The Numbers Game II: How Many Americans Have Chronic Pain?
A new study is reviving an old debate about chronic pain: How many Americans have it?
A report published this week in The Journal of Pain estimates that 39 million people in the U.S. have persistent or chronic pain – far less than the 100 million reported by the Institute of Medicine (IOM) in its landmark 2011 study “Relieving Pain in America.”
Other estimates have placed the number of people in pain at 50 million or 70 million.
Why does it matter? As we reported a couple of years ago, the “numbers game” can be used by all sorts of special interest groups – the pharmaceutical industry, drug screening companies, non-profit pain organizations, healthcare providers, addiction treatment centers and anti-opioid groups – either to exaggerate or downplay the need for more chronic pain treatment and research.
The idea that over one in three Americans suffers from chronic pain – as claimed by the Institute of Medicine – was called “ridiculous” by Dr. Andrew Kolodny, president of Physicians for Responsible Opioid Prescribing, a group that lobbies against the overprescribing of narcotic pain medications.
“This was language that was lobbied for by the pharmaceutical industry and by organizations funded by industry. They wanted a report on chronic pain because they knew it could be used in advocacy for opioids or other treatments and ultimately they got the report that they wanted,” Kolodny told National Pain Report.
The IOM originally estimated that 116 million people were in pain, before discovering a “computational error” and quietly revising its estimate a few months after its report came out. Despite the correction, the discredited 116 million figure still turns up occasionally, as you can see here and here.
One reason the number varies so widely is the different ways that chronic pain is defined and where the data comes from.
The Journal of Pain study, which was conducted by researchers at the Washington State University College of Nursing, looked at data from a 2010 survey of over 35,000 households by the National Center for Health Statistics. It defined persistent or chronic pain as frequent or constant pain felt “every day” or “most days” in the preceding three months.
“Older adults, women, Caucasians, and people who did not graduate from high school are all more likely to report frequent or constant pain lasting 3 or more months, as are adults who are obese, who describe their overall health as fair or poor, and who have been hospitalized in the past year,” wrote lead author Jae Kennedy, PhD, a professor in the Department of Health Policy and Administration, Washington State University.
About 19% of the adults who were surveyed reported persistent pain when they were interviewed in 2010 — which is how the 39 million estimate was arrived at.
But over half the adults who had lower back pain, severe headache or migraine, or neck pain said their pain was not persistent – so they were not counted among the 39 million. People with neuropathic pain or muscle pain were also excluded if they didn’t report persistent back pain or headaches.
The Institute of Medicine took a different approach to the numbers and cast a much wider net — defining “persons with pain” as anyone who reported severe or moderate pain, joint pain, arthritis or pain that interfered with their ability to work or do household chores during the previous four weeks. It then used data from a 2008 federal health survey of over 20,000 adults to reach its estimate of 100 million.
Three years later, the IOM is still defending that estimate.
“The report’s estimate of the number of US adults affected by chronic pain has generated debate among researchers and policy makers that sometimes has distracted attention from the development of an effective public health response,” wrote Victor Dzau, MD, an IOM member, in an op-ed piece recently published in JAMA, the Journal of the American Medical Association.
“Although the IOM stands behind the estimate that 100 million Americans have chronic pain, the committee’s recommendation that better data are needed to help shape these efforts should also be underscored.”
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There’s an old saying that says ‘those who live in glass houses shouldn’t throw stones. Maybe psychiatrists like Kolodny should stick to psychiatry and leave the treatment of pain to the pain experts. Why? One of PROP’s theories is that this ‘epidemic’ of abuse is tied to treating chronic non-cancer pain long term with opioids because there is no evidence of its effectiveness and should be limited to <90 days. Well what about the complete absence of evidence used to diagnose and treat psychiatric conditions? Should we limit treatment of depression, bi-polar disorder, anxiety, etc to <90 days? If we go by Kolodny and his Koolaid theory and apply it equally then I think the answer is painfully obvious. At least most of those w/ chronic pain have medical testing to prove the underlying cause of pain. Failed surgeries, automobile accidents, genetic disorders, etc. In my case two autoimmune diseases that are systemic and incurable. One has been proven by blood work showing antibodies and the other by biopsies. What medical proof do we have to prove a psychiatric diagnosis. NONE WHATSOEVER. He may wish to see that his own house, the psychiatric profession, is in order before casting aspersions upon the experts who treat pain. If there is an epidemic one doesn't need to look very hard to see that psychiatrists and THEIR puppeteers in Big Pharma have created their own 'epidemics' by turning any quirky personality trait into a psychiatric condition requiring medication. This practice is described Christopher Lane's book "Shyness: How Normal Behavior Became a Sickness". https://www.biopsychiatry.com/bigpharma/drugcompanies-doctors.html "Given its importance, you might think that the DSM represents the authoritative distillation of a large body of scientific evidence. But Lane, using unpublished records from the archives of the American Psychiatric Association and interviews with the principals, shows that it is instead the product of a complex of academic politics, personal ambition, ideology, and, perhaps most important, the influence of the pharmaceutical industry. What the DSM lacks is evidence. Lane quotes one contributor to the DSM-III task force: There was very little systematic research, and much of the research that existed was really a hodgepodge—scattered, inconsistent, and ambiguous. I think the majority of us recognized that the amount of good, solid science upon which we were making our decisions was pretty modest. Lane uses shyness as his case study of disease-mongering in psychiatry. Shyness as a psychiatric illness made its debut as "social phobia" in DSM-III in 1980, but was said to be rare. By 1994, when DSM-IV was published, it had become "social anxiety disorder," now said to be extremely common. According to Lane, GlaxoSmithKline, hoping to boost sales for its antidepressant, Paxil, decided to promote social anxiety disorder as "a severe medical condition." In 1999, the company received FDA approval to market the drug for social anxiety disorder. It launched an extensive media campaign to do it, including posters in bus shelters across the country showing forlorn individuals and the words "Imagine being allergic to people…," and… Read more »
I hope Dr.Kolodny’s next bowel movement is square!
Dr Kolodney is making bank off of $500 an hour psychiatry re hab clinics make like $50k in 2 months they r all liars & feeding their own agenda! It is absolutly against our civil rights to tell us what we can have & pay off the DEA & FDA . I am pursuing a class action Law suit against all of this & umpteen others need to speak up too. Every Pain patient needs to go on CNN their local News papers & anything with a voice & expose the Dictatorship of the USA & hippocracy of it all while ciggarettes kill 168 ka yr & alchohol kill 89k a year but r legal. Also the drug dealers have more new formulas of opiods from pharma to sell to drug addicts because we r being deprived or underprescribed since doctors r scared!!
Like I said to my Doc, lord help us both .. if there are any lords .. I hope to live when they make a machine that can accurately mimic my pain and connect a few electrodes or some similar booster cables so that he feels my pain. Then my good fellow, then you would immediately boost my MG’s back to liveable levels. I was a t just shy of 300mg Oxycontin slow release and some IR - and life was normal, very close. no side effects, no issues. None. I do not drink, smoke, etc.. now at under 180mg daily, I live at 45% of my potential as when I was at 280mg. Not kidding. The whole 200mg Morphine equivalent is a absolute hoax and farce.
Rainey said: “I wish my doctors would find the root of my pain and then I could get on with my life.”
I’m sorry, but that’s usually not how it goes…
It took a year for the diagnosis of the major cause of my pain; I did the surgery and all available standard (and alternative) treatments; and finally ended up on opioid therapy. If your doctor keeps giving you pills and none of them are helping, then maybe your pain has reached intractable levels.
I think the only benefit I’ve gotten from knowing the major cause of my pain is learning how to keep the pain from getting worse.
Thank you, Kurt W.G. Matthies, for correctly labeling what appears to be more of an ideology than any belief based in modern medicine. I guess even doctors and medical experts can have phobias, but it’s weird that these learned professionals are afraid of chemicals.
Opiophobia can be found in all of the professionals you’ve listed, but also includes those who don’t understand that drugs are just chemicals — they should not be blamed when a loved one abuses or overdoses on them. It is understandable that those who have suffered tragedies in the drug war need to place the blame anywhere but on their loved ones. But if you think about it, we really don’t need to assign blame for being human.
If you want to consider yourself an expert on drugs, then you have to admit that drugs include products like caffeine, sugar, and nicotine, even though these drugs aren’t on the scheduling list. You would have to admit that the term “illegal” shouldn’t refer to any drug — there are drugs that offer benefits and those that produce harm — and some that give us both. We are surrounded by chemicals that are harmful, and so we teach our children not to drink Lysol or swallow pennies. We need more education, not more restrictions.
And while I applaud compassionate, competent pain specialists, I have to wonder how they’re going to continue practicing if they don’t stand up to opiophobics like Dr. Kolodny and his group. PFROP has the advantage of being very vocal, organized, wearing an aura of respectability, and also appears to have lots of money. If anyone knows who is funding Dr. Kolodny and his group, please speak up and let us know. Isn’t anyone else dying of curiosity?
Maybe it’s the arm of Big Pharma that sells drugs which treat addiction? Maybe it’s the Koch brothers? The AMA? Mexican cartels? The DEA? All of the above?
The extent people go to minimize chronic pain never ceases to amaze me. If “only” 39 million people suffer from chronic pain, then it is not such a big problem.
How many is 39 million? The state with the largest population is California (38,332,521 people in the 2013 census). The Journal of Pain Study has projected that almost a million more people than our most populous state suffer from chronic pain (667,479).
I guess it’s easy to say that those 39 million people just need to suck it up. It gets Dr. Koldony and PROP a lot of attention. Other people’s pain is always bearable. I mean, why should this guy blend in? Why not just troll the whole pain scene? Get angry and blame the patients. Forget that medicine isn’t perfect. Who cares that there is still a lot to discover. Just don’t prescribe opiates.
It makes me so angry that Dr. Andrew Koldony calls the figure of 100 million (from the less restrictive Institute of Medicine survey) “ridiculous”. Given that the IOM survey did not arbitrarily restrict their definition, it is probably in line with the Journal of Pain Survey. Both figures are in the tens of millions.
I’ve tried just about every drug under the sun for my chronic pain problem. I am not impressed. It has been a long, expensive, side effect riddled journey. I wish my doctors would find the root of my pain and then I could get on with my life. Instead they just keep giving me pills. Especially when I ask for accommodations, or diagnostic tests. I didn’t choose to get sick. I wanted to have a life.
Opiophobia describes a licensed physician’s fear of prescribing opioid analgesics for his or her patients in pain. Groups like PFROP are full of opiophobic doctors who are in denial that chronic pain exists in many people, and therefore concludes that opioid pain medication is not applicable to their patients condition.
Opiophobia causes doctors to under prescribe effective pain medication or refuse to prescribe these medications altogether, and thereby exacerbating their patients pain syndrome.
Opiophobia comes in all forms of practitioner — the addiction specialist who sees only the negative side of opioid use, and therefore believes opioids present a threat to the public health. It comes in the form of a “pain doctor” who continues to perform interventional pain medicine by injections, when those injections are reported over and over by the patient that the injections do not relieve pain. Some of these doctors inject their patients up to 50 or 60 times, and yet will not provide pain medication.
Opiophobia exists in the physiotrist and sports medicine “pain clinic” where chronic pain is too often treated like acute pain. They will not treat pain, but proscribe rigorous exercise programs that may build core strength, but do not improve reported pain scores.
And opiophobia exists in primary care offices where doctors refuse to treat pain with effective opioid pain medications, and instead choose to rely solely on adjuncts like TCAs, muscle relaxants, and inappropriately prescribe the so-called GABA analogs (that do not affect GABA receptors) like gabapentin and pregabalin.
For an opiophobic physician like Andrew Kolodny, it is much easier to deny the problem than come to terms with his own prejudices and misconceptions.
Fortunately, there are still plenty of compassionate, competent pain doctors practicing in America who are not blind to the seemingly endless line of patients coming in their clinic doors who complain of pain. These doctors see the wisdom is using all modalities of treatment, including opioid analgesics when appropriate, because they understand their role in treatment of those who suffer from the pain of disease, whatever the cause.
Yet, this article does NOT mention the christen nation wide who live with chronic pain. Chronic pain does NOT discriminate against age, gender, religion, ethnicity, social economic status, etc. children can develops chronic pain via an accident or an illness such as muscular dystrophy, multiple sclerosis and cancer. My daughter developed her chronic pain due to her pregnancy and deliver of her son almost 2 years ago. Chronic pain can occur within a few seconds or gradually come on. I firmly believe there are more than the newest number of people living with chronic pain in the United States.