1999 National Pain Survey ~ Executive Summary This section is compiled by Frank M. Painter, D.C.
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Executive Summary
Major Findings
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Approximately 24 percent of Americans, or roughly 48 million people, suffer from chronic pain, which is pain that lasts for six months or longer.
About 21.6 million Americans, or one in ten (11%) adults, take prescription pain medication regularly to manage chronic pain.
Chronic pain sufferers taking prescription pain medication regularly are more likely to be female than male (59% vs. 41%).
One in five (22%) chronic pain sufferers taking prescription pain medication regularly is between 45 and 54 years of age.
Nearly seven in ten (68%) chronic pain sufferers taking prescription pain medication regularly are forty-five years of age or older.
Among individuals taking prescription pain medication, the most common types of chronic pain are arthritis (31%), lower back pain (25%), other types of bone/joint pain (17%), muscle pain or stiffness (13%) and fibromyalgia (12%).
People age 55 and over are two times as likely as their younger counterparts to suffer from arthritis (66% vs. 33%).
One in twenty (6%) suffers pain from gastrointestinal disorders.
Other than cancer pain, the most common types of chronic pain physicians treat are lower back pain (75%), osteoarthritis (40%), headaches (26%) and migraines (26%), and fibromyalgia (15%).
88% of physicians treat patients with fibromyalgia.
90% treat patients with diabetic neuropathy.
Pain greatly affects the lives of those who suffer from it. Two in five (42%) pain sufferers experience such severe pain that they are unable to work, and three in five (63%) are unable to engage in routine activities of daily living.
A plurality of those who were unable to work (30%) say that pain has prevented them from working for 22 or more days during the past month.
Among those pain sufferers who work, one-quarter (24%) report that their pain condition limits the number of hours they are able to work. On average, these individuals work 26 fewer hours per week.
Two in five (38%) changed jobs or to stopped working altogether as a result of their pain condition. Of these, 81% stopped working.
Besides working, the activities most likely to be restricted by chronic pain are carrying out daily activities (38%), walking on level ground (26%), walking up and down stairs (17%), physical exercise and sports (17%), and cleaning in the home (11%).
Physicians believe that pain limits the ability of sufferers to engage in routine or social activities for an average of some 40 percent of their chronic pain patients.
Pain specialists think pain limits a larger proportion of their chronic pain patients' ability to perform routine or social activities than primary care physicians or other specialists (58%, on average).
Three in four pain sufferers (78%) take over-the-counter pain remedies now, or have done so in the past five years. Acetaminophen (60%), non-prescription NSAIDs (ibuprofen (43%), naproxen (13%) and ketoprofen (1%)), and aspirin (25%) are the three types of over-the-counter pain remedies chronic pain sufferers are most likely to take.
Pain sufferers who take over-the-counter pain remedies are most likely to take them on a daily basis (46%).
Nearly one in four (23%) has taken them for two to five years.
One in five (21%) has taken them for five to 10 years.
One in seven (14%) pain sufferers (about 2.4 million adults) who use over-the-counter pain remedies say they developed an ulcer or severe gastrointestinal problem that was caused by their over-the-counter pain drug.
Despite the risks associated with over-the-counter NSAIDs, only one-quarter of physicians ask chronic pain patients about their use of these drugs (26%) or discuss their potential side effects (27%) each time they see chronic pain patients.
Pain specialists (42%) and rheumatologists (42%) are more likely to ask pain patients about their use of over-the-counter NSAIDs every time they see them than primary care physicians (26%) or orthopedists (27%).
NSAIDs (28%), oxycodones/hydrocodones (16%), and propoxyphenes (11%) are the types of prescription pain drugs pain sufferers are most likely to take.
Only 4 percent take tramadol.
Besides analgesics or anti-inflammatories, other types of prescription medication chronic pain sufferers take are muscle relaxants (8%), antidepressants (5%), corticosteroids (4%), and sleep sedatives (3%).
On average, in the past six months, physicians prescribed pain medication for about two-thirds (68%) of their chronic pain patients.
For lower back pain (69%), osteoarthritis (69%) and fibromyalgia (46%), physicians were far more likely to prescribe NSAIDs than any other type of pain medication.
