The Cost of Pain

Last Editorial Review: 1/31/2005

Loss of productive work time? $61.2 billion. Personal suffering? Enormous.

By R. Morgan Griffin
WebMD Feature

Reviewed By Charlotte Grayson

How much does a bad back cost?

Maybe it's just $10 a month for a new bottle of Advil? But what about your chiropractor bills? What about the housekeeper you had to hire to do the housework that you can't do? What about that pricey ergonomic chair? Or what if you need to cut down on the hours you work, or quit your job altogether? What if you lose your insurance as a result?

The costs of pain can be enormous, and they spill out well beyond what you spend at the drugstore. "If you have pain all the time, it gets into every nook and cranny of your life," says Sean Sullivan, CEO of Institute for Health Productivity Management. "It's about as pervasive as something can get."

Big and small, those costs -- financial and emotional, obvious and hidden -- can add up. And you're not the only one footing the bill: your spouse, your family, and your employer are all affected. That's all from one achy back. Now imagine a nation's worth of achy backs -- and arthritis pain, and migraines, and other types of pain. How much does all that pain cost us as a society?

It's a tough question to answer. But because pain is emerging as a serious health problem in the U.S., it's one that more and more researchers are trying to answer.

Pricing Pain

Here's one estimate for the cost of pain: $61.2 billion per year. That's from a recent article by Walter "Buzz" Stewart, PhD, MPH, in the Journal of the American Medical Association. But Stewart points out that it's still only part of the picture. That staggering sum is only the money drained from U.S. businesses because of productivity lost from employees in pain. Stewart's study also only included arthritis, back pain, headache, and other musculoskeletal pain.

As pain researchers know, putting a number on the cost of pain is tricky. Pain is a subjective experience -- no one can ever know what someone else's pain feels like.

But even though pain won't show up in blood tests or on X-rays, its effect is undeniable. Experts in pain management argue that pain needs to be studied so that we can come to grips with its costs. It's also crucial that people see pain not just as a symptom, but as a widespread, debilitating condition in itself.

How common is pain?

In 2003, Research!America released the results of a survey of 1,000 people in the U.S. The survey showed:

  • 57% of all adults have had chronic or recurrent pain in the last year.
  • 75% of people currently in pain had to make adjustments to their lifestyle because of their pain, including 33% who had to make major adjustments.

Moreover, many people in pain are undertreated, according to surveys. In 2004, the American Chronic Pain Association released the results of its Americans Living with Pain survey. Of the 800 adults with chronic pain interviewed, almost half say that their pain isn't being controlled by their treatment.

Next: Who's in Pain and Why?

Who's in Pain and Why?

So who makes up the bulk of pain sufferers? One might expect that pain tends to worsen with age; as you get older -- and you've accumulated a few decades of wear and tear -- you're more likely to have pain. Right?

Not really. The Research!America survey found that people under 35 are about as likely to have chronic pain as people over 35.

Stewart, from the Center for Health Research & Rural Advocacy at Geisinger Health System in Danville, Pa., came to a similar conclusion: the percentage of people in pain is roughly the same across different age groups. What varies is the cause of the pain, he says. For instance, as you'd expect, older people are more likely to have arthritis pain. But migraine pain is most common in young and middle-aged adults, especially women. So no matter what the age, the risks of serious pain are similar.

The long-term dangers of pain are significant.

"People in pain are at risk of going into a downward spiral," says Stewart. "The pain can make them depressed, and the depression can exacerbate their perception of pain. That leads to even more disability. It can become a serious condition, and it needs the most aggressive treatment we have."

Depression appears to have a strong link with pain. In one recent study of 573 people with depression, two-thirds reported that they were in physical pain. Many had headaches, back pain, and joint pain. The study indicated that the severity of pain might even be an indicator for the severity of depression.

Pain on the Job

According to Stewart's 2003 study, over half of the almost 29,000 workers in the random sample said that they had headache, back pain, arthritis or other musculoskeletal pain in the last two weeks. But as widespread as it is, both Sullivan and Stewart report that some employers have trouble grasping the costs of this pain.

Traditionally, employers have focused on pain's most concrete manifestation: sick days. If an employee doesn't show up to work, it's easy to notice.

