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Everybody Hurts: Chronic Pain Is In the Body of the Sufferer

Everybody Hurts: Chronic Pain Is In the Body of the Sufferer

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When I started writing about questionable pain statistics, a weightlifting friend asked: “What is chronic pain defined as?”

Now, this guy should understand pain. He bench presses more than 300 pounds.

So I took him seriously when he said, “I guess I have lived with back pain for years, and typically I have pain from powerlifting most days. But it’s not debilitating, so I was curious what the exact definition was.”

Well, that depends on whom you ask.

When the authors of the September 2011 Pain Medicine paper say that 150 million people suffer from chronic pain or pervasive pain, they didn’t define it. They were relying on 2005 piece in the American Pain Society newsletter. That piece, in turn, relied on a study from Scotland in 1999.

Alison Elliott at the University of Aberdeen in Scotland, the lead author on the paper, explained to me how she and her co-authors defined chronic pain:

In terms of our study, our definition of chronic pain was based on the most commonly used standard definition – the International Association for the Study of Pain’s (IASP) definition. They define chronic pain as ‘pain which persists beyond normal tissue healing time, which is assumed to be three months’. Since this definition did not allow for pain of an intermittent nature we defined chronic pain in our study as “pain or discomfort, which has persisted continuously or intermittently for more than three months”. It is important to note that this is a very broad definition of chronic pain that is likely to capture a lot of pain and it is perhaps not surprising that nearly half of the population met this broad and inclusive definition.

And so that’s why Elliott and her co-authors went further than the authors who have cited her work. She quantified the severity of the pain, meaning the intensity and pain-related disability. They broke the pain down into four categories, based on the Chronic Pain Grade (CPG), which is frequently cited in pain studies. Of the 1,145 people they identified as being in any sort of “chronic pain,” here’s what they found:

48.7% grade I pain (the mildest grade, low disability - low intensity pain)

24% grade II pain (low disability - high intensity)

11% grade III pain (moderately limiting)

16% grade IV pain (the most severe grade, high disability - severely limiting).

Remember, these percentages are breakdowns of the people who told surveyors they had suffered from pain. Elliott wrote me:

So while approximately 50% of our sample met our broadest definition of ‘any chronic pain’, only about 8% of our sample had chronic pain that impacted severely on their day-to-day lives.

To put it in actual numbers, this means that 225 people in Scotland said they suffered from the most severe grade of pain. That’s a very far cry from 150 million people in the United States.

But let’s be generous. Let’s say that it’s fair to use the top two grades of pain, moderately limiting and severely limiting. That adds up to about 14% of the population.

As I explained in my last post on pain estimates, the Scotland study only looked at people aged 25 and older. In the U.S., 14% of that group would be 29 million people.

Think that’s too low? You might be right. Some of those people experiencing the lower grades of pain, especially those with high intensity pain who are not really limited in what they do, may deserve to be added to the “chronic pain” category.

Remember that all of this started with the claim that 75 million to 150 million Americans are in chronic pain but that only 3 million of them seek treatment from a pain specialist. As Elliott explained to me, part of the equation has to be whether people think their pain is severe enough to be treated.

My weight lifter friend might feel the same pain that I feel, but the pain is less significant to him than it is to me. He doesn’t seek treatment. But I do.

I’ll write about that in my next post.

Next: People May Feel Pain But Not Treat It

Related Posts:

Everybody Hurts: How 2,000 Scots Became 150 Million Americans in Pain

Everybody Hurts: Check the Time Stamp on Those Chronic Pain Estimates

Everybody Hurts: Why Pain Is Not the Same at Every Age and in Every Place

Everybody Hurts: Why Pain Statistics Should Give You a Headache 

Photo credit: Andreanna Moya via Flickr


Picture of Kate  Benson

Excellent series of posts as always. Although this issue is in some ways secondary to the point, part of the problem is that scientists have few objective ways to measure pain. Pain then often becomes what the patient ore person says it is. Acute pain is easier to quantify by signs whereas chronic pain is often far more subtle and can be misinterpreted as depression.

The experience of pain is then further filtered by the personal experiences of the physician, the researcher, or even the reader despite the fact that how they perceive pain and the severity and type of pain they have experienced may have nothing to do with the pain of the first party. However, it often substantially influences how they perceive the pain of another, whether they consider it valid and indeed in the case of scientists how they study and even quantify pain.

Estimating how many people experience chronic pain is difficult to do without an objective way to define and measure pain - a visual analog scale isn't the same as biomarkers.

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The Definition of Chronic Pain, in my opinion needs to change or more realistically reflect what people are experiencing.

I am in no way a Health Care Professional, but i feel i can contribute to this area, just from my own experience. Some of the factors i would consider are:

1) Can the Pain be managed (on your own) to the extent that Its impact on your everyday activities are minimal? and Do not affect your quality of life.

2) Does the patient experience pain in areas that are not related to the original trauma or injury? and are not easily explained?

3) Looking at the Patients History, Is there evidence that the Patient was experiencing substantial emotional stress or events. (This is Based on the new evidence that chronic pain is at least partially a retraining of the brain in how to manage pain by areas of the brain that are largely responsible for emotions.

This is indeed an interesting topic, i will try to add some more info from my own experience if you find it helpful.

(My Chronic Pain Blog -


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