Luis Garcia-Larrea looks back on his three years as European Pain Federation President:
“We work in the dark,
We do what we can,
We share what we have”
Henry James
Dear Colleagues, Dear Friends,
As I approach the end of the third and final year of my Presidency, I would like to share with you in my last “letter from the President” a few thoughts on the progress and achievements of the past three years; on what is reasonably on track, and also on the challenges we have faced and the objectives that remain to be accomplished.
Building bridges
‘Breaking barriers and building bridges’ has been the guiding spirit of these three years. I am happy that we have been able to attain a number of achievements in this respect, in particular by strengthening ties with our Chapters and with allied scientific societies.
EFIC’s Chapters remain at the heart of what we do; they are our “raison d’être”, and considerable efforts have been made to strengthen their relation with the EFIC leadership. The increased presence of Board members at national congresses, the translation and inclusion in national journals of key articles from the European Journal of Pain, the creation of an award for the best European poster, and the new liaison system ensuring each Chapter has a direct point of contact with the Board, have all proven helpful in this regard. Transversal contacts between the chapters themselves have been fostered by numerous initiatives, including the sharing of abstracts of national pain meetings via an open Web repository, the involvement of Chapters in institutional European discussions (e.g. with the European Medicine Agency) and the dissemination of initiatives such as the Toolbox on intrathecal drug delivery (SFETD) and the Self-management of pain (SED) documents, initially designed for a single Society and now available to all. Of particular significance has been the development of joint trans-national schools co-directed by several Chapters, such as the recent one on multidisciplinary pain management, set up via the coordinated efforts of five different pain societies from South-Eastern Europe, and which I hope will be reiterated in the years to come.
We have also developed and reinforced contacts between EFIC and allied scientific societies. Cross-promotion of congresses and events has become a regular feature, and collaboration with European societies sharing a common idea of pain as a biopsychosocial phenomenon is bearing fruit. In 2024, the signing of a Memorandum of Understanding (MoU) with the European Society of Physical and Rehabilitation medicine (ESPRM) and the revival of the existing one with the European Headache Federation (EHF) gave rise to educational sessions incorporating both Societies, followed by a number of webinars jointly produced with EHF, ESPRM and ESRA on topics of shared interest, along with joint congress symposia. These are now a regular and valued part of each other’s meetings, featuring top-level participants from each society, and translating into concrete visibility for our fields. Enhanced contacts with ESRA have led to reciprocal invitations to our respective pain medicine exams, and a cross-validation of selected parts of these examinations is underway thorough a Memorandum of Understanding to be finalised this year. We also participate to the European Academy of Neurology (EAN) panel on pain, a collaboration we value greatly, and are actively building our relationship with the European Associations for Rheumatology (EULAR), and for Anaesthesia and Intensive Care (ESAIC). Last and surely not least, our partnership with IASP, of which we represent the strongest Federation, remains firm and steady. I have valued very much our working relationship with IASP Presidents Catherine Bushnell and Andrew Rice, and I am certain next incoming presidents Esther and Mary will continue in this trend.
Advancing Education and Research
Our Diploma examinations in pain medicine, physiotherapy and nursing are EFIC flagships, and all have seen a rise in prestige and in candidate numbers in this period. I’ve been pleased to see how several Chapters have adapted their own education programmes to match the EFIC pain curriculum, since national recognition of EFIC diplomas is a crucial step toward harmonisation and cross-talk. After the pioneering credit given to EDPM by the Dutch Society, an important agreement was signed in 2025 with the French College of Pain Medicine (CEMD): as a result, holders of our EDPM diploma are now able to enter directly into the 2nd year of the French specialisation in pain, while doctors with the French specialisation have the right to access directly the oral part of the EFIC EDPM exam. I consider these new bridges as extremely important to the development of common European standards of training in pain management, and I expect other national Chapters to follow this path in the years to come.
