Chronic Pain

What Is Chronic Pain?

Definition of Chronic Pain…

Pain is classified as acute or chronic, based on its duration. Chronic pain is defined as pain lasting 3-6 months or more. Acute pain usually is caused by injury or trauma, and it stops once the injury is healed. The two must be treated differently. With chronic pain, the pain itself is the disease, and it does not respond to such standard therapies as surgery, medication, or bed rest.

While acute pain is a normal sensation triggered in the nervous system to alert you to possible injury and the need to take care of yourself, chronic pain is different. Chronic pain persists. Pain signals keep firing in the nervous system for weeks, months, even years. There may have been an initial mishap -- sprained back, serious infection, or there may be an ongoing cause of pain -- arthritis, cancer, ear infection, but some people suffer chronic pain in the absence of any past injury or evidence of body damage.

Many chronic pain conditions affect older adults. Common chronic pain complaints include headache, low back pain, cancer pain, arthritis pain, neurogenic pain (pain resulting from damage to the peripheral nerves or to the central nervous system itself), psychogenic pain (pain not due to past disease or injury or any visible sign of damage inside or outside the nervous system).

One of the most common causes of chronic pain is osteoarthritis, an age-related process of wear-and-tear in the joints. Chronic and cancer pain can be made worse by conditions resulting from the experience of the pain itself: emotional and muscular tension, misuse of drugs, inactivity or overactivity, and chronic depression.

It has been estimated several years ago by various associations and groups in the field that 80 million Americans suffer from chronic pain (from persistent backaches, migraines, repetitive stress injuries, cancer pain, etc.). This estimate is wildly inflated, in Marketdata’s opinion, and requires clarification. Indeed, when one adds up the various conditions individually, the number of sufferers does reach 130+ million. But, many people suffer from multiple conditions and a substantial amount of overlap or duplication occurs. In addition, most people are able to function with their pain, and are not totally disabled. The true, unduplicated figure is probably in the range of 19-30 million, based on Gallup Poll data from 1999 and the estimated share suffering from pain, cited in that report.

Chronic back pain sufferers are estimated to comprise the bulk of pain clinic patients--about 55%. Other conditions may include: chronic irritable bowel syndrome, temporo-mandibular joint (TMJ) syndrome (where jaw-clamping or tooth grinding may cause severe head and facial pain), migraine headaches, cancer pain, neuropathic and myofascial pain, stress-related disorders, arthritis, and carpal tunnel syndrome (repetitive stress and carpal tunnel injuries). The latter condition is becoming more common today, as more white-collar workers spend more time working on computers keyboards which may be ill-designed for long-term use.

Some experts believe that 80% of Americans are likely to develop back pain at some point in their lives, with the greatest risk taking place between 35 and 55 years of age. But, 90% of these injuries will heal within six weeks. Blue-collar occupations present the most risk, but white collar executives are not unaffected.

Prevalence of Chronic Pain Among Americans

Results from the “American Productivity Audit,” presented at the IASP/10^th World Congress on Pain in 2002, provided the first direct estimates of LPT from these pain conditions. Researchers found lost productivity time — i.e. work absence and reduced performance at work-averaged 5.9 hours per week for arthritis, 5.8 hours per week for back pain, 3.6 hours per week for headache, and 6.6 hours per week for other musculoskeletal pain.

It has been estimated that 21.7% of adult Americans, or 34 million people, experience mild to moderate chronic pain to the degree that they seek relief from a physician. Pain is the second most common reason people visit physicians - topped only by colds and upper respiratory infections.

The National Institutes of Health claims that 40 million Americans are unable to find relief from their pain, which is chronic. Other sources say the right figure is 50 million. It may not be quite that high.

An excellent study was conducted in January 1999 for the American Pain Society by Janssen Pharmaceutica and The American Academy of Pain Medicine. The name is: Chronic Pain in America: Roadblocks to Relief.

One of the more significant findings of this study was that it is estimated that 9% of the U.S. adult population suffers from moderate to severe non-cancer related chronic pain. However, a newer Prevention Magazine/CBS News poll found that 12% had been diagnosed with chronic pain. U.S. adult population estimates available from the government would indicate that there are approximately 19-20 million chronic pain sufferers in the United States.

Chronic pain sufferers seek treatment because they are unable to perform daily activities, sleep, work, exercise, or concentrate. Because of chronic pain, one-third of sufferers are not able to work or perform routine activities for one out of every three days of the year. Of the people suffering from chronic pain, 60% are women.

Treatments

Marketdata estimates that there are 3,549 pain programs, clinics, centers and/or specialists now active in the field, up from 3,411 in 1997 and 2,356 in 1995. Added to this figure, there are an undetermined number of chiropractors, stress and biofeedback centers, massage therapists, physical therapists, dentists, radiologists, HMOs/PPOs, and acupuncturists who also treat pain patients and who frequently call themselves pain "clinics". Obviously, the terminology in the field is a little loose, and is the source of some of the image problems pain facilities face.

An estimated 9 million Americans were treated by pain clinics, centers, and solo practitioners such as chiropractors, anesthesiologists, and biofeedback therapists in 2002. Fully 7.1 million of these people are treated by anesthesiologists who provide nerve blocks, mostly on an outpatient basis. No doubt, many more are in need of treatment but don't receive it due to inadequate health insurance, denial of treatment by their insurers, ignorance of available facilities, etc.

Chronic pain sufferers are having difficulty finding doctors who can effectively treat their pain, since almost one half have changed doctors since their pain began; almost a fourth have made at least three changes. The primary reasons for a change are the doctor not taking their pain seriously enough, the doctor's unwillingness to treat it aggressively, the doctor's lack of knowledge about pain and the fact they still had too much pain.

A Chronic Comprehensive Pain Management Program should address the needs of persons with complaints of enduring pain which has not responded to previous appropriate medical and/or surgical treatment and which interferes with the person’s physical, psychological, social, and/or vocational functioning.

The best pain management clinics (usually the most costly) utilize a comprehensive multidisciplinary team of specialists, including the following......MD, anesthesiologist, physiatrists.... doctors specializing in rehabilitation, psychologists, physical therapists, occupational/vocational therapists, therapeutic recreation specialists, dietitians, social workers, nurses, biofeedback and stress management specialists, and neurologists.

The 2003 Marketdata survey found an average value or cost per visit of $571.94 for multidisciplinary programs and an average of $378.77 for anesthesiologists. The total combined group average cost per visit is $502.40. Furthermore, this survey determined that the “typical” pain patient makes 9.7 visits to a pain program. Consequently, the average cost of treatment in 2003 was $4,873.