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AAPM Facts and Figures on Pain 

Charles M. Carlsen

Published April 23, 2024
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The International Association for the Study of Pain (IASP) has doned pain as an emotional exposure and an unpleasant sensory feel that is a result of a potential or actual tissue damage. This is a feeling no one would love to experience. The precise mechanism of pain still gives scientists and medical professionals headaches, but many suggest that some nerve fibers of various body tissues might intertwine into the same part of the spinal cord, allowing nerve impulses from completely different pathways to pass through one another. 
Estimates suggest that 20% of fully grown adults experience chronic pain around the world and about 10% of mature adults are said to have developed chronic pain on a yearly basis. The responsibility of AAPM is to address these health concerns and make it less difficult to get pain care. They also advocate for enhance pain management.

How pain affects the body

A huge majority of us would say they never liked experiencing pain, but this feeling of hurt is actually a way our body protects itself from harm. Let's say it is our built-in defense mechanism that helps keep the body safe from harm.
We have these special receptors that are connected to two types of nerves. These nerves help us detect when we are in trouble or around something that is dangerous to us. There's this one type of nerve that sends messages really fast, which is why you feel a sharp, sudden pain all of a sudden. The other relays send messages at a slow pace, which can be quite frustrating and uncomfortable I must say.
Have you ever noticed how certain parts of our body seem to feel pain, more than others? It's quite fascinating, isn't it? Let me explain. Our skin is equipped with receptors that help us identify the location and type of pain we are experiencing. On the other hand, pinpointing the source of a stomach ache can be more challenging because the gut has receptors.
When we come into contact with something like a hot or sharp object specialized nerves in our skin spring into action. These nerves swiftly transmit signals to our cord. Then, to a region of our brain known as the thalamus.
Sometimes the spinal cord sends a signal to the muscles to contract. This action would help your body, or that part of the body to move away from that harm.
When the 'alert!' message reaches the thalamus, it processes the information sent by the nerves, combines all of your past experiences (if any), beliefs, social norms, expectations, and culture to aid you.
The thalamus acts as a relay station, passing the information to different parts of the brain that are involved in physical reactions, thinking, and emotions. Imagine a situation where you experience pain, and you react by thinking, "Ouch! What just happened?" and feeling frustrated.
The thalamus also contributes to your state and level of alertness impacting how you experience pain based on your mood.

Prevalence of Pain

More than 25% of the United States citizens suffer from long-term pain. It's a very common complaint doctors often see in their various clinics. If individuals diagnosed with this condition fail to handle it it could result in health issues or potentially escalate especially when opioid dependence is a factor.
The widespread occurrence of pain in America
In 2021 many people, in the United States faced challenges, with pain affecting around 51.6 million adult citizens, which makes up 20.9% of the total population. Additionally, 17.1 million individuals (20.9%) were diagnosed with impact chronic pain. Research indicates that non-Hispanic American Indian adults have a likelihood of experiencing both types of pain. This trend is also observed among individuals who are divorced or separated and those who identify as bisexual for reasons.
Data from 2019 to 2021 showed that about 20.5% to 21.8% of adults (both male and female) had to live their lives with chronic pain and high-impact chronic pain. These all draw down to the estimate that about 1 in 10 adults get to experience pain, and about 1 in 20 adults suffers from chronic pain each year in the United States.
Prevalence by age group
A specific age group doesn’t really have a playing field when it comes to pain conditions; however, chronic pain is more prevalent in old people. This comes from a recent research that found out many older adults go through pain as they age. According to the stats, a minimum of 25% and a maximum of 76% of older people in a community would probably be diagnosed with chronic pain. For adults living in residential care, the figure can go up to 83% or 93% maximum.
Putting into a condition that the world’s population is going to double in the next 40 years, especially those over age 65, medical treatment needs to consider the additional health issues that come with chronic pain and the use of multiple medications. 
Prevalence by gender
Matured females tend to show a higher influence on chronic pain as compared to adult male individuals. This could probably be because of their lower pain tolerance and thresholds. A lot of adult females go through pain episodes more often than not, and in most cases, it last much longer than it is experienced in men. This is to say that chronic syndromes are quite obvious between the two genders.
However, there are still debates between experts on the reason for such significant differences between sexes. Some experts suggest that it is caused by biological factors or social and psychological factors. 
Prevalence by Socio-economic status
What really does socio-economic status have to do with chronic pain per se? Well, research has it that people living in difficult economic situations in different regions of the world tend to experience more chronic and severe pain regardless of their age or their medical history.
We would, however, advise that the right steps should be taken when giving these kinds of comparison due to differences in methodology

