The International Symposium on Chronic Pain brought together experts and health professionals at the University of the Azores to discuss ways to improve patient care, strengthen timely access to treatment, and promote health literacy initiatives. During the event, the development of the protocol between the Hospital do Divino Espírito Santo (HDES) and the Azores Chronic Pain Patients Association was also presented. Among the main obstacles identified are the increased demand for specialized care, the lack of human resources, and waiting lists that already stretch for several months.

The Azores Chronic Pain Patients Association (ADDCA) organized the International Symposium on Chronic Pain at the University of the Azores.

The meeting aimed to discuss the best ways to support those living with chronic pain, promote timely access to treatment through coordination between multidisciplinary teams, and plan health literacy initiatives in the area of pain.

Topics discussed included the use of invasive hospital procedures, the practical application of science, pain management by general practitioners and family doctors, and the importance of prevention and its complications through healthy lifestyle habits, nutrition, regular physical activity, emotional control, and mental health. The event will culminate in the preparation of a report to be sent to the Regional Health Secretariat.

In statements to the press, the President of ADDCA, João Ribeira, emphasized that many people remain focused on an exclusively curative approach, seeking to “combat” chronic pain rather than prevent it.

“Chronic pain cannot be combated, but rather treated and monitored. To prevent chronic pain, the first step is to make the patient aware that they must be at the center of this prevention.”

Ribeira said that there are several tools available to people, such as psychosocial support, physical therapy, massage, meditation, breathing techniques, yoga, gymnastics, dance, or dramatic expression, which are “all ways that the brain has to release this component of chronic pain maintenance.”

“People have to realize that they must take action to prevent pain. Patients have to become proactive in preventing their pain; they can’t always wait for the doctor to come. It doesn’t work that way.

”It usually starts with some kind of change or injury, which then becomes chronic in terms of the brain’s pain signal. So what we want is for that not to happen, but when it does happen and the person is suffering from chronic pain, they really have to realize that it is in their hands and that they have tools at their disposal to prevent it.”

The President of ADDCA also revealed that the association currently supports around 90 people, with members from several islands. He recalled that, as mentioned in the symposium, one in three people suffer from chronic pain.

“If we think about it, a third of the Azorean population is 70,000 people, perhaps. We have 90 members. Therefore, there is everything to be done in terms of reaching people and people reaching us.”

He added that there is still a misconception that the association functions as a Day Center. He emphasized that this is not its mission and that, although there is a social space, 85% of ADDCA’s activity consists of providing information, psychoeducation, and specific prevention and support activities for people with chronic pain.

ADDCA’s main objective, in addition to establishing protocols, is to spread its message and increase the number of people covered. “We are gathering the resources that exist and are available to people, so that they can also improve their situation locally in some way (…) If we think about some of the smaller islands, resources are relatively limited,” he concluded.

One of the speakers yesterday morning was Tiago do Nascimento Cabral, Director of the Anesthesiology Service at the Hospital do Divino Espírito Santo (HDES). He explained that, since the fire last year at HDES and with the construction of the modular hospital, there has been a need to double human resources and create redundancy in the surgical area, especially in the emergency room. This situation raised important questions regarding the management of the service and also the monitoring of chronic pain.

Given this scenario, the Director pointed out that surgical waiting lists have increased and that, when there are patients with chronic pain waiting for consultation and others waiting for surgery, it becomes difficult to reconcile all priorities. Nevertheless, he stressed that “the defense of the patient must always be our first concern.”

The average waiting time for a first consultation for chronic pain at HDES in São Miguel Island is 4 months

Tiago do Nascimento Cabral revealed that, according to data updated this week, the average waiting time for a first consultation for chronic pain is around four months, adding that “if we are talking about surgery, these waiting lists can be even longer.”

Also speaking at the symposium, Maria Teresa Flor de Lima, Vice President of ADDCA, stated that the waiting list proposals for consultations presented by the Regional Health Directorate a few years ago are “a little long” and that they “go against international rules and guidelines.”

