Persistent Pain

Around 100 million Americans live with persistent pain--more Americans than are affected by diabetes, heart disease, and cancer combined. Persistent pain is a significant public health problem, costing the American economy around $560 to $635 billion annually. This amount is equal to a cost of $2,000 for every US citizen due to cost of health care and lost productivity.

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    • Approximately 100 million Americans live with persistent pain.  
    • Persistent pain affects more Americans than diabetes, heart disease, and cancer combined.  
    • Around 43% of the US population lives with persistent pain.  
    • At least 1 in 3 Americans will experience severe persistent pain during their lifetime.  
    • Around 14% of adults who experience pain report that it lasts 3 months to a year and 42% report pain that lasts more than a year.  
    • An Internet study of patients with persistent pain found that the typical patient with persistent pain taking opioids to control their pain has had their condition for more than a…  
    • Around 10% of Americans have severe, disabling persistent pain.  
    • Half of those with persistent pain report severe daily pain–rated as a 7 on a scale of 0 to 10.  
    • Most people with persistent pain have multiple sites of pain.  
    • An Internet study of patients with persistent pain found that on average, patients with persistent pain taking opioids for their pain experience more than 8 different types of pain on…  
    • An estimated 80% of surgical patients report post-operative pain. Around 10% to 50% of those patients develop persistent pain, and for 2% to 10% of them the persistent pain…  
    • When asked about 4 common types of persistent pain, low back pain was ranked the most common at 27%, followed by severe headache/migraine pain (15%), neck pain (15%0, and…  
    • Musculoskeletal pain, especially joint and back pain, is the most common single type of persistent pain.  
    • More than 26 million Americans between the ages of 20 and 64 experience frequent back pain.  
    • Around 46 million Americans suffer from pain-causing arthritis or other rheumatic conditions.  
    • Arthritis is the most common painful condition reported in U.S. nursing home residents.  
    • Nearly 1 million Americans develop shingles each year and 10% to 15% of sufferers develop postherpetic neuralgia (PHN)–shingles associated pain that lasts for more than 3 months.  
    • Most people with advanced cancer report pain–60% to 85%.  
    • Fibromyalgia is a widespread pain disorder that affects 3.4% of women and 0.5% of men in the U.S.  
    • A third of people in hospice report pain at their last hospice care visit before death.  
    • More than 50% of all hospitalized patients experience pain in the last days of their lives and despite proven therapies for pain relief, family members report that the patient experienced…  
    • The Percentage of Americans Age 20 and Older With Pain is On the Rise  
    • Persistence of Pain Increases with Age  
    • Around 50% of non-institutionalized older adults suffer from persistent pain.  
    • Between 62% and 83% of institutionalized elderly in the U.S. report a pain problem and 17% have substantial daily pain.  
    • A survey of U.S. nursing homes found that in most states, at least 39% to 46% of residents are in persistent pain.  
    • Surgery is a common cause of persistent pain, and adults ages 65 and older are 2.6 times more likely to have surgery than those ages 45-64.  
    • Shingles–a common cause of persistent pain–affects 1 in 3 Americans in their lifetime, with half of all cases occurring in people age 60 and older.  
    • Around half of adults 65 and older have been diagnosed with arthritis, a common cause of persistent pain.  
    • The risk of developing invasive cancer, a common source of persistent pain, increases from 1 in 69 for men and 1 in 46 for women under the age of 39,…  
    • A community-based survey found 28.8% of men and 26.6% of women reported feeling pain at sampled times. The average pain rate increased with age.  
    • 71% of patients with persistent pain taking opioids for their pain have seen a health care professional in the past month. 1 in 4 have seen a health care…  
    • Patients with persistent pain are 5 times more likely than those without persistent pain to use health care services.  
    • Extent of Pain-Related Disability Among Adults with Pain in the Last 3 Months, United States, 2009  
    • 83 million Americans have pain that impacts their participation in various activities.  
    • In an Internet survey of patients with persistent pain, 97% currently using opioids for their pain reported either a physical or social hardship as a direct result of their pain.…  
    • As many as 45% to 80% of nursing home residents have pain that contributes to functional impairment and a decreased quality of life.  
    • Among adults age 65 and older who reported low back pain, more than 1/2 had a limitation in their daily activities–compared with 27% without recent low back pain.  
    • Occurrences As a Result of Pain  
    • Impact of Pain on Day-to-Day Activities  
    • Back pain is the leading cause of job-related disability and a leading contributor to missed work.  
    • A survey about how persistent pain patients deal with pain found that 20% have taken disability leave from work, 17% have changed jobs, 13% have sought help with activities of…  
    • At least 36 million Americans miss work each year due to pain.  
