Friday, September 11, 2009

Dismal Portrait of Chronic Pain Relief; Survey

Despite a year of treatment for chronic pain, 95% of patients were still in moderate to severe pain, according to results of a newly reported survey. In more than half of patients the pain failed to improve at all and nearly 1 in 5 reported that their pain worsened during the year — overall, 46% remained in severe pain at the end of the 12-month study.

The survey, entitled PainSTORY (Pain Study Tracking Ongoing Responses for a Year), is the first of its kind to follow the impact of chronic pain on patients’ lives during the course of 12 months (ending May 2009). Participants included 294 patients in 13 European countries (United Kingdom, France, Germany, Switzerland, Italy, Spain, Ireland, Belgium, Sweden, Denmark, Finland, Netherlands, and Norway). They were suffering from nonmalignant moderate to severe chronic pain associated with osteoarthritis, back pain, osteoporosis, neuropathic pain, mixed pain, or other long-term pain. Participants recorded information about their types of pain, who they had consulted for help, and what treatments they received.

Although nearly all participants continued to suffer pain, the number of them visiting a doctor declined during the year from 83% at the beginning of the survey to 70% at the end. By the end of the year, only 58% had been given a physical examination, 22% were rated on a pain scale, 19% were sent for further tests, and merely 2% had consistently visited a pain specialist. Most patients (83%) were prescribed pain medication but nearly a third also resorted to over-the-counter (OTC) remedies either alone or in combination with other therapies. Only about 1 in 8 patients (12%) were prescribed strong opioid therapy, 25% a weak opioid, and 43% were prescribed nonopioid agents. The research also reveals that less than a quarter (23%) had their prescription changed to a stronger type of pain medication during the year.

Even though their pain persisted unabated in most cases, 64% of patients believed they were taking the most appropriate level of medication and 58% thought that everything possible was being done to help them. However, chronic pain took a high personal toll: 44% of participants reported feeling alone in tackling their pain and two thirds felt anxious or depressed as a result of their pain. They reported feeling trapped by a pain that varied in intensity but continuously affected every aspect of their lives. More than a quarter of patients (28%) said their pain was so bad at times that they wanted to die.

Commentary: The obvious message here seems to be that healthcare practices in Europe are inadequate for persons with chronic pain. However, this was a relatively small study, considering the amount of geography covered, and the researchers do not report how patients were selected for the survey. There could be biases in subject selection and the types and quality of treatments that were available to them. It would be important to know if certain subgroups of patients, receiving select treatments, did better than others; however, with only 294 participants in total such subgroup analyses probably would not have statistical power. Hopefully, this sort of long-term research will be continued and expanded in Europe, and initiated in the United States and other countries. Prior surveys have revealed that chronic pain is a *disease* of epidemic proportions, and increasing worldwide.

Source: The PainSTORY survey was conducted by an independent research company, Ipsos MORI, in collaboration with the European Federation of IASP Chapters, World Institute of Pain, and OPEN Minds. It was sponsored by a restricted educational grant from, and prepared in association with, Mundipharma International Limited, a manufacturer of opioid analgesics. For much more information, visit