Chronic pain costs society more than $100 billion a year, but it's often misunderstood and untreated.
Reviewed By Charlotte Grayson
What medical condition do these three people have in common: an 80-year-old with arthritis, a 50-year-old with a bad back, and a 20-year-old with migraines?
The answer, which may not be obvious, is chronic pain. While many of us think of pain as a symptom of something else and not a condition in itself, all those aches add up to a serious public health problem. Regardless of its origin, pain is the No. 1 cause of disability in America and it costs us a great deal.
"Pain in itself probably costs the American population upwards of $120 billion each year," says Marc Hahn, DO, president of the American Academy of Pain Medicine. "That's not only in its medical treatment, but in its impact on society, in missed days, and decreased productivity at work."
And while looking at pain's bottom line is important, no price can be put on the enormous suffering it causes.
"If you're a person with chronic pain, every moment is affected by it," says Penney Cowan, founder and executive director of the American Chronic Pain Association. "Pain spills over into every aspect of life and can become your identity. It can make people lose everything -- even their homes and their families."
Fifty million people in America are either partially or completely disabled by pain, says Hahn, and according to a recent survey of 1,000 people conducted by the Partners for Understanding Pain, one out of three are affected by it. But in a nation with such sophisticated medical treatment, why are so many of us suffering from an often-treatable condition?
The Causes and Costs of Pain
So what's causing all of this pain? For the most part, it's the usual suspects.
"Low back pain and headaches are the most common sources of intractable pain in our society," says Hahn, and many such injuries are caused on the job. Diseases and other conditions such as diabetes and especially cancer can cause pain as well. For people with cancer, treatments like chemotherapy and surgery can result in pain themselves.
While many people might assume that chronic pain is a bigger problem for the elderly, the Partners for Understanding Pain survey found that 80% of those with chronic pain are between 24 and 64. Cowan -- whose organization, the American Chronic Pain Association, spearheaded the survey -- reports that sports injuries are among the most frequent causes of chronic pain for people in their 20s.
Cowan says that a lot of people are reluctant to admit they're in pain, especially when they're hurt on the playing field.
"People will tell you to shake it off and play through pain," she says. "But there are pains that you shouldn't ignore. It's your body's way of telling you something is wrong."
One of the biggest risks of ignoring pain is that it will turn the acute pain from a pulled muscle or other injury into a chronic pain that can last your lifetime.
The Problem With Pain
Part of the difficulty in diagnosing and treating pain may lie in how we look at it. While Hahn tells WebMD that up to 90% of all diseases cause pain, alleviating the pain often takes a backseat to the diagnosis and treatment of the disease. Obviously, treating the underlying condition is crucial, but easing people's suffering is important, too.
"Doctors are very well-trained in diagnosing and hopefully treating medical problems," Cowan tells WebMD. "What they're not well-trained in is managing pain."
Another reason that pain may not have received enough attention from the medical community is that it can't be measured, Cowan says. Feeling pain is, ultimately, a personal experience, and there's no way for a doctor to gauge how much distress a person is really in.
Because feeling pain is purely a subjective experience, it often leads to problems with family and co-workers. While you may be in terrible distress, the people around you just can't see or feel what you're going through.
"It's sometimes difficult for patients who are suffering from pain to get the recognition they deserve," says Hahn. "It would be a lot easier for them if they had a cast on a broken arm, since society recognizes that sort of badge of courage."
The emotional costs of pain can be devastating, not only to you, but to those around you. "Pain can lead to serious dysfunction in family and social life," says Hahn.
He also observes that depression and pain often go together. "Pain can be a symptom of depression and depression can result from chronic pain," he says. "And chronic pain also increases a person's risk of suicide."
A Partners for Understanding Pain survey shows most Americans know little about who suffers from chronic pain and how it is treated. The group is a coalition of 50 medical organizations.
The survey revealed that 78% of people are afraid they would become addicted to pain medication. But pain expert Daniel Carr, MD, of the Tufts-New England Medical Center, says in a news release that most pain medications rarely cause addiction because they don't produce a "high." They merely relieve pain.
Most people in the survey also believe that most chronic pain sufferers are 65 or older. But the Partners for Understanding Pain says 80% of sufferers really are between 24 and 64.
Can your doctor diagnose your pain problem and treat it? Most people in the survey believe so. But Carr says few doctors have formal training because few medical schools teach pain management.
Taking Your Medicine
A wide variety of treatments are available for pain, but not enough people are seeking them out, Hahn says.
One reason is that many have inaccurate views and fears of pain medications. We've all heard the stories about celebrities and public figures who've developed an addiction to painkillers, and many people fear that taking these medications will lead directly to drug addiction. According to the Partners for Understanding Pain survey, 78% of people interviewed believed that becoming addicted to painkillers was a likely risk of treatment. However, that isn't the case.
"It's a misperception," says Hahn. "The appropriate use of pain killers for a specific condition is effective and causes very little risk of addiction."
Hahn also observes that untreated pain can lead to a real addiction to alcohol or other substances that can dull sensation. Certainly, it's better to let your doctor prescribe a medicine instead of doing it yourself.
Depending on the condition that causes your pain, other treatments may be available that don't use medication. For instance, Cowan says that physical therapy can be tremendously helpful for many painful conditions. Hahn agrees, and adds that biofeedback and hypnosis can also be effective treatments.
The good news about pain, Cowan and Hahn believe, is that attitudes are changing and doctors now better understand how to treat pain. The American Academy of Pain Medicine is also currently working on a medical education project that will help doctors and medical students learn more about diagnosing and easing pain.
In the meantime, Cowan stresses that those suffering from pain need to stand up for themselves. "People with pain need to know that they're not alone and their pain is not in their heads," she says.
"Also," she adds, "you have the right to have your pain treated and managed. Talk openly with your doctor about what you're feeling." Because the costs of pain -- emotionally and financially, personally and societally -- are just too high to ignore.
Originally published Dec. 30, 2002.
Medically updated Oct 8, 2004.
SOURCES: Penney Cowan, founder and executive director, American Chronic Pain Association. Marc Hahn, DO, president, American Academy of Pain Medicine. American Chronic Pain Association. American Academy of Pain Medicine. American Pain Foundation. WebMD Medical News: "Is Pain Misunderstood?"
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