1. Healthy ageing in relation to chronic pain in the EU Jos Kleijnen and Nigel Armstrong Kleijnen Systematic Reviews Ltd, York, UK

2. Disclosure Statement of conflict of interest in the context of the subject of this presentation This report is published supporting the scientific aims of the international multi-stakeholder platform “Societal Impact of Pain” (SIP). The report was developed by Kleijnen Systematic Reviews Ltd. The scientific framework of this report is under the responsibility of EFIC® (European Federation of IASP® Chapters). The pharmaceutical company Grünenthal GmbH is responsible for funding and non-financial support (e.g. logistical support). The funding source did not have any influence on the conduct and reporting of this study.

3. Societal challenges for Europe: By 2050 >30% of EU-27 population will be aged 65+ With the demographic changes of an ageing population the European Union and its member states are facing a tremendous challenge

4. European Innovation Partnership on Active and Healthy Ageing (EIP on AHA) EU Commission pilot project: to enhance competitiveness in the EU to tackle these societal challenges by fostering innovation and research One objective is enabling EU citizens to lead healthy, active and independent lives while ageing: The frame target of the partnership: “increase the average healthy lifespan by two years by 2020”

5. Prevalence of chronic pain % of population Age (years) P < 0.001 N = 1817 Elliott AM et al. Lancet 1999;354:1248-52 The prevalence of pain increases with age

6. Chronic pain The numerous impacts of chronic pain in the elderly Depression & anxiety Walking and mobility problems Fatigue Decline in social activities Increased caregiver burden Reduced QoL Increased healthcare utilization Slower rehabilitation Impaired decision making Worsening of gait disturbances Sleeping problems

7. EFIC ® ’s response to EU policy plans: Correlation between pain and healthy ageing? Key Questions: How to gain two additional healthy years of life by 2020? What is the evidence that reducing chronic pain can help? Methodological approach: Quality of life measures can be used to assess healthy years of life eventually gained. Could this be achieved by reducing pain/discomfort in the elderly?

8. Addressing at EU level: The role of chronic pain in improving quality of life Systematic literature review Commissioned by Grünenthal from Kleijnen Systematic Reviews Ltd in York, U.K., on the most recent epidemiological data from the EU: Chronic pain in relation to quality of life in people >50 years old? Aim of review: Investigate correlation of chronic pain, quality of life and ageing Highlight role of chronic pain for overall health state of the ageing EU population.

9. Systematic literature review: The role of chronic pain in improving quality of life Systematic literature review: Observational studies from 2009, systematic reviews from 2005 on. Only EU countries or EU overall 6 observational studies and one systematic review (6800 patients) included in analysis of relationship between pain and QoL. For effects of interventions on pain and QoL, 8 systematic reviews were analysed. Limitations: No study focused on those >50. Average age of participants in all studies was in the 40’s, at least. Parallel improvement of pain and QoL does not imply causality! All included systematic reviews demonstrating QoL improvement by pain management were in fibromyalgia.

10. Review findings: Clear correlation between QoL and severity of pain Correlation between QoL and pain severity: strong pain: 0.5-0.8, moderate pain: 0.2-0.5 (FSH = facioscapulo-humeral)

11. Review findings: Chronic pain has an impact on quality of life Size of relationship of pain intensity and QoL (e.g. -1 means 1 point decrease in pain produces 1 point increase in QoL)

12. Review findings: Clear relationship between change in pain after treatment and change in QoL Relationship between change (intervention vs comparator treatment) in QoL and pain

13. Chronic pain results in lost working days

14. Literature review results: Summary Prevalence of chronic pain increases with age Chronic pain associated with reduced quality of life Chronic pain results in lost working days Pain negatively influences the quality of life for individuals and population groups Chronic pain interventions reduce pain and improve quality of life Relevance for policy makers: Consider pain prevention and treatment one promising approach to improve quality of life as part of the Healthy Ageing framework.

15. Conclusions In EU chronic pain is a substantial burden on individuals and the society, including enormous costs for healthcare systems. Chronic pain is common in elderly people (>65 yrs every second at least). QoL lower among chronic pain sufferers and correlated to severity of pain. Prevention and treatment of chronic pain likely to improve quality of life and increase healthy lifespan by two years, as intended by the Active and Healthy Ageing Partnership project. However, there is only limited evidence for this so far! A structured programme is urgently needed to target these challenges and their long-term consequences on EU and Member State level.