The Importance of Pain

Benjamin Franklin once observed: "In this world, nothing is certain but death and taxes." Few can challenge the wisdom of Mr. Franklin's words, although it can be argued that he failed to mention a third certainty: pain.

Pain has confounded health care providers for centuries; in 1931, no less an authority on health and healing than the great missionary Dr. Albert Schweitzer described pain as "a more terrible lord of mankind than even death itself."¹

The National Institute of Neurological Disorders and Stroke estimates that up to 85 percent of all Americans will experience one or more episodes of chronic pain in a lifetime. Recent research also provides evidence of the prevalence and significance of pain: A study in the Nov. 12, 2003 issue of the Journal of the American Association (JAMA)² found that common pain conditions such as headaches, back pain and musculoskeletal problems cost American companies more than $61 billion per year in lost productivity and reduced performance. A study of Australian adults found 11 percent of men and 13.5 percent of women suffer daily chronic pain severe enough to interfere with everyday activities,³ and poor health scores have been linked to increased incidence of morbidity and mortality in various populations.^4,5

However, until now, little research has dealt with how chronic pain influences the way people perceive their health. A new study, also published in the Nov. 12 issue of JAMA,⁶ has found a dramatic link between chronic pain and self-rated health scores in the general population. The study found that more than one-third of all adults suffer some type of chronic pain, and that the frequency and severity of pain have a direct effect on how people rate their general health.

To conduct the analysis, a questionnaire was sent to 6,500 residents of Finland. Subjects ranged between the ages of 15 and 74, and the sample population was stratified by sex and age to ensure comparable responses from all age groups and genders. The form used a series of questions to detect individuals with pain, and determine the severity of pain and overall health in each person. "Chronic pain" was defined as pain lasting at least three months. Frequency was measured on a four-point scale, with "0" signifying no chronic pain and "3" signifying daily or continuous pain.

In assessing overall health, patients were asked to self-rate their health on a five-point scale from "good" to "poor." Incidence of chronic disease was tabulated based on Sickness Insurance Card reports maintained by the Social Insurance Institution of Finland. The questionnaire also included a depression scale to screen for patients suffering from clinical depression.

After adjusting for age, frequency of chronic disease and other factors, the researchers estimated that over 35 percent of the respondents suffered some type of chronic pain. Of those with chronic pain, 45 percent reported daily or continuous pain. All told, one out of every seven members of the population - 14.3 percent - suffered daily, continuous chronic pain. The prevalence of daily pain increased markedly at age 40, and continued to rise with age.

Analysis of the questionnaires showed that, "In general, the prevalence of poor health among individuals with chronic pain was eight-fold higher than in those with no chronic pain." The more frequently pain was experienced, the more likely a patient considered himself or herself to be in poor health. For instance, those who experienced chronic pain once a week (or less) were 1.16 times likely to rate their health as "poor" compared to individuals with no chronic pain. However, individuals who experienced pain several times a week or daily were 2.62 times and 11.82 times as likely to report being in poor health, respectively, compared to pain-free individuals.

These ratings remained relatively constant across age ranges. According to the researchers, "Among individuals aged 15 to 44 years, frequent pain and chronic diseases associated strongly with poor health," while "in older individuals, chronic daily pain associated with poor health nearly as strongly as among younger persons."

Prevalence of chronic disease and depression also played a factor in health ratings. Patients with high depression scores were 10.43 times as likely as patients with normal depression scores to consider themselves in poor health. Similarly, patients with one chronic disease were almost three times as likely to rate their health as poor, and patients with two or more chronic diseases were 5.23 times more likely to assess their health as "poor" compared to patients with no chronic disease.

In a separate analysis comparing individuals with and without chronic disease, the authors noted "an association between self-rated health and daily chronic pain ... in both cases." Individuals who experienced daily pain without chronic disease were 11.28 times more likely than those free of pain and disease to give a rating of poor health. In individuals with chronic disease, the odds ratio for poor health was 13.81.

The authors' closing paragraph makes clear the significance of chronic pain and its influence on general health and well-being. These words should be of particular interest to doctors of chiropractic, who are considered experts on health, wellness and pain management [emphasis ours]:

"... daily chronic pain is common in the general population ... and chronic pain is independently and significantly related to self-rated health. These findings support the view that chronic daily pain is a dominant manifestation of chronic morbidity or even a chronic disease by definition, which emphasizes the importance of the management and prevention of chronic pain. More attention should be paid in clinical practice to the detection, assessment, and treatment of pain. At the community or society level, pain management and prevention should be implemented in health-promotion strategies."

References

1. Chronic pain. Medicine Net (www.medicinenet.com/Chronic_Pain/article.htm).
2. Stewart WF, Ricci JA, Chee E, et al. Lost productive time and cost due to common pain conditions in the U.S. workforce. Journal of the American Medical Association Nov. 12, 2003;290(18):2443-2454.
3. Blyth FB, March LM, Brnabic AJM, et al. Chronic pain in Australia: a prevalence study. Pain 2001;89:127-134.
4. Idler EL, Benyamini Y. Self-rated health and mortality: a review of 27 community studies. J Health Soc Behav March 1997;38(1):21-37.
5. Mossey JM, Shapiro E. Self-rated health: a predictor of mortality among the elderly. Am J Public Health August 1982;72(8):800-808.
6. Mþntyseklþ PT, Turunen JHO, Ahonen RS, et al. Chronic pain and poor self-rated health. Journal of the American Medical Association Nov. 12, 2003;290(18):2435-2442.

Editor's note: For more information on this topic, refer to the graph on page 1 and the publisher's report of findings ("The Issue of Pain") on page 3.