Chronic Pain has a Price
Find this blog post as Picture of Pain Podcast here.
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 (see figure).
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.
Some years ago I came up with the idea of DoloTest® a both comprehensive and contemporary pain and health related quality of life assessment tool, which I have developed together with two colleagues. The idea was to improve quality of life for pain patients, but since it is also a very fast and easy way for screening for both pain and mood problems, it can be used to identify the patients in the high cost end.
We need to reduce both the human and the economical cost of chronic pain, one of the major health problems of our time.
Raftery, Miriam N, Padhraig Ryan, Charles Normand, Andrew W Murphy, Davida de la Harpe, and Brian E McGuire. “The Economic Cost of Chronic Noncancer Pain in Ireland: Results From the PRIME Study, Part 2.” The journal of pain : official journal of the American Pain Society 13, no. 2 (2012): doi:10.1016/j.jpain.2011.10.004.
Gustavsson, A, J Bjorkman, C Ljungcrantz, A Rhodin, M Rivano-Fischer, K-F Sjolund, and C Mannheimer. “Socio-Economic Burden of Patients with a Diagnosis Related to Chronic Pain – Register Data of 840,000 Swedish Patients.” Eur J Pain (2011)doi:10.1016/j.ejpain.2011.07.00
Kim Kristiansen, M.D. (2012). Chronic Pain has a Price Picture of Pain
DoloTest
How are we going to reduce it, Kim?
It seems to me after 10 years trying to study the science (and science and research blogs) that we, the clinicians, tend to get it all upside down even though our hearts are really in it and we work hard. There is still a huge gap between what is now known in science about pain and suggested approaches and modalities and then what we as everyday clinicians do to help the people in chronic pain, but more importantly those at RISK of developing chronic pain.
We all still focus on the structures “at fault” (clinical tests, diagnostic imaging and other “objective” testing) when we really should be focussing on the physiology in a true biological, psychological and evolutional perspective. But it seems that it takes a shift in paradigm of paramount proportions… Probably because the models are more complicated and doesn’t make intuitive sense like a “tight muscle”, a “poor posture”, a “slipped disc” or a “worned out and degenerated joint”.
Love your blog and work by the way.
Cheers
Adam Bjerre
PT
Denmark
Hi Adam
Thank you very much for your comments and for your kind words !
I definitely do agree we need to create awareness to both chronic pain and the risk to reduce the risk of developing it.
As you mention we have quite a substantial knowledge about pain and pain mechanism, and we need to educate all healthcare professionals in these mechanisms so we can change attitude and improve pain management.
We also need to educate patients about the chronic pain being more than something that hurts, but merely a complex of many factors including psychological and social components in order to address the problems we are dealing with, instead of calling them something else as you mention.
To say it with the words of Mark Twain:
“What gets us into trouble is not what we don’t know
- It is what we know for sure, that just aint so “
So truth when dealing with pain management
BW kim
Dr. Kristiansen, it warms my heart to find doctors who are giving their all to get a handle on this problem. As both a chronic pain sufferer and a pain coach, though, I can tell you that, with the co-morbid depression and all, we kind of cringe when too much attention is given to the cost, before relief systems have been properly developed. On the other hand, it’s the hight cost that will eventually help us — just people in pain won’t do it.
Dear Gerhard Venter. Thank you for your comment. I most definitely do agree, we must develop healthcare systems properly to handle and take care of persons with chronic pain in an individualized and patient centered way. However the question of costs are in the language politicians and other decision makers use and understand, and perhaps yet another way of creating (their) awareness.
Kind regards
Kim Kristiansen