The Modern Problem of Pain
Chronic pain is the №1 global health burden ~ this can & must change.
Most of us can think of someone we know who suffers chronic pain. For a moment, consider how this affects them each day, each moment, and the impact upon those around them who care. Perhaps you are that person in pain and know what this is like for you. Commonly people will describe how they are at the mercy of their pain, which dominates their life, affecting every decision and every action.
Chronic pain affects a huge number of people across the globe. Recent figures from a study suggest that between one third and one half of the UK population is afflicted with chronic pain (1). Estimates suggest that 20–35% of children and adolescents across the globe experience on-going pain (2). Pain costs more than diabetes, heart disease and cancer combined according to the NIH (3). The cost to society is in the billions, combining treatment expenditure and the loss of productivity. The cost of suffering to individuals is immeasurable. This societal issue must change, which is the purpose of UP | understand pain, a social enterprise delivering practical pain education with simple practices that work, together with approaches that foster living well.
In the 1990 Global Burden of Disease Study (GBD) back pain was identified as the leading non-fatal burdensome condition measured in Years Lived with Disability (YLD). Despite all the work to tackle the problem of back pain, subsequent GBD Study in 2011 showed little change with 1:10 people suffering back pain (4). Somehow, society was not addressing the issue. The thinking revolved around the biomedical model, which is an exclusive search for and explanation based on purely biology, lacking consideration of the person and their life. In healthcare and society this still predominates. Unfortunately this model fails to capture what we really know about pain and hence the outcomes are low.
However, pain is not just about musculoskeletal conditions, it is the primary reason why people seek help for many health problems. Think about all the conditions that can hurt: heart disease, cancer, headache, endometriosis, diabetes, irritable bowel syndrome, Parkinson’s disease, and many more. Pain is a problem in itself but instead is addressed as a mere symptom. Additionally, although a disease or condition may not be considered musculoskeletal, all are embodied as are our behaviours and hence this system is always involved by the very nature of being human.
Pain does have a purpose. It is a protective device and a key part of our ability to learn and survive. Without pain, our ability to detect danger is compromised with severe consequences. Congenital insensitivity to pain has gained coverage in recent years, demonstrating this fact as well as moving our understanding of pain forward. Sadly this is the cost to those with the condition.
One of the main reasons why pain, particularly chronic pain, is such a huge issue in society is the implicit belief that pain and injury are related. However, for many years it has been known that this relationship is tenuous and in fact at times absent. Consider phantom limb pain for example, when the absence of a limb by amputation results in painful sensations in the space once occupied.
In 1979 neuroscientist Pat Wall, who together with Ron Melzack was an originator of pain medicine and science, published a key paper: ‘On the relation of injury to pain’ in Pain (5). In this paper, Wall stated:
“The period after injury is divided into the immediate, acute and chronic stages. In each stage it is shown that pain has only a weak connection to injury but a strong connection to the body state”.
Since this time, a large body of research has demonstrated clearly that pain is poorly related to tissue health. Instead pain is a reflection of the perceived or predicted threat to the person. The more the perceived threat that exists in the form of actual or potential danger, the more likely that pain will be experienced. There is always a context in which this happens as our neurobiology weighs up the evidence as to whether danger exists or not. This is why there are many influences upon pain at any given moment. For example stress, tiredness, past experiences, what we are doing or might do, the meaning and environment to name a few.
Pain is one of the best examples of a conscious experience. Love is another. Pain is complex as are humans. It is one of many perceptions, yet it is one that dominates, particularly in chronic pain when choices in life appear to narrow as the impact grows, reaching into more and more parts of the person’s life.
Yet there is great hope as we gain deeper knowledge about pain: what is it and what we CAN do. The fact is that we are designed to learn and change, which is why we know that pain can and does change. This begins with the person understanding their pain and then focusing upon new thinking and actions that together maintain a course in line with their desired outcome. Typically this would encompass specific training and practices as well as skills of well-being. This has not been the primary approach to date, which is one of the reasons why chronic pain continues to be such a health burden to society. There is no doubt that chronic pain is a public health issue of enormous proportions requiring an urgent shift in society’s thinking. We need to focus on the person, their story, their vulnerabilities to developing chronic pain and the influences upon pain that exist in their life. Only by addressing pain by addressing the person in this comprehensive manner will we be successful.
Classical and existing treatments seek to circumnavigate the problem of pain rather than face, learn about and overcome pain. Pills and injections do not teach the person to live again. That requires understanding, patience, compassion and the practice of the skills of well-being. There is a simple and scale-able way of applying this across the globe to benefit the masses. For it is a shift in the thinking of the masses that is needed.
This first article is an introduction to some of the themes of the modern problem of pain. We will explore these themes in more detail in subsequent pieces, painting a new picture of how we can tackle this problem together as a society within which pain is embedded. It is an exciting time as fresh thought, science and therapies offer a way forward, providing a grounding for an approach I purport, Pain Coach, which seeks to gain the very best from the individual by focusing on their strengths and motivations to get better.
Let us talk about success and overcoming pain, leaving behind notions of management and coping. Let us talk about living meaningfully and drawing upon our individual strengths to achieve success by focusing upon doing our very best. Let us inspire change in society to ease suffering and live well.
The next article will look at the issue of women in pain
(1) Fayaz et al. (2016) Prevalence of chronic pain in the UK: a systematic review and meta-analysis of population studies. BMJ Open 2016;6:e010364. doi: 10.1136/bmjopen-2015–010364
(2) Assessment and Management of Children with Chronic Pain. A Position Statement from the American Pain Society (2012)
(3)NIH. Pain Management https://report.nih.gov/nihfactsheets/ViewFactSheet.aspx?csid=57
(4) Vos et al. (2012) Years lived with disability (YLDs) for 1160 sequelae of 289 diseases and injuries 1990–2010: a systematic analysis for the Global Burden of Disease Study 2010. Lancet 380:2163–96
(5) Wall (1979) On the relation of injury to pain. Pain 6:3: 253–64.