Saturday, November 20, 2010

U.S. Chronic Pain Data Updated — Alarming News!

Research UpdateNew data from the largest single survey to date propose that an astounding 78 million American adults suffer from chronic pain lasting 3 months or longer. This is higher than previous estimates and suggests this is an unrestrained epidemic that could become a major political issue concerning the quality of healthcare in the United States.

Last June, 2010, we reported [here] on a comprehensive examination of worldwide surveys that discovered chronic pain prevalences ranging from 12% to 80% in the selected populations, with an estimated 76.5 million adults afflicted in the United States. Now, a very large research survey in the U.S. corroborates those findings and reports an alarming increase in prevalence of chronic pain. Using a unique cross-sectional, Internet-based approach researchers were able to gather data from a representative sample of 27,035 adults (ages ≥18 years) to estimate the point prevalence of chronic pain, and to describe sociodemographic factors and other characteristics of the problem [Johannes et al. 2010].

Reported in the November 2010 edition of the Journal of Pain, a key question asked of participants was, “Do you have any chronic, recurrent, or long-lasting pain, more than aches and pains that are fleeting and minor?” Only those persons responding that they had experienced chronic, recurrent, or long-lasting pain [referred to in this blogpost simply as “chronic pain”] for at least 6 months were included in the full survey. Therefore, this was more stringent and conservative than the usual 3-months duration required in most accepted definitions of chronic pain. The survey was conducted during mid-December 2008 through mid-February 2009.

Using a statistical weighting system, which balances data to be in accordance with the overall composition of the U.S. population, the researchers reported an overall chronic pain prevalence of approximately 31%. In terms of the adult U.S. population today — roughly 311 million individuals, 233 million adults as of November 19, 2010 [census data here] — this amounts to 72 million adult Americans with chronic pain lasting 6 months or longer. Other data from the survey shed further light on this epidemic:
  • The vast majority of persons with chronic pain (89%) had been afflicted for a year or longer, with most (86%) experiencing pain attacks 2 to 3 times each week, or more often. A third of respondents reported severe average pain intensity that had significant impact on their lives [and, perhaps, their families as well].

  • As past surveys have found, overall prevalence was higher for females than males. Roughly 1 in 3 women (34.3%) and 1 in 4 men (26.7%) in the surveyed population had chronic pain.

  • As might be expected, chronic pain prevalence increased with age. Compared with the youngest age group (18-24 years) there was more than a 3-fold increase in the odds of chronic pain reported in the 3 oldest age groups (encompassing ages 45-65+).

  • About a third of chronic pain suffers reported having no formally diagnosed pain condition, and they tended to have milder pain on average than the others. Among respondents with physician-diagnosed conditions, the most common and painful (≥7 on a 0-10 scale) were back pain, osteoarthritis, rheumatoid arthritis, and migraine headache.

  • Overall, 13 different, diagnosed pain conditions were included in respondent self-reports; however, cancer-related pain as a primary pain source accounted for only 1% of overall chronic pain prevalence. So, noncancer pain is by far the greatest driving force of the chronic pain epidemic.

  • Statistical analyses revealed that poorer socioeconomic status — low household income, unemployment — are significant correlates of chronic pain. While the study authors did not comment on this issue, poor socioeconomic status may be associated with less access to pain care, along with underinsurance or no healthcare insurance.

  • Persons living in metropolitan areas had a slightly decreased odds of reporting chronic pain as compared with those in non-metro (rural) locales. Again, this may suggest an access-to-care problem, with persons living in larger cities having more and more easily accessible services for pain management.

  • A consistent relationship of chronic pain with lower education was not observed; although, college educated respondents generally had lower odds of having chronic pain than those with only a high school degree or less.

  • Divorced or separated adults were somewhat more likely to have chronic pain than married respondents (Odds Ratio: 1.15); whereas, single persons (never married) were less likely to report chronic pain (OR: 0.87).
COMMENTARY: This new survey by Johannes and colleagues was large in scope and capitalized on a unique, Web-enabled panel of roughly 36,000 adults broadly representative of the U.S. population; they received a high, 76%, response rate. Selected households for the panel without computers or Internet access were provided with free access to the survey via WebTV; however, certain groups were most likely not included, such as military personnel, the indigent, and institutionalized persons (eg, in long-term care facilities, justice system detainees, etc.). Inclusion of these groups would probably have further elevated chronic pain prevalence.

Of interest, interpolating from data in the report, an additional 2.55% [adjusted rate] of respondents noted pain duration of at least 3 months but less than 6 months, and they normally would be defined as having chronic pain and included in surveys of this type. This would add another 6 million persons, approximately, bringing the total to 78 million adult chronic pain suffers in the U.S. Therefore, this survey portrays a tremendous burden of chronic pain in the U.S.; greater than previously estimated.

Along with that, there is evidence of a failed healthcare system when it comes to pain management. Persons with poorer socioeconomic status and living in more rural areas exhibited a greater prevalence of chronic pain, which suggests inadequate access to pain care and, most likely, substandard or absent healthcare insurance coverage. The finding that divorced or separated adults suffer more chronic pain could be troublesome, as it might reflect the domestic turmoil triggered by a chronic, debilitating health condition and a loss of insurance or other access to care; more research is needed to examine this issue. Finally, it is important to note that almost all reported chronic pain was noncancer-related, which reinforces the notion that this is a disease entity in itself requiring much more attention in terms of education, research, and appropriate resource allocation.

As we have previously observed, taken as a whole, the U.S. population of adults with chronic pain — plus, in many cases, family members who are directly or indirectly impacted — represents a huge constituency of tax-paying citizens that could become a powerful driving force in American politics; if they ever come together in lobbying for their best interests. The “Patient Protection and Affordable Care Act” signed into U.S. law last March, 2010, also included several provisions of earlier legislation, the “National Pain Care Policy Act of 2009” [see UPDATES blogpost here]. However, there is much more to be accomplished before freedom from pain for everyone becomes a keystone of the American healthcare system, and Congress needs reminding of its importance.

Certain organizations can serve as rallying points for persons with chronic pain and their families. Probably the largest independent, nonprofit organization serving an advocacy role for improving the quality of life for persons with pain and in removing barriers to effective pain management is the American Pain Foundation [here]. Currently, the organization has an ongoing “10,000 Voices Campaign” [here] allowing anyone to tell their story to help illustrate the magnitude of chronic pain as a public health crisis and demonstrate its impact on people’s lives. We think they should be thinking in terms of at least “10 Million Voices” — there are certainly enough persons with chronic pain to participate.

REFERENCE: Johannes CB, Le TK, Zhou X, et al. The Prevalence of Chronic Pain in United States Adults: Results of an Internet-Based Survey. J Pain. 2010(Nov):11(11):1230-1239 [abstract here].