Types of Pain

Neuropathic Pain: 
Neuropathic pain is also known as neuralgia pain or nerve pain. This kind of pain happens when a health condition reaches the nerves that are responsible for transporting sensations to your primary engine – the brain. Neuropathic pain can affect any nerve in your body, but surprisingly, its level of effect is quite different from nerve to nerve.
Neuropathic pain can be caused by low blood supply to the different nerves, body infection, essential vitamin deficiency [Vitamin B12, B1], Tumor invasion, and heavy alcohol use. Now, let’s take a look at some of the symptoms of Neuropathic pain;
  • Pins and needles in the feet
  • Crushing pain after a body part removal i.e, amputation
  • Sharp pain around the body
  • Pain when clothes touch the skin
  • Difficulty feeling hot or cold sensations 
  • Spontaneous burning
Musculoskeletal pain
Pain like this can be felt in areas of the body, such as joints, bones, muscles, nerves, ligaments and tendons. As that is not all; musculoskeletal pain, as the name interprets, can occur at these body parts individually or as a whole. You can be diagnosed with this type of pain if you strain your body with an activity suddenly or repeatedly. It can also occur when you are exposed to vibrations, forces, or uncomfortable positions over and over again.
Here are some symptoms of musculoskeletal pain:
  • Fatigue,
  • Tenderness
  • Stiff joints, 
  • Inflammation, 
  • Muscle spasm,
  • Swelling, 
  • Difficulty moving,
  • Bruising and discoloration. 
Headache disorders
Headache disorder is a whole other level of pain. Headache disorder branches out to tension-type headache, migraine, and cluster headache. Causes of this type of pain range from stress/strain to medication-overuse headache. 

Impacts of Pain

Pain can really make people's lives look like a living hell. It affects not just their wellbeing, but also puts a financial strain on them, and also on the healthcare systems. The financial burden comes in two; direct costs, and indirect costs. Direct costs are expenses like medical care, while that of indirect costs are expenses for things people can no longer do.
Studies suggest that individuals who suffer moderate to severe chronic pain miss about 8 days of work every 6 months on average, and around 22% of them miss at least 10 workdays. As could be seen in many countries and States, the workforce seems to be aging really fast, resulting in a major economic downturn if these individuals are forced to retire early due to serious health issues. Those suffering from certain pain conditions make use of the healthcare resources twice as much as the general public, and this brings out a great concern. The management of Pain involves various services that can be quite costly, although this is based on specific conditions and the country in question. The numbers are really big. For instance, Belgium's healthcare system spent somewhere between 83 and 164 billion euros in 2004, while the UK's NHS paid a whopping 1 billion pounds in 1998 just for treating low back pain.
A group of researchers took it upon themselves to analyze data from the American Productivity Audit, computer-assisted telephone survey conducted between August 2001 and July 2002, which asked working adults, about 28,902 in number, about their health and work. They looked specifically at how much time and money was lost due to conditions like headaches, arthritis, back pain, and other muscle and bone problems, which were expressed in hours/worker/week and measured in US dollars.
  • About 52.7%, which was more than half of the individuals, reported having headache, arthritis, back pain, or other musculoskeletal pain two weeks behind, and 12.7% of them lost productive time within those weeks as a result of pain.
  • Headache which amounted to 5.4% was said to be the most common pain condition responsible for the low work output per time, followed by back pain, arthritis pain with 3.2%, 2%, respectively, and other musculoskeletal pain.
  • Overall, the workforce didn’t get an average of 4.6 hours/week of productivity with time because of some pain conditions.
  • Other musculoskeletal pain (5.5 hours/week) and back pain or arthritis (5.2 hours/week) gave a huge amount of lost productive time.
  • Headache gave about 3.5 hours on average.
  • Age did not seem to cause any after-effects on research.
  • Lost productivity per time from common painful conditions was estimated to be 61.2 billion dollars per year, while 76.6% of loss was said to be because of reduced work performance instead of work absenteeism.

