European Pain Federation EFIC Ethics and Transparency Policy

When reading the text below, please consult the list of definitions at the bottom for any terms which may be unclear.

1. Purpose and Scope

The European Pain Federation EFIC (EFIC) is a federation of national pain societies (European chapters of IASP), representing healthcare professionals and scientists working in the field of pain with the aim to promote excellence in pain management, education and research. Organisations like EFIC are often referred to at European level as healthcare professional organisations (HCOs).

HCOs play several important roles where ethics and transparency are crucial. Their activities can include:

1. Establishing a scientific consensus on a subject, designed to influence the practice of individual clinicians
2. Developing evidence-based educational material (e.g. CME activities)
3. Using evidence-based argumentation to influence political debates, healthcare authorities and the community at large.

Such activities have a public dimension and have a direct impact on the welfare of people living with pain. Therefore, it is essential that an HCO can be trusted to act impartially, guided by scientific evidence in their activities.

EFIC is composed of 38 member societies, each of which is a legal entity. While EFIC recommend that each member society adhere to a similar policy, this policy is principally applicable to EFIC directly, meaning the leadership, volunteers and staff of the organisation. The policy will be implemented across all relevant aspects of EFIC’s activities.

As well as the individual conduct of healthcare professionals active within EFIC, a policy on ethics and transparency is necessitated based upon the organisation’s own financial activities. HCOs are often funded by scientific congresses and through grants and other means of funding where potential conflicts of interest are inherent. This is covered in detail in the policy.

2. General ethical principles supported by the European Pain Federation EFIC

The ethical principles to be supported and followed by EFIC should not be limited only to a written policy. There are various general ethical principles that should be followed by any healthcare professional as well as anyone engaged in volunteer activity or paid employment to support the work of a non-profit organisations. Such principles include:

• Humanity
• Scientific integrity
• Quality
• Honesty
• Accountability
• Objectivity and openness
• Always acting in the best interests of the patient
• Respect for peers
• Non-discrimination.

The purpose of this policy is not to determine how all such principles should be implemented, but to establish a framework for areas of activity inherent to EFIC and for which specific guidance may be warranted. Nevertheless, acting in accordance with principles such as these specified above will support the ethical conduct of an HCO.

3. Overview of ethical aspects related to how the European Pain Federation EFIC is governed

EFIC is a not-for-profit organisation registered according to Belgian law. EFIC shall retain this status, acting in accordance with the principles and objectives as set out in its bylaws, article 4.

EFIC shall hold open and fair elections to select its leadership, as set out in its bylaws. These elections shall be held in a fair and transparent way, with the approval of EFIC’s election nominations committee and under the overview of EFIC’s Ethics Committee.

EFIC shall make its bylaws publicly available for reference and consultation by all relevant parties.

EFIC’s executive board members shall publish conflict of interest (COI) statements as part of their election process and shall maintain them throughout their term (See section 6).

EFIC shall establish COI declaration policies relevant to specific projects, especially where the potential risks of COI are significant (See section 6).

EFIC shall establish a publication policy for COI declarations in relation to its leadership and projects, that shall be publicly available for scrutiny (See section 6).

EFIC shall maintain independence from any sponsor or financial interest in determining its own strategic direction, policies and scientific positions.

When working with sponsors or other financial interests, EFIC shall cooperate only on the basis of shared objectives and mutually supportive interests.

EFIC shall respond to any sincere inquiries concerning its finances and collaborations in an open and transparent way.

EFIC shall publish an annual record of its financial activities in relation to sponsors. (See section 5).

EFIC shall publish a summary of its accounts and the opinion of its statutory auditor on an annual basis.

4. Policies on representation within the European Pain Federation EFIC

EFIC represents the multidisciplinary professional and scientific community in Europe dedicated to pain research, education and management. As such, it should include representatives of different disciplines and professions within its leadership structures and projects.

EFIC represents national pain societies from 38 European countries named as EFIC Chapters. As such, EFIC should aim to include representatives from its diverse geography within its leadership structures (e.g. committees, working groups and task forces) and projects (e.g. clinical practice recommendations, curricula, position paper development).

EFIC shall aim to incorporate other important representation criteria within its projects (e.g. gender, career stage, language) where relevant, whilst maintaining adherence to the highest standards in science (See section 2).

