Not All Pain Is the Same: Characterizing the Extent of High-Impact Chronic Pain – painresearchforum.org – Epidemiological findings highlight the need for patient-centered care – by Stephani Sutherland – Apr 2019
Chronic pain exacts a huge toll on patients, healthcare systems, and the economy. But the way that chronic pain is typically defined—by how long it lasts—provides little information about
- the people suffering from chronic pain,
- the degree to which they are affected, and
- how to best treat them.
These days, chronic pain seems defined mostly by how many milligrams of an opioid need to be taken to make it bearable. The patient’s specific condition is considered irrelevant.
This is a sad side effect of medical pain: because it is only perceptible to the patient suffering from it, the easily accessible numerical measure of medication is used instead (scientific laziness, bordering on fraud).
A recent population study now characterizes people who have “high-impact” chronic pain (HICP), which takes into account not only pain but also disability. [See Prevalence and Profile of High Impact Chronic Pain]
The report, published in the February 2019 issue of the Journal of Pain, put the number of people with HICP at 10.6 million, or about 5 percent of the US adult, non-institutionalized population (Pitcher et al., 2019).
Beth Darnall, said they highlight a growing “appreciation of the need to focus on patient centeredness, and a recognition that in the context of any health condition, and with chronic pain in particular, there is so much heterogeneity.
Across this continuum, some people can be high functioning in day-to-day life, whereas others are entirely disabled by pain.
Everyone deserves treatment, but we need to appreciate that heterogeneity and deliver care accordingly.”
Focus on the patient
Chronic pain is now established as a massive public health problem that must be addressed.
In the midst of all the suffering caused by the latest restrictions, one side effect of making opioid pain-relievers much more inaccessible has been to uncover the overwhelming presence of crippling pain in the population.
I suspect the people creating the opioid restrictions had no idea of how many people would be affected, nor how severely they would be harmed.
Their bungled efforts to manage the “opioid crisis” have not only worsened the rate of overdose deaths by spawning the “fentanyl crisis”, but have also created a new “pain crisis” that must be addressed.
The current anti-opioid policies are following the same old ineffective anti-drug efforts of decades past and have resulted in a rapidly worsening “failed drug-war crisis”.
Maybe it’s time to address the root of all these metastisizing crises: the utterly counter-productive “war on drugs”.
the study identified people with chronic pain and disability without asking whether pain itself caused the disability. However, Pitcher said, “our analyses showed that even if assessed independently from pain, disability in the chronic pain population was most likely due to pain.”
I’m always amazed when “scientific research” “discovers” such truths that are completely obvious to the subjects of their studies.
The researchers used data from the National Health Interview Survey (NHIS), a massive undertaking meant to gauge the health of the US population.
From an initial pool of more than 100,000 respondents, about 33,000 adults underwent more detailed interviews.
Subjects reported whether they did, did not do, or were unable to do a range of eight activities including
- going to school,
- participating in social activities, and
- household chores.
Subjects were also classified as having chronic pain if they reported having pain every day or most days in the past three months.
Most subjects with chronic pain were “without limitations” (CPWL), but a subset that had disability in one or more of the eight areas were considered to have HICP.
The data suggested that more than 40 million people—or 18.4 percent of the US adult population—have chronic pain, and about a quarter of them—10.6 million people—suffer from HICP.
For people with HICP, the disruption of normal activities, social interactions, and perhaps even self-care can be “really pretty severe,” Pitcher said.
Compared to patients without limitations, “they’re not in the same ballpark; they’re at a whole other level,” according to Pitcher. A whopping 85 percent of people with HICP were not working, and more than half had at least two limitations to life activities.
“They have greater disability and more comorbidities—that suggests they need a greater level of care, but how to help them” is more difficult to pin down. “It may mean we need a targeted, intensive treatment program” for some patients.
Porter agreed, saying, “People with high-impact pain really need a more comprehensive level of pain care, not just a simple intervention. This means lifestyle changes, perhaps physical therapy, cognitive-behavioral therapy—a whole cadre of integrated care.
“Of course, they can’t always get access,” she added, because barriers to multidisciplinary treatments remain high, including lack of availability and insurance coverage.
Mental health was also compromised in HICP patients.
I’m glad they didn’t state this the way we usually see it: “chronic pain was found in patients with mental health problems”, which always hints that mental problems led to the pain, instead of the far more logical and realistic phrase above.
They were more than twice as likely to report daily or weekly depression compared to people with CPWL
Will understanding high-impact chronic pain improve treatment?
“It already is,” Darnall said, “by the nature of our beginning to integrate into our parlance that one size does not fit all with pain care.”
“These data that characterize differences in patient experience lay the critical foundation for evidence that some patients do require different types of treatments.”
After describing how much pain and its effects on an individual can vary, we still need more evidence that patients require different treatments?
It’s hard to believe that highly educated doctors can remain oblivious to the established and necessary practice of “individualized medicine”, especially when it comes to a symptom only the patients can detect.
Author: Stephani Sutherland, PhD, is a neuroscientist and freelance journalist in Southern California. Follow her on Twitter @SutherlandPhD.