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The Chronic Pain Puzzle
Financial costs alone are higher than cancer, heart disease and HIV combined

Type the words “chronic pain” into your web browser, and you instantly get over 70 million hits. Try “cost of chronic pain in Canada” and you get over 900,000. Wow. You have to ask yourself what’s going on.

Like all of us in the benefits management business, I’m all too familiar with some aspects of chronic pain. We know that there are a lot of people out there who suffer from chronic pain. We know it’s a huge driver of costs and claims. We know the numbers have gone through the roof in recent years.

Chronic pain is loosely defined as severe pain that lasts at least 12 weeks and often has no obvious direct cause. It often persists long after the original cause – such as injury or surgery – has healed. Some of the most common are as follows:

  • post-injury pain,
  • post-surgical pain,
  • neurogenic (nerve damage) pain,
  • psychogenic pain (having a psychological cause),
  • back pain (persisting after a strain or injury),
  • unexplained headaches.

In addition, there is chronic pain caused by identifiable conditions, such as cancer, arthritis, diabetes and endometriosis.

Finally, there are several poorly-understood conditions, such as fibromyalgia and chronic fatigue syndrome, that can manifest themselves with symptoms of chronic pain.

The first thing you find in any web search on the topic are some truly mind-blowing statistics.

A much-cited article in the academic literature says that the cost of chronic pain in Canada exceeds the cost of cancer, heart disease and HIV combined. It ranks chronic pain as the number one cause of disability cost. Direct costs of $6 billion per year, and lost productivity of $37 billion. (I could go on quoting articles and estimates like that – another puts current lost productivity at $60 billion – but you get the picture.)

Another statistic that I see repeated over and over again – by advocacy groups, commercial sites, self-help sites, and even medical association sites – is that 20 percent of Canadians report suffering from chronic pain. One in five people.

Statistics Canada’s Community Health Survey reports that one in 10 Canadians between the ages of 12 and 44 say they experience chronic pain. That would be well over 1.5 million people in the prime of life.

The second theme I see played out in the “chronic pain” hits on my browser is the scepticism, controversy, appeals and litigation over claims that seem to dominate cyberspace on this issue.

There are sites offering advice on how to prove you have chronic pain, other sites on how to win an appeal if benefits are denied.

There’s a lot of information on opioids such as oxycodone and, frankly, controversy over whether they are the cure or the cause. And medical marijuana comes up frequently.

I admit that I’ve always been a little leery about statistics, and especially ones that I find on the Internet, but the numbers on chronic pain leave me scratching my head. I think of all the people I know, my family, friends, co-workers, and acquaintances, and ask myself, are one in five or even one in 10 of them fighting chronic pain? Really? Could it be that there are people with chronic pain all around me, and I don’t even know about it?

A story from CBC News reports that wait-times for access to pain clinics in Canada can be over a year. Wait, what? You’re suffering from chronic pain and you have to wait a year to see a pain specialist? Your life and your relationships are stressed, your productivity suffers, you’re off work – or repeatedly on and off work – and all you can do is wait? And take pain medications – let’s not forget that part of the equation.

That same CBC story claims that 50% of people on that long waiting list for care also suffer from depression, and that 35% have had thoughts about suicide. (Other sources list depression and related issues as affecting up to 70% of chronic pain sufferers.)

There does seem to be research and advanced care that offers some hope of prevention, mitigation and treatment for chronic pain. These seem to fall into three main efforts that are already being used by specialists:

  • increased training for physicians on the treatment of acute post-injury and post-surgery pain to prevent the development of chronic pain;
  • better understanding of the apparent relationship between temporary use of pain medications, especially opioids, and the development of long-term pain afterwards; and,
  • a more holistic approach to chronic pain treatment and associated conditions such as depression and lifestyle issues.

At the end of this adventure into trying to understand chronic pain and what we can do help our clients and their employees, I have to admit that I’m not much further ahead. This seems to be one of the big issues of our times, and I can only hope that it will be brought under control as medical science finds new ways to prevent and treat it.

If there is a topic that you would like me to write about, please email me at bill@penmore.com.

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