Download Chronic Pain Backgrounder

CHRONIC PAIN FACT SHEET
Chronic pain is one of the most under-recognised, under-treated medical problems of the
21st century. It can have a devastating impact on the quality of sufferers’ lives and, in turn,
can severely affect the quality of life experienced by their families and friends.
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Chronic pain afflicts around 14.1 million people in the UK.1
Chronic pain is the second most common cause of days off work through sickness,
accounting for 206 million lost working days in 1999–2000.3
One in four sufferers of chronic pain have lost a job due to their condition.2
Costs of back pain alone have been estimated to be £1.6 billion per year to the NHS.4
Back pain costs the economy £10.6 billion per year – one of the most costly medical
conditions.4
The Pain Society, the UK branch of the International Association for the Study of Pain (IASP),
defines chronic pain as pain that has persisted for longer than three months, or past the expected
time for healing following injury or disease.
Left under-treated, chronic pain adversely affects all aspects of health and wellbeing. It is
associated with significant disability, unemployment and loss of other physical roles. These can lead
to wider issues, including reduced earning capacity, family problems and social isolation. In turn,
chronic pain can lead to low self-esteem. It is also often linked to depression, anxiety, sleep
disturbance and even suicide.
Despite the scope and impact of chronic pain, only 23% of sufferers have actually seen a
pain specialist.2 Why?
Patients with chronic pain face significant barriers to treatment. In today’s society, living stoically
with pain is viewed as a sign of strength, and sufferers are often reluctant to take medication for fear
of being seen as weak or becoming reliant on drugs. Others resign themselves to living with pain as
a necessary part of ageing or as an inevitable consequence of an underlying illness or condition.
Personally, people with chronic pain often feel guilty for ‘complaining.’ They sometimes avoid
seeking treatment for their pain, feeling that they are wasting their GP’s or consultant’s time.
Lack of awareness in the medical community also contributes to the under-treatment of pain, as
clinicians are not always aware of the advances in pain therapies. As a new specialty, Pain
Medicine is relatively underfunded; therefore, waiting lists to be seen and for treatment are long.
More investment is necessary.
WHAT IS PAIN?
Pain is a process, and usually forms a valuable part of the body’s natural warning and defence
system. Receptors in the skin and other tissues send impulses through the nerves to the spinal cord
where they are processed. The impulses then travel to the brain.
Acute pain differs from chronic pain. Acute pain is something everyone has experienced: this is the
pain perceived when the body is injured in some way. In these cases the cause of the pain is
usually obvious, and the pain can usually be controlled with medicine until the injury heals. This kind
of pain is self-limiting and has an important physiological warning function.
CHRONIC PAIN
Some pain, however, has no obvious cause or doesn’t fade as the injury heals. This kind of pain
provides no useful warning. It is called chronic pain.
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Chronic pain can be caused by a variety of injuries and diseases including arthritis, nerve damage
and cancer. Most commonly, chronic pain affects the legs and the lower back.
TREATMENTS
Ultimately pain is perceived when the brain registers signals it receives from the nerves. From
research, doctors have learned that the brain can ignore pain signals, and that if these signals are
prevented from reaching the brain no pain is registered. Both of these findings have had important
implications for the development of treatments for chronic pain.
In the UK almost all hospitals operate some type of chronic pain management service. However,
there is little consistency in the way that pain services are delivered or in their funding, or the
availability of particular services in a particular area. Once a patient has been referred to a specialist
chronic pain team, there are usually a number of treatments available.
Learning new life skills: Utilising proper coping strategies can reduce the effects of chronic pain.
These include:
• Exercise – reduces stress and anxiety, increases muscle flexibility and strength, and
promotes healing;
• Relaxation training – imagery and pain control techniques, such as controlled deep breathing
and positive imagery;
• Support groups – talking to others who experience similar challenges.
Rehabilitation: Non-invasive, non-drug techniques for treating pain are often included in
comprehensive pain management programmes to help relieve pain and improve movement.
Techniques may include physiotherapy, chiropractic care, massage and acupuncture.
Oral medications: Pain relievers can help relieve pain from the initial onset of symptoms, through
treatment and recovery. Often, pain relieving drugs are the first line of treatment, but other types of
medication are sometimes helpful in pain.
Injection treatments: These may often reverse some of the chronic pain process and help in
patient recovery. Examples include epidurals, nerve root blocks and facet joint injections.
Spine surgery: This type of surgery involves removal or modification of the cause of pain and
includes:
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Disc decompression – removal of the disc to reduce nerve pinching;
Lumbar microdiscectomy or lumbar laminectomy – removal of the lamina to provide more
room for the spinal cord;
Anterior cervical discectomy – fusing of two vertebrae together after removing a disc.
Interventional therapies: Neurostimulation and intrathecal drug delivery block pain signals as they
travel up the spinal cord to the brain, where pain is perceived.
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Neurostimulation involves stimulation of the spinal cord or peripheral nerves by tiny electrical
impulses. An implanted lead and an implanted neurostimulator send electrical impulses that
block the pain messages to the brain.
Intrathecal drug delivery involves a pump and catheter, both of which are surgically placed
under the skin. Released at a set rate, the medication flows from the pump, through the
catheter, to the site of delivery in the intrathecal space, the fluid-filled area surrounding the
spinal cord.
Neuroablative surgery: Surgery involving the destruction of actual nerves – or, in some cases, a
portion of the spinal cord – that carry pain signals to the brain is typically only performed when all
other treatments have failed. For example, the surgeon may use heat to sever the nerves that
transmit pain signals. Neurostimulation and intrathecal drug delivery almost always considered
before non-reversible neuroablative surgeries are performed.
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References
1. Elliott, The epidemiology of chronic pain in the community. Lancet. 1999 Oct 9;354(9186):124852.
2. The Pain Society (British Chapter of the International Association for the Study of Pain)
Pain in Europe Survey 2003.
3. Arthritis Research Campaign. Arthritis: The Big Picture 2003
4. The economic burden of back pain in the UK. Maniadakis N, Gray A.Pain. 2000 Jan;84(1):95103
www.tamethepain.co.uk - Tame the Pain - 0800 3280 8100