Why does a deeper understanding of pain matter? A modern epidemic

Advances in acute medical care are obviously welcome. However, many diseases that used to be fatal are now treatable, leaving people with long-term health conditions and pain to contend with. Consequently, chronic pain is increasingly common and can have a major impact on individuals and their families; it also exerts a major burden on health care services and on society as a whole.

On average, around one in five people in the developed world now suffers from chronic pain and a recent survey in the UK reported that 31% of men and 37% of women experience chronic pain (Health Survey for England 2011). This equates to around 20 million people in the UK, with 7.8 million of them suffering moderate to severe pain that has lasted for more than six months. The prevalence of chronic pain also increases with age, from 14% of men and 18% of women aged 16-34, to 53% of men and 59% of women aged 75 and over. In 2004, primary care management of patients with chronic pain in the UK was estimated to account for 4.6 million appointments per year; this is equivalent to 793 whole-time GPs at a cost of approximately ?69 million (Belsey 2002). Figures are similar in the USA with some 116 million people suffering chronic pain, causing estimated costs of $635 billion a year, which is more than the yearly costs for cancer, heart disease, and diabetes (Gaskin and Richard 2012).

People with chronic pain not only suffer with physical pain itself but frequently have co-morbidities to manage, such as depression, anxiety, physical dysfunction, and social isolation, which can make pain management even more complex (Royal College of General Practitioners 2013). A recent metaethnography investigating patients’ experiences of chronic pain revealed a number of key themes:

  • ? 16% of sufferers feel their chronic pain is so bad that they sometimes want to die (Donaldson 2008, p. 37).
  • ? 49% of patients with chronic pain experience depression (Donaldson 2008, p. 34).
  • ? The overall quality of life for people with chronic pain is very poor; the average life score was 0.4, where 1 is perfect health (National Pain Audit 20102012, quoted in Royal College of General Practitioners 2013, p. 6).
  • ? The average mental well-being score for men and women with severely limiting chronic pain was at a similar level to that of the lowest-scoring 10% of people who were pain free (Health Survey for England 2011).
  • ? Sufferers were more likely to be anxious or depressed; 69% of people with severe pain reported one of these compared with 17% (anxious) and 22% (depressed) respectively among those with no chronic pain (Health Survey for England 2011).
  • ? 25% of pain sufferers lose their jobs (Donaldson 2008, p. 34).

With obesity and sedentary lifestyles becoming more prevalent, the problem of chronic pain will only increase as a result of the associated physical strains and dysfunctions. Add in an ageing population and it is no surprise that chronic pain is sometimes referred to as a silent epidemic.

In the UK, in recognition of the burden of pain to the NHS, it was announced in Parliament on February 1, 2012, that chronic pain should be viewed as a long-term condition (LTC). Historically, pain was viewed only as a symptom of other diseases, rather than as a condition in its own right, so defining pain as a LTC constitutes a major shift in how chronic pain is managed by the NHS.

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