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1 Why we want to CHANGE PAIN Grünenthal the company behind the initiative Think Innovation. Feel Life.

2 Grünenthal why we want to CHANGE PAIN

3 4 Grünenthal the company behind the initiative 5 Did you know that one in five Europeans suffers from chronic pain? Pain is not a single problem. It is 96 million individual problems in Europe alone. 1 Today, chronic pain affects up to 19% of the European population. 2 In a pan-european survey, 21% of the respondents with chronic pain had suffered for more than 20 years. 2 96,000,000 problems in Europe fotolia.com 1 96 M equals 19% of EU population of 506 M. Accessible at 2 Breivik H, Collett B, Ventafridda V, et al.: Survey of chronic pain in Europe: prevalence, impact on daily life, and treatment. Eur J Pain. 2006; 10:

4 6 Grünenthal the company behind the initiative 7 Did you know that there is a lack of recognition and understanding of pain? e34 billion loss for the European economy Did you know that pain still is no priority for governments and health services? 40% of the patients were not satisfied with the management of their pain, and 12% said their physician never determined how much pain they were experiencing. 2 Efficient communication between physicians and patients is very important for accurate assessment of the level of pain and its impact on the patient s quality of life. However, in many cases this communication is too limited to enable optimal assessment and therapy. 40% dissatisfied Now that my chronic pain is under control, I am so happy to be enjoying my life again. But it needed time! After a 15-year battle I finally feel victorious. Across Europe chronic pain accounts for nearly 500 million lost working days every year costing the European economy around e 34 billion. 3 One in five chronic pain sufferers have lost a job as a result of their pain. 2 2 Breivik H, Collett B, Ventafridda V, et al.: Survey of chronic pain in Europe: prevalence, impact on daily life, and treatment. Eur J Pain. 2006; 10: José, Patient Ambassador from Spain 2 Breivik H, Collett B, Ventafridda V, et al.: Survey of chronic pain in Europe: prevalence, impact on daily life, and treatment. Eur J Pain. 2006; 10: Wiffen P: Pain there is a lot of it. Eur J Hosp Pharm. 2013; 20:1 Picture European Union Picture European Union

5 we develop solutions to change change how pain is understood Who we are From Germany across the globe The Grünenthal group is an independent, family-owned international research-based pharmaceutical company headquartered in Aachen, Germany. 26 affiliates 8 Grünenthal the company behind the initiative countries At Grünenthal... 4,400 employees change how pain is treated change how pain affects millions of sufferers. We focus on the intensive search for new ways to treat pain better, more effectively and with fewer side-effects than before. With outstanding initiatives we aim for a better understanding of chronic pain and patients needs. At Grünenthal, we want to lead therapy innovation building on our unique position in the pain therapy area. Our objective is to become the most patient-centric company. Altogether, the Grünenthal Group has affiliates in 26 countries worldwide. Our products are sold in more than 155 countries. Today, approximately 4,400 employees are working for the Grünenthal Group worldwide. 973 M revenues In 2012, Grünenthal achieved revenues of e 973 M.

6 10 Grünenthal the company behind the initiative 11 how pain is understood At Grünenthal we want to go further. Therefore, in 2009 we founded the unique CHANGE PAIN initiative. CHANGE PAIN aims to: enhance the understanding of chronic pain patients needs help improve the management of chronic pain. This initiative is endorsed by the European Federation of Chapters of the International Association for the Study of Pain, EFIC. A group of renowned international experts in the field of pain provides guidance on how to improve pain management. 4 Müller-Schwefe GHH, et al.: Make a CHANGE: optimising communication and pain management decisions CMRO; 27(2); 2011; Varrassi G, et al.: Pharmacological treatment of chronic pain the need for CHANGE. CMRO; 26(5); 2010; Effective communication between physicians and patients The way in which physicians and patients communicate with each other is very important, as understanding the level and impact of pain forms the basis for agreeing upon a pain management plan. One of the tools the initiative has developed is the CHANGE PAIN scale to support physicians and patients in establishing individual treatment goals. The tool facilitates assessment of pain intensity and desired pain reduction. Additionally, the impact of pain on the quality of life and the invidual need for improvement can be evaluated. 4 Get patients out of the Vicious Circle! Physicians and patients struggle to find the balance between pain relief and tolerability. Understanding this Vicious Circle and the mechanisms behind it can help physicians improve chronic pain management. 5 Pain therapy should be mechanism-oriented To offer patients a more effective pain management plan at an early stage, a deeper knowledge of the underlying mechanisms of pain and different pharmacological principles is crucial.

7 12 Grünenthal the company behind the initiative 13 how we advance PAIN EDUCATION how pain is treated today PAIN EDUCATION is the key to change The PAIN EDUCATION program consists of Non-accredited elearning modules as a quick update on key topics in pain Grünenthal our pain product portfolio Our portfolio covers a broad range of products indicated for both chronic pain conditions and acute Today, healthcare professionals are working in an evolving environment where it is critical to stay informed about the latest innovations in medicine as well as to continuously maintain and improve their medical knowledge. CHANGE PAIN provides healthcare professionals with a comprehensive PAIN EDUCATION program which helps them to stay up-to-date with the latest scientific information about diagnosis, treatment, and management of chronic pain. Online suite of educational material: electronic Continuing Medical Education courses (ecme), accredited by the Union Européenne des Médecins Spécialistes (UEMS). It consists of seven modules available in several European languages which can be accessed on management. PAIN Compendium, a comprehensive online textbook on pain management. Additionally, many accredited PAIN EDUCATION face-to-face training courses are organized across While there is Europe. no cure for chronic pain, there is life with chronic pain. Edith, Patient Ambassador from the UK Pain is the most single common reason why an individual consults a medical professional. 5 As a pharmaceutical company with many years of experience in the field of pain medicines, we are proud of the innovative results of our research and development. pain conditions. Pain is diverse: several distinct types of pain exist which require different treatment approaches. Grunenthal s portfolio includes products for the relief of nociceptive pain and neuropathic pain. ( 5 Varrassi G et al.: Pharmacological treatment of chronic pain the need for CHANGE. Current Medical Research and Opinion, 2010; 26(5):

