Public health

Clinicians resign from back pain taskforce after opioid sponsorship revealed


Two Australian clinical leaders in musculoskeletal health have resigned from an international back pain campaign over concerns about hidden sponsorship from pharmaceutical companies that market opioids.

Rheumatologist Professor Rachelle Buchbinder of Monash University and Professor Christopher Maher, Director of the Institute for Musculoskeletal Health at Sydney University, are among seven clinicians who have resigned from the Global Year Against Back Pain taskforce set up by the International Association for the Study of Pain (IASP) and the European Pain Federation (EFIC).

The clinicians were outraged when they discovered that –  despite being told there was no industry sponsorship – the taskforce’s briefing documents were being produced with support by Grunenthal, makers of tramadol.

Professor Maher subsequently found that a “Societal Impact of Pain” report, which advocates for patients with chronic pain to have better access to analgesia, was produced by people who either worked for Grünenthal or had financial links to the company.

Professor Maher and colleagues from the UK and Denmark said they believed they had been misled by the taskforce after being told there was no industry links, and there was a lack of transparency over conflicts of interest

According to the Sunday Times, Professor Buchbinder said she was “appalled” when she discovered the links to Grunenthal.

“We need to be very careful about how industry might be manipulating well-meaning but possibly naive healthcare professionals,” she wrote in her resignation letter.

According to the Times, the task force was funded by the IASP while the sponsored report circulated to members was from a project managed by EFIC.

The Brussel-based EFIC responded to the resignations with a statement saying it had been transparent about the sponsorship of its Societal Impact of Pain (SIP) advocacy campaign by Grunenthal.

“Almost every European medical society works with pharmaceutical and medical device manufacturers among other sponsors. The European Pain Federation is no different,” it said.

“EFIC works independently of any commercial sponsor unless specifically acknowledged … When Grunenthal employees have contributed to published policy documents, this has always been acknowledged transparently.”

It added that EFIC is due to publish a new set of clinical practice recommendations on the use of opioids for chronic non-cancer pain in coming months.

“These have been developed completely independently of industry with a rigorous conflict of interest approach for all authors,” it said.

Speaking to the limbic, Professor Maher said the episode provided important  lessons for clinicians involved in developing  guideline  or advocacy campaigns.

“You need to do your own research to check if the group has ties to industry because what you are initially told by the group may not be the complete story,” he said.

He also warned that Australia was not immune to concerns about industry links, which extended beyond opioids to other analgesics such as pregabalin.

“These types of conflict of interest most definitely occur in Australian settings. We know that groups who have an interest in pain [such as] medical colleges, professional associations and patient advocacy groups have accepted large amounts of money from drug and device manufacturers,” he said.

“We also now know that a company can engage ‘patient influencers’ to create a narrative on social media platforms that aligns with the company’s interests or products.

“The internet is global so what these patient influencers are doing offshore will reach us here in Australia.”

Earlier this year the WHO retracted guidelines on the use of opioids for pain after a review found that the drafting process had been unduly influenced by opioid manufacturers.

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