Written by Professor Dominic A. Hegarty, BSc., BMedSc., MB., MSc. (Pain Management), PhD. FCARSCI, FFPMCAI, FIPPConsultant in Pain Management & Neuromodulation, Mater Private Hospital, Cork Associate Professor of Pain Medicine, UCC, Ireland
Every September since 2001, when the American Chronic Pain Association first led a coalition of groups to highlight the needs of those with living with chronic pain the spotlight is shone on one of the most common illnesses that effects so many individuals. Every year the same staggering number of 1 in every 4 individuals attend healthcare professionals with chronic pain does not seem to change. Every year we lament the cost chronic pain has on society.
Under-recognised and under treated
“Chronic pain is vastly underrecognized, funded, and treated when considering its significant impact on American lives,” so says U.S. Pain Foundation CEO Nicole Hemmenway. In fact, the recently published report from the US Foundation on Pain (2022) highlights that nearly three-quarters (74%) of the 2,378 respondents had lived with pain for more than 10 years. The most common pain conditions were primarily musculoskeletal in nature: back pain (67%), arthritis (56%), chronic low back pain (56%), nerve pain or neuropathy (53%), and neck pain (51%).
Over half (52%) said their average pain level is 7 or more on a scale of 1-10. 95% of respondents had at least one comorbidity, and almost all report that pain restricted their ability to engage in routine activities, like exercise, household chores, sleeping, and socializing. The majority (60%) said they feel anxiety-like symptoms daily or a few times a week, and a similar portion (59%) feel depression-like symptoms daily or a few times a week. Closer to home these statistics reflect a similar pattern in the Irish healthcare service.
Global Year of Pain 2022
The aim of the IASP 2022 Global Year in Pain is to increase awareness of pain knowledge and how it can benefit those living with pain. The key objective is to increase the awareness of clinicians, scientists, and the public of our accumulating pain knowledge and of how this may be used for the benefit of those living with pain.
How timely it is especially when the majority of people with chronic pain feel stigmatized by their medical providers. This was a key finding of a comprehensive survey by the U.S. Pain Foundation. The report’s identified that people with pain often feel their health care providers are not equipped to manage their pain effectively. Over two-thirds (69%) either did not feel, or only “rarely” or “sometimes” felt, that their provider was on a team with them.
Treatments that help—and barriers to access
The value of multidisciplinary (MDT) approaches in pain management are well recognised. The same resources are not equally available nationally and in some regions the concept is no more than a long-term ambition. However, not everyone in pain needs access to all aspects of MDT. For example, the top strategies used in MDT including activity restriction or modification (73%), stress reduction techniques (42%), heat therapy (41%), and meditation and mindfulness (40%). In fact, activity restriction or modification is the most-used specific “therapy” of any kind across all categories, aside from prescription medications as an entire category.
When it comes to medications, a majority (77%) said prescription medications are the most helpful treatment in managing their pain. Access to interventional pain procedures continue to be the Holy Gail for many but with demand out stripping supply there is an obvious bottle-neck.
In this context perhaps we should assess individuals on a case-bycase basis to identify the clinical need to maximise outcome and not simply take a one-size fits all approach referring individuals into an already overcrowded healthcare system.
Change is needed
At present the physical limits of an already overburdened and underfunded pain service are evident. For this reason, one must consider all possible options to support individuals. But there is hope. For example, University College Cork, recognised that ensuring our graduate doctors appreciate the importance of pain management, and to reduce the risk to those with chronic pain of feeling stigmatized by their medical providers, appoint of the first Associate Professor in Pain Medicine. Also, Chronic Pain Ireland is once again supporting the Pain Awareness September campaign and their 2022 theme is “Inspiring pain freedom”. They inspire and empower people by ensuring they have knowledge, skills and self-awareness to take control and improve their quality of life. For certain individuals’ part of that healing journey starts with self-management strategies and tools. Chronic Pain Ireland are collaborating with the HSE for Pain Awareness Month and running the Living Well with Chronic Pain Programmes with several informative talks and webinars throughout the month. By directing some individuals to this pathway, they can be provided with timely and effective support.
The Pain Awareness month allows us to recognise the importance of what we can do for our individual patients. It highlights that not enough is being done for the management of chronic pain in Ireland. Clearly the are ample opportunities for all of us—patient groups, health care providers, insurers, and policymakers—to work together to better serve people with pain and improve pain care for everyone.
To learn more about the results and download the full report, visit uspainfoundation.org/surveyreports/a-chronic-paincrisis.
Professor Dominic A. Hegarty. BSc., BMedSc., MB., MSc. (Pain Management), PhD. FCARSCI, FFPMCAI, FIPP
Consultant in Pain Management & Neuromodulation, Mater Private Hospital, Cork
Associate Professor of Pain Medicine, UCC, Ireland
Honorary Consultant Guy’s & St. Thomas’ Hospital, London
Clinical Lead Neuromodulation Research, Tyndall National Institute, UCC
President Elect World Institute Of Pain (WIP)
Clinical Director Pain Relief Ireland www.painreliefireland.ie
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