New cases of chronic pain outnumber those of diabetes or depression, study finds

According to a study by the National Institutes of Health, new cases of chronic pain occur more often in the United States than those of other chronic diseases, such as diabetes, depression and high blood pressure. The results offer large-scale confirmation of what previous research has shown: chronic pain is incredibly common in America.

Experts know that about one-fifth of American adults suffer from chronic pain, but the new study offers insight into the number of people who suffer again each year. The researchers analyzed data from 10,415 adults who participated in two editions of an annual survey conducted by the Centers for Disease Control and Prevention; respondents indicated how often they had experienced pain in the past three months and whether this pain had interfered with their daily life.

“We’re talking about a major public health issue,” said Dr. Gregory Terman, a pain medicine specialist at the University of Washington School of Medicine and co-author of the study.

The study shows that as more people develop new cases of chronic pain, existing patients struggle to recover. Only about 10% of people with chronic pain in 2019 were pain free in 2020, underscoring how difficult it is to treat.

“It’s astronomical,” said Richard L. Nahin, the study’s lead author and senior epidemiologist at the National Center for Complementary and Integrative Health.

And it’s possible those numbers have increased during the coronavirus pandemic, said Beth Darnall, professor of anesthesiology, perioperative medicine and pain medicine at Stanford School of Medicine who was not involved in the study. . But a number of existing and emerging treatments can provide pain relief.

“There really are solutions and there is help,” said Dr. Darnall. “Unfortunately, it’s not easy to find.”

It is difficult to establish a singular definition of pain. The study defined people with chronic pain as those who reported experiencing pain almost every day, or every day, in the previous three months. And chronic pain itself can be a disease, said Dr. Prasad Shirvalkar, associate professor of anesthesia and neurological surgery at the University of California, San Francisco, who studies pain management. He added that it could take years for some patients to get an accurate diagnosis of conditions that cause chronic pain, and more than a third of cases occur without a clear cause.

“It’s like a fire alarm going off, but there’s no fire,” he said.

Even when doctors can diagnose the conditions that cause chronic pain, many are not equipped to treat it. “There really is an underappreciation in the medical community of pain management,” said Dr. Michael Bottros, Chief of Clinical Operations and Medical Director of Pain Services at the University’s Keck School of Medicine. of Southern California. And because the pain is “nebulous” and varies from person to person, he added, it can be difficult to determine the appropriate treatments.

The study also looked at how pain progresses to chronic pain. Participants who experienced acute pain were more likely to develop chronic pain over the following year, with around one in six people with non-chronic pain reporting chronic pain a year later. In other words, without early intervention, experts say, the pain can sometimes get worse; what starts out as a sharp or occasional pain can escalate into a long-term problem. But not everyone has equitable access to this care, Dr. Darnall said.

Experts recommend seeing a primary care physician first if you experience pain that interferes with your daily life. If you’re not improving after six weeks, Dr. Bottros recommends seeing a specialist. If you’re having trouble finding a chronic pain specialist, Dr. Shirvalkar recommends checking out major university pain centers, many of which offer telehealth appointments.

Community hospitals may also be able to offer resources. Dr. Darnall said special conditions advocacy organizations, like the Marfan Foundation, can also provide educational materials and help patients find providers. Recent changes to Medicare have also expanded coverage for chronic pain treatment, Dr. Nahin said.

In response to the opioid epidemic, some physicians have attempted to move away from drugs as a first response to treating chronic pain. It’s essential to treat chronic pain through a multimodal approach, experts said, using multiple therapies. A patient may undergo physical therapy, for example, but also see a mental health professional for cognitive behavioral therapy. “A treatment flavor will never be adequate,” Dr. Shirvalkar said.

Mental health treatment is a particularly promising, but often underused, way to treat chronic pain. “A psychologist can fundamentally help reframe how people relate to their pain or even the signals they’re listening to in their body,” Dr. Shirvalkar said.

New treatments are also on the horizon: researchers are examining whether psychedelics, virtual reality treatments and brain stimulation can relieve pain.

“It’s not one size fits all,” Dr. Darnall said. “Patients are not a monolith.”

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