Pain Management

AAPM advocates for diagnosing and addressing pain by prioritizing the patients needs and preferences. It should also take into account all aspects of a patient's condition, and involve different healthcare professionals working together. Chronic pain can be caused by many different things, meaning it can be treated and managed in many different ways. These options could include interventional techniques, use of medications, like opioids if necessary, and also the rehabilitation approaches, amongst others.
Sadly, chronic pain doesn't come with a cure. So, basically, going for treatment just helps reduce the pain, improve quality of life, and alleviate suffering. This can involve using medications and other non-medication approaches.
Pain management strategies
Certain research suggests that one's emotional state can influence their response, to pain. By gaining insight into the source of your pain and discovering coping strategies you have the potential to improve your quality of life. Key pain management strategies include:
  • Psychological therapies (such as relaxation techniques, cognitive behavioural therapy, and meditation)
  • Physical therapies (such as cold or heat packs, hydrotherapy, massage and exercise)
  • Body and mind techniques (like acupuncture)
  • Community support groups.
  • Pain medicines
AAPM believes in working together to address pain control and overall well-being if biological, psychological, and social factors are put into consideration. COT, short for Chronic opioid therapy are given to individuals who suffers from severe and long-lasting pain that hasn't improved while using other treatments. With that said, AAPM does not recommend opioids as the first choice of treatment, but we believe that these medications can be helpful if prescribed with care and as part of a logical treatment plan. Of course, the doctor must be calculative and experienced during prescription. This is to avoid addiction, respiratory depression, diversion, dependence, and other adverse effects. We also think that doctors should not be afraid of getting in trouble with the law or facing regulatory consequences when prescribing opioids responsibly.  
Now, speaking of addiction, this is a very serious issue that should not be taken lightly for all patients who are on opioids. Physicians should take caution and responsibility so as to reduce the chances of their patients being an addict. 
However, if individuals lack a grasp of addiction and incorrectly label individuals as addicts there is a possibility that these individuals may be refused the necessary opioid medications. When making choices healthcare providers should also take into account the potential for addiction. Evaluate it in relation to the advantages of the treatment. Their objective is to reduce the likelihood of addiction as they can. In circumstances however it may become essential to consult with an expert in addiction medicine, for treatment.

Challenges That Restrict the Utilization of Opioids in Pain Treatment.

Respiratory depression and other negative effects: Many individuals believe that opioids can cause breathing to slow down leading to depression. However, the likelihood of experiencing depression while using opioids can be reduced by taking precautions. It is important to exercise caution and take care when combining opioids with medications that affect the nervous system, such as benzodiazepines or alcohol as this can increase the risk of respiratory depression.
Doctors need to be cautious when prescribing medication to individuals, with conditions such as end stage disease or sleep apnea as it can increase the risk of heart and breathing complications. There is some new information indicating that COT may be linked to central sleep apnea, although we don't fully understand how they are connected. In simple terms, patients don't become fully immune to the breathing problems caused by opioids. The risk of breathing problems goes up as the dose of opioids increases. This means that patients who have a huge chance of contracting respiratory infections or asthma attacks on COT may risk of hypoxia. It is worth noting that the dosage should be reduced during these situations.
Tolerance: It was previously thought that the development of analgesic tolerance limited the ability to use opioids effectively on a long-term basis for pain management. Tolerance, or decreasing pain relief with the same dosage over time, has not proven to be a significant impediment to long-term opioid use. Experience with treating cancer pain has shown that what initially appears to be tolerance is usually progression of the disease. In the non-cancer patient, the failure to respond to increasing doses of opioids should be evaluated very carefully. The possibilities include tolerance, disease progression, non-opioid responsive pain syndromes, and opioid-induced hyperalgesia. 
Diversion: Diversion of controlled substances should be a concern of every health professional. Attention to patterns of prescription requests and the prescribing of opioids as part of an ongoing relationship between a patient and a healthcare provider can decrease the risk of diversion. Urine and/or blood drug screening, frequent follow up and patient contact, and pill counts are some commonly used clinical interventions that may be helpful in ruling out the issue of diversion. A periodic review of state prescription monitoring program databases, where available, is also a useful tool to monitor compliance and adequacy of communication. 
There are some groups that are more likely to misuse or consume opioids in overdose. Let’s take a look:
  • According to research, men are likely to kick the bucket of overdose from opioids or from any prescribed painkillers out there.
  • Adults in their mid-years have the highest Opioid overdose rates.
  • People living in rural areas are at more risk of overdosing on prescription medications than those residing in urban areas.
  • Whites and American Indians or the Alaska Natives are more liable to an overdose.
  • 10% of Alaska Natives or American Indians, over the age of 11 have been reported to misuse prescribed medications within the last year, a higher rate compared to 1 in 30 among blacks and 1 in 20 among whites.