    • Pain is a leading cause of medically-related work absenteeism–results in more than 50 million lost workdays each year.  
    • More than half of workforce adults surveyed reported experiencing headache, back pain, arthritis, or musculoskeletal related pain in the previous 2 weeks. 12.5% of the workforce reported that their…  
    • Adults age 65 and older who report low back pain are twice as likely to be in fair or poor health compared to those without pain–40% rate their health as…  
    • During the 4-year period between 2005 and 2008, 5.7% of the U.S. population reported using opioids for pain.  
    • An Internet survey found that the typical patients with persistent pain takes pain medication as many as 4 times a day–including a prescription 2.6 times a day. 43% of…  
    • An Internet survey found than 31% of patients with persistent pain supplement their prescription medications with over-the-counter medications.  
    • In an Internet survey of patients with persistent pain who were currently using opioids to treat their pain, only 6% report having a “great deal of control” over their pain.…  
    • 1 in 5 American adults–42 million people–report that pain or physical discomfort disrupts their sleep three nights a week or more.  
    • Adults with low back pain are more than four times as likely to experience serious psychological distress, compared to those without back pain.  
    • An Internet survey found that 94% of patients with persistent pain taking opioids report at least one major impact on their lives from pain–3 in 4 (77%) report feeling depressed,…  
    • An estimated 40% to 50% of people with persistent pain also have mood disorders.  
    • One study found that 70% of persistent pain respondents expressed anger–62% toward health care providers, 39% toward significant others, and 30% toward insurance companies. The most frequent target of…  
    • In one study, around half of the patients with persistent pain reported that they had considered suicide.  
    • The risk of suicide among people with persistent pain is around double that of those without pain–with 5% to 14% lifetime prevalence rates of attempted suicide in persistent pain sufferers.  
    • A study of people with persistent pain found that they were 2.5 times more likely to think about suicide than those without pain, 3.5 times more likely to plan suicide,…  
    • The annual economic cost of persistent pain in the U.S. is at least $560 to $635 billion (in 2010$).  
    • The estimated annual cost of persistent pain of $560 to $635 billion includes health care costs ($261 to $300 billion) and lost productivity ($299 to $335 billion). However, these…  
    • The annual cost of pain is greater (in 2010$) than the annual cost of heart disease ($309 billion), cancer ($243 billion), and diabetes ($188 billion)–and nearly 30% higher than the…  
    • The cost of lost productivity from persistent pain includes days of work missed ($11.6 to $12.7 billion), hours of work lost ($95.2 to $96.5 billion) and lost wages ($190.6 to…  
    • The economic burden of treating persistent pain that develops from acute pain in a 30-year-old over a lifetime is as much as $1 million.  
    • The annual cost to society of persistent pain is equal to around $2,000 for every person living in the U.S.  
    • Medicare bears one-fourth of all expenditures for pain-related treatment in the U.S.  
    • The cost of pain to Medicare was $65.3 billion in 2008–14% of all Medicare costs.  
    • Cost of Persistent Pain and Other Major Chronic Conditions in the U.S.  
    • Low back pain alone was estimated to have contributed almost 3% to the total national increase in health care spending from 1987 to 2000.  
    • The annual direct and indirect costs of several pain-related conditions include: $14 billion for migraines Hu et al. 1999, Burden of Migraine in the U.S. $189 billion for arthritis Yelin et al. 2007, Medical…  
    • The annual direct and indirect costs of several pain-related conditions include: $14 billion for migraines Hu et al. 1999, Burden of Migraine in the U.S. $189 billion for arthritis Yelin et al. 2007, Medical…  
    • A person with moderate pain has health care expenditures $4,516 higher than those without pain. A person with severe pain has health care expenditures $3,210 higher than those with…  
    • Persistent back problems reduce financial capacity by reducing wealth accumulation. Over 99% of individuals who are employed full-time have accumulated some wealth at 65 years, whereas only 74% of…  
    • The prevalence of lower back pain amongst veterans is increasing by about 5% per year.  
    • Trends in Pain Prevalence, United States, 1999-2004  
    • An opiate agonist often used for persistent pain, tramadol was found in one meta-analysis to significantly reduce neuropathic pain when compared to placebo.  
    • Antiepileptic drugs relieve persistent neuropathic pain. One meta-analysis found gabapentin to be associated with moderate benefit (equivalent to 30% pain relief) in close to 1 in 2 patients, and…  
    • Pregalbin, an antiepileptic drug, produced around a 32% pain reduction (a significant reduction) at week 16 versus around 20% for placebo, in patients with neuropathic pain due to spinal cord…  
    • Topical capsaicin was found in a meta-analysis to provide a degree of pain relief to some patients with painful neuropathic conditions.  