But Stewart says that absenteeism is not the biggest problem for employers. According to his study, absenteeism makes up less that 25% of productivity lost because of pain. The rest comes from people who show up to work, but who can't work efficiently because of their pain. Stewart calls it "presenteeism."

Sullivan's company, the Institute for Health Productivity Management, encourages businesses to look at health issues like pain in a larger context. He argues that once businesses grasp the real costs of pain, they will work harder to treat it. In the end, a more aggressive approach to pain treatment will help employees and employers alike, he says.

Next: The Effects of Pain at Home

The Personal Cost of Pain

What impact does pain have on an individual person or a family? Tallying up the financial and emotional costs of pain at home can be even trickier than figuring out its effects on businesses.

"Just as you'd expect, when people are frequently in pain, their relationships suffer," Stewart tells WebMD. "In a marriage, for instance, the household demands get shifted to the other person. Pain has an impact beyond the person in pain -- it affects the spouse and family, too."

Sullivan points out that most studies have only looked at pain in a broad context and ignored the individual effects. But that's changing. Stewart has worked on several recent papers about people with migraines and their families. In one survey of over 1,100 people in Britain and the U.S., he charted the real impact of pain on a person's quality of life. Because of their migraines:

  • 85% said that they were significantly less able to do household chores
  • 45% missed out on family, social and leisure activities
  • Over 50% believed that migraines made them more likely to argue with their spouses or children
  • 36% believed that they would be better partners if they didn't have migraines

The researchers also interviewed their spouses. It turned out that 29% of them agreed that their partner's migraines caused more marital arguments. Of course, this only applies to migraines. But plenty of anecdotal evidence suggests that any chronic pain condition causes similar family tensions.

Treating Pain

Discussions of the risks of chronic pain -- depression, financial problems, possibly even substance abuse as a form of self-medication -- may make them seem cataclysmic. Don't panic. Your slipped disk probably won't set you on an inexorable path to misery and ruin.

"Physicians have a lot of good treatments for pain to choose from these days," says Stewart, "It's a much more satisfying experience for the patient than it was."

First, however, you must get treatment. And experts in pain management agree on one thing: on a societal level, pain is grossly undertreated. In one study that Stewart worked on, he found that only 41% of migraine sufferers reported that they ever received prescription medication for their condition. That's a low number for a condition as severe as migraine. If we're in so much pain, why aren't we getting treated? Are we just being brave or stoic?

"That could be part of it," Sullivan tells WebMD. "But I don't really think that there are many stoics left in our society. I think the real reason is that people aren't getting diagnosed."

Talk With Your Doctor About Pain

Why aren't people getting diagnosed? Stewart argues that part of the problem stems from how we talk about pain.

"We all have a tendency to describe pain in terms of our experience," he says. We focus on where it hurts and how it feels. The problem is that this information is often too abstract for others to really understand, even doctors.

So what should you do? Explain how your pain affects you, Stewart says. Talk in concrete ways about how it interferes with your life.

"The literature is very clear on this," says Stewart. "When people talk about their pain in terms of how it's limiting them -- like if it stops them from working -- physicians are much more likely to respond and treat it seriously."

Talking in concrete terms may make it easier for you to see the impact of your pain. Many people become accustomed to painful conditions and don't see their pain as abnormal, Stewart says.

Whatever you do, don't ignore the pain. "Don't assume that your pain will get better on its own," says Stewart. "Getting medical care early is always better than getting it later." The costs of treating pain now -- whether it's yours, your spouse's, or your employee's -- will be much lower now than if you wait until it worsens.

Published Dec. 14, 2004.

SOURCES: Walter "Buzz" Stewart, PhD, MPH, director of the Outcomes Research Institute for The Center for Health Research & Rural Advocacy at Geisinger Health System, Danville, Pa. Sean Sullivan, president and CEO of the Institute for Health & Productivity Management, Scottsdale, Ariz. Lipton, RB. Headache, 2001; vol. 41: pp 638-645. Lipton, R.B. Cephalgia, July 23, 2003; vol. 23: pp 429-40. Stewart, W.F. JAMA, Nov. 12, 2003; vol 290: pp 2443-2454. Bair, M. Psychosomatic Medicine, August 2004; vol. 66: pp 17-22. American Chronic Pain Association web site. American Pain Foundation web site.

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