Chronic Pain In America: Roadblocks To Relief

Tom Rovine, (212) 445-8132 and Carol Lee Ferrero, American Pain Society, (847) 375-4843

FEBRUARY 17, 1999, Glenview, IL

New Survey Of People With Chronic Pain Reveals Out-Of-Control Symptoms & Impaired Daily Lives
Treatment Woes Highlighted by Long-Term Suffering, Search for Relief

More than four out of every 10 people with moderate to severe chronic pain have yet to find adequate relief, saying their pain is out of control, according to a new survey released today by the American Pain Society, the American Academy of Pain Medicine and Janssen Pharmaceutica. The survey of 805 individuals also revealed a population of sufferers who often don't receive the type of care experts consider necessary -- despite the fact that nearly half have switched physicians at least once and more than 50 percent have been in pain for more than five years.

"Many Americans with chronic pain are suffering too much for too long and need more aggressive treatment," says Russell Portenoy, MD, president of the American Pain Society and chairman of the Department of Pain Medicine and Palliative Care at the Beth Israel Medical Center in New York City. "This survey suggests that there are millions of people living with severe uncontrolled pain. This is a great tragedy. Although not everyone can be helped, it is very likely that most of these patients could benefit if provided with state-of-the-art therapies and improved access to pain specialists when needed."

The survey was conducted by Roper Starch Worldwide and sponsored by Janssen Pharmaceutica, a developer of pain treatments, the American Pain Society and the American Academy of Pain Medicine. All individuals surveyed had experienced pain for at least six months, and described their pain as being a 5 or higher on a scale of 1-10, with 10 being "the worst pain imaginable." The source of their pain was fairly evenly split between arthritis, back disorders and other causes. (Individuals with cancer were specifically excluded from the survey, since there is a large body of knowledge about these individuals, and aggressive pain treatment for persons with terminal illness is generally well accepted.)

A majority of all survey respondents reported some difficulty doing such basic activities as sleeping, doing chores at home and walking. These problems are accentuated among those whose pain is very severe (8, 9 or 10 on the pain scale) -- of whom nearly one in five had been forced to visit an emergency room at least once in the past year due to their pain.

Search for a Physician Who Will Help
More than half (56%) of respondents reported suffering from pain for more than five years. Yet only 22% had been referred to a specialized pain treatment program or clinic, which offers a comprehensive, multidisciplinary approach to care. In fact, 49% of those currently being treated for very severe pain were still being seen by a family doctor or internist.

"Pain that persists and impairs a person's ability to be productive and enjoy life often requires evaluation and treatment by a team of health-care professionals who specialize in pain," says Dr. Portenoy. "But too often, patients don't seek out this option because they're not aware of it, and physicians don't refer them."

In their quest for pain relief, almost half (47 percent) of all chronic-pain sufferers surveyed had changed doctors at least once. Among those with very severe pain, almost a third (29 percent) had switched physicians three or more times. The most common reasons for the decision to search for a new doctor were "too much pain" (42%), the perception that their last physician did not know a lot about pain treatment (31%), the belief that their doctor didn't take their pain seriously enough (29%) and the physician's unwillingness to treat their pain aggressively (27%).

Pain Treatments: Too Little Too Late
Despite the fact that "opioid" drugs, such as morphine and the fentanyl skin patch, were rated the most effective treatments by those respondents who had used them, these medications were seldom used.

Only about a quarter (26 percent) of respondents with very severe pain reported taking opioid medications at the time of the survey. Instead, many said they were using less-potent medications such as non-prescription pain relievers. While opioid drugs are not suitable for all patients with moderate to severe pain, experts agree that some patients benefit greatly and that both the public and professionals need more education about their use.

"This survey shows the stigma associated with opioid drugs. Although these drugs can clearly benefit some patients with chronic pain, patients, caregivers and physicians overestimate the risks and fail to use them appropriately," observes Dr. Portenoy. "Many patients suffer needlessly because of an inappropriate level of concern about long-term reliance on medication in general, and about addiction caused by strong pain medications such as opioids specifically. The input of pain specialists may be helpful when deciding on the best drug therapy for patients with severe chronic pain." Dr. Portenoy also emphasized that medication is only one of many strategies that can be used to treat pain and the disability that may accompany it. Both drug therapy and non-drug approaches may be needed concurrently.

The American Academy of Pain Medicine (AAPM) was founded in 1983 as the American Academy of Algology. Through the years, AAPM has evolved as the primary organization for physicians practicing the specialty of pain medicine in the United States. By enhancing the practice of pain medicine in the United States, AAPM hopes to develop a socioeconomic and political climate that is conducive to effective and efficient pain management and comprehensive, quality medical care by physicians specializing in pain medicine.

The American Pain Society is a multidisciplinary educational and scientific organization dedicated to serving people in pain. The society was founded in 1978 as a national chapter of the International Association for the Study of Pain (IASP), and now includes nearly 4,000 physicians, nurses, psychologists, dentists, scientists, pharmacologists, therapists and social workers who conduct research and treat pain, as well as advocate for patients with pain.