Pijnbehandeling, een advies van de Gezondheidsraad

– In December 1986 the Health Council of The Netherlands reported on the treatment of pain. The report is based on an extensive overview of present pain concepts. The basic idea is that every type of pain involves somatic, mental and social factors. A classification of pain, to be used in daily practice, is presented: acute pain, chronic pain with or without a major somatic component, and central pain. The report emphasizes the importance of prevention of pain, which has primary, secondary and tertiary aspects. The Council concludes that acute pain and cancer pain are still being undertreated and chronic pain of benign origin is being overtreated and gives recommendations on a more proper management of especially these types of pain. An organizing model for pain treatment in the current Dutch health care system is discussed.

It specifies which groups of patients should be treated at the different levels of health care. The main responsibility for the treatment of (chronic) pain should be assigned to general practitioners. Single pain specialists, like anaesthetists and neurosurgeons, can play an important but complementary role. Multidisciplinary pain groups should primarily have an advisory task and, in addition, should have a role in performing clinical trials, preferably using nationally accepted protocols. Treatment in multidisciplinary pain management centres and multidisciplinary pain groups should be restricted to a limited number of carefully selected patients for a limited period of time. The Health Council recommends more education in medical and paramedical curricula.