After three years of intense work with my colleagues, the first EFIC Handbook of pain medicine will see the light at the end of this year. Handbooks have existed for over a millennium, and the Greek term used to describe them (encheiridion = ‘in the hand’) refers both to instructional texts and to hand-held daggers. I expect this dual meaning also apply to this Manual, which we want to be both portable and delivering teachings distilled to a cutting edge. The Handbook was born in response to demands of EDPM candidates, who explained how much a compact reference resource would have helped them in preparing the exam. Like many books of this kind, this one evolved considerably during its development, and whilst it remains firmly aligned with EFIC’s curriculum, we expect its usefulness to extend well beyond the exam, and help any physician who wishes to begin, or deepen, their journey into the field of pain medicine. I want to warmly thank my co-editors Drs Victor Mayoral, Silviu Brill, Indre Biliviciute-Ljungar, Daniele Battelli (also Director of the EDPM exam), and Jesús de Santiago – the one who first pushed me to initiate this venture – whose remarkable work in selecting the best authors and reviewing each chapter has been indispensable in bringing this to life. My gratitude also goes to all the authors who contributed their expertise and time to make such a comprehensive and authoritative resource.
Despite a challenging financial situation, EFIC has continued to support its pain schools … and to develop new ones. During the 2024–26 period, three new schools have been launched, respectively on ‘pain psychology for non-psychologists’ (Verona, Italy); ‘physical and rehabilitation medicine for pain doctors’ (Larissa, Greece); and ‘multidisciplinary pain management’ (Osijek, Croatia) –the latter organised thanks to the coordinated efforts of EFIC chapters in Serbia, Croatia, Bosnia & Herzegovina, Slovenia and Greece. Other proposals involving EFIC together with allied European Societies are in the pipeline, and one of my hopes is that the model of joint schools might continue to develop and endure, not only because of its advantages in cross-collaboration and networking, but also because of the economies of scale and sustainability it may bring in the future. I am deeply indebted to the leaders of the Education Committee, Indre Bliliviciute-Ljungar and Victor Mayoral, who have been instrumental with their dedication and hard work in bringing all of this to life.
An important novelty in 2026 was the enhanced connection of EFIC schools with the EFIC Academy, which provided attendees with educational content relevant to the school themes. I expect this innovation will become a standard for EFIC schools in the future. The EFIC Academy has evolved considerably in the last two years. The way clinicians engage with online learning is rapidly changing, and despite the quality of Academy contents, and the steady increase in membership, its user interface was becoming less appropriate. A new strategic direction is taking shape, which enriches the offering, makes it more accessible to users, and aims to attract new audiences. A thorough overhaul of the platform is due to be finalised next year thanks to the technical and logistical efforts of our colleagues at the Office — in particular Giacomo Quaglio and Melinda Borzsak, under the guidance of Sam Kynman. Such de-construction and reconstruction efforts would not be possible without the work of the clinical group responsible for development of Academy materials, headed by Asbjørn Dreewes. A number of developments are already available, including short video spotlights, quizzes and the recent EFIC Clinical Cases Programme developed this year, which includes interdisciplinary video sessions on different chronic pain conditions, and combines recorded content with live interaction. These and other improvements have led to the award of new Continuous Medical Education (CME) credits to 15 Academy modules, a significant achievement that further legitimises the Academy as a professional development resource.
The publication of the European Pain Research Strategy (PRiSE) in 2025 remains an outstanding achievement, initiated during the mandate of my predecessor President Brona Fullen. PRiSE is the first initiative establishing a shared vision for the future of pain research across Europe, offering guidance to the scientific community, but also (we expect) to funders and policymakers. This year we have been focused on bringing that vision to those “with the power to act”, via high-level political meetings with the EU Directorate for Research, and with representatives of the Ministries for Science & Research from Spain, Ireland and Cyprus –the two latter respectively the current and next Presidents of the EU Council. These conversations will continue after the summer break to track every opportunity to keep pain research on the European agenda.
