National Geographic magazine dedicates the first issue of 2020 to pain. More and more popular scientific journals in the last 1-2 years have chronic pain syndromes as their topic. In fact, spots have started to appear on TV and radio for migraine. Associations of patients with chronic pain syndromes are increasing, as is their influence on the medical guidelines of medical companies and on the decision-making committees of insurance agencies and official government regarding health policy. Is it my sense or not that in recent years "pain", from an invisible lonely experience turns the spotlight on it and begins to demand awareness from the public and the state as a condition of a large part of society? Although invisible, affecting the quality of life of the patients. After all, the World Health Organization (WHO), in the lists it makes and shows the causes of disability due to illness, pain syndromes are consistently in the first ten places. About the same applies to the lists paraded by the causes for lost years of life (disability-adjusted life year - DALY).

We also know from a large pan-European study published in 2006 that 19% of EU adults suffer from some moderate or severe chronic pain syndrome, whatever it may be (chronic back pain, headache, autoimmune diseases, malignancies, post-traumatic pain, etc., etc. .). In fact, half of those who suffered, consider that their pain is not effectively treated. If we calculate among them that 10-14% suffer from episodic migraine and 0.5 to 2% from chronic migraine it is very likely that many patients suffer from two locations of pain or chronic pain. And indeed recent (2019) epidemiological reviews have shown that there is an association between sciatica (pain "in the middle") and migraine. Indicatively in a study of 1034 patients who suffered from back pain in the past year 40% also suffered from migraine. Furthermore, in a sample of 5605 migraine patients, 76% of patients with episodic migraine also suffered from back pain, while 88% of those with chronic migraine also suffered from back pain (!!). It is undeniable that we are talking about a lot of pain!

Two issues arise. The first is that pain is indeed recognized by society and the state as an invisible scourge that reduces the quality of life of a large percentage of the world's population and is responsible for part of the disability and lost years of life. Public information must continue. But also informing the sufferers themselves must continue. To understand their problem, to integrate it and to feel that there are people suffering from the same problem. Informing all doctors, regardless of their specialty, must also continue. Why this is so important, we will return to in the next paragraph. And of course the awareness of the state, the recognition of the problem and its inclusion in the common diseases. In Denmark, they give a pension to patients with severe chronic migraine... In all of the above, associations, associations of patients who suffer from some form of pain must also play an important role. It is no coincidence that such associations now exist internationally and that their voice and power is increasing.

The second issue is managing so much pain. We know that a large part of the treatment of pain is done in the context of primary health by the general practitioner or by the pathologist or orthopedist or in conditions of general duty of a hospital or clinic. Usually the treatment is simply symptomatic (treatment is given to pass for that moment the pain). This leads to non-preventive treatment of pain, abuse of painkillers and unfortunately many times addiction to opiate painkillers. In the US there is a so-called "opiate epidemic" and millions are addicted to this type of painkillers. In the emergency room in the US the most likely to be given for a pain is an opioid drug, while the guidelines are strictly to the contrary. It is now an absolute necessity to treat any kind of pain by a specialist doctor or a team of doctors and other specialties. It is not the same pain in low back pain, fibromyalgia, cancer metastases, migraine, autoimmune diseases, diabetic neuropathy pain or chronic post-traumatic pain. It will require different preventive and symptomatic treatment from a different medical specialty each time. One could argue that this leads to the over-specialization of medicine and thus the holistic view of the problem is lost. This is not the case because one way or another we are talking about a team effort of various specialties, but also special pain requires a very special treatment: when our tooth hurts we go to the dentist and secondly a more holistic approach is of interest. So it seems from experience, that not even the general pain clinics that exist, can provide a solution in many cases. There should probably be back pain clinics, headache clinics, cancer pain clinics, etc., etc. So it is understandable that the proper management of pain is just as important as the awareness of its specificity.

Finally, it is important that new, effective drugs without particular side effects are now available to treat pain. Scientific research, which the truth is that is supported to a very large extent by the multinational pharmaceutical companies, provides us and will provide us in the future with these drugs after well-planned studies that are done simultaneously in different parts of the world. So pain, this invisible epidemic that steals days from life has come right into the crosshairs of science in the sense that science must serve humanity and cannot ignore that large part of it that suffers. Painful times, but times are changing…