Publications
APS Bulletin • Volume 16, Number 1, Winter 2006
President’s Message
Pain Hurts—Individuals, Significant Others, and Society!
Dennis C. Turk, PhD
A quick survey of the statistics associated with pain reveals that there are a staggering number of people who experience acute pain and are diagnosed with specific pain syndromes. A survey published by the Arthritis Foundation (2000) found that 42% of adults in the United States experience pain daily and 89% monthly. When extrapolated, data from the National Health Interview Survey (Lethbridge-Cejku & Vickerie, 2005) of the U.S. population suggest that in a 3-month period nearly one-third experience some type of pain. Of those who experienced pain, 31,066,000 experienced migraine; 28,401,000 experienced head-neck pain; 52,325,000 experienced low back pain; and 9,535,000 experienced jaw pain. Weighted mean prevalence of chronic pain in the general population has been estimated at 35.5%, or 105 million, in the United States (Harstall, 2003).
The number of people seeking care for their pain is striking. Nearly half of all Americans see a physician with a primary complaint of pain each year (Mayo Clinic, 2001). In 2003, there were more than 99 million office visits to physicians for acute injuries, and during these visits analgesics drugs and NSAIDS were mentioned 117.8 million times (Hing et al., 2005). In fact, during visits to physicians’ offices and emergency rooms, pain medications are the second most-prescribed drugs after cardiac-renal drugs (Schappert, 1998).
Direct costs of medical care and indirect costs (i.e., costs associated with disability, lost time from work, reduced productivity, or tax revenue) are astronomical. The U.S. Census Bureau (1996) suggested that chronic pain is responsible for more than $150 billion spent on healthcare- and disability-related costs. Lost productive time because of common pain conditions alone among workers costs an estimated $61.2 billion per year (Stewart et al., 2003). Costs of acute pain are more difficult to determine, but, given the more than 99 million injury-related office visits (Hing et al., 2005), the number of people taking nonprescription drugs in a 1-year period (84% of participants in a national survey conducted by the American Pharmaceutical Association [1997]), the estimated 147 million adults consuming monthly prescription and nonprescription analgesic medication (Paulose-Ram et al., 2003), and the number of surgeries (more than 23 million more than a decade ago; Peebles & Schneidman, 1991), it would not be surprising if the expenditures for treatment of acute injury and post-surgical pain exceed the amounts spent on chronic pain.
People Experience Pain
Although the figures enumerated above are mind-numbing, they do not provide any indication of the incalculable human costs of pain. It is the person who experiences pain—not the neck, back, or leg.
As we focus on symptoms, injured or malfunctioning body parts, and even people with pain, we tend to forget that the significant others of those with pain also are affected. Most people live within a social milieu and not in isolation. In one study, the spouses of patients treated in a pain rehabilitation program were more than 2.5 times more depressed than the patients themselves (Flor et al., 1987). Using the figure that there are 50 million Americans with chronic pain, and assuming that each person has at least two significant others in their life, it calculates that roughly half of the U.S. population is directly involved in chronic pain.
Public Awareness of Pain
So, if pain hurts us all, why is there not more emphasis in our current discourse about health care? Perhaps one explanation is that pain is a symptom of many physical problems, and, despite efforts of APS and its sister organization the American Pain Foundation, it has not achieved an identity such as what is observed with some specific diseases like cancer or arthritis. Significant lobbying groups advocate for these diseases and the National Institutes of Health (NIH) is primarily organized around diseases, although there is currently a trans-institute Pain Consortium. Yet, in 2003, only 1% of the NIH budget-supported grants had a primary focus on pain (Bradshaw et al., 2005).
Information about the importance of pain needs to be disseminated more broadly. In December 2005, a delegation from APS (Judy Paice, Ron Dubner, Dick Chapman, Lonnie Zeltzer, Cathy Underwood, and myself) met with leaders of the NIH Pain Consortium to express concerns about the disparity of grant support portfolios across the different institutes and to offer the expertise of APS members to advise and collaborate, increasing the visibility of research related to pain. When we met with the members of the Consortium, we emphasized that pain is a perfect example of an area heavily involved in translational research, which is a major focus of the NIH. We plan to continue this dialogue, exploring ways that we can collaborate.
