About Pain: 10 Things You Should Know

Pain is a significant public health problem that costs society up to $635 billion each year-about $2000 for every person who lives in the United States. Chronic pain affects more Americans than diabetes mellitus, heart disease, and cancer combined.

At least 100 million adult Americans had a common chronic pain condition in 2011. Most persons with chronic pain had multiple sites of pain.

A problem with pain that persisted for longer than 24 hours was reported by more than one-fourth of Americans aged 20 years or older-an estimated 76.5 million Americans. Pain lasting more than 24 hours was reported more frequently in adults aged 45 to 64 years.

Low back pain is the most common kind of pain, followed by severe headache or migraine pain, neck pain, and facial ache or pain.

In “Relieving Pain in America: A Blueprint for Transforming Prevention, Care, Education, and Research,” the Institute of Medicine (IOM) recommended that primary care physicians-“who handle most frontline pain”-collaborate with pain specialists in cases in which pain persists.

Here are some facts and figures about pain for you to consider:

1.Low back pain is the fifth most common reason for doctor’s visits and accounts for more than $26 billion in direct health care costs nationwide each year. A clinical practice guideline issued by the American Pain Society emphasized the use of noninvasive treatments over interventional procedures. It also encouraged shared decision making between providers and patients.

2. During the 3 months before an interview survey, 16% of adults had experienced a migraine or severe headache, 15% had experienced pain in the neck area, 28% had experienced pain in the lower back, and 5% had experienced pain in the face or jaw area. The percentage of persons who experienced migraines or severe headaches was inversely related to age.

3. A new pain relief treatment is available for patients with fibromyalgia syndrome who are resistant to more routine therapies. Intravenous lidocaine infusion provided significant pain relief, although the relief was much less for African Americans and cigarette smokers than for others.

4. Health care providers were encouraged to aim increasingly at tailoring pain care to each person’s experience and to promote pain self-management.

5. In a study of the relationship between patients’ perceptions of pain control during hospitalization and their overall satisfaction with care, patient satisfaction was more strongly correlated with the perception that caregivers did everything they could to control pain than with pain actually being well controlled.

6. Primary care physicians overwhelmingly prefer to prescribe NSAIDs for patients with nonmalignant chronic pain, in accordance with published clinical practice guidelines. NSAID use was surprisingly high, with rates of 97% to 99% in all chronic pain types studied; acetaminophen use was reported by 4% of respondents.

7. More than 50% of clinicians who write prescriptions now prescribe electronically-a nearly 8-fold increase over just 4 years ago. The share of clinicians (doctors, nurse practitioners, and physician assistants) who used e-prescriptions jumped from 7% to 54% over the 4-year study period (or from 47,000 to 398,000 e-prescriptions).

8. The AMA now offers an updated pain management education program that provides physicians with the latest information on assessing and managing pain. The AMA supports full funding and staffing for up-to-date, interoperable, at-the-point-of-care prescription drug monitoring programs integrated into a physician’s workflow.

9. Expectations for consistent, comprehensive pain management education for new health professionals, including physicians, nurses, physical therapists, and pharmacists, have been developed by University of California, Davis researchers, who followed an IOM recommendation.

10. A new handbook, “Pain Control In The Primary Care Setting,” is designed for health care professionals as a tool to improve the quality of pain management, with emphasis on the primary care setting. The primary focus is chronic noncancer pain for which management often is complex. The goal is to introduce evidence-based and practical strategies for diagnosis and management of painful symptoms.