Chronic pain is common
Being conservative, approximately 10% of the world’s population experience chronic pain. According to a study on pain prevalence in Europe, chronic pain of moderate to severe intensity occurs in 19% of adult Europeans, seriously affecting the quality of their personal, social and working lives. However estimates vary according to country; in Spain, the estimated prevalence is 12%, in Norway 30%, in Denmark 25%, in Iceland 30%, in Ireland 38% and in Italy, France, and Ukraine greater than 40%. Close to 90% of those individuals endured pain for over two years, and almost 1 out 3 did not receive treatment for their pain.1,2
Chronic pain prevalence and its impact increases with age. Central nervous system changes in aging increase the risk of enduring chronic pain; they increase the probability of perceiving pain more frequently and intensely and decrease the functioning of mechanisms to inhibit these signals. As the European population is aging, the number of older adults living with advanced illness and comorbidities will increase substantially in the following years.
The burden of chronic pain symptoms
Management of chronic pain is associated to a huge economic burden. Only in the USA, up to $635 billion were spent to manage persistent adult pain in 2010.3 The cost of opioid treatment is about 2,500 euros per patient/year. But chronic pain is much more than a question of economic cost. Living with pain is associated with enormous physical and psychological suffering. Pain is one of the most debilitating symptoms, with a very negative impact on well-being. Chronic pain patients often complain of memory decline, confusion, speech difficulty, and impaired mood regulation and behaviour (e.g. worry, inactivity and fatigue, affect instability, social isolation…). The relationship between chronic pain and suicide confirms the huge psychological suffering associated with the pain experience. Across Europe, approximately 1 in 5 patients reported losing their job due to their pain, and one third reported that their work was significantly affected by their pain.
Inadequate management of chronic pain
Only a minority of chronic pain patients is followed up by pain specialists, and nearly half may receive inadequate pain management, underscoring that chronic pain remains a major health care problem in Europe. Pain control has been identified as the second most common deficiency in elderly homecare in Europe.
Thus, there is no effective pain control for many patients with chronic or degenerative diseases. The current models for treatment of pain in palliative care are highly dependent on pharmacological interventions, mostly opioids; however, over a long period these interventions lose effectivity and may lead to unwanted side effects due to addiction, misuse and abuse. The side-effects of medication very often contribute to a poorer quality of life and diminished functionality of patients.
Thus, to reduce the symptom burden associated with diseases and with medication side-effects, it is necessary to improve the strategies to manage pain, by obtaining a better knowledge of the mechanisms involved in pain maintenance and in the inefficacy of pharmacological treatment. In sum, chronic pain should be one of the most important public health priorities of the 21st century.
1 Breivik H, Collett B, Ventafridda V, Cohen R, Gallacher D. Survey of chronic pain in Europe: Prevalence, impact on daily life, and treatment. Eur J Pain. 2006;10:287–333.
2 Breivik H, Eisenberg E, O’Brien T. The individual and societal burden of chronic pain in Europe: The case for strategic prioritisation and action to improve knowledge and availability of appropriate care. BMC
Public Health. 2013;13.
3 Gaskin DJ, Richard P. The Economic Costs of Pain in the United States. J Pain. 2012;13:715–724.