Chronic pain has reached truly epidemic proportions in Europe. One in five Europeans suffers from pain that has been occurring regularly for three months or longer; one in eleven, suffers from pain daily. There are 100 million people affected by chronic pain in the 27 EU Member States”, according to Professor Dr Hans Georg Kress (Vienna), President of the European Federation of IASP® Chapters (EFIC). “Across the EU chronic pain accounts for nearly 500 million lost working days every year – costing the European economy around €34 billion.”
These alarming figures were presented today at the launch of the first “European Year against Pain” (EYAP) in Brussels. “Our most important goal with this campaign is to present pain, the most neglected and frequently underestimated health problem, in all its aspects and also in all its social consequences. In doing so, we want to support those affected and inform the broad public but also give a wake-up call to political decision-makers. Not only does pain, especially chronic pain, cause individual suffering, it also has much greater social and economic relevance than people often assumed.”
Important societal impact
A survey indicates that 19% of patients with moderate or severe chronic pain have lost their jobs. The risk of these patients having to give up their occupation is seven times greater for the healthy population. The review Epidemiology of chronic non-cancer pain in Europe came to the conclusion that 22% of pain sufferers who are required to take sick leaves because of their chronic pain are absent from work for longer than ten days.
Only 2% of pain sufferers are treated by pain specialists
“It all comes down to the correct management of chronic pain, a task that is frequently neglected”, Professor Kress said. “Many pain patients are treated inadequately, too little or not at all”. According to a survey, only 2% of all pain patients in Europe are treated by a specialist trained in pain management, a third of chronic pain patients remaining without any treatment. Professor Kress: “The most important cause for these deficits is probably that pain continues to be seen as merely a symptom for an underlying disease. What we need is a new view of chronic pain. We must acknowledge chronic pain as a disease in its own right”.
Visceral pain, the ‘silent epidemic’
In this first ‘European Year against Pain’ from October 2012 to October 2013, the topical focus is on a type of pain that practically every person has experienced in its acute form and that is clearly underestimated in its chronic form – visceral pain.
“Visceral pain refers to common types of pain coming from the inner organs, such as the heart, blood vessels, respiratory passages, the urogenital tract or the digestive tract. It has been shown that they can have organic causes but also so-called functional causes without any detectable damage to the organ involved”, said Dr Chris Wells (Liverpool), President elect of EFIC and Chair, EFIC (EYAP) Committee on the International Year against Visceral Pain.
“Acute visceral pain can be extremely unpleasant and at times life threatening. However, chronic visceral pain can also pose a significant burden. Acute visceral pain is second only to trauma as a reason for patients visit emergency wards. Although of statistical significance, this category of pain has been subject to much less research than pain from tissue damage or nerve injuries, for example”.
The prevalence of visceral pain is as impressive as it is alarming, as a number of examples demonstrate:
20–30% of the population suffers from dyspeptic disorders, whereby only half of these individuals show organ-related causes.
- Irritable bowel syndrome (IBS) is estimated to affect between 6% and 25% of the population depending on the study and also on gender and accounts for up to half of all consultations with gastroenterologists. In Germany, for example, IBS occurs in about 16% of women but in only 8% of men.
- Bladder pain affects women more frequently than men; surveys assume 900 pain sufferers per 100,000 women.
- Dysmenorrhoea (period pain) affects one in two women with periods; in 10% of the women affected, this pain is as severe as to cause them to take sick leave every month.
- In total, women are affected three times more frequently by visceral pain than men.
“There is no adequate treatment for chronic visceral pains in many cases, unlike for the acute forms of this pain”, Dr Wells pointed out. “That is why this disorder is often connected with far-reaching stress, which in itself, gets too little attention. With the European Year against Visceral Pain now beginning, we have set a special priority to help those who may have been silently suffering for a long time. We want to point out to them which problems their symptoms might be indicating and motivate them to seek out assistance in the diagnostic and therapeutic system”. That is why EFIC is making available thorough fact sheets on different types of visceral pain at www.efic.org.
Dr Wells: “We hope this annual campaign will also give a boost to research. After all, many details in the context of visceral pain have not yet been clarified. For instance, when exactly does visceral pain occur and how is it affected by genetics and the environment? Biomarkers and brain imaging can help significantly in this research, for example, on the issue of why women are affected more frequently than men”.
“Pain is my constant companion.”
It is often dramatically underestimated just how severely people’s lives can be impaired by chronic pain in general and visceral pain in particular – in a physical, psychological and social sense – as chronic pain patient Jaqueline Riley (Warrington, GB) knows from her own experience. “Pain is my constant companion and has been for a very long time. It started 16 years ago. I had just turned 40 and was suffering increasingly severe back and joint pain as well as chronic exhaustion”. But her illness was only correctly diagnosed six years ago: fibromyalgia, a severe chronic disease from the rheumatic group of disorders. The illness can have a variety of attendant symptoms.
“In my case, my greatest difficulty is with irritable bowel syndrome, which I’ve had for more than ten years. By now, I never get a full night’s sleep, because sharp pain in my back or the abdominal pain mean I get at best an hour’s peace”, Jaqueline Riley reported. “However targeted pain therapy can in the meantime give me at least intermittent relief”.
Beforehand, she had a history as a patient typical of what many chronic pain patients go through, according to the former nurse: “From the GP to the orthopaedist, who can’t find anything wrong with the spine, and back again, to the next specialist, who can find no evidence of inflammation of the bowel, and so on. Back and forth in the health system, often with unbearably long waiting times, and without any result. I’m very glad I came across a specialist, with whose help the pain has become more bearable. But it shouldn’t be a question of luck, and certainly not of money, whether a fibromyalgia patient with irritable bowel syndrome gets a correct diagnosis and optimal pain treatment”.
Despite the therapies she now receives, she is still far from able to live a normal life, Ms Riley explained: “I was sent into retirement ten years ago on health grounds. I simply couldn’t carry on. Many, doctors included, suspected me in the course of my illness of faking my problems, or of exaggerating them wildly, or that I simply didn’t want to work any longer. That is hurtful beyond words. If I could have a wish – besides being free of pain – then it would be for greater understanding for pain sufferers.”