    • A meta-analysis of antidepressants found that 1 in 3 patients with persistent neuropathic pain will get at least moderate pain relief. Another meta-analysis of duloxetine found it useful for…  
    • Topical NSAIDs were found in a meta-analysis to be significantly more effective than placebo in reducing persistent pain from musculoskeletal conditions.  
    • In individuals with persistent low back pain, tanezumab, a humanized anti-nerve growth factor antibody, showed clinical and statistical analgesic efficacy that was superior to placebo and naproxen.  
    • A meta-analysis of duloxetine, an anti-depressant, found a 50% reduction in pain at 12 weeks for diabetic peripheral neuropathy, and a 50% reduction in pain at 12 weeks for fibromyalgia.  
    • A meta-analysis of pscychological interventions for chronic low back pain found small but statistically significant effects for all interventions for as long as 5 years.  
    • A biopsychosocial approach (i.e., one that takes into account physical, emotional, and environmental factors in the assessment and treatment of pain) has been found to improve the pain care of…  
    • Exercise has shown to be effective in reducing persistent pain from osteoarthritis of the knee.  
    • 60% of people with persistent back pain who turned to complementary and alternative medicine perceived a “”great deal”” of benefit.  
    • Acupuncture, in combination with routine care, was associated with marked clinical improvements in patients with persistent low back pain. It has also shown improvement in primary and secondary outcomes…  
    • Opioids have been found to reduce pain intensity and improve physical functioning for patients with persistent noncancer pain. It’s important to note that a decrease in mental health functioning…  
    • Subthalamic nuclei deep brain stimulation (STN-DBS) raises pain thresholds in Parkinson’s disease patients.  
    • An oral cannabinoid was found effective in relieving diabetic peripheral neuropathic pain symptoms and improving disturbed sleep, quality of life, and overall patient status.  
    • Topical clonidine gel significantly reduces foot pain in patients with painful diabetic neuropathy.  
    • Growth hormone treatment in patients with fibromyalgia is effective in reducing pain with sustained action over time.  
    • The use of sodium oxybate (SXB) in fibromylagia patients reduced pain by 30% or more in 54-58% of patients (versus 35.2% for placebo). SXB also reduced fatigue and sleep disturbance.  
    • Pain education programs and pain consultations have been found to improve pain (average pain was 31% versus 20%) and daily interference (20% versus 2.5%) in oncology outpatients. Patient adherence…  
    • The Mayo Clinic Pain Rehabilitation Center helps people with persistent pain return to an active lifestyle and has found that among patients who finish the program, nearly 84% report greater…  
    • 57% of American adults say they would pay an extra $1 per week in taxes in order to support government research into the causes of and treatment for chronic pain.  
    • People with persistent pain who used complementary and alternative medicine (CAM) had lower average health care expenditures than nonusers ($3,797 versus $4,153).  
    • Resolvins, a family of lipid mediators, have shown potential in resolving persistent inflammatory pain.  
    • Nerve growth factor (NGF) has been found to be a major mediator of inflammatory and neuropathic pain and provides a new therapeutic target.  
    • Use of stem cells to create neurons could enable the study of the response of human cells to new drugs in vitro, early in the drug development process.  
    • The combination of information for neuroimaging and circulatory biomarkers could improve both the sensitivity and specificity of pain diagnosis and thereby improve treatment.  
    • Understanding the role of genetics in pain mechanisms is increasing and the potential now exists to conduct genome-wide screens in model organisms to look for pain-associated genes.  
    • Researchers have developed several sub-types of ion channels that allow inflammation and growth factors to trigger persistent pain.  
    • Researchers have discovered that some types of glial cells have a major impact on persistent neuropathic pain and that targeting these cells may result in a new class of disease…  
    • Advances in neuroimaging will continue to offer information on the brain’s functioning and how it correlates to the pain experience.  
    • Targeting A-type K+ channels in primary sensory neurons could provide a novel mechanism-based therapy for the treatment of bone cancer pain–one of the most severe types of chronic pain.  
    • A proteasome inhibitor was found to reduce pain and joint destruction in an animal model of osteoarthritis, suggesting that nontoxic proteasome inhibitors could offer a novel pharmacotherapy option.  
    • Statin use in mouse models show pain-alleviating effects for neuropathic pain.  
    • Brain imaging is showing that pain changes the structure and function of brain regions that perceive pain, making it persistent. These brain networks and receptor targets are being identified…