The Epidemeology of Pain

All of us know too well what it feels like to be in pain. Whether it’s the sharp yet fleeting pain of an injection or the constant dull grinding of joint pain, every one of us has experienced pain at some point in our lives. But though we can all sympathize with those among us who are in pain, it is hard to quantify what they are experiencing — even for doctors and medical experts.

Defined by the international association for the study of pain (IASP) as “an unpleasant sensory and emotional experience associated with actual or potential tissue damage,” pain is nevertheless an entirely personal and subjective experience. The feeling of pain can be vastly different between people as the same phenomena cause differing sensations: some may find a stubbed toe or walking on LegosTM exceedingly painful, while others may think it no more than a fleeting nuisance. Experts theorize that pain exists to alert the mind to potential or actual danger befalling the body. However, there are times when pain can overshadow this usefulness and become a barrier to normal life. Indeed, for too many people, pain, particularly chronic pain, is a highly disruptive and limiting experience. Chronic pain is uniquely challenging to cope with because it persists for long periods of time, sometimes even years or decades; it is not something that most people can wait out. Constant pain of this type, in addition to being at minimum uncomfortable and at most overwhelming and highly disruptive, can also be incredibly physically and emotionally exhausting, further complicating the scenario.

In the United States alone, roughly 100 million adults suffer from chronic pain. Even if you yourself aren’t experiencing chronic pain, chances are good that some of your close friends or family are. Disability-Adjusted Life Years (also known as DALYs) provide a helpful look into the impact of this suffering. The DALY measure was invented in the 1990s and is a metric used to demonstrate how many years of life are ‘lost’ (e.g. missing out on personal experiences, promotions, economic growth and productivity, etc.) due to living with a disability. In 2013, roughly 7.05% of DALYs (equivalent to 1,999.48 years per every 100,000 years collectively lived) in the United States were attributed to pain of the neck and lower back. Additionally, more than twice as many adults with chronic low back pain are additionally restricted because of one or more comorbidity, compared to just 10% of adults without chronic low back pain. Essentially, this means that people with just chronic neck and lower back pain had substantially fewer personal and/or work opportunities and life experiences per year compared to what they would have had without that pain.

When this many people — nearly a third of the United States population — are in chronic pain, it is easy to imagine that there would be an impact on the country. And indeed, this type of pain puts a large economic burden on society in the form of absenteeism from work or, more commonly, decreased productivity. On average, workers lose 4.6 working hours every week due to pain. But exactly how much pain impacts economic growth is hard to pinpoint. While absenteeism is highly visible and easily quantified, decreased productivity is more elusive to measure. Still, estimates suggest roughly $61.2 billion dollars are lost each year due to pain, most of which (over 75%) stems not from absenteeism but diminished performance at work.

So far, one thing is clear: pain costs — a lot — both to society at large and people individually. Decreased productivity leads to corporate losses, and chronic pain often leads to medical bills racking up at home. Chronic pain also leads to losses of personal experience: an exotic vacation you can’t afford because of your medical payment, a sport you can no longer enjoy because it just hurts too much, or pay raises and promotions missed out on because of decreased productivity. But what to do to reduce the burden of pain on American society and individuals remains unclear, especially since, while some of this pain stems from easily detectable sources, pain itself can be the disease, as is the case for neuropathic pain like headaches. The multiple origins of pain and the differing tolerances individuals have makes it difficult for doctors to know when and how to treat it.

You may have already heard of one potential solution for chronic pain: prescription opioids. However, as more Americans are becoming addicted to and abusing these drugs, doctors are becoming more reluctant to prescribe them — even to the people who genuinely need and would benefit from them.

We know that there isn’t always one blanket solution to managing chronic pain. Every patient is different, so every patient should deserve a personalized pain management approach, tailored to his or her needs. This is undoubtedly a more efficient approach to progressing the collective fight against chronic pain.