Chronic pain is defined as continuous or intermittent pain lasting for a period of at least six months. While chronic pain is not limited to any one condition, and can include arthritis, back pain, leg pain and headache, it is “one of the most common reasons why patients visit their physicians,” says Dr. Dwight Moulin, lead author of the Chronic Pain in Canada study and a neurologist at London Health Sciences Centre.
The Chronic Pain in Canada study, the largest Canadian pain study ever published, revealed that chronic noncancer pain is quite common among adult Canadians, with more than one in four, or 25 per cent, of Canadians suffering with chronic pain. This number climbs to almost 40 per cent in those over the age of 55.
Along with prevalence of pain, the pain study also examined the social and economic impact of chronic pain in patients taking prescription pain medication. Despite the reality that chronic pain is debilitating, 80 per cent of the chronic pain patients who were prescribed therapy still regularly experienced moderate to severe pain. Nearly 50 per cent of pain sufferers taking a prescription medication reported that they had great difficulty attending social and family events due to their pain and 61 per cent were unable to participate in their usual recreational activities. A full 58 per cent were unable to carry out their usual daily activities, such as housecleaning or preparing meals. People also reported missing, on average, almost ten days of work per year because of chronic pain and, for those with severe pain, that number rose to 16 days, equivalent to more than three full weeks of missed work.
Even though almost 50 per cent of sufferers were prescribed anti-inflammatory agents (e.g., ibuprofen), less than ten per cent were prescribed a major opioid, such as fentanyl, hydromorphone, methadone or morphine. “It is interesting to note that while 77 per cent of chronic pain sufferers expressed satisfaction with their doctors’ care, only a third of these respondents reported that their pain treatment was very effective,” says Dr. Moulin. “Patients need to have an open dialogue with their doctors about the full range of treatment options available to better manage their pain.”
Although opioid analgesics are becoming more widely accepted as a safe and effective treatment option for the management of moderate to severe chronic noncancer pain, there has been a general hesitation to prescribe major opioids. Randomized, controlled trials have demonstrated that major opioids reduce pain intensity in the range of 20 to 50 per cent and lead to a variable improvement in functionality, quality of life and mood. The risk of psychological dependence or addiction to major opioid treatments is very low in patients without a history of substance abuse. Any patient using a major opioid is screened prior to beginning therapy and is then carefully monitored throughout the treatment. As treatment progresses, the dose can be adjusted in order to prescribe the lowest required amount of opioid to manage pain and reduce the risk of dependence.
The Chronic Pain in Canada study results demonstrated that more education for both physicians and patients is required to be able to better understand and manage chronic pain. Dr. Moulin concludes: “Pain management will vary for each patient and a comprehensive, multi-modal treatment program, including a mix of prescription medications, physical therapy and psychological and behavioural approaches, should be discussed by the physician and patient to achieve optimal pain management results.”