Not All Pain Is the Same: Extent of High-Impact Chronic Pain

Not All Pain Is the Same: Characterizing the Extent of High-Impact Chronic Painpainresearchforum.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

  1. the people suffering from chronic pain,
  2. the degree to which they are affected, and
  3. 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

  • working,
  • 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.

16 thoughts on “Not All Pain Is the Same: Extent of High-Impact Chronic Pain

  1. Kathy C

    I have noticed a pattern with the CAM practitioners, they are often referred to as an alternative for pain. I came across this gem today, a “Survey” on chronic pain. Of course the survey only refers to CAM for “low back pain.” The CAM industry typically inflates the effects of CAM interventions for basic low back pain, and misreports the findings for all Intractable Chronic Pain. In general most low back pain resolves with time, a walk in the woods or a vacation. Massage has been helpful for thousands of years too.

    Cocrane does a bait and switch, https://twitter.com/CochraneCAM/status/1118876084227969026

    Cocrane tries to make it look Sciency https://journals.plos.org/plosone/article?id=10.1371/journal.pone.0059202

    https://cam.cochrane.org/priorities-mind-body-medicine-and-chronic-non-cancer-pain
    https://www.surveymonkey.com/r/BFR3DFW They claim it is a survey on chronic pain, but it is only a survey on low back pain. Nearly every government publication, or mass media article treats all pain the same, encouraging chiropractic, or acupuncture, only because it helped a few people with low grade low back pain. They deliberately conflate LBP with all intractable chronic pain.

    I might also mention that Darnel made a lot of money, undermining people with chronic pain, she sold a lot of books and profitable speaking engagements misinforming the general public about pain and sociological distress. https://www.amazon.com/Opioid-Free-Pain-Relief-Kit-Simple/dp/1936693984
    “CONGRATULATIONS! Picking up this book shows you want to help yourself feel better. That’s the first step toward having less pain and using less pain medication. You are not alone. About 100 million Americans—one in three people—have ongoing pain. It can be mild or very strong, come in waves or always be present, be simply annoying or make your normal life hard to live. Pain is the most common reason people visit their doctor. Many people mistakenly believe that chronic pain is best treated simply by taking powerful painkillers, also known as opioids. But people who think pills are the only answer are mistaken, because the best treatment for chronic pain includes much more than pills. In fact, the most important part of pain treatment isn’t your medication or even your doctor: it’s YOU. This book gives you the right road map and skills to help you reduce your own pain, so you need less medication. It is a formula for success—your own personal pain relief kit.”

    She left out the fact that some people have intractable chronic pain, and her ads are misleading. She cashed in on the opiophobia, and helped reframed pain as something that could be cured with good thoughts or a little exercise. Darnell added to the misinformation campaign about pain, opioids and addiction to sell her books and get funding for her research at Stanford. Stanford peddles CAM, and the media .covered some of their more ridiculous research. Here is an example of the deceptive “research” at Stanford, https://www.healthcmi.com/Acupuncture-Continuing-Education-News/1452-stanford-university-acupuncture-reduces-pain-after-surgery

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    1. Zyp Czyk Post author

      Thanks for a good collection of debunking. The generalization of all “chronic pain” as being some vague low back pain is infuriating. But as long as the outcomes go against opioids, no one examines the logic or facts.

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      1. Kathy C

        Thanks Zyp,

        The latest casualty, https://www.abqjournal.com/1314851/illegal-opioid-prescriptions-net-prison-time.html https://www.justice.gov/usao-nm/pr/pawankumar-jain-pleads-guilty-unlawfully-dispensing-prescription-painkillers-and-health
        What they don’t tell us, is that none of his patients had any other options. One commenter on Facebook claimed, “BTW, one “death” Dr. Jain was accused of was a psychiatric patient (under another Drs. Care) who HUNG himself but had a prescription rx on board. Yup, prescription overdose by Dr. Jain. MBA;MHCA, RN”

        This state has a sever shortage of doctors, including neurologists, they had no drug treatment at the time. Worse of all they were not even collecting data on outcomes at any health related services.

        This was another interesting article, https://sciencebasedmedicine.org/integrative-medicine-advocates-coopting-opioid-crisis-promote-medicaid-funding-acupuncture/

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        1. peter jasz

          The AMA (Physician’s Governing Groups -including the much-loved ‘lobbyist’s), government regulatory agencies (DEA, CDC -and the despicable FDA) are all responsible for the wreck of a mess called American (and by extension Canadian) Medicine
          Has anyone, ever considered the incredible detail required to enter Med School (and of course the devotion/time, discipline -and ‘smarts’ ?

          Yet, at the other end (post-graduate/in-the-field), “they” get by with vague references, BS “peer-reviewed” research papers, throwing around/abusing sensible medicine (for decades) and continue to run freely/wildly with nary a trace of any oversight counsel (from any source). This groups deadly indifference has went unchallenged for far too long.

          In the end, we must reference a TV program that shows the devastating plight that hundreds-of-thousands of North American’s face daily -year after year ?

          pj

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  2. Kathy C

    While Darnell is appearing to be in the corner of science and reason she her peddling things like this, https://empoweredrelief.com/ She is using her public position, her affiliations with Stanford, and social media presence to sell things like “Empowered Relief.” There was a time in this country when this kind of deceptive marketing would have been illegal.

    She was instrumental, using her marketing skills, presenting Catastrophizing as something real, and a good reason to ignore intractable chronic pain, and discredit all patients who describe pain. Catastrophizing was something psychologists created, to distract people. They know they could get a response out a person with pain, by acting incredulous or deliberately misunderstanding them. If a person with pain stated their back hurt, they could illicit a response by acting confused, or projecting disbelief.

    The subject would then explain or use even more expressive language to describe their condition. The subject would not know they were being goaded, after all they had turned to these providers for help. It is kind of like Gas Lighting. She legitimatized this by studying it. Essentially anyone could get that kind of response by Gas Lighting or patronizing a person in distress with pain. Of course women and low income people would be more likely to have already been mistreated by the medical community.

    Darnell chose low back pain for her Catastrophization study for a reason. https://clinicaltrials.gov/ct2/show/NCT03167086 These people would have all received a medical diagnosis before participating in the study. She then extrapolates the biased, self selected finding to describe all pain and all medical disorders. Clever!

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    1. Zyp Czyk Post author

      And yet, Darnall become one of our most vocal and influential advocates.

      She did a complete turnaround, and is now campaigning for patients to have access to opioids and not to be force-tapered:
      https://edsinfo.wordpress.com/2018/12/23/dr-darnall-now-supports-necessary-use-of-opioids/
      https://edsinfo.wordpress.com/2019/04/21/reducing-the-global-burden-of-chronic-pain/

      I admire her courage to make such a big change, and publicly!

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      1. Kathy C

        I am not sure if she was motivated by science or compassion, or this is another way to spread her brand. She fully monetized her position at Stanford, and got a lot of free publicity with her articles, content marketing and book sales. Her really clever marketing campaign, that promoted psychology for pain, and recommended “alternatives” was very popular and got her a lot of attention, and free publicity. She is just one of many who saw an opportunity to profit from the misinformation and false narratives in our media.
        Her target audience, wealthier white women, who could afford massages, alternative treatments, and good healthcare, were conflated with the people who were in despair, unable to afford healthcare, with no prospects for the future, who turned to street drugs. Darnell was one of many, who re-framed the problem, and spread misinformation. They did not see this as a pubic health crisis, they saw it as an opportunity to promote themselves, sell books and speaking engagements. She tailored the message to please certain audiences.

        Here she is in an interview in 2016, https://med.stanford.edu/news/all-news/2016/09/5-questions-beth-darnall-on-opioids-and-pain-management.html

        “Q: What happens when patients taper off of opioids? Does their pain increase or decrease?”

        “Darnall: Many people remain on opioids out of fear that their pain will increase if they stop taking them. However, the data show that when people taper off opioids slowly, their pain tends to remain the same or improve. If opioids are stopped too quickly or if a single dose is missed, withdrawal symptoms are likely to occur, along with worse pain. A good, slow opioid taper will help patients avoid withdrawals altogether.”

        She claimed then that when tapering off of opioids, the patients pain, “remained the same or improved.” That as what her audience wanted to believe, and her marketing amplified the idea that opiates cause chronic pain, and justified the “forced tapers” they presented as compassionate response to the opioid epidemic. Nowhere in her interview does she warn about patients going into withdrawal, or patients with intractable pain, who benefit from opiates. She also markets her books CDs, and “Opioid Free Pain Relief Program.”

        I doubt that Darnell or the other health marketers, and psychologists are even aware of the damage they have done. Suddenly Darnell has come out on the side of compassion and common sense. Now “Not all pain patients are the same,” even thought Darnell and so many others conflated their selected low back pain studies, to describe all pain conditions. Those fake news articles about opiates making pain worse, trace back to Darnell. Psychologists have spread a lot of misinformation about pain and helped fuel the horrors that are driving patients to suicide.

        I am glad that Darnell has come out on the side of reason, but her motives are probably self and career protection, she has to continue to appear credible and relevant.

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      2. Kathy C

        I am not convinced. Here is one of her articles from last November, http://www.apamonitor-digital.org/apamonitor/201811/MobilePagedReplica.action?pm=2&folio=48#pg51

        These behavioral interventions have been around for 2 decades. They tried them out on “Low Value” patients. There was no evidence they made any impact, these interventions were meant to deter people from medical care, or replace medical care, in places where there is little or no access to medical care. The powers that be knew they were going to have a problem, and they could save a lot of money and increase profits, by framing pain as a psychological disorder. They funded these alternative studies, where the pain was always secondary to the psychological issue. They repeated this false narrative over and over again in the media. It was all a misinformation campaign which increased the profits of pharma, the insurance and medical industries. Pharma cashed in, selling alternatives, anti depressants and even more expensive, on patent replacements for Oxycontin, like Opana, Lyrica and assorted anti depressants which show no effect on pain. First they had to discredit and dehumanize people with pain.

        People like Darnell launched their careers, by misstating the problem, for the industries that are profiting. Perhaps she has turned a corner, after seeing the deaths and despair she caused by misreporting scientific facts, to promote herself, and get paid to do speaking engagements in Davos Switzerland. Darnell and the other pain researchers, who lied to the public for corporate dollars and fame are never going to come clean. 20 years in on the so called opioid epidemic, and we are no closer to facts. We have all been Gas Lighted, we don;t have to have empathy for sick people, people without healthcare or the children dying in our wars, because pain can be wished away. Even our veterans who deserve better, are being Gas Lighted, and lied to. Darnell has a lot of blood on her hands. It was really convenient that none of her studies ever discussed the significant drop out rates, or any long term outcomes. The corporations loved her “research” that is why they so generously funded it.

        Here is a list of her accomplishments, there is a pattern, and a reason she is so popular with the media.
        https://bethdarnall.com/in-the-news/

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    2. peter jasz

      Clever ????

      One who manipulates data for their own greedy, selfish, psychopathic needs while simultaneously and deliberately worsening the horrific life endured by intractable pain patients is “clever” ?????
      In fact, what she is is a brutal self-serving liar; a scandalous, corrupt and indifferent wench.

      It amazes (and disappoints) when I hear/read of such interpretations of people who’s only objective is to enrich an already grandiose, self-serving existence. Such behaviours/personality traits MUST be seen (and spoken to) for what it is: Psychopathology. Such “talk” is twisted, manipulative and plain ugly. The term ‘Cleverly Deranged’ would be too generous -but more apt.

      pj

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      1. Kathy C

        Clever and innovative is their terminology. Personally I find it horrific, similar to the Nazi psychologists, or the psychologists that endorsed torture. There are plenty of resources and college level courses in marketing that encourage this kind of manipulation and deception. There are lots of sites like this. They encourage psychologists to do content marketing, picking a topic that affects people emotionally, pain and addiction are really good topics that get attention.
        http://www.drjuliehanks.com/2011/08/30/5-free-ways-to-market-your-therapy-practice/ Even more disturbing, the psychiatrist that studied torture and helped our government allow it, came up with how to motivate in marketing, https://www.wellbeingandresilience.com/perma-plus. The internet is full of these marketing sites, https://blog.thesocialms.com/power-emotions-in-content-marketing-reactions/ Journalism and TV advertising uses these techniques too. They recommend that to build an online reputation, they market themselves with thoughtful topical articles. Even suicide can draw attention, and be a great marketing tool.

        The word opioid is an attention grabber, people are so desperate, scared, in pain or have been conditioned by mass media. It typically gets an emotional response, so it is great in and ad or a headline. The FTC and the FDA used to regulate false health claims, and many of the websites contain disclaimers so it is all legal. Physicians are under more regulations about endorsing products than psychologists. This article went viral,, picked up by every newspaper and news outlet across the country. Of course it was misleading, but it laid the groundwork for more patients to have their medications taken away.

        they claim the “epidemic” started with Perdue’s marketing campaign for Oxycontin in 1996. It is no coincidence that was the same year that the FTC and FDA removed restrictions on marketing pharmaceuticals. That was before the internet took off as a source of misinformation and a marketing extravaganza. Our government prior to 1980 and 1996 viewed patients as needing to be protected from marketing exploitation. Sick people are vulnerable to these claims, and can be exploited. The FTC failed to regulate much of the online content marketing, and as log as there is a disclaimer somewhere, anything goes. With so many Americans in pain, and unable to access healthcare, this is really profitable.

        Certain people in our administration view healthcare as a choice. The idea of free market healthcare should have meant that everyone had access to fact based information, but the opposite is true. The misinformation created gaps where people could be exploited by these marketers. Nothing is off limits for them and there are no ethical considerations at all. Like Darnell, all they have to do it believe they are helping. The facts, data and statistics tell us otherwise, but at least it was profitable. Psychologists gave the industries a way to get rid of their low value patients, especially pain patients. It appears almost genocidal.

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        1. peter jasz

          “Marketing”, “stories”, “advertising” -Opiate “Epidemic” Has anyone even considered what a ‘Epidemic’ entails (is) ?
          The “advertised” opiate-deaths, firstly (we’ve been informed) are falsely, inaccurately reported; if a OD victim autopsy has “5” illegal, narcotic substances, plus alcohol it’s reported/counted as six (6) deaths !? What kind of plain lying is that ? No one cares to hammer that point back at them ?Or answer to it ?
          But here’s the sad thing; even if the 47,000 OD deaths are all opiate-only deaths (that it is NOT -not even close) that “number” hardly represents an “Epidemic”, considering that cocaine, meth and alcohol fatalities show (accidental/OD deaths) numbers that are 100X GREATER (than opiate mortality).
          And, if anyone cared to to examine and reveal the number of deaths from prescription opiates alone -there may not even be a single case ! Again, is this ever brought to anybody’s (the fictional story-teller’s) attention ?? WHY NOT ?

          Starting with these facts WOULD HAVE ended the Opiate Epidemic BS before it could/would gain any traction. But no one cared to point out such simple, basic facts -before the fabricated opiate epidemic went ‘viral’ -and continues to be re-hashed/packaged year-after-year, as intractable pain patients suffer -and perish/expire ? Now, that’s an impressive story, huh ?

          Sensibility. Legal action/lawsuits are demanded. As cheap and cowardice people (with means/resources) cower in fear, good people (in desperate, intractable pain) die a slow,torturous, agonizing death. For sure, let’s keep talking. Absolue bunk.

          We ALL must step up to the plate with purpose; dignity, constructive-anger, support and dollars in hand. And finally fight. Really fight, the good fight.

          pj

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