Prescription Drug Misuse Facts from the Stance of National Drug

Control Policy (ONDCP):
  • Between 2004 and 2009, there was an increase in emergency room visits associated with the inappropriate use of prescription painkillers.
  • In 2009 the number of individuals experimenting with prescription pain relievers, sedatives, tranquilizers and stimulants for the time was almost equivalent to those trying marijuana for the first time.
  • A survey carried out by the Department of Defense in 2008 revealed that 11% of active-duty service members had engaged in prescription drug misuse previously.
  • Two million adults aged 50 or older – about 2.1% of individuals within that age bracket – have used prescription type drugs without necessity in the past year.
  • Prescription drug misuse is an issue in the United States coming second to marijuana concerning substance abuse rates.
  • Out of the top ten substances used among high school seniors, six of them are pharmaceutical drugs illegally, of course.
  • 30 percent of individuals aged 12 or older who experimented with substances for the first time, in recent years began by using prescription medications without a legitimate medical reason.
  • From 1998 to 2008 the number of individuals seeking help for substance abuse and acknowledging the use of painkillers surged by fourfold.
  • Prescription painkillers play a role in the count of drug related fatalities. To provide some perspective in 2007. 28,000 Americans lost their lives due to drug overdoses. Of these cases nearly 12,000 were associated with prescription pain relievers.
  • The number of adults seeking assistance for substance abuse almost doubled between 1992 and 2008 rising from 6.6 percent to 12.2 percent of all admissions. During the timeframe there was an uptick in the proportion of older individuals admitted for misuse of prescription drugs climbing from 0.7 percent, to 3.5 percent.

Conclusion

Chronic pain can’t be taken lightly; neither is the misuse of prescription drugs, especially opioids. Much awareness needs to be done as regards its intake. Those in the healthcare sector need to educate the public about its advantages and concerns. However, such concerns should not scare off the benefits of opioid prescription under trained professionals. 

Sources

1. Raja, Srinivasa N., et al. “The Revised International Association for the Study of Pain Definition of Pain: Concepts, Challenges, and Compromises” Pain, vol. Articles in Press, no. 9, 5 Aug. 2020.

2. Goldberg, Daniel S, and Summer J McGee. “Pain as a Global Public Health Priority.” BMC Public Health, vol. 11, no. 1, 6 Oct. 2011

3. “Chronic Pain Management and Opioid Misuse: A Public Health Concern (Position Paper).” Www.aafp.org

4. “Epidemiology of Pain.” Physiopedia, 2015

5. ‌Rikard, S. Michaela. “Chronic Pain among Adults — United States, 2019–2021.” MMWR. Morbidity and Mortality Weekly Report, vol. 72, no. 15, 14 Apr. 2023

6. Sees, Karen Lea, and H.Westley Clark. “Opioid Use in the Treatment of Chronic Pain: Assessment of Addiction.” Journal of Pain and Symptom Management, vol. 8, no. 5, July 1993, pp. 257–264

7. ‌ Better Health Channel. “Pain and Pain Management – Adults.” Vic.gov.au, 2021
Article by
Charles M. Carlsen
Hello! I'm Charles, As co-founder of Drsono, I contribute to the DRSONO blog, providing valuable insights and up-to-date information on ultrasound technology and diagnostic imaging.

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