5. Policies on funding of the European Pain Federation EFIC

EFIC shall publish an annual record of its financial activities (within the scope of its annual report) in relation to sponsors, with the following details to be included:

• The percentage of operating income derived directly and/or indirectly from the pharmaceutical and MedTech industries
• All sponsors of EFIC
• A breakdown of income derived directly and/or indirectly from the pharmaceutical and MedTech industries by categories (e.g. unrestricted grants, project funding, congress sponsorship)

EFIC shall seek to diversify its sources of income, both within the range of pharmaceutical and MedTech companies as well between income from ‘industry’ and ‘non-industry’ sources, with the aim of increasing the percentage of income derived independently of industry sources. This approach should be reflected in the way EFIC seek sponsors for projects, wherein a multi-company approach should be considered best practice. EFIC shall not receive more than 33% of its operating income from any one sponsor per financial year. 

EFIC shall identify the sources of funding for projects with sponsors on all key project outputs. 

EFIC shall maintain contractual agreements and/or invoices in relation to all forms of funding received.  

EFIC shall aim to prioritise sponsorship agreements with pre-defined projects, or to pool sponsorship aligned with EFIC’s objectives and with clearly identifiable actions. 

EFIC shall not receive financial support for projects deemed sensitive to its scientific and educational credibility. A non-exhaustive list of projects to be avoided is provided below: 

• Clinical guidance documents 

• Evidence reviews 

• Curriculum development 

• Definition of central strategic documents for education, research or advocacy. 

6. Policies on personal COI declarations of volunteers

Declarations of potential conflict of interest (DOI) are good practice within all aspects of the work of HCOs and should be encouraged in EFIC wherever possible.

The following areas of activity are deemed essential in requiring a COI declaration from the people involved:

• The President and Executive Board of EFIC
• The Core Committee Chairs of EFIC
• The Core Committee Working Group Chairs of EFIC
• Task Force Chairs of EFIC
• EFIC Councillors
• All members of any Task Force developing clinical practice guidance
• All members of any expert panel allocating prizes or funding
• All Congress and educational event SPC members
• All members of the Editorial Board of the European Journal of Pain
• All members of the EFIC Ethics and Transparency Committee
• All speakers at Congresses and educational events.

COI declarations shall be provided at the start of the individual’s engagement in the role concerned and updated each calendar year.

The EFIC Executive Office shall request and maintain all COI declarations and publish them with yearly updating on the EFIC website via an accessible data bank.

The subjects of COI declarations shall be responsible for providing updates to their COI statements if their declaration changes during the period of work.

EFIC shall establish a standardised COI declaration form that should be used in all cases unless an external process requires a different template to be followed.

EFIC shall manage COIs according to the degree of conflict, the sensitivity of the project, and the extent to which the individual concerned is in a position of influence. Project leaders can refer any case to the EFIC Ethics and Transparency Committee for an independent opinion if in doubt.

EFIC officers and volunteers shall always declare potential COIs in the course of work whenever they arise and, if necessary, take a step back from discussions or projects. For example, an

Executive Board member shall declare a potential COI when a matter arises in an Executive Board meeting relevant to their potential COI. They shall refrain from contributing to the discussion and voting. At internal meetings of the European Pain Federation EFIC, such as Executive Board meetings, it is good practice to request that attendees orally notify the meeting of any recent updates to their DOI that should be taken into account.

6.9. The following framework defines some basic principles for COI management amongst key individuals and groups:

*For lines marked with this symbol, a COI should only be considered valid if a transfer of value has been made from the company to the individual.

**For lines marked with this symbol consult Ethics Committee on individual basis for possible exception.

7. Role of the Ethics Committee

• The Committee is tasked with monitoring adherence to the policy and providing an annual report of its activities as part of the EFIC annual report.
• The committee shall be consulted for senior nominated positions in EFIC, such as Core Committee Chairs and SPC Chairs.
• The Committee or Executive Board may propose amendments to the policy where needed. The Committee will be consulted if the Executive Board see the need to propose amendments.
• The Committee can request documentation from the EFIC Executive Office to seek clarification on any outstanding issues of relevance to the policy.
• The Committee shall be consulted for ad hoc opinions on any issues requiring interpretation (e.g. how the policies should apply to novel therapeutic areas).
• The Committee shall be consulted if any project leader with EFIC is uncertain of how COIs should be managed in a case.

8. Term of the policy and review clause

This policy will take affect from 1 April 2026.

The policy will be reviewed within 5 years from the date it takes effect, unless the Executive Board or Ethics and Transparency Committee agree that a review is required ahead of this deadline.

9. Definitions

• Conflict of interest (COI) 

The term ‘conflict of interest’ means a situation in which an individual could be perceived to have interests that potentially influence their decision-making beyond scientific reasoning and professional judgement. In most cases, these interests are financial e.g. an individual has personally received funding from a company relevant to the field of activity (see below). Other conflicts of interest are possible, such as an individual making a decision in which a beneficiary of the decision is a close personal contact, or a beneficiary of a decision is a former student or current colleague. For the most part, this document relates to conflicts of interest of a financial character. 

• Conflict of interest declaration (DOI) 

A ‘conflict of interest declaration’ or ‘DOI’ is a written statement made by an individual declarating any potential conflicts of interest relevant to their field of activity e.g. speaking at a congress, being part of a judging panel for a prize, or standing for election within EFIC. Declarations are not in themselves considered evidence of an actual conflict that has or will affect the decision-making of the individual, but rather a position of transparency to reinforce trust in a process. Declarations should be addressed to Ethics Committee and accessible upon request if not proactively published. Individuals completing a declaration should be offered guidance on what is to be included and through what time period. 

• COI management 

‘COI management’ refers to a process in which the organisation establishes processes to minimise potential conflicts of interest and thus proactively safeguard a project before it is executed. Conflict of interest declarations would be requested before a project is launched, and those with significant potential conflicts would be either removed from the project or placed outside of more influential roles. The aim would be to have more participants than not with no potential conflicts. Such a proactive approach may be useful in the context of developing clinical practice recommendations. 

• Transfer of value 

A ‘transfer of value’ is a term used to describe the process of an individual receiving something of financial or material benefit from a party listed as a potential conflict of interest. The term is helpful in distinguishing between a collaboration in which an individual receives personal material benefit and one in which an individual does not. For example, a company may provide a grant to a University department that supports a research project. If no transfer of value has been made to the researcher leading the department (i.e. there is no fixed fee dedicated to him personally), then the potential conflict of interest is more negligible than if they were dedicated to a person)  

• Consultant 

‘Consultant’ in this context refers to an individual playing a short-term advisory role to a company (or a service provider acting on behalf of a company), offering their scientific expertise within an advisory board or similar. In such a context, the individual is not an employee of the company, and may believe they are acting as an independent sounding board. Nevertheless, if a transfer of value occurs, this should be declared. 

• Company relevant to the field of activity 

‘Company relevant to the field of activity’ refers to a) companies involved in the commercialisation of pharmaceutical products and medical technology and b) the specific project in question (e.g. congress, prize, position paper) which in most cases should be broadly relevant to pain management. In most cases, this should simply be interpreted as ‘company developing pain management products’, though the individual is expected to think critically about how broad this definition could apply. A distinction can be made between companies involved in the commercialisation of products and those involved in early-stage R&D. Only those involved in the marketing and commercialisation of production of products should be included.  

• Sponsors 

‘Sponsors’ refers to companies who have provided funding to EFIC that is used to fund EFIC’s core activities or specifically identified projects. Sponsorship can take place via the elements of the congress that are open to funding from companies (e.g. sponsored symposia), unrestricted grants offered directly to EFIC, or items of funding that relate specifically to a project (e.g. funding for research grants). The term ‘or other financial interest’ is used elsewhere in the document to capture any company not specifically sponsoring EFIC at the present moment but who could potentially have an influence as a potential future or past sponsor. 

• Operating income 

‘Operating income’ is the income received by EFIC that contributes towards its general activities (operating expenditure), such as staff salaries, office running costs, meeting expenditure etc. Operating income is distinct from ‘project income’, which is income which is dedicated to a fixed project, where EFIC has no flexibility to determine how the money is spent. 

• Volunteer (of EFIC) 

A ‘volunteer’ is someone supporting the work of EFIC in an unpaid capacity, but not an elected officer. In most cases they are healthcare professionals or researchers working in their spare time or after they have retired. A proportionality test should be applied here, with the ethics policy applying when a volunteer has some form of established position, e.g. a member of a working group. 

Declarations of Interest

Our principal officers and volunteers are asked to adhere to our ethics and transparency policy and make declarations of interest, updated on a regular basis. These declarations of interest are available upon request. The COI submission form can be found here.