Burden of Acute Pain

Benjamin W. Friedman, MD, MS: Let’s move the discussion to the burden of illness and to what extent acute pain can impact a patient’s quality of life. Paul, can I turn it over to you for that?

Paul Arnstein, RN, PhD, FAAN: Yes. We’re talking about tens of millions of people in terms of the prevalence of acute pain with surgery and traumas: about 30 million to 50 million people each year in the United States, as well as the tens of millions with post-cancer pain.

The burden of illness, especially with high levels of acute pain, basically affects every system in the body. It puts stress and strain on the cardiovascular systems. It decreases the effectiveness of our respiratory system and creates atelectasis through short, shallow breathing, putting people—especially older adults—at risk for pneumonia. It also affects our immune system in a couple of ways. That puts persons with pain at risk for complications. It also puts the patient’s metabolic state into a catabolic state, which impedes healing and recovery.

As my colleague mentioned, it interferes with sleep. It can interfere with nutrition. Most importantly, it interferes with activities of daily living and with the structure and function of the nervous system. If it isn’t controlled, it puts a person at risk of developing lingering pain or heading down the pathway toward chronic pain and high impact chronic pain, where the person isn’t able to perform their activities of daily living or work as a result of the severity of their pain or illness. This creates an enormous cost or burden to our health care system and our society in general.

When you look at some of the studies that have been done on global burden of disease, for as long as these studies have been done, and they’re done every 3 years globally, low back pain has been at the top of the list in terms of the cost and the years lived with disability. This is virtually every country around the world, both developed and undeveloped countries, in terms of the resources that it costs. When you look at some of the top 5—low back pain, headache, and neck pain—we’re talking about 150 million years lost or lived with disability related to only those pain conditions. That’s an enormous cost to the individual, family, and society in general.

Benjamin W. Friedman, MD, MS: Indeed, it is.

Transcript Edited for Clarity