First EFIC® Symposium Societal Impact of Pain - SIP

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Magdi Hanna
Magdi Hanna MD
Director of Analgesics & Pain Research Unit (APRU)
APRU
PO BOX 22
BECKENHAM
KENT, BR3 1UR
ENGLAND, UK
TEL/ FAX:00442083256473
MOBILE:0044778525560
EMAIL:MAGDIHANNA6262@AOL.COM
Magdi H. Hanna became Director of the Pain Research
Unit (PRU) at King’s College School of Medicine in London
(UK) in 1985. Since then he has been an Honorary
Senior Lecturer at King’s College School of Medicine
and Dentistry,
Director of the Pain Relief Unit and Consultant in Pain
Medicine at the Department of Anaesthesia, Intensive
Care and Pain Relief at King’s College Hospital, London.
He became the Clinical Director of PCRH (Pain Clinical
Research Hub), a collaborative academic research unit
at King’s College School of Medicine and Pfizer in 2003
that specializes in developing pain biomarkers for chronic,
nociceptive and neuropathic pain states.
He has been Member of the European Academy of
Anesthesiology, European Association for Palliative Care
(EAPC), International Association of the Study of Pain
(IASP) and the British Pain Society for the last 25 years.
He has published extensively on the subject of pain, and
has been an invited speaker in numerous pain and
anesthesiology meetings, both nationally and internationally.
Currently a Consultant in Pain Medicine in the Independent
Health sector and the Clinical Director of the “Analgesics
&Pain Research Unit” (APRU) which acts as an independent
advisory unit for the pharmaceutical industry
and research units on drug development, use of human
pain models, translational research and Phase II clinical
studies as well as conducting due clinical diligent and
registration filing advice. He is a member of “Pain
Medicine Teachers” group and is on the Faculty of the
1st EFIC school for “NEUROLOGICAL DIAGNOSIS IN
CHRONIC PAIN”.
The Social Costs of Painful Diabetic Neuropathy
The dramatic increase in newly diagnosed cases of type
2 diabetes is a major public health concern within the
European Union.
It has been estimated that up to 50% of people with
type 2 diabetes will develop a degree of neuropathy
(Boulton, 2005). At least 20% of those affected are
likely to suffer from chronic neuropathic pain. The
majority of PDN patients experienced constant moderate
to very severe pain. In addition to the pain itself, there
are associated high levels of co-morbidity and related
symptoms, including difficulty sleeping, depression, and
anxiety. This has led to significant impairments in quality
of life (Benbow et al, 1998; Galer et al, 2000). PDN is a
clear area of unmet clinical needs. Currently there is no
effective therapy to treat, prevent or reverse the neuropathy
once it has been established. The goals of
available therapies are: pain, symptom control, a reduction
of co-morbidity and an improvement in quality of life. Traditionally
antidepressants, anticonvulsants, and opioids
have been the main compounds used for pain control in
PDN patients. Newer agents, such as SNRI (eg duloxatine),
α2δ ligands (gabapentin, pregabalin) have been found
to have proven efficacy in treating PDN. However, all of
these compounds have less than 50% responder rate
and most patients are left with significant residual pain.
Adverse side effects are a considerable hurdle for
patients, particularly sedation and weight gain. Overall
the quality of PDN treatment appears to be poor, with
few patients receiving recommended medications in efficacious
dosages.
Though knowledge of the health care costs associated
with neuropathic pain is somewhat limited, recent
studies have identified that PDN has the highest additional
health care costs even in comparison with other painful
neuropathies such as postherpetic neuralgia (PHN)
(Dworkin RH 2009). The substantial cost to society of
PDN derives from direct medical costs, loss of the
ability to work, loss of caregivers' ability to work and
possibly greater need for institutionalization or other
living assistance (O’Connor AB 2009 ).
The cost of managing painful diabetic neuropathy can
increase the basic cost of managing diabetes by two
and up to 10 fold depending on the degree of associated
co-morbidity such as anxiety and depression (Boulanger
L 2009).
It is hoped that better understanding of the economic
burden of PDN will provide a basis for evaluating the impact
on health care costs of new interventions for their
treatment and prevention.