The EFIC 2025 congress in Lyon was an outstanding success which exceeded all expectations. Under the heading “Pain and Mental Health” and with André Mouraux as SPC Chairman, it gathered over 2,200 attendants who benefited from interdisciplinary sessions, plenary lectures and parallel workshops bringing together over 280 speakers. I’m especially proud that this happened in my city of adoption. Many innovations were introduced, including externally-sponsored mini-grants for young colleagues, and initiatives such as the Rising Star Programme (RSP) aimed at supporting early career researchers. And for the first time in many years, the ‘book of abstracts’ was published as a special issue of the European Journal of Pain, thus allowing all presentations to hold a DOI identifier, and be citable by other work. This will prevent them from disappearing from memory, which is the usual fate of congress abstracts, and will also help to position the seminal work of many colleagues in the scientific literature while their full article is being completed.
Our attention is now firmly turned to Glasgow, where the next EFIC Congress will take place from 21 to 23 April 2027, and where much of what we learned from Lyon is being put to good use. Under the chairmanship of Daniel Ciampi de Andrade, the theme for Glasgow — “Thriving through Communication: Building Bridges in Pain” — is well in line with my own motto, and reflects that progress in science depends not just on research, but on how well we are able to share our knowledge. We have carefully reviewed feedback from the 2025 congress, and made several structural improvements based on what we heard from attendees. Poster walks have been moved out of the lunch break and separated from general poster viewing to allow for more focused and enjoyable engagement, and we are introducing a new role — ‘bridge builders’ — who will serve as liaisons between the Scientific Committee and the groups responsible for different tracks. We also launched the first EFIC National Poster Prize contest, aimed at selecting the best posters presented at national scientific meetings, and awarding the winner with a free registration to the Glasgow Congress. I do hope that this prize will also serve to gently push all Chapters to include poster sessions in their future national meetings!
A multiprofessional task force directed by Michiel Reneman and coordinated by Mary O’Keefe has drawn up a comprehensive definition of multimodal chronic pain management, as well as a list of modalities for its implementation. The work spanned more than 2 years; it included a thorough evaluation of previous approaches, and was subsequently reviewed and endorsed by the EFIC Board and 12 other European scientific medical associations. Meeting the highest scientific and clinical standards, and incorporating the bio-psycho-social model of pain whilst avoiding internal contradictions and conceptual pitfalls required many months of lively debate. The result is worth the energy put into it, and I do believe that it should improve both scientific communication and care delivery. Similar efforts to channel the expertise of our community into evidence-based advice for care led to an open call for clinical guidance proposals in pain management. Out of over 25 applications received, three were selected for development, each of which will be upheld to rigorous methodological standards, with EFIC providing research assistance, administrative support, and a pathway to publication and dissemination. I very much look forward to seeing the results of this work in the coming two years, and to championing these guidelines as official clinical recommendations of EFIC. Esther Pogatzki-Zahn and Daniel Ciampi de Andrade, in their capacities as Chair and Vice-Chair of the Research Committee, have played a vital role in getting these and many other initiatives off the ground over the past three years; allow me to express my heartfelt gratitude to them here.
Advancing Pain Policy in Europe
Advocacy is the third pillar of EFIC’s work, and over the last three years there have been a number of specific achievements that are worth highlighting. Our advocacy group at the Office, masterfully managed by Angela Palomares assisted by Marta Bartnicka, has positioned EFIC as a trusted scientific partner to policy makers, with the primary aim of making pain a priority research area, and encouraging funding bodies to allocate the necessary resources to it.
