Flemish specialist wants to put pain on every doctor’s agenda

Summary

Bart Morlion, the freshly minted president of Europe’s largest professional organisation for doctors involved in pain research and treatment, says it’s high time medical practitioners started paying more attention to it

Sixth sense

“Pain is an extra sense, in addition to our traditional five human senses. It’s also an emotion because it’s so personal and subjective.”

This is not a spiritual healer or medical guru speaking, but Dr Chris Wells, a UK specialist in pain management who until recently headed the European Pain Federation (EFIC), an international professional organisation in the field of pain research and medicine based in Diegem, Flemish Brabant.

Wells is being succeeded by Dr Bart Morlion (pictured), a Flemish anaesthetist who serves as the co-ordinator of the Leuven Center for Algology and Pain Management at the city’s University Hospital. Morlion, also a professor at the University of Leuven, is taking up the job of EFIC president at a time when pain is still too often treated as a symptom of an illness or disorder, or as an inconvenience.

With one in five Europeans suffering from some kind of chronic pain, however, it is becoming ever clearer that our “sixth sense” deserves proper care from dedicated specialists.

According to Wells, a pain doctor is different from all other medical specialists. “We work on the psychological level much more, while a surgeon treats his patients more like biological samples in which certain parts have to be fixed or replaced,” he says. “Many classically schooled doctors feel like gods, while we are more like salesmen.”

Guarding the quality of pain specialists

An important part of a pain doctor’s job, he explains, is to convince a patient to try something or suggest changes in the patient’s behaviour that might offer relief.

Being a doctor, and especially being a pain doctor, also means treating non-responders, people who don’t seem to react to a certain treatment or medication, Dr Morlion adds. “Handling these patients is almost a speciality in itself,” he says.

Wells officially passed the three-year post to Dr Morlion at the EFIC conference held earlier this month in Copenhagen, Denmark. The event attracted pain specialists, trainees, researchers and representatives from the pharma industry, who gathered to discuss the latest trends in pain medication and learn more about future developments.

The environment we live in is not well suited to avoiding diseases, including pain

- Dr Bart Morlion

In addition, doctors could also take an exam to obtain a certificate in pain medicine – the only such qualification in Europe. “Our certification is a very powerful tool to improve and safeguard the quality of pain specialists in Europe,” explains Morlion.

According to the doctor, who will also be featured in the Vier programme Topdokters (Top Doctors) later this year, there are several ways in which our approach to pain could be improved in Europe. But his main ambition, and the one that’s the closest to his heart, is to build a better relationship between caregivers and patients.

“Ours is one of the most multidisciplinary fields in medicine,” says Morlion. “There’s no connection with a particular medical speciality. When it comes to pain, only the patient is central.”

Power of the patient

At the Copenhagen event, a patient led a conference session for the first time in the organisation’s history. Morlion wants to see many more such initiatives that do a better job of involving patients.

“Many of us are still reluctant when it comes to the participation of patients, but we forget that many patient groups are very efficiently organised,” he explains. “Some have almost transformed themselves into lobby groups that influence policymakers. So we can achieve much more if we work together with them.”

When it comes to pain, and especially the chronic kind, such as back pain – which is becoming a true epidemic as European populations age – there is no silver bullet, Morlion admits. “We have powerful medication, but there’s always the risk of addiction and of immunity, which requires ever bigger doses.”

No sexy solutions

Dr Morlion cites one of the biggest ongoing public health crises in the US as an example. At the heart of this drug epidemic are opioids, morphine-like painkillers that are extremely addictive.

According to Morlion, a solution for the chronic pain epidemic that is currently rocking Europe begins with the realisation that many pain-related problems are of our own making. “Our daily lives are not preventive enough, and the environment we live in is not well suited to avoiding diseases, including pain,” he says. “That’s why I want to strongly focus on primary prevention. I know it’s not the most attractive solution for patients, but it’s the best one we have that doesn’t have any side effects.”

Morlion advises everyone to carve out sufficient time in their schedules for exercise and to, for instance, start counting their steps. But the world of medicine itself also has to change and focus on pain much more, he says.

Every doctor will encounter patients with pain, while many disorders they actually learn about are so rare that only a few doctors will ever have to deal with them

- Dr Bart Morlion

He notes that this year’s conference programme included many sessions aimed at helping medical practitioners improve their knowledge – from introductory, general workshops to highly specialised lectures.

Morlion finds the lack of attention to pain in medical curricula particularly problematic. “In most European countries, this remains an open wound,” he says, pointing out that student veterinarians typically receive more training in pain medicine than general practitioners.

The same is true, he says, when you compare the curricula of nursing schools and of medical specialities. “Even at my own university, I’m struggling to get these hours into the curriculum,” he says, referring to the University of Leuven. “Isn’t that strange? Every doctor will encounter patients with pain, while many disorders they actually learn about are so rare that only a few doctors will ever have to deal with them.”

‘We have to work together’

It’s of course impossible to train “super doctors” who excel in every medical speciality, which is why Morlion isn’t arguing for neurologists, surgeons and oncologists to also become veritable pain specialists. To him, good pain management instead exceeds the multidisciplinary level.

“I prefer the term ‘interdisciplinary’ – doctors have to learn to work together,” he says. “They have to know who is good in a particular area.”

Still, it would help if all medical specialists had at least some general knowledge about pain, he says. “For example, that we can quite accurately measure pain, even though it is a very subjective phenomenon.”
Photo by B&K Nicholas Bettschart

Health-care system

The health-care system is federally organised in Belgium. Competing health insurance providers and a proportional contribution-based system ensure that healthcare is accessible to virtually all citizens and costs remain relatively low.
Law - From the age of 25, Belgian citizens and residents – both employees and those self-employed – are legally obliged to have health insurance.
Insurance providers - The mutualiteiten or mutual insurance associations are typically Christian, liberal, socialist or independent.
Services - Refunds are given for services such as doctor’s consultations, prescribed medication and hospital care costs.
1 945

national health-care system is born

13

percent of salary employees contribute to social security

50

to 75% of healthcare costs reimbursed by mutuality