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Poorly controlled pain is a global public health issue. The personal, familial and societal costs are immeasurable. Only a minority of European patients have access to a comprehensive specialist pain clinic. More commonly the responsibility for chronic pain management and initiating opioid therapy rests with the primary care physician and other non-specialist opioid prescribers. There is much confusing and conflicting information available to non-specialist prescribers regarding opioid therapy and a great deal of unjustified fear is generated. Opioid therapy should only be initiated by competent clinicians as part of a multi-faceted treatment programme in circumstances where more simple measures have failed. Throughout, all patients must be kept under close clinical surveillance. As with any other medical therapy, if the treatment fails to yield the desired results and/or the patient is additionally burdened by an unacceptable level of adverse effects, the overall management strategy must be reviewed and revised. No responsible clinician will wish to pursue a failed treatment strategy or persist with an ineffective and burdensome treatment. In a considered attempt to empower and inform non-specialist opioid prescribers, EFIC convened a European group of experts, drawn from a diverse range of basic science and relevant clinical disciplines, to prepare a position paper on appropriate opioid use in chronic pain. The expert panel reviewed the available literature and harnessed the experience of many years of clinical practice to produce these series of recommendations. Its success will be judged on the extent to which it contributes to an improved pain management experience for chronic pain patients across Europe., Significance: This position paper provides expert recommendations for primary care physicians and other non- specialist healthcare professionals in Europe, particularly those who do not have ready access to specialists in pain medicine, on the safe and appropriate use of opioid medications as part of a multi-faceted approach to pain management, in properly selected and supervised patients., (© 2016 The Authors. European Journal of Pain published by John Wiley & Sons Ltd on behalf of European Pain Federation - EFIC®.)

Objective: Hyperhidrosis (Hh) and facial blushing (Fb) are conditions caused by hyperactivity of the sympathetic system; they affect around 2% of the population. Severe cases have been typically treated with thoracic sympathectomy through a minimally invasive approach. We sought to determine if severe Hh and/or Fb patients, who are reluctant to go through an operation with general anaesthesia, could benefit from receiving percutaneous radiofrequency ablation of the sympathetic chain., Methods: Prospectively collected data obtained from May 2007 to May 2010 were analysed to compare the treatment efficacy and effects on quality of life of the two procedures., Results: From a total of 58 patients enrolled in the study, 31 were treated with radiofrequency procedures, whereas 27 received surgical sympathectomy. Patients with Hh had better results with surgery than with radiofrequency sympathicolysis in terms of efficacy (p=0.0001) and quality of life (p=0.0002). However, there was still a significant improvement in quality of life in the group of patients treated with radiofrequency sympathicolysis (p=0.004). Patients with Fb had good results with surgical procedures and poor outcomes with radiofrequency ablation, resulting in significant differences in treatment efficacy (p=0.005) and in quality of life (p=0.003). Fb patients treated with radiofrequency procedures had no improvement in quality of life after the intervention (p=0.28)., Conclusion: Our results support the view of surgical sympathectomy as the gold-standard treatment in severe cases of Hh and Fb. Radiofrequency sympathicolysis is useful as a second-treatment choice for Hh patients. Fb patients do not benefit from radiofrequency sympathicolysis., (Copyright © 2011 European Association for Cardio-Thoracic Surgery. Published by Elsevier B.V. All rights reserved.)