Awareness-raising campaigns are essential to provide visibility and funnel energies toward pressing issues in pain management. EFIC has led such campaigns every year, making them culminate with sessions at the European Parliament, and touching hot-topics such as “Pain Management and Prevention – Is Europe Providing Adequate Access? (2024), “From Pain Burden to Pain Prevention” (2025), and “The Hidden Cost of Pain” (2026). These sessions assemble policy makers, researchers, clinicians and patient advocates to explore how the EU can scale up preventive action on chronic pain, how it will promote programmes to reduce the risk of pain at the workplace, ensure early access to rehabilitation, and in general whether there is a real willingness in the EU policy makers to fund prevention-focused actions. Although we seldom get concrete responses, a growing number of MEPs are becoming sensitive to the problem and willing to help. For the first time, pain was specifically mentioned in the Political Guidelines published by EU President Ursula Von der Leyen, and since then pain has been recognised in two significant European policy documents: the EU Report on the Rights of Persons with Disabilities, and the SANT Committee study on women’s health — both of which include references to pain. Notably, EFIC contributed to the committee on Gender Inequalities in Health, which set a motion for a EU Parliament resolution, thus placing the gendered dimension of pain firmly within a formal parliamentary process.
The expertise to develop effective campaigns on pain-related policies needs years of ground work. To help national actors build and run effective policy campaigns, the Societal Impact of Pain (SIP) EFIC team developed this year a ‘Pain Advocacy Toolkit’ —a practical resource to help implement fruitful advocacy initiatives, which we are now rolling out across European countries, starting in Italy with the help of Prof. Caterina Aurilio. EFIC’s role in supporting and amplifying advocacy programmes by colleagues around the world is also reflected in our endorsement of the Lima Declaration on Paediatric Pain, which not only emphasises the right of every child and adolescent to effective pain management, but also urges governments to adopt supportive public policies, through a Decalogue that reminds us all that children suffering from pain and their families have an immensely valuable voice, which must be heard and amplified. EFIC is doing just that.
Our collaboration with the WHO is a relationship we are committed to building on, and which took an important step forward with a joint webinar in June 2026 on the topic of ICD-11 implementation. In parallel, we are seeing a continuous growth of the European Pain Forum —our platform for cooperation between European medical, scientific and patient organisations— which has broadened with several new members in the last three years. This expanding community, combined with the WHO collaboration, reflects the kind of bridge-building that I believe should define the next chapter of pain advocacy in Europe. I look forward to seeing it develop further in the years ahead, and I thank from here Prof. Patrice Forget and Dr. Joanne O’Brien Kelly, chair and vice-chair of our advocacy Committee, for their dedication and leadership in bringing all of this to life.
Finances
As with any Presidency, finances have been a major priority –and sometimes a major headache of my term. Brona Fullen before me bore the brunt of the pandemic’s impact, and my task as President, assisted by Executive Director Sam Kynman and Treasurer Patrice Forget, was to steer EFIC back towards profitability. Most importantly, our congress returned to financial health in 2025, where we obtained a consequential profit which put our meetings firmly back in a sustainable place for the organisation. We have also spent three years building up additional sources of income and new contacts for industry support, income has grown and losses have been reduced by more than 80%. Progress is therefore real, and steady. I am confident that it will continue, and that the next biennial cycle 2026-27 will see EFIC return to real-terms profit –the first since the pandemic blow.
Goals not (yet) achieved
This report would not be complete, nor would it be fair, if it did not also mention a number of objectives which were not successfully achieved. Multiple attempts to secure recurrent external funding for pain schools did not collect success, sometimes just when we thought we were very close to it. Whilst ad hoc funding is useful — and, fortunately, usually secured — recurrent support is essential to ensure the sustainability of our schools, and I hope that some of the contacts we have recently established will bear fruit over the coming year. Also, the development of an ‘EFIC accreditation’ for European pain clinics compliant with EFIC standards has remained out of reach (for the time being), pending the resolution of a myriad of logistical and technical issues, not to mention international disparities. The alignment of EDPM with national certifications has advanced slowly. Although the overall picture is positive thanks to the Dutch and French examples, the task is proving laborious and very slow-paced. A number of national Societies have adapted their education programmes to match the EFIC pain curriculum, and I thank them from here, but the key point is to have EDPM represent a factual added value in the career of our European colleagues. Indre Ljungar and Victor Mayoral’s work on mapping out alignment with national qualifications should be a key milestone to increase the number of countries supporting cross-validation of EDPM with national pain diplomas. Not to make the list exceedingly long, let me finish stating that we were unable to develop the ‘weekly briefings on pain’ which I dreamed of, and which aimed at reporting weekly EFIC-curated data on research advancements, and directing attention to management improvements or innovations. Although the original idea had to be shelved, part of it is being transferred to the Academy under a new format, and I am confident that it may resurface in the form of ‘chat with the expert’ sessions led by the baton of Victor Mayoral and the Education Committee.
