Chronic pain is a global phenomenon which affects hundreds of millions of people and can be caused by risk factors such as injury, trauma, disease, surgery, and surgical complications. There are notable problems when it comes to the treatment methodology and the overall economic impact on society. Just how big of a problem is this, though, and how is our current approach to it panning out?
The issue of chronic pain has long been regarded as just a medical problem, rather than being viewed through the lens of public health. The difference between the two, as the T.H. Chan School of Public Health at Harvard University explains, is simple: medicine focuses primarily on the individual, while public health focuses on entire populations at large.
Why is it important to look at the big picture here? Because viewing pain as a public health problem allows us to recognize that it is multifaceted and requires interdisciplinary action. It also happens to be â€œgrowing both in absolute numbers and in its inequitable distribution across the globe.â€Â It is the leading cause of disability and is a major contributor to healthcare costs.Â According to the peer-reviewed journal, BMC Public Health, one out of every ten adults around the globe are diagnosed with some form of chronic pain every year.Â Pain affects more people in America than cancer, diabetes, and heart disease combined.
The American Pain Society explains:
â€œBased on data from the 2012 National Health Interview Survey (NHIS), the study estimates that within a previous three-month period, 25 million U.S. adults had daily chronic pain, and 23 million more reported severe pain. Those with serious pain need and use more health care services and suffer greater disability than persons with less severe pain.â€
According to a publication in Oxford Universityâ€™s British Journal of Anaesthesia, some degree of chronic pain affects around twenty percent of the entire European population. Clinical, biological, psychological, and socio-demographic components have each been concluded to be risk factors. Not only does chronic pain affect the patient, but there is an enormous economic impact on society as a whole. The same publication states that the cost is â€œcurrently estimated at more than â‚¬200 billion per annum in Europe and $150 billion per annum in the USA.â€
As pointed out in a joint discussion forum by Harvard University and The Huffington Post, when you factor in both costs of treatment and lost productivity, that number checks out at around $635 billion. A lot of this money is wasted due to many patients having to see up to four or five different doctors before finding one who addresses their needs. This should come as no surprise, given the fact that students in veterinary school spend five times as many hours on studying pain management as do primary care physicians. A 2011 study published in the Journal of Pain concludes that â€œpain education for North American medical students is limited, variable, and often fragmentary. There is a need for innovative approaches and better integration of pain topics into medical school curricula.â€
This phenomenon is not unique to adults, either. A publication in the Journal of Pain from September 2014 estimates that the total annual cost to the United States for treatment-seeking adolescents (ages 10-17) pans out to around $19.5 billion. Much like the case in Europe, one in five Canadians suffer from chronic pain. A number that is about the same for children as adults. Based on a systematic review of 38 different pain prevalence studies from several different countries, somewhere between 11-38% of children and young people will experience chronic pain and 5-8% percent of them are considered â€œseverely disabled.â€
The pediatric Journal, Nursing Children and Young People, points to some specific figures to show just how many young people are suffering with this:
â€œFor example, in 2013, the population of people aged 19 years and younger living in Canada was 7.85 million (Statistics Canada 2014). Based on this statistic, between 863,500 and 2.9 million will experience chronic pain and about 392,000-628,000 of them will experience disability because of their pain.â€
As Dr. Jennifer Stinson, Scientist and Nurse Practitioner at the Hospital for Sick Children, mentioned in a panel discussion on The Agenda with Steve Paikin back in January 2016: chronic pain can significantly impact these kids at school, as well as in their social life, and it will require extensive rehabilitation and care from multiple disciplines to help them get their lives back. Later in the program, Dr. Stinson also points out that, despite the fact that the doubled suicide rate among sufferers is mainly an adult statistic, there have been a number of cases of kids who are transitioning from childhood to adult care and â€œget lost in the systemâ€ who have taken their own lives. Much like the Harvard discussion forum, thisÂ program is very informative and worth watching if you care to learn more about the issue.
Speaking of this doubled risk of death by suicide, according to the U.S. Department of Veterans Affairs, â€œIt is estimated that 45% of people who ultimately die from suicide were seen by their primary care provider within one month of their suicide.â€ Is it starting to seem like we have a serious problem on our hands? How are we, as a society, addressing these issues? BMC Public Health briefly summarizes what we should set our sights on:
â€œThe prevalence, incidence, and vast social and health consequences of global pain requires that the public health community give due attention to this issue. Doing so will mean that health care providers and public health professionals will have a more comprehensive understanding of pain and the appropriate public health and social policy responses to this problem.â€
It begins with a better understanding of this complex issue by both the medical and public health communities of professionals at large. It is necessary to explore how we should approach refining treatment methods. However, to do this will take an entirely separate article of its own. The purpose of this one is simply to examine the extent of both the economic and public health impacts at large. Â