Chronic pain, some facts and figures

Chronic pain facts

• Chronic pain is widespread and affects about 20% of the population.

• The cost burden for society is more than 600 billion per year, which is more than the cost for care of cancer, diabetes and heart disease combined.

• Chronic pain is despite its prevalence and devastating impact on people’s lives largely neglected and not specifically targeted by the public healthcare systems.

• The most common pain representations (in non-cancer patients) are back pain, neck pain, headaches, pelvic and abdominal pain, facial pain and widespread pain, which includes fibromyalgia.
  

IOM, http://www.iom.edu/Reports/2011

• Common treatment approaches include OTC pain medication, prescription pain medication, steroid and analgesic injections and surgery. Luckily physical therapy and some pain management techniques may also be prescribed or advised before invasive interventions are scheduled. The efficacy of these interventions for chronic pain is unfortunately very poor because they do not address the underlying problem of sensitized pain pathways and psychosocial factors.

• Chronic pain sufferers undergo a variety of often unnecessary and invasive interventions. Many times the diagnosis that such interventions are justified with are in fact normal signs of aging in the body. Please see the table with common diagnoses for back pain below. They are common at a young age and practically everyone has them as they get older.

Rates of “abnormal” spinal disc and facet joint imaging findings in people without back pain

	Age, n=3300
Imaging Finding	20	30	40	50	60	70	80
Disk Degeneration	37%	52%	68%	80%	88%	93%	96%
Disk Bulge	30%	40%	50%	60%	69%	77%	84%
Disk Protrusion	29%	31%	33%	36%	38%	40%	43%
Annular Fissure	19%	20%	22%	23%	25%	27%	29%
Facet Degeneration	4%	9%	18%	32%	50%	69%	83%
Spondylolisthesis	3%	5%	8%	14%	23%	35%	50%

Brinjiki W, et. al. Am J Neuroradiol. 2015, 36:811-6.

• Sleep is very important in pain recovery. Unfortunately it is not often addressed in the treatment of chronic pain. The lack of sleep associated with the pain intensifies it, prolongs it and is contributing to other issues such as fatigue and depression.
  

• Patients with chronic pain will often feel belittled and ignored by the medical profession. They may be labeled as hypochondriacs and malingerers. Women as a rule are often undermedicated for pain as they are seen as exaggerating their symptoms, which is especially cruel since women actually suffer more commonly from chronic pain than men.

Most psychological interventions for chronic pain show only mild efficacy since they are employed as coping methods instead of as curative interventions. (A review of 41 studies on the effectiveness of CBT (cognitive behavioural therapy, ACT (acceptance and commitment therapy) and BT (behavioural therapy) on pain reduction finds they are only mildly effective. https://pubmed.ncbi.nlm.nih.gov/32794606/)