The Scope of Chronic Pain

According to the American Pain Society (APS), about 50 million Americans suffer from some sort of chronic pain with an additional 25 million people having mild to moderate pain.  Eight million people suffer from cancer pain and an untold number of people deal with acute pain, following an illness, surgery or injury.  Measures of pain and the number of people suffering from pain are likely underestimated because many people do not see the doctor about their pain and instead treat pain themselves at home.
 
Pain is more prevalent as one ages.  For example, it is estimated that between 25 and 50 percent of the geriatric population suffers from some sort of chronic pain, with about 20 percent taking medications for pain on a regular basis.
 
Pain can be described in a myriad of ways, including aching, biting, burning, gripping, excruciating, piercing, pinching, pulsating, pounding, and many other descriptors of pain, some of which are considered more tolerable than others.
 
The Major Sources of Pain
 
Pain can come from many sources.  The following are the major sources of pain in the US:
  • Arthritis Pain. About 40 million Americans suffer from arthritis pain.  Other measures indicate that one in six people suffer from arthritis pain that limits daily activity.  The most common form of arthritic pain is osteoarthritic pain (about 21 million people), while 2.1 million Americans suffer from the pain of osteoarthritis.
  • Headache pain.  About 45 million people suffer from chronic headache pain.  The pain is considered debilitating and severe in about half of all cases.  Of these, about 25 million people suffer from migraine headaches.
  • Back pain. More than 25 million people in the US suffer from intermittent bouts of back pain, which can be debilitating.  Five million people suffer from debilitating low back pain and more than one million people suffer from a work-related back pain each year.
  • Pelvic pain.  Pelvic pain is suffered by one in six women due to various problems.
  • Cancer pain.  There are about 8 million Americans who have suffered from cancer in the past and another 1.2 million Americans are diagnosed with cancer each year.  Of these, about one third of all patients being treated for cancer have some sort of cancer-related pain.
  • Jaw pain.  About 7.5 million people suffer from some form of facial or jaw pain, usually suffering from temporomandibular joint disease.
  • Fibromyalgia. This is a condition mostly of women that affects about 4 million Americans.
  • Reflex Sympathetic Dystrophy.  This is a specific type of central pain that results in burning and skin sensitivity to an extremity or part of an extremity.  About 1.5 million Americans suffer from RSD.
  • Whiplash.  About one million Americans suffer from some sort of whiplash-related neck pain each year.  The majority of this pain comes from motor vehicle accidents.  The symptoms tend to be debilitation in up to 40 percent of cases.
  • Occupational Injuries. About 650,000 workers a year suffer from some type of occupational injury that results in pain.  Pain is often related to repetitive motion or overexertion on the job.
Pain is Expensive
 
The dollar cost of pain in the US is astounding.  It is estimated that the total cost of pain in the US is about $100 billion per year with over 50 million lost work days per year occurring in the US alone.  The cost of pain comes from lost income, direct medical care, lost productivity,  and compensation pains.  These alone cost the system about $50 billion USD per year.
Arthritis pain alone accounts for $65 billion USD per year. Arthritis pain is the second leading cause of disability at work. About 750,000 hospital discharges list arthritic pain as part of the reason patients are discharged from the hospital.
 
The leading cause of disability in Americans who are under the age of 45 is back pain with costs about $5 billion USD per year and about 93 million lost workdays per year.  Direct costs of treating low back pain, according to an article in the Journal of the American Medical Association are estimated to be about $15 billion USD per year with indirect costs reaching as high as $100 billion USD yearly.  Workers’ compensation injuries involving back pain make up about a fourth of all workers’ compensation claims.
  • People with headaches visit the doctor about 8 million times per year. More than 157 million workdays are lost per year with about $4 billion USD going into medications alone for headaches.
  • Work injuries involving repetitive motion, back pain, or other musculoskeletal injuries cost about $13-$20 billion USD per year in the form of lost work days and workers’ compensation claims.
The Meaning of Chronic Pain

Chronic pain, unlike many forms of acute pain, has no particular meaning or purpose, making it difficult to handle.  We don’t often understand chronic pain and this makes it more difficult to live with. Chronic pain leads to suffering, sadness and sleeplessness—a terrible triad of symptoms that plagues many chronic pain sufferers.  Certain movements become impossible and work becomes difficult, if at all possible.  Chronic pain leads to fatigue, depression and hopelessness.

Chronic pain leads to the “eight D’s of chronic pain”, which include the following:
  1. Depression
  2. Distraction
  3. Doctor shopping
  4. Disability
  5. Disease
  6. Drinking
  7. Drugs
  8. Death, often due to suicide
A common complaint of people who suffer from chronic pain is a lack of sleep.  Pain costs a third of all Americans about 20 hours of sleep per month, from one estimate.  It takes people with pain about four times as long to fall asleep as healthy people.  People with chronic pain tend to awaken during the night more than people who are healthy.  The quality of sleep and sleep efficiency is poor when you have chronic pain.
 
The Undertreatment of Pain
 
Most pain authorities agree that pain is under-treated.  Up to 80 percent of patients residing in a nursing home have pain that is under-treated and studies show that four out of ten pain sufferers feel that their pain is not well managed.  They feel that doctors don’t know enough about how to treat pain and do not take pain seriously enough.
 
There is no good way to quantify pain.  X-rays and other evaluations can show the background of pain but no one can say exactly what the cost of the pain is for the sufferer.  Patients’ emotions and psychological makeup determine the degree to which pain is experienced.  The person’s past experience with pain determines their present experience of pain and cultural attitudes determine the degree to which pain is felt.  People of Nordic origin, for example, are more stoic around pain than people who come from Jewish or Italian stock.  Soldiers handle pain better than civilians, due to the reasons behind the pain.  Athletes perceive pain less than those who are non-athletes.
 
It is difficult to factor in all that goes into pain, even when we see and know how many sensory neurons are associated with the pain. Because pain cannot be objectified, some doctors worry about addiction to pain medication and therefore under-treat it.  While there are those who use pain symptoms for secondary gain, the vast majority of pain sufferers just want to be cured of their ailment.
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