8 14 Grünenthal the company behind the initiative 15 how pain is treated tomorrow how to encourage new findings in clinical pain research Grünenthal new products through investment in research and innovation with headquarters in Germany which sustainably invests in research and development. The EFIC-Grünenthal Grant: research grants for clinical and human experimental pain research E-G-G promotes pain research on a long-term basis. With these grants, Grünenthal emphasizes its willing- Our investments are already signifi- ness and ability to go beyond the The reason for us to be in business cantly above industry average. In The importance of the EFIC-Grü- horizon of short-term commercial is innovation. And innovation starts 2012, research and development nenthal Grant is to support pro- interests. with patients and their needs. costs amounted to about 26 percent mising scientists at a critical phase of of revenues. their early career when independent As pain specialist we appreciate the Seeking innovation leadership R&D made in Germany R&D investment 26% We are intensely focused on discovering new ways to treat pain better and more effectively, with fewer side-effects than current therapies. Grünenthal is one of the last five remaining research-oriented pharmaceutical companies We are one of the innovative leaders within our industry: Grünenthal ranks amongst the top pharmaceutical companies worldwide regarding its number of projects in preclinical up to phase III development. financial and logistic support is often difficult to obtain. The biennial grant totals up to e 200,000 with individual research grants of up to e 40,000. The successful applications are independently selected by the EFIC Committee on Scientific Research. fruitful exchange of information and experiences with promising junior scientists. It helps to identify treatment gaps and potential solutions for new medications. The aspiration of ( the grant scheme is to kick-start research that will be sustainable through future competitive funding from other sources. Prof Martin Koltzenburg, Chair of EFIC Committee on Scientific Research

9 16 Grünenthal the company behind the initiative 17 How pain affects millions of people SIP Societal Impact of Pain The Societal Impact of Pain A Road Map for Action We call on European governments and the EU Institutions to: How we ask policy-makers to do more to address pain In 2001, the European Federation of the International Association for the Study of Pain, EFIC published its Declaration on Pain which called The Societal Impact of Pain a Multi-Stakeholder Platform in Europe In 2010, a joint initiative of EFIC and Grünenthal called the Societal Impact of Pain, SIP, was founded as a pan-european multi-stakeholder fessionals, pain advocacy groups, politicians, insurance companies, representatives of health authorities, regulators and budget holders. The scientific framework of SIP is under the responsibility of the Euro- 1. Acknowledge that pain is an important factor limiting the quality of life and should be a top priority of the national health care system. 2. Activate patients, their family, relatives and care-givers through the availability of information and access to pain diagnosis and management. 3. Raise awareness of the medical, financial and social impact that pain and its management has on the patients, their family, care-givers, employers, and the healthcare system. on national governments and the EU Institutions to increase the level platform. SIP aims to: pean Federation of IASP Chapters (EFIC ). Grünenthal is responsible for 4. Raise awareness of the importance of prevention, diagnosis and management of pain amongst all healthcare professionals, notably through further education. of awareness of the societal impact of pain. It stated that chronic and recurrent pain is a specific healthcare problem, a disease in its own right. raise awareness of the relevance of the impact that pain has on our societies, health and economic systems funding and non-financial support (e.g. logistical support). The scientific aims of the SIP symposia have been endorsed by a large number of inter- 5. Strengthen pain research (basic science, clinical, epidemiological) as a priority in EU framework programme and in equivalent research road maps at national and EU level, addressing the societal impact of pain and the burden of chronic pain on the health, social, and employment sectors. Ten years on from the EFIC Declaration on Pain, national and EU policy action has been very limited. At the same time, basic and clinical science have demonstrated the feasibility of exchange information and share best practice across all member states of the European Union develop and foster Europeanwide policy strategies & activities for an improved pain care in national and national pain advocacy groups, scientific organisations and authorities. ( 6. Establish an EU platform for the exchange, comparison and benchmarking of best practices between member states on pain management and its impact on society. 7. Use the EU platform to monitor trends in pain management, services, and outcomes and provide guidelines to harmonize effective levels of pain management to improve the quality of life of European Citizens. pathways out of pain for many types Europe (Pain Policy). of acute and chronic pain, but health care systems currently do not guarantee general access to these pathways. The platform provides opportunities for discussion for health care pro- Picture European Union This Road Map for Action to address the societal impact of pain in the EU has been endorsed by many organisations and was signed at the Symposium Societal Impact of Pain 2011, 3-4 May 2011, Brussels.

10 18 Grünenthal the company behind the initiative 19 How pain affects millions of people Put the patient at the center of the entire process that is what Grünenthal is passionate about. Further partnerships Put the patient at the center of the entire process that is what Grünenthal is passionate about. In order to help create a bottom-up approach to effective and holistic pain management, we decided to participate in further promising projects. Grünenthal has entered into an official partnership on the development of European Pain Patient Pathways Recommendations with Pain Alliance Europe (PAE), an organization representing chronic pain patients in Europe, and the Active Citizenship Network (ACN), an organization that promotes and supports citizens powers and responsibilities in policymaking. These projects aim to create a greater awareness of chronic pain and to promote European policymaking for improved management of chronic pain. ( (

11 Learn more about how we want to CHANGE PAIN Grünenthal GmbH Strategic Business Unit Europe & Australia Aachen, Germany

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