Chronic Pain Institute

Chronic Pain Fact Sheet

By Stephen R. Bunker, MD on Oct.31,1999

An estimated 34 million Americans suffer from chronic pain, defined as pain that lasts for 6 months or more, does not generally respond to conventional medical therapies and affects more people than any other type of pain. Most sufferers are significantly disabled by their symptoms, some permanently.1- 3 The estimated annual total cost of pain from all causes is estimated to be more than $100 billion, with back pain, migraine headache, and arthritis alone accounting for medical costs of greater than $40 billion annually. Pain is also the cause of an estimated 25% of all sick days taken yearly.2-4 Most patients with chronic pain remain grossly under treated today, despite the magnitude of their suffering and its economic impact on society. The reasons for this are multiple: 1) our current health care system applies a low priority to pain relief; 2) there is a general lack of knowledge about pain management among both health professionals and their patients; 3) fears of side effects and addiction associated with opioid analgesics are exaggerated; and, 4) health professionals themselves fear the scrutiny of medical boards and the DEA, even when controlled substances are prescribed appropriately for pain relief.2,3,5,6

Contrary to popular belief, numerous studies have shown addiction is extremely rare in pain patients taking opioid drugs, even in patients with histories of prior drug abuse and/or addiction. Chronic pain patients will develop a physical dependence upon opioid drugs, but this is not to be confused with addiction, which is an aberrant psychological state.2,4-14

Unrelieved chronic pain has many negative health consequences, including increased stress, changes in metabolic rate and blood clotting times, increased water retention, delayed wound healing and an impaired immune system, various hormonal imbalances, changes in gastrointestinal tract function related to decreased gastric and intestinal mobility, interference with appetite and sleep, and needless suffering. Chronic pain also causes many additional psychological problems, such as feelings of powerlessness, hopelessness, low self-esteem, and depression.3,15-18

The inadequate treatment of chronic pain often results in suicide. In a recent survey, 50% of chronic pain patients had suboptimal pain relief and had considered suicide to escape the unrelenting agony of their symptoms. Unrelieved pain also leads to requests for physician-assisted suicide, another indicator of it's harsh impact on the quality of life of many patients and their families.3,5,6,10,11,16

Discrimination against chronic pain patients is also prevalent in the American health care system. Women, racial/ethnic minorities, children, the elderly, worker's compensation patients, and previously disabled patients (e.g., those with cerebral palsy, or who are deaf, blind, amputees, survivors of childhood polio, etc.) are at great risk for inadequate or incomplete treatment of their pain, even though patients belonging to one or more of these underserved groups are the vast majority of all chronic pain patients.2,5,19

Chronic pain patients with severe, unrelenting pain from permanent structural damage to the neurologic or musculoskeletal systems are often subjected to expensive, invasive and unnecessary surgeries and other painful invasive procedures. Sudeck’s atrophy or reflex sympathetic dystrophy (RSD) and arachnoiditis are the most common causes of severe chronic pain, followed by post-traumatic pain, adhesions after abdominal surgery, systemic lupus, headaches, degenerative arthritis, fibromyalgia, and various neuropathies.3,11,17,18

REFERENCES:

1. American Chronic Pain Association. "Coping with Chronic Pain." 1995.

2. Brownlee, Shannon, and Schrof. "The Quality of Mercy." U.S. News and World Report, March 17, 1997: 55-57, 60-62, 65, 67.

3. Canine, Craig. "Pain, Profit, and Sweet Relief." Worth. March, 1997: 79-82, 151-157.

4. American Academy of Pain Medicine and American Pain Society. "The Use of Opioids for the Treatment of Chronic Pain." Clinical Journal of Pain, Vol. 13, March, 1997: 6-8.

5. Medical Board of California. "Prescribing for Pain Management." May 6, 1996.

6. California Board of Pharmacy. "Health Notes: Pain Management." 1996.

7. Pasero, Christine L., R.N., B.S.N., and Margo McCaffery, R.N., M.S., F.A.A.N. "Pain Control." American Journal of Nursing. Vol. 97, No. 6., June, 1997: 20-21.

8. Medina J.L., M.D., and S. Diamond, M.D. "Drug Dependency in Patients with Chronic Headache." Headache, 1977, Vol. 17: 12-14.

9. Porter J., M.D. and H. Jick, M.D. "Addiction Rare in Patients Treated with Narcotics." New England Journal of Medicine 1980, Vol.302: 123.

10. Hitchcock, Laura S., Ph.D., et al. "The Experience of Chronic Nonmalignant Pain." Journal of Pain and Symptom Management, Vol. 9, No. 5, July 1994: 312-318.

11. Tennant, Forest, M.D., Dr. P.H., and Harvey Rose, M.D. "Guidelines for Opioid Treatment of Stage III Intractable Pain." California Task Force on Opioid Treatment of Stage III Intractable Pain. January 1, 1997. Research Center for Dependency Disorders and Chronic Pain Community Health Projects Medical Group, West Covina, CA

12. Zenz, Michael M.D., et al. "Long-Term Oral Opioid Therapy in Patients With Chronic Nonmalignant Pain," Journal of Pain and Symptom Management, Vol. 7, No. 2, February 1992: 69-77.

13. Friedman, David P., Ph.D. "Perspectives on the Medical Use of Drugs of Abuse." Journal of Pain and Symptom Management, Vol. 5, No. 1 (Suppl) February 1990: S2-S5.

14. Portenoy, Russell K., M.D. "Chronic Opioid Therapy in Nonmalignant Pain." Journal of Pain and Symptom Management, Vol. 5, No. 1 (Suppl) February 1990: S46-S62.

15. Dellasega and Keiser. "Pharmacologic Approaches to Chronic Pain in the Adult." Nurse Practitioner. Vol. 22, No. 5, May 1997: 20-25.

16. Liebeskind, J.C. "Pain Can Kill." Pain, Vol. 44, No. 1, January 1991: 3-4.

17. National Institute of Arthritis and Musculoskeletal and Skin Diseases. "Scientific Workshop Summary: The Neuroscience and Endocrinology of Fibromyalgia." July 1996. Bethesda, MD.

18. Davis, Nadyne, et al. (eds.). "Third Annual Fibromyalgia Research Conference." February 1994. Inland Northwest Fibromyalgia Association. Spokane, WA 99206

19. Morse, T.B. "America's War on the Disabled." Albuquerque, NM: 60's Press.

*Do you know someone with chronic pain or interested in the subject, but who may not be 'on line' yet? Why not print and send them a copy of this page?

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