Chronic pain has a price

Everyone who knows a person with chronic pain is aware that it comes with a huge price on quality of life, but indeed chronic pain also have a heavy economic price for the society in general. A price we might be able to reduce by awareness and intervention for those who need it and especially for those who need it most.

The size of the economic burden is of cause different from country to country, based on differences in health economy and in the organisation and extent of health care and social care. But all presented figures from different countries are high and in it self calls for action.

Recently a Swedish study was published looking at “Diagnosis Related To Pain” (DRTP), that is not for chronic pain alone but total costs for persons with diagnosis connected with chronic pain conditions. The total cost for society was a huge 20% of Swedish tax burden. Indirect costs associated with lost production because the patient is absent from work constituted the largest proportion of the cost estimate (about 60%).

If we hold this in mind when looking at another recent published study looking at the economic burden associated with chronic pain, there is important information to get. In this study from Ireland the researches found, that a small proportion of patients account for the bulk of costs—the top 5% most expensive patients accounted for 26% of costs, the 10% most expensive patients were responsible for 43% of all costs, and the top 20% of patients accounted for 64% of all costs.

Now who are those patients with the highest costs? Well, the Irish researchers found two important determinants of costs one is the intensity of experienced pain, high levels of experienced pain was four times higher than for the group with low level of pain. The other factor was patients with depression, as the authors pointed out, this is unsurprising, but highlights the importance of intervention also from an economic perspective.

You would probably also guess, that higher pain scores are connected to higher economic costs, but these two papers make it clear and provide the evidence as well as documents the surprisingly high costs and their distribution among the patients.

While we often are still looking for the biomedical solution for the pain, encouraged by the patient experiencing that “something must be wrong”, there is a great risk of missing the co-existing depression, and miss the opportunity to reduce the risk of developing chronic pain, by early sufficient pain treatment – and that is more than pharmaceuticals.

We must screen for depression and pay attention to the experienced pain intensity, because we need to reduce both the human and the economical cost of chronic pain, one of the major health and health care problems of our time.

Kim Kristiansen is a family physician in Denmark who blogs at Picture of Pain.

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  • Anonymous

    The depression part is true.
    But the depression medicine part…..

    In my 35 years of practice I have come to this conclusion

    Antidepressants don’t work, rather they ruin the patients health.
    Time and understanding heal or tend to heal our sadnesses.

    Anti depressants are a joke.
    Placebo affect to the max.

    • Anonymous

      Diagnosing a Chronic pain condition is most important,if not assessed within the first 6 months people suffering with Chronic pain could eventually fall in to a deep depression,then they will have two problems instead of one. Recognizing that the sooner a person suffering from Chronic pain is treated the better off they will be. And even have a chance to recover depending on the severity of symptoms.

      So many people suffering from a chronic pain condition get passed from doctor to doctor and nothing ever gets accomplished.
      Myself and my own chronic pain was not treated correctly for 10 years. I could have fallen in to a deep depression but for some reason I’ve never had a problem with depression and I feel blessed for that.

      My hope is for people that are just now experiencing chronic pain to get diagnosed sooner rather than later so something can be done so it does not turn into a life long type chronic pain situation. I would like to see these people get the help they need and all that suffer from chronic pain get the treatment that best helps them, no matter how their pain is relieved that they receive it as soon as possible.

  • Anonymous

    It will be difficult when the US is a country that profits from the sick. The chronically ill provide billions of dollars to many companies especially pharma; I don’t think they would willingly cooperate easily in healthcare reform.

  • Anonymous

    Despite the legions of malingerers and drug-seekers clogging the ED’s and clinics, there is another sub-group that is rarely mentioned (and to which I belong) and that is people dealing with chronic pain AND continuing to work and be productive.

    Like thousands of others, I take my meds,get up early to stretch and take hot baths or showers to loosen up, and plan my workday around my peak performance and needed quieter times. Unless the limp shows up, whcih I dismiss as an old athletic injury, few people know that I live with chronic pain…and will do WHATEVER it takes to stay active and employed, both for money and for self-respect.  I have changed to a position that uses my nursing brains instead of muscles and stamina (I teach) and know that if I stop struggling it will be a slipperly slope to disablity and being a burden.

    Please note that I am only an EXAMPLE of the men and women out there across the world who have it MUCH worse and who do not have the luxury of a ‘desk job”.  I think of these brave workers when I start thinking about a pity-party, and mentally slap myself, grateful for an amazing doctor who shares my goals of staying “in the saddle”.

    But, when I run into young people who need weeks off and narcotics for sprained pinky fingers and menstrual cramps, I am inclined to more than a MENTAL slap!  Thanks to all the docs and everyone else who supports us in the “silent minority”……..bless you for allowing us work.

  • Anonymous

    As a retired psychotherapist who worked exclusively with chronic pain and chronic illness patients, I discovered that the best pain meds were the endogenous ones. Although self-hypnosis, biofeedback, and many other methods with proven efficacy exist, the sad story is that reimbursement is higher for expensive prescription drugs than it is for training in how to access the endogenous pharmacy.

    • http://www.facebook.com/mrjohnsonho Johnson Shiuan-Jiun Ho

      I understand. Due to reimbursement issues primarily, expensive prescription drugs are preferred over recently developed methods with proven treatment efficacy. What can be done to resolve this issue?

  • Anonymous

    Depression is different in chronic pain sufferers because they overwhelmingly have a deep persitent YEARNING to be able to participate in life and its social activities, but they CANNOT. Clinical depression is characterized by social apathy and anergy. Furthermore there is ongoing grieving over the lost life, and the problem is that the “loss” is constantly recurring. Grief resolution models have usually dealt with the single event major loss and its aftermath. They have not begun to even recognize the added problems for an ongoing and recurrent loss pattern that renews itself daily! That is the real psychic problem for pain sufferers.

  • http://twitter.com/DoloTest Kim Kristiansen, M.D

    Thank you very much for your thoughts and comments!
    The co-existence of pain and depression is a big problem and often combined with disability, sleep problems and both reduced quality of life and as mentioned: grief. I do agree with several of you: that is not just pharmaceutical treatment – as I also state in my blog post
    I believe we must create an awareness for the patchwork of problems each individual patient have, an awareness from both the patient and the healthcare professionals. I have created the DoloTest® (a visual oriented pain- and QoL-assessment tool), developed together with two colleagues, as a way to bring that awareness up front in the disease management, and facilitate a patient centered approach. But it is also urgent that we as societies accept a responsibility for these problems affecting so many people, and insure acceptance, understanding and willingness to help, despite missing findings of pathology … and not just for economic reasons, that is just yet another argument to bring pain management forward. 
    Kim Kristiansen

  • Anonymous

    Diagnosing a Chronic pain condition is most important,if not assessed within the first 6 months people suffering with Chronic pain could eventually fall in to a deep depression,then they will have two problems instead of one. Recognizing that the sooner a person suffering from Chronic pain is treated the better off they will be. And even have a chance to recover depending on the severity of symptoms.

    So many people suffering from a chronic pain condition get passed from doctor to doctor and nothing ever gets accomplished.
    Myself and my own chronic pain was not treated correctly for 10 years. I could have fallen in to a deep depression but for some reason I’ve never had a problem with depression and I feel blessed for that.

    My hope is for people that are just now experiencing chronic pain to get diagnosed sooner rather than later so something can be done so it does not turn into a life long type chronic pain situation. I would like to see these people get the help they need and all that suffer from chronic pain get the treatment that best helps them, no matter how their pain is relieved that they receive it as soon as possible.

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