Rheumatologists are more likely than primary care physicians or other specialists to prescribe tramadol for chronic pain conditions.
A majority of physicians (78%) think that treating inflammation is somewhat or very important when treating osteoarthritis.
More than half of orthopedists (55%) believe that treating inflammation in these patients is "very important."
Only 10% of rheumatologists think treating inflammation is "very important" when treating this condition.
Almost half (49%) of doctors say that whether or not a drug is scheduled is very important and 34 percent say it is somewhat important in terms of prescribing pain medication.
Primary care physicians (50%) and orthopedists (50%) are more likely to think scheduling is very important than rheumatologists (33%) or pain specialists (20%).
Pain medicine specialists (20%) are least likely to think scheduling is very important.
Nearly nine in ten pain sufferers (88%) take prescription pain medication at least once a day. They are also likely to take prescription pain medication for long periods of time.
One in four pain sufferers (25%) take prescription pain medication once a day, three in ten (29%) take it twice a day and another one in three (34%) take them several times a day.
The typical NSAID user has taken NSAIDs for 20 months (median=20 months).
The typical propoxyphene user has taken the drug for 25 months.
The typical tramadol user has taken the drug for 29 months.
Almost nine in ten (87%) pain sufferers think their prescription pain drug is effective in controlling their pain. Most physicians also think prescription pain drugs are effective in controlling pain.
Physicians are most likely to think oxycodones are "very effective" in relieving chronic pain (44%), followed by hydrocodones (40%).
Physicians are about equally likely to think NSAIDs and tramadol are "very effective" (13% and 10% respectively).
Three in five pain sufferers (62%) say their pain medication "works better on some days than others," and one in three (33%) says it becomes less effective the longer they take it, that is, there is a ceiling effect.
Doctors believe that codeine combinations (86%), propoxyphenes (83%), and hydrocodones (82%) are most likely to have a ceiling effect.
Doctors believe tramadol is least likely to have a ceiling effect (60%).
Two in five (41%) pain sufferers have asked their doctors to change their prescription pain medication at some point. Ineffectiveness (59%) and side effects (23%) are the primary reasons why they ask for such a change.
The most common reason why doctors change their chronic pain patients prescription pain medication is ineffectiveness (88%), followed by side effects (65%).
One in four doctors (25%) changes patients' prescriptions because of the potential for addiction.
Three in ten (31%) pain sufferers experience side effects caused by their prescription pain medications.
Among these, drowsiness was the most commonly experienced side effect (28%), followed by stomach problems (25%), nausea (21%), and dizziness (14%).
One in four (23%) pain sufferers who experiences side effects takes medication to manage the side effects of their prescription pain drug. They are most likely to take drugs to manage gastrointestinal discomfort.
Two in five (40%) take over-the-counter antacids to manage the side effects of their prescription pain medication.
One in five (22%) takes non-prescription H2 antagonists (e.g., Pepcid, Zantac).
Fifteen percent take laxatives.
One in twelve pain sufferers (8%) has fallen as a result of dizziness caused by their prescription pain medication.
Of these, one in seven has experienced a hip fracture (1%) or another type of fracture (13%) as a result their fall.
One-fifth of physicians (19%) have had patients in their practice who have experienced hip fractures as the result of a fall that was caused by the side effects of their pain medication.
One in twenty-five pain sufferers (about 864,000 people) say they have been hospitalized as a result of an ulcer or severe gastrointestinal problem that was caused by their prescription pain medication.
Nearly three-fourths of physicians (74%) have had patients who were hospitalized as a result of ulcers or other GI complications caused by pain medication.
Physicians estimate that, on average, about 2% of patients in their practices have been hospitalized for such an event.
Many pain sufferers are not told by their doctors about potentially serious side effects of pain medication.
Half (49%) report that their doctors did not tell them about the potential of pain medication to cause ulcers or GI bleeding. Two in five (41%) taking prescription NSAIDs, which are known to cause these types of complications, report that their physicians did not talk to them about this possible side effect of their pain medication.
Two-thirds (65%) of pain sufferers were not told that pain medication could affect blood pressure. Seven out of ten (71%) prescription NSAID users were not told about this potential risk.