“There are patients who cannot wait a day. There are patients who cannot wait more than a week. At most, we can go up to two months for those cases that are more or less under control, which is what is indicated.” Flor de Lima stressed that “we cannot extend waiting lists beyond two months.”

With regard to human resources, the Vice President warned that there is an increasing need for professionals with specific training in pain, namely doctors with postgraduate degrees in Pain Medicine. However, she added that the Portuguese Association goes even further by advocating for the Portuguese Medical Association to obtain competence in Pain Medicine, emphasizing that this “is not easy for those in the Azores” because the respective courses take a year or two to complete, and that “in addition to the lack of resources, this is also a limitation.”

Regarding the evolution of techniques, he explained that there has been a shift from more invasive methods to minimally invasive techniques. He noted that today there is talk of simpler surgeries with fewer complications, and that there are approaches such as neurostimulation or peripheral stimulation, which allow superficial nerves to be stimulated through external devices.

On the other hand, he stressed the importance of careful indication: “It is very important to understand that these techniques are not miraculous. We have to combine these techniques with psychosocial support.”

On the positive side, the Director of the Anesthesiology Service highlighted the ongoing process, funded by the PRR, to acquire an ultrasound machine dedicated mainly to chronic pain. This will increase the ease and volume of ultrasound-guided techniques, constituting an added value for the treatment of patients and may also act as a factor of attractiveness and appreciation for new professionals interested in multidisciplinary intervention practice.

Protocol between ADDCA and HDES with the “sole objective of improving the quality of life of patients”

One of the topics mentioned at the event was the coordination protocol between ADDCA and HDES, which is already under review and has been submitted to the hospital’s Board of Directors. The Association’s president emphasized that the protocol being developed with HDES has precisely this purpose: to allow the hospital itself to refer patients to ADDCA and to help reinforce the credibility of the Association’s intervention.

Tiago do Nascimento Cabral explained that this protocol has already been proposed and that a meeting with all the entities involved will soon be scheduled to move forward with the practical implementation of this collaboration. He stressed that the intention is for the agreement to work bilaterally and complementarily, allowing the association to offer what the hospital cannot provide, and vice versa, always with “the sole objective of improving the quality of life of patients with chronic pain.”

The protocol provides for ADDCA to provide psychological support, cognitive and motor stimulation activities, relaxation activities, cultural and leisure initiatives, relevant information, and psychoeducation for users, family members, and caregivers.

On the part of HDES, it includes support in guiding pharmacological treatment for users without a family doctor, performing invasive and hospital treatments, jointly organizing workshops and information sessions for health professionals, patients, caregivers, and citizens, referring people with chronic pain to ADDCA, supporting the dissemination of the association’s activities in various specialties, defining referral criteria, and collaborating/promoting jointly organized workshops.

In addition to the president and vice president of ADDCA, the Regional Director of Health, Pedro Paes, MEP Paulo do Nascimento Cabral, and the vice rector of the University of the Azores, Susana Caldeira, participated in the International Symposium on Chronic Pain.

There was also a panel on Pain in the Autonomous Region of the Azores, followed by a panel on the Science of Pain, with contributions from João Ribeira, as a neuropsychologist, ISCTE researcher Sónia Bernardes, and Valentina Malafoglia, a researcher at ISAL Fondazione in Italy.

There was also a panel dedicated to Pain in Family Medicine and another on Pain Prevention, with health professionals from the region and several testimonials from users.

José Henrique Andrade is a journalist for Correio dos Açores, under the direction of Natalino Viveiros.

Translated into English as a community outreach program by the Portuguese Beyond Borders Institute (PBBI) and the Modern and Classical Languages and Literatures Department (MCLL), in collaboration with Bruma Publication and ADMA (Azores-Diaspora Media Alliance) at California State University, Fresno. PBBI thanks Luso Financial for sponsoring NOVIDADES.