Chronic pain: a disease in its own right
Managing Pain Chronic pain is a condition that carries an enormous economic burden as well as an invidual one. Fundamental changes are required in how we treat it, says a leading pain expert.
Chronic pain is a leading cause of disability and a major contributor to rising healthcare costs. In Europe, as many as one in five adults suffer from chronic pain, a quarter of whom are likely to lose their job because of the condition.
"People in older age groups and the lowest income brackets, are at the greatest risk of a chronic pain condition."
“Persistent, ongoing pain changes the nervous system. It becomes over-sensitised and responds to lower pain thresholds,” says Dr Bart Morlion, President of the European Pain Federation (EFIC).
The World Health Organization plans to classify chronic pain, not only as a symptom but also as a disease in its own right. Defined as pain that lasts longer than three months, it is more prevalent in older age groups (although up to 30 per cent of 18-39 year olds are affected too) with men and women in the lowest income brackets at the greatest risk of developing a chronic pain condition.
Chronic pain is related to stress and mood disorders
“Pain is a useful symptom because it tells us something is wrong and prevents further damage. But where there is ongoing pain, other symptoms develop, including anxiety, depression and sleep disorders. Chronic pain then becomes a syndrome in its own right, one with broader problems that need to be addressed,” says Morlion.
"Other symptoms develop, including anxiety, depression and sleep disorders."
In the brain, the areas that deal with pain are integrated with the parts that control mood and emotional reaction. When pain is persistent, mood disorders develop because of this interconnection.
“It becomes a vicious circle,” he says. “More stress leads to more pain and more pain leads to more stress.”
“As a society, we sit too much”
To break the grip that chronic pain has on society, Morlion advocates more investment in teaching medical staff about pain management and encouraging greater expertise.
"If you operate on certain kinds of patients, it can lead to chronic pain."
He supports better pain prevention through lifestyle changes. “As a society, we all sit too much. More movement and exercise would prevent many musculoskeletal conditions from developing in the first place.”
Non-essential surgical interventions also need reviewing with stricter guidelines introduced, he says.
“We know that if you operate on certain kinds of patients it can lead to chronic pain. For example, those patients with depression, ones with an existing pain condition or a body mass index over 35.”
Morlion also calls for a more holistic approach to be taken. At the EFIC, social workers, nurses, physiotherapists, psychologists and doctors work together to treat persistent pain conditions.
Opioid pain relief must be closely monitored
Unlike acute pain, drugs aren’t always successful in chronic cases. Where opioid analgesics are prescribed, the risk of drug dependency needs to be explained, says Morlion, and the patient monitored to minimise problems arising as a result.
"Where opioid analgesics are presecribed, patients need to be monitored to minimise problems arising as a result."
The increase in life expectancy is one of the reasons behind a rise in chronic pain conditions. In well selected circumstances, such as chronic cancer pain, opioids may be routinely prescribed – a situation that is not analogous to the opioid epidemic sweeping the U.S.
“That is a problem specific to North America where opioids are prescribed far more frequently than in Europe and where a huge black market exists in prescription pain killers,” says Morlion. “In Europe, we are far more selective when it comes to putting someone on opioids.”