Similarly high numbers of prescription NSAID users were not told by doctors that pain medication can potentially cause blood clotting (80%), fluid retention (68%), or kidney disorders (60%), which are also associated with these drugs
Half of pain sufferers are reluctant to take certain types of prescription pain medications. Side effects (50%), the potential for addiction (20%), and stomach problems (12%) are the three most likely reasons for patients' reluctance to take prescription pain drugs.
Six in ten (61%) physicians believe their chronic pain patients are reluctant to take certain types of pain medications.
Physicians think that side effects (60%), potential for addiction (55%) and ineffectiveness (27%) are the most common reasons why patients are reluctant to take pain medication.
Physicians are most likely to think chronic pain patients are reluctant to take NSAIDs (47%).
Virtually all (96%) physicians are at least sometimes reluctant to prescribe certain types of pain medications. The most common factors for their reluctance are potential for addiction (57%), side effects (40%), and a history of addiction or abuse (20%).
Oxycodones are the types of pain medication physicians are most reluctant to prescribe (54%), followed by hydrocodones (22%).
Physicians are less reluctant to prescribe propoxyphenes (5%), NSAIDs (3%) and tramadol (5%).
Nine in ten physicians are somewhat or very concerned about the side effects of NSAIDs.
Of these, 86 percent say that ulcers and GI bleeding are the side effects that concern them the most.
Half of all physicians (53%) are concerned about the potential of NSAIDs to cause renal (kidney) toxicity.
Nearly all physicians (91%) are somewhat or very concerned about the side effects of oxycodones.
Of these, three-fourths (74%) are concerned about the potential for addiction.
One-third (36%) are concerned about constipation.
One-fifth (20%) are concerned about drowsiness.
Physicians are less likely to be concerned about the side effects of tramadol than any other type of prescription pain drug.
Half of all physicians are very (9%) or somewhat (41%) concerned about the side effects of tramadol.
Of these, about one-fourth (28%) are concerned about the potential for addiction.
Roughly one in five (18%) are concerned about nausea.
No more than 10% express concern about any other possible side effects of tramadol, with the exception of 18% who say they are concerned about ulcers and GI bleeding. (Because it does not affect prostaglandins, tramadol does not cause these types of side effects.)
Half of all pain sufferers (51%) also suffer from some other medical condition. More than half (55%) take prescription medications, in addition to their pain medication, to control their other medical conditions.
The concomitant medical conditions people with chronic pain are most likely to suffer are high blood pressure (42%), diabetes (21%), and congestive heart failure/ angina (14%).
Half (48%) of those who take prescription medication in addition to pain drugs take antihypertensives, 31% take antidepressants, 27% take medication to help them sleep, and 14 % take warfarin or other blood thinners.
One in four pain sufferers (25%) takes aspirin on a daily basis to prevent heart attack or stroke.
Of these, six in ten (60%) take regular aspirin (325 mg) and one-third (34 %) take low-dose aspirin.
At the time this survey was conducted, more than seven in ten (72%) physicians had heard about COX-2 NSAIDs.
Of these, 87% would prescribe them for osteoarthritis and 86 percent would prescribe them for low back pain.
Only one in eleven pain sufferers (9%) had heard of COX-2 NSAIDs at the time this survey was conducted. Of these, half (51%) said they would be willing to try this type of pain drug if they were available.
Half (51%) of pain sufferers who had heard of COX-2 NSAIDs say they learned about them from television, 26 percent learned about them from magazines, and 18 percent from newspapers.
One in seven (14%) said they learned about COX-2 NSAIDs from their doctors.
Three in four (74%) pain sufferers would be reluctant to take prescription pain medication for which no studies had been conducted in people over 50 years old. Four out of five (82%) would be reluctant to take prescription pain medication for which no long-term studies had been completed.
Nine in ten (92%) physicians recommend non-drug pain management techniques to their chronic pain patients.
The types of non-drug techniques physicians are most likely to recommend are physical therapy (60%), exercise (45%), acupuncture (27%), and biofeedback (26%)
Only one-third (35%) of pain sufferers has tried alternative pain therapies such as acupuncture, massage therapy, relaxation techniques or TENS (transcutaneous electrical nerve stimulation).
© Ortho-McNeil Pharmaceutical 1995-2003.
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