Some personal reflections
These three years as president have involved a great deal of hard work and a lot of learning. Although I was already familiar with the world of political relations between scientific societies, I suddenly found myself immersed in its day-to-day mixture of attraction and repulsion, of mutual respect and mutual distrust, and the uncomfortable sensation that we may be fighting for the same portion of the cake. But I could also witness that there is strength in unity, that language can serve purposes other than lying, and that there are many people around us who do understand that we’re here to serve our patients. This reinforced my vision that collaboration is certainly more rewarding and more profitable than competition. But also that, if you are forced to compete, you do it to win.
These years have often led me to reflect on that one should accept what is beyond our control, and focus on what one can change. As the Stoics teach us, do not want reality to be different from what it is, but thrive to make evolve what is worth making the best use your power – even if speaking of ‘power’ may be an exaggeration here. This is particularly relevant to our contacts with EU institutions, committees, sub-committees, directorates…, which are not exactly renowned for their speed and responsiveness, but which have convinced me (if I needed it) of the importance of being, at times, politically incorrect.
While we often feel it is our duty to continually add new ideas and initiatives like toys in a child’s basket, perfection is achieved, as Saint-Exupéry put it, not when there is nothing more to add, but when there is nothing left to take away. Deconstructing and reassembling in a better way is much more difficult than simply adding more elements to the pile. We have tried to do that over different axes –notably the Academy, the exams, the handbook. But I suspect we’ve still much to learn in this domain.
And given the spirit in which I began this presidency, it is only natural that I would discover what every bridge-builder eventually realises: that to span a bridge, the people on the opposite bank must also want it to be built. This is the way of life, and I’m just happy that on so many occasions I found goodwill on the other side of the river.
I am deeply grateful to the many people who have stood by me during these three years, and without whose dedication most of what I have described above would not have been possible. A number of them, especially from the Executive Board and core committees, have been already cited. I have been able to interact directly with many Presidents, Councillors and members of different Chapters –unfortunately not with all of them– and I have always taken from them some useful message. Attendants to the pain schools I have participated to –both students and faculty– have helped me to refine ideas in multiple aspects of pain research and management. A particular word of thanks is due to the Executive Board members and EFIC officers, who have surrounded me like a close guard. They are the engine behind everything we do. Christel at the Executive Secretariat, Melinda and Giacomo in Communication and Education crucial positions, Angela and Marta fostering advocacy, Mary and Nathan advising on research projects, and Inbar coordinating the congress work, all have given me invaluable help –and from time to time a few headaches. And the tireless Sam Kynman, our Executive Director, heading the Office and helping everywhere; benevolent with new presidents and respectful towards the old ones. We don’t always see eye to eye, but that’s probably why our discussions are always fruitful.
I hand over the Presidency to Esther Pogatzki-Zahn with a sense of pride in what we have accomplished together, and with full confidence in the path that lies ahead under her leadership. Our mission is important and difficult, and (again St Exupéry): “the future is not a matter of predicting, but of making it possible”. I look forward to continuing to contribute to it in the years to come.
Luis Garcia Larrea
President, European Pain Federation EFIC®