Thursday, May 20, 2010

Severe Chronic Pain - Life Threatening?

For many of my patients, life as they had known it is over. Following injury and pain, life will never be the same. This is a very serious matter. Long-term pain can create intense suffering, as well as serious and permanent losses in people's lives.

But, does chronic pain really influence life and death?

Some recent scientific studies suggest that severe chronic pain can have a strong influence. One recent study, for example, was brought to my attention by a newsletter (Pain Monitor, May 2010) from the American Pain Foundation and the blog Pain Topics (April 8, 2010).

They highlight a credible study, Severe chronic pain is associated with increased 10 year mortality, published in the European Journal of Pain (2010, volume 14, 180-186). This large study was conducted in Scotland, by Drs. Torrance, Elliott, Lee and Smith, from the University of Aberdeen. In this study, 5858 individuals were studied over a 10 year period. These individuals suffered from a variety of long-term pains, including back, neck, arthritic, or chest pains. The severity of their chronic pain was assessed using the Chronic Pain Grade scale, developed and published by Drs. Von Korff, Ormel, Keefe and Dworkin (Pain, 1992, 50, 133-149). This is a well-known and accepted measure in the scientific study of pain.

This study found that severe chronic pain, defined as a chronic pain grade level 3 or 4 (out of 4), was associated with an significantly increased risk of death over a 10 period. This increased risk was for circulatory system deaths, respiratory deaths as well as for all deaths. The survival curves plotted by the authors were quite striking. These findings held true, even after factors such as age, sex, education, income or the presence of long-term limiting illnesses were ruled out.

The authors note, interestingly, that "... it is either the high intensity of their pain and/or the associated disability that is the key to this increased mortality". Chronic pain grades 3 and 4 both include high disability components. These individuals would also experience high levels of loss and stress in their lives associated with high disability and pain levels. For the patients we see with chronic pain, significant stresses are directly connected to both the pain and disability that they experience.

As the authors point out, this is not an isolated finding. Other studies have also pointed to connections between chronic widespread pain and increased cancer and cardiovascular mortality. More research needs to be done, of course, to investigate these very serious health issues.

This kind of research is vitally important. It highlights the importance of treatment for people who struggle to live every day in pain. They need treatment to help reduce their suffering, their limitations and losses, and the serious risks to their overall health.

On behalf of people who live every day in pain, I ask you to share these important findings, so that much needed treatments can become more available to all.

Yours with care

1 comment:

  1. Michael- good job- most people and doctors believe pain is a dubious subjective experience with no real consequences- few appreciate that pain has cardiovascular and immune effects,or often leads to depression, anxiety, insomnia. I guess as humans we prefer to avoid the unpleasantness of how people with painn suffer rather then compassionately consider the realities of the pain of others