APS is a member of the Pain Care Coalition, which comprises the American Headache Society, the American Academy of Pain Medicine, and the Anesthesia Society of America. Partnering with other professional organizations maximizes efforts to sensitize policy makers about important issues related to the under treatment and mistreatment of pain. However, there are limits to what professional organizations can do, and there are a number of other organizations, which are often disease-specific, that represent a significant number of people who are affected by pain and their significant others. There have been some initial efforts, guided by the American Chronic Pain Association, to bring disease-specific groups together toward a common goal. These efforts hold significant promise to spread the word about pain. APS is examining ways to work with these disparate groups.
The Roger’s Bill, HR 1020, raises the consciousness of Congress, if not the country, about the central role of pain in health and health care. APS and other professional and non-professional organizations have actively endorsed the passage of this bill.
The media has the greatest opportunity to inform the public about the importance of pain. In an effort to support this role of the media, APS created the Kathleen Foley Journalism Award, which acknowledges a significant media contribution. However, although there are some excellent stories about pain, there is usually little follow-up. Today’s news is tomorrow’s garbage can lining.
We need to do a better job of conveying the message in all venues. Pain hurts. APS must take a leadership position by partnering with both professional and nonprofessional organizations that share a common concern. However, APS is made up of members, many of whom treat people with chronic pain and many more who know people who experience pain. Each of you, us, also needs to take up the challenge of spreading the word. Pain hurts—it hurts us all! It is time to give this problem a more prominent position in society.
References
American Pharmaceutical Association. Americans at risk from self-medication, survey reveals [news]. (1997). American Journal of Health-System Pharmacy, 54, 2664–2666.
Arthritis Foundation. (2000). Pain in America. Retrieved December 28, 2005, from www.arthritisfoundation.org.
Bradshaw, D.H., Nakamura, Y., & Chapman, C. R. (2005). National Institutes of Health grant awards for pain, nausea, and dyspnea research: As assessment of funding patterns in 2003. Journal of Pain, 5, 277–293.
Flor, H., Turk, D. C., & Scholz, O. B. (1987). Impact of chronic pain on the spouse: Marital, emotional, and physical consequences. Journal of Psychosomatic Research, 31, 63–71.
Harstall, C. (2003). How prevalent is chronic pain? Pain: Clinical Updates, X, 1–4.
Hing, E., Cherry, D. K., & Woodwell, D. A. (2005). National Ambulatory Medical Care Survey: 2003 summary. Advance data from vital and health statistics; no 365. Hyattsville, MD: National Center of Health Statistics.
Lethbridge-Cejku, M., & Vickerie, J. (2005). Summary health statistics for U.S. adults: National Health Interview Survey, 2003. National Center for Health Statistics. Vital Health Statistics, 10 (225)
Mayo Clinic. (June 1996). Managing pain: Attitude, medication and therapy are keys to control. Mayo Clinic Health Letter, (Suppl.). Retrieved September 19, 2001, from www.mayoclinic.com.
Paulose-Ram, R., Hirsch, R., Dillon, C., Losonczy, M. S., Cooper, M., & Ostchega, Y. (2003). Prescription and non-prescription analgesic use among the U.S. adult population: Results from the third National Health and Nutritional Examination Survey (NHANES III). Pharmacoepidemiology Drug Safety, 12, 315–326.
Peebles, R. J., & Schneidman, D. S. (1996) Socio-economic factbook for surgery, 1991–92. Chicago: American College of Surgeons.
Schappert, S. M. (1998). Ambulatory care visits to physicians offices, hospital outpatient departments, and emergency departments: United States, 1996. Vital and Health Statistics, 13(134), 1–80.
Stewart, W. F., Ricci, J. A., Chee, E., Morganstein, D., & Lipton, R. (2003). Lost productive time and cost due to common pain conditions in the workforce. Journal of the American Medical Association, 290, 2443–2454.
U. S. Census Bureau (1996). Statistical abstract of the United States: 1996 (116th ed.). Washington, DC: Author.