María Varela Cerdeira, coordinator of the Working Group on Palliative Care of the SEMFYC, has insisted that "we need a more equitable, accessible and coordinated range of services, as well as to train professionals to identify and reduce gender, origin, and social class risks that may condition care and treatment of pain."
In line with this vision, the congress has included two specific sessions in which it has been proposed that one of the key changes in the approach to chronic pain is to review how treatment outcomes are assessed and to incorporate the recovery of functionality as the main goal. Dr. Francisco Vargas Negrín, director of the Health Center Dr. Guigou in Tenerife, has pointed out that "we will not always be able to completely eliminate pain, but we can work so that it takes up less space in the person’s life and help them recover what is important in their life."
The person in charge of the Pain Unit of the Insular Materno Infantil University Hospital Complex of Gran Canaria, María del Mar Mateos Pérez, has focused on the active role of patients: "It is necessary to empower patients, helping them to understand their illness, its prognosis and its evolution, offering realistic expectations so that they take on self-care of their illness," she said, and then went on to emphasize that "achieving motivated people who adopt an active role in their process is the best approach to chronicity."
Finally, the physiotherapist from Primary Care in Tenerife, Laura Batista Pérez, has argued that "what should be a priority is to adapt treatment to the conditions of each patient." In her view, "not all pain follows the same course nor do all respond in the same way to different treatments," which requires adjusting